Addendum 1 Health Addendum 1 QA as of 3.31.pdf
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- Attached to
- RFP #2021-03 Health and Wellness Services
- Solicitation number
- 2021 - 03
- Issued by
- Wisconsin
About this file
This is Addendum 1 to a Health RFP (#2021-03) issued by Dunn County, Wisconsin, addressing clarifications and additional information requested by prospective health insurance vendors. The addendum provides responses to bidder inquiries regarding health and wellness services, stop loss coverage, plan designs, claims data, and census information. Key service elements under consideration include health insurance plans with multiple design options (Plans 1-4 with varying deductibles and copay structures), stop loss coverage both with and without a No New Laser provision, transplant and bariatric specialty networks through Medica, and health and wellness services. The county is seeking vendors capable of providing comprehensive reporting including large claims reports, top provider reports, utilization review information on high-cost claimants, and detailed claims data by member. Census information requirements specified include employee demographics, coverage types, dependent information with dates of birth, zip codes, plan design enrollment details, and address information provided in Excel format.
The county currently maintains multiple plan designs through its existing provider and is evaluating continuation or modification of the current 24/15 contract structure or alternative paid arrangements. The county does not currently have a structured wellness program in place but does maintain an independent EAP program. Prior year benefit documents are being made available on the county's website. The current stop loss specification has been set at $150,000 since 2018, with no current laser provisions in place. Bidders are directed to contact John McLaughlin at jmclaughlin@co.dunn.wi.us for census information and additional clarifications regarding the scope of services and coverage requirements.
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We have requested from the current provider, but it is unlikely that we will receive anything additional
We have requested this from the current provider but have note received anything to date.
6 Last two years of Top 25 Rx Claims report
Please see attached and labeled Dunn County Top Drugs
7 Confirm spec is $150,000 This has been the Spec since 2018
8 Current Lasers
There are no current lasers
9 Do you need NNL moving forward?
10 Transplant policy?
RFP #2021-03
Census information is available by contacting John McLaughlin at jmclaughlin@co.dunn.wi.us
We would like to see the Stop Loss both with a No New Laser and without a No New Laser
Health and Wellness Services
Can you please send a census in Excel format that also includes the type of coverage (single, Employee Spouse, Employee Children and Family)? Can you send an
Excel census with address, zip code, tiers of coverage, and which plan the employee has elected? Please provide an updated census with dependent names, DOB, and zip codes, and relationship to the employee/sunscriber. Please provide census in an excel format and it appears that the county has multiple plan designs, please add to the plan design to the census showing which plan design each employee is taking. Please update the census to include the plan design/network that each employee is enrolled in and if the employee is enrolled in a single plan or a family plan or if they waived.
Please see attached for 2019 and 2020
The large claims reports are provided in the Standard Reporting Package, on the second tab titled Claims by Member.
Will you be able to obtain Top Provider reports for the claims reporting periods included in the submission?
Also, are there any utilization review notes relative to the high cost claimants?
We would like to know if the cases are resolved or on-going; if on-going, what expected claims are anticipated for each case going forward?
Last two years of large claim reports with diagnosis
Yes, we have specific networks/providers for bariatric & transplants. Information can be found on Medica.com under ‘Providers’, then under the Resources section choose ‘Health improvement programs’, then scroll down to Transplants.
11 Looking for the same 24/15 contract?
Yes or a paid contract
12 Provide the prior year benefit documents
These are being posted to the website
13 Does the County has a structured health and wellness program in place and, if so, what components does it include (eg, digital wellness, on-sight/nearsite visits, clinical services, etc)?
The group currently offers a Health plan, they do not currently have a wellness plan in place
14 Does the County presenty offer an EAP program?
The county does have an independent EAP program
15 Please confirm which benefit plan is “Plan 1, Plan 2, Plan 3, Plan 4” in the Stop Loss Contract (attached).
H:\My Documents\2014 timesheets\[Sick Vacation.xls]2017
Benefit Plan 1: MSI PP 3000-20% HSA - 25343
Benefit Plan 2: MSI MHS 3000-20% HSA - 25355
Benefit Plan 3: MSI PP 5000-20% HSA - 25340
Benefit Plan 4: MSI MHS 5000-20% HSA - 25344
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