ADDENDUM_2_Medical_Plans_Pharmacy_and_Vision_RFP__1-15-25_Official_.pdf

OFFICE OF PROCUREMENT

CONTRACT ADMINISTRATION AND PROCUREMENT DIVISION

1400 McCormick Drive, Room 200 Tara Jackson Largo, Maryland 20774 Pamela F. Dickerson Acting County Executive (301) 883-3419 FAX (301) 883-6440 Director

TDD (301) 925-5167 Office of Procurement

January 15, 2024

Request for Proposal (RFP) RFP NO.: WS1381744989

Medical Plans, Pharmacy Benefit Management, and Vision Services

ADDENDUM NO. 2

ALL OFFERORS: This Addendum No. 2 contains information pertinent to the above referenced solicitation. This Addendum No. 2 shall supplement, amend, and become part of the RFP Document for the titled solicitation. All Proposals shall be based on this Addendum No. 2 in accordance with the RFP documents.

This Addendum No. 2 contains the following:

• ATTENDANCE SHEET FROM THE PRE-PROPOSAL CONFERENCE HELD ON

DECEMBER 16, 2024, AT 10:00 A.M ARE INCLUDED IN THIS ADDENDUM.

• QUESTIONS AND ANSWERS RECEIVED BY MONDAY DECEMBER 23, 2024, AT

2:00P.M. DEADLINE ARE INCLUDED IN THIS ADDENDUM.

• PRE-PROPOSAL CONFERENCE SLIDES ARE INCLUDED IN THIS ADDENDUM.

• THE CLOSING DATE OF THE MEDICAL PLANS, PHARMACY BENEFIT

MANAGEMENT AND VISION SERVICES RFP HAS BEEN EXTENDED FROM FRIDAY,

JANUARY 24 AT 2:00 PM TO MONDAY, FEBRUARY 3, 2025, AT 2:00 PM.

THIS ADDENDUM NO. 2 MAY CONTAIN MATERIAL CHANGES AND MUST BE SIGNED AND

RETURNED WITH THE PROPOSAL. FAILURE TO ACKNOWLEDGE IN THIS MANNER MAY

RENDER THE OFFEROR NON-RESPONSIVE.

SIGNATURE COMPANY DATE

PRE – PROPOSAL CONFERENCE MEETING ATTENDEES:

Nena Charity Barbara Manley Christian Sutton Anna Cruser Natasha Dorsey Demetrius Coffey Wesley Girling Deborah T. Sullivan Jennifer Black Gitana Y. Stewart Ponder Michael L. Wagner Ashley Thomas Pat Burns Johanna Agueda Vera R. Allen Bonnie Benson Tim Hicks Jason P. Webb Jackie DePolo Carlton Ingram Denisa Kim Andrew Conroy Jay Nwamadi Kimberly Milby Steven J. Kunkel Eric Palmquist Max Baresich Melody L. Dennis Steph Doane Mascia Griebe Marcus E. Duckworth

QUESTIONS AND ANSWERS:

Question # Question Answer

1 Can you provide referenced Exhibit #8? This is referred to as "A summary of Medical, Pharmacy and Vision paid claims is provided in Exhibit #8

Medical, Pharmacy and Vision Paid Claim File for your information." in 3.1.6 of Section 3 - Scope of Work of the RFP

Exhibit #8 Vision Paid Claim File was shared as part of the data sent via MoveIt and Exhibit #15 Provider Disruption – Vision instructions were shared via MoveIt.

2 Can you share what are other carriers are bidding? PG County will not share what other carriers are bidding.

Please propose your best solution.

3 Can you please provide the Provider Match file for

Tab 14?

Exhibit #14 Provider Disruption – Vision was shared as part of the data sent via MoveIt. Additionally, Exhibit #15 Provider

Disruption – Vision instructions was shared via MoveIt.

4 Section 4.1.3 of the RFP identifies the order in which proposal should be submitted, however, section 4.1.4 contradicts

4.1.3 identifying a slightly different layout.

-Can you please advise which of the two sections takes precedent and/or if one should be not applicable? If both 4.1.3 and 4.1.4 apply, can you please confirm the Statement of Qualifications and

Proposal Responses including Technical

Questionnaire response(s) would go under Section I-

Proposal? Can you please also confirm the sections/tabs identified in

4.1.3 are not applicable as

4.1.4 instructs bidders to organize by sections?

Section 4.1.3 provides the components of the technical proposal format outline, which includes 10 tabbed sections as listed on pages 35 and 36 of the RFP. Section

4.1.4 Formal Description provides the format description

for each of the tabbed section.

As a point of clarification, the Statement of

Qualifications, Tab 4, identified in 4.1.3 is not referenced in 4.1.4. The requisite and section labels should be listed as follows:

Tab 1. Transmittal Letter Tab 2. Title

Page

Tab 3. Table of Contents

Tab 4. Statement of Qualifications Tab 5.

Section I - Proposal

Tab 6. Section II - Supplier Participation Plan Tab 7.

Section III - Exceptions or Restrictions Tab 8. Section

IV - References

Tab 9. Section V -Annual Financial Report Tab 10.

Section VI -Affidavits, Certifications, and Affirmation

5 Should bidders add a Section VII for any additional documentation that may fall outside of these sections?

All proposal responses and attachments should follow the format set forth in Section 4.1.3 and Section 4.1.4 Formal Description layout as described above.

Given the timing of the RFP files being uploaded and the time needed to properly review them, may we have an extension to Monday, December 30th to pose questions?

The due date for questions was extended until Monday, February 3, 2025, at 2PM.

7 Certificate of Good Standing: mentioned to be provided w/in 7 days of notice of intent to award, also included in 4.1 Technical Offer (4.1.11) question should be submitted if required with response or notice of intent to award a.1.26.2: The successful Offeror shall truthfully execute the Offeror Affidavit, Corporation

Registration and Tax payment and submit this form, together with a copy of its Certificate of Good

Standing, as applicable, within seven

(7) calendar days of the County’s Notice of Intent to

Award.

b.4.1.11 Licenses and Qualifications: b. Certificate of

Status (State of Maryland Certificate of Good

Standing with the Department of Assessments and

Taxation)

Can you please confirm whether the Certificate of

Status/Certificate of Good Standing is required with proposal submission or within seven (7) calendar days of the County’s Notice of Intent to Award?

The Certificate of Good Standing shall be provided within

7 calendar days of Notice of Intent to Award.

8 The introduction tab of the Exhibit #2 Medical

Technical Questionnaire workbook states:

“Next to each response cell, additional space is available for a brief text explanation. However, if the length of the explanation is greater than 400 characters, you must go to the

"Explanation" worksheet to provide your detailed explanation. All explanations must be numbered to correspond to the questions to which they pertain and should be brief.”

Individual Tabs within the Exhibit #2 Medical

Technical Questionnaire workbook as well as Exhibit

#5 Medical Financial Questionnaire state: “To

Offeror: Use Column "Explanation" to provide a brief explanation. However if the length of the explanation is greater than 50 characters including spaces, you must use the "Explanation" worksheet to provide your detailed explanation. Please note, your explanations must be limited to 400 characters or less”

Can you please confirm that we can provide responses in the Explanation columns throughout the applicable questionnaire workbooks with up to 400 characters?

Can you please confirm that we can provide detailed explanations on the Explanation tabs throughout the applicable questionnaire workbooks beyond 400 characters?

If the length of an explanation exceeds the characters available to provide a response, the Offeror can use the

Explanation worksheet to provide additional information.

9 We are unable to open Exhibit #4 PGCG Vision

Technical Questionnaire. Can you please re-send without restrictions?

A replacement questionnaire was sent to those vendors that continued to have access problems and the questionnaire has been updated in SPEED to remove restrictions.

10 We are unable to open PGCG Application Security

Questionnaire Checklist. Can you please re-send without restrictions?

A replacement questionnaire was sent to those vendors that continued to have access problems and questionnaire has been updated in SPEED to remove restrictions.

11 Can you please confirm the contract period to begin

1/1/26 and include 3 years followed by 2 optional years? While the Questionnaire does clearly state

1/1/26 as the effective date, the RFP document section 1.1.1 lists 7/1/2025.

The proposed contract Effective Date is January

1,2026 and includes an initial term of three (3) years. Additionally, the contract will include two

(2) options to extend the term for a period of one

(1) year.

12 Can you please detail the participation requirements of Section 10A-161, et seq. and 10A-136 of the

County Code as referenced in section

2.2.2 of the RFP?

This solicitation does not require any Prince George’s County

Government certified supplier participation, therefore, the referenced section of the RFP

(2.2-2.2.2) does not apply in this case.

13 Can you please confirm, on Medical Technical

Questionnaire Tab 3A - Performance Guarantee if the date range of January 2021 - December 2021 is accurate?

The correct date range for Medical Technical

Questionnaire Tab 3A - Performance Guarantee is

January 2023 - December 2024.

14 The enrollment within the Cigna medical claims experience provided does not align with the enrollment as noted in the Financial Questionnaire on tabs 6D and 6E. Can you please provide Cigna medical monthly claim experience by product with corresponding enrollment for at least a 24 month period that correlates to the enrollment within the

Financial Questionnaire by product/plan? Or please explain the discrepancy between the enrollment in the Financial Questionnaire and the Cigna claims file?

Please disregard the enrollment in the Financial

Questionnaire and proceed using the enrollment noted on the

Census file shared 1/3/25.

15 Can you confirm the current out of network reimbursement schedule (percentage of FAIR Health, percentage of Medicare, something else)?

The current out of network reimbursement schedule is at the

80th Percentile (of the usual and customary Fair Health Data) for their OAP plans and at the 100th percentile (based on

Medicare based fee schedule) for the OAPIN plans, of charges made by health care providers in a given geographic area where the service is received.

16 Can you please confirm that a proposal will be accepted if responding to any of the following: only the HMO/PPO ASC population, only the HMO

Fully Insured population, or the total HMO/PPO

ASC and HMO Fully Insured populations.

Yes, the Offeror's proposal(s) will be accepted for one or more of the identified plans.

17 Hello, please let us know how we can access the

Medical, Pharmacy, and Vision exhibits that are listed in the main RFP doc.

Exhibit #8 Vision Paid Claim File and Exhibit #8 Medical Paid

Claim File were shared via MoveIt. This exhibit was broken into two separate files, one for vision and one for medical data.

18 Do you integrate with any outside vendors for your vision program (wellness, eligibility, on-site solutions, etc.)?

No, not at this time.

19 How could your vision plan better align with your benefits strategy?

The County is currently seeking vision provider services that best support the needs of our employees and retirees.

20 If you could change anything about your vision plan, what would it be (provider access, cost containment, wellness, claims, eligibility, communication etc.)?

Please review the response provided for Question #19.

21 Within the solicitation in the SPEED portal, is there a section for additional files and the requested attachments to be loaded?

Please review the response provided for Question #4.

22 According to Attachment Y, a condition of bidding is that we submit one copy signed and sealed. Please confirm that this condition is met by uploaded the electronically signed copies of the proposals to the secure portal.

Yes, this condition is met by uploading the electronically signed copy of the proposal to the

SPEED secure portal.

23 Will there be a secondary question period with the release of the updated files and data file, once received?

No. Please review the response provided for Question #6.

24 Will a new Exhibit #3 - Pharmacy Benefit

Management Technical Questionnaire and Exhibit #5

- Pharmacy Benefit Management Financial

Questionnaire be provided to include the minimum qualifications and other tabs outlined in Section 3.2.2 in order to meet the Offeror Requirements?

The Pharmacy Minimum Qualification Tab was inadvertently not included in the questionnaire. Please see the attached

(separate) Minimum Qualifications spreadsheet. NOTE All bidders are expected to complete each tab originally included in the Technical and Financial Questionnaires as presented.

25 For the pharmacy disruptions and Geos, would you prefer reports run against the entire population, or would you also like the information for the secondary quote without the fully insured population?

The County will be weighing the implications of covering the entire population currently enrolled under the self-insured

Pharmacy Benefit Manager (PBM) relationship versus excluding the Staff Model, which includes all closed-panel

HMO plans, and only covering the remaining population under the self- insured plan.

We have received the RFP files from Aon and while there is a note about the census, Network Access census and Network Access instructions being provided as soon as possible, the files did not contain or reference Exhibit #2 - Medical Technical

Questionnaire, Exhibit #5 - Medical Financial

Questionnaire, Exhibit #3 - Pharmacy Benefit

Management Technical Questionnaire, Exhibit #6 -

Pharmacy Benefit Management Financial

Questionnaire, Exhibit #4 - Vision Technical

Questionnaire, or Exhibit #7 - Vision Financial

Questionnaire. Please clarify when and how these exhibits will be provided.

All questionnaires have been provided to vendors as part of the data sent via MoveIt. If you are missing files (other than the Census File which will be released shortly), please contact the designated procurement officer for this RFP.

27 There are no attachments other than the main RFP file and no indication in the file about how they will be distributed or how to request them. Would you please clarify?

All questionnaires and files have been provided to vendors as part of the data sent via MoveIt. If you are missing files, please contact the designated procurement officer for this RFP.

28 Please confirm the effective date for the coverages included under this RFP. The RFP document shows

7/1/25 but the group currently has a 1/1 renewal effective date.

July 1, 2025, is the anticipated award data (subject to change)

The contract effective date will be January 1, 2026

29 Please provide the Letter of Intent/NDA that needs to be completed in order to obtain the additional RFP files.

Offerors must submit a Letter of Intent/Non-Disclosure Agreement by the time and date specified in Timetable.

The signed letter should be emailed to Anna Cruser

(anna.cruser2@aon.com) and carbon copy Nena Charity nlcharity@co.pg.md.us and Christian Sutton clsutton@co.pg.md.us

The NDA/Letter of Intent has been provided to all vendors that requested it.

30 1. Exhibit #5 – Medical Financial Questionnaire begins on Tab 6A – Cost Question Med. Is this correct or are there tabs missing?

The Exhibit #5, which is included in the Section I -

Proposal, should only include Tabs 6A - 6F.

mailto:anna.cruser2@aon.com mailto:nlcharity@co.pg.md.us mailto:clsutton@co.pg.md.us

31 2. Please provide full benefit summaries or EOC’s for the current vision plans.

The requested data is included within this addendum.

32 3. Exhibit #3 – Pharmacy Benefit Management

Technical Questionnaire – The RFP document states the spreadsheet includes various tabs including

“Minimum Qualifications” and “TAB 3A-Hold

Harmless”. These tabs look to be missing from the

Excel document. Is that correct or are these tabs missing?

See updated Pharmacy Benefit Management Minimum Qualifications attachment.

Disregard reference to Hold Harmless tab.

33 4. Exhibit #6 Pharmacy

Benefit Management

Financial Questionnaire –

The RFP document states there are 16 tabs in this document but then only lists 15 tabs. The Excel document only has 14 tabs and looks to be missing the “Tab2A- Exclusions

EGWP”

tab. Is this correct or are there tabs missing?

5. What is the current type of Rx Pricing (Traditional Rx pricing, Retail Pass-through, Transparent/Acquisition Cost, etc.)?

6. What is the requested Rx Pricing structure (Traditional Rx pricing, Retail Pass-through, Transparent/Acquisition Cost, etc.)?

7. Is there a goal for the MWBE participation and, is that

Please review the responses provided for Question #36 and #38.

34 Exhibit #5 – Medical Financial

Questionnaire begins on Tab 6A – Cost

Question Med. Is this correct or are there tabs missing?

The Exhibit #5, which is included in the Section I -

Proposal, should only include Tabs 6A - 6F.

35 Please provide full benefit summaries or

EOC’s for the current vision plans.

The requested data is included within this addendum.

39 Exhibit 18a, Exhibit 19a and Exhibit 20a were provided in "txt" format.

Can these be provided in Excel?

The County will not provide files in an alternative format.

Offerors may convert the text files as needed for their own internal working purposes. Files must, however, be submitted in the format requested.

40 The current deadline for the proposal is Friday, January 24, 2025. We did not receive the required

NDA until 12/18 at 1:00 PM ET. As of today 12/20 we have not received Exhibit 1 Active and Retired Census.

Although we have executed the NDA required to release RFP documents, we have been adversely affected and delayed for nearly a week in beginning the

RFP process. Would the County be willing to extend this procurement opportunity?

Yes, The County has extended the due date for this RFP to

February 3, 2025 2:00 PM.

41 Please advise how bidders are to obtain the Excel

Exhibits A-AA that are associated with this proposal.

There are no excel exhibits A-AA associated with this RFP.

42 Please advise how bidders are to register for the pre-proposal conference that is scheduled for Monday

12/16.

Registration was not required for the pre-proposal conference held on Monday 12/16/24.

43 Indicates "Notice to Proceed is anticipated to be on or about July 1, 2025" but does not specify the contract effective date. Is this the same as the "Contract award date?" And what is the effective date of the contract?

The effective contract date is January 1, 2026.

44 Please advise whether electronic signatures are acceptable on forms and attachments.

Electronic signatures are acceptable on forms and attachments.

The current deadline for proposal questions is this

Friday 12/20. Given that there is a delay to provide bidders with an NDA for the Exhibits to be released by procurement, can an extension be given for bidder questions to be submitted?

Deadline to submit questions was extended to 12/23/2024.

46 The RFP Document references the following tabs that are not part of Exhibit 3. Please confirm the tabs the

County would like completed.

Tab 1A is the Technical Questionnaire. The name on the tab is abbreviated. Account Team is the same as Account Team Hold

Harmless is not included and reference to this tab should be ignored. Officer Statement is the same as Officer Statement. All bidders are expected to complete each tab in the original technical and financial questionnaires.

36 Exhibit #6 Pharmacy

Benefit Management

Financial Questionnaire –

The RFP document states there are 16 tabs in this document but then only lists 15 tabs. The Excel document only has 14 tabs and looks to be missing the “Tab2A-

Exclusions EGWP” tab. Is this correct or are there tabs missing?

Please complete the tabs as the appear in both the technical and financial questionnaires. Include any EGWP exclusions on the existing exclusion tab and as part of your response and note in the “Explanation” column whether the exclusion applies to commercial, EGWP, or both.

37 What is the current type of Rx Pricing

(Traditional Rx pricing, Retail Pass-through, Transparent/Acquisition Cost, etc.)?

The County currently has a transparent arrangement in place.

38 Is there a goal for the MWBE participation and, is that goal tied to the annualized base ASO fee or total ASO fee?

There is no MWBE goal for this RFP.

TAB 1A-Tech Question- Rx = Is this the same as

"Questionnaire" or "Technical"?

TAB 2B-Account Team = This is the same as "Account

Team"?

TAB 3A- Hold Harmless

= This is not included TAB 4A-Officer Statement = Is this the same as "Officer Statement"?

47 The RFP does not reference the following tabs.

All bidders area expected to complete each tab in the original technical and financial questionnaires.

Disregard any naming inconsistencies.

Definitions Medicare Part D

Performance Guarantees Customer Service

48 As a fully insured Yes, the intended diverse supplier list must be finalized provider we subcontract by the execution of the contract.

with Diverse Suppliers based on our needs.

Because these needs fluctuate, listing values doesn't provide contract flexibility and is viewed by the Diverse Supplier as a contract. Is there any way to list intended

Diverse Suppliers without acquiring signatures?

49 Additionally, would the County consider increasing the number of days for payment to the subcontractor from seven

(7) calendar days to thirty

(30) calendar days?

No, As stated in Section 1.38.2 page 6 of the RFP and the

County Code Section 10A-153 Prompt Payment, the prime contractor shall pay each of its subcontractors (including a material supplier) for satisfactory performance under the respective subcontract within seven (7) calendar days after receipt of such amounts that are paid to the prime contractor by the County for such work performed under the contract.

50 Please confirm the County's diverse supplier spend requirement as a percent of the total contract or good faith effort.

Yes, the County’s diverse supplier spend requirement is a percentage of the total contract or good faith effort.

Would the loss runs and claims history for the past three years, along with the current census data be available for quoting purposes?

All vendors that provided an NDA have been given access to claims information and a census file.

52 Will the County provide additional Vision documents such as: the current plan design, rates, employee census and claims experience?

Vendors received Exhibit #8 Vision Paid Claim File via

MoveIt. Current rates will not be shared. The Census file was shared on 1/3/25.

53 For Attachments Z & AA, what is the required response from prospective bidders?

There are no required responses for Attachments Z & AA.

54 Is there a MBE participation target? There is no MBE participation goal for this RFP

55 2.2.1 states there is no CBSB participation goal; does not mention MBE participation. All the supporting documents “imply” participation and utilization, but unable to locate clear requirement of participation percentage

This RFP shall not require any participation from a Prince

George’s County Government certified supplier. No CBSB or

MBE participation required.

56 Business preference section (page 41) states that firms points can be award if 45% utilization target is met

As stated, this RFP does not require any participation from a

Prince George’s County Government certified supplier. Page

41, business preferences and supplier participation indicates that in the event that a certified business in any of the mentioned certification categories submits a bid/proposal as the prime and/or responsible for at least 45% of the work, they shall receive preference points.

57 What is the current fee? What is included in the current fee?

This question is not clear and cannot be answered at this time.

58 What is the current shared savings arrangement and what percentage is charged?

Currently, 27% net savings for Network Savings

Programs and Bill Negotiation Services. Note: The County is not necessarily looking to duplicate the current shared arrangement(s). Please provide your most competitive proposal.

59 What is the group’s current out of network arrangement?

Do they use a wrap network and/or a combination reference-based pricing?

The County currently uses a wrap network

60 Is it possible to receive Claims files that include fixed charges and what services are included in those columns and Claim reports that include cost containment and that confirm what services are included in this column?

(Typical programs include; Behavioral care services, capitated charges for Hi-Tech Radiology, and/or third-party care management programs and what services are included in this column)

No additional Claims Data will be provided. Please provide you best quote for the services requested.

61 Are there any outside vendors that bidder’s will need to interface with?

If so, who those vendors are?

If no, outside vendors currently in place, are there any plans to add vendors next year?

No, there are no outside vendors the bidders will need to interface with at this time.

62 What are the claim run- out provisions? Specifically, how many months will current vendor process claims and what’s the charge?

The current vendors will process run-out claims for 12 months after contract end date at no charge.

63 Are there any unique arrangements for banking, billing, eligibility, plan design?

The RFP provides an overview of the applicable arrangements

64 Are there any unique Care Management programs, prior- authorization or non- covered requirements?

The RFP outlines the Care Management programs.

65 Provide detail of any services/fees that are currently charged through the claim wire other than capitation?

The services/fees that are currently charged through the claim wire, other than capitation, include Network Savings Programs, Bill Negotiation Services, Collaborative Care; Payment Integrity.

66 Please describe the wellness program in place today, to include the design, staffing, incentives, Prince George’s

County wellness ambassador network, any onsite wellness staff paid for and provided by the current health management vendor. Also please provide your latest annual wellness program report.

Please refer to the County’s website for the description of the

Wellness Program. Please see links below:

https://www.princegeorgescountymd.gov/departments-offices/human-resources-management/employees/wellness/wellness-demand https://www.princegeorgescountymd.gov/departments-offices/human-resources-management/employees/wellness

67 Please describe any and point solution vendors in place today and what you would like going forward.

The County asked Offerors to agree to our security standards which were included in the security exhibit. Otherwise, the

County is not asking for help/support with security hardware or software solutions at this time.

68 Please describe any first responder challenges fee you need to more effectively address with your behavioral or EAP programs.

The County is not seeking First Responder services in this RFP.

69 • Would you like us to quote an EAP as well? If yes, please describe the visit model you have in place today, what you would like going forward, how many training hours/CISD hours, should work life be included, are there any onsite

EAP staff being provided by the current EAP vendor.

The County is not seeking EAP services in this RFP.

Please explain the reason(s) that this RFP is out to the market.

Generally, the County puts its plans out to bid when no additional extensions are available on those contracts. From time to time, the County rides the contracts of other public employers. This RFP is seeking Medical, Pharmacy and Vision proposals as part of the County’s periodic RFP renewal strategy.

The vision plan is currently riding another public employer contract, and the County wishes to have a direct contract relationship with its vision vendor rather than ride another contract.

How long has the coverage been with the current carrier? What was the original effective date of the plan?

All of the plans under this RFP have been in place with the incumbent vendors for more than 10 years. However, The plan designs have been in place for more than 20 years and amended from time to time.

72 Does the customer currently partner with or have plans to partner with a third-party entity that will assist in their benefit administration? Please include the name(s) of the entity partner(s) being considered and explain the scope of services they will provide.

There are no current third-party entities assisting Prince

George’s County with benefit administration matters.

However, the County is considering options to partner with a benefit platform vendor in the future, but no decisions to proceed in that direction have been made.

73 What specific services would the requested credit(s) funds would be covering? Who will be performing the services (customer, TPA)?

Prince George’s County has a variety of information technology and communication needs and desires to use vendor credits to support initiatives and related services, including but not limited to, help with funding a benefits platform.

https://www.princegeorgescountymd.gov/departments-%20%20offices/human-resources-management/employees/wellness/wellness-demand https://www.princegeorgescountymd.gov/departments-%20%20offices/human-resources-management/employees/wellness/wellness-demand https://www.princegeorgescountymd.gov/departments-%20%20offices/human-resources-management/employees/wellness/wellness-demand https://www.princegeorgescountymd.gov/departments-offices/human-resources-management/employees/wellness https://www.princegeorgescountymd.gov/departments-offices/human-resources-management/employees/wellness

74 Per #32-

Electronic Execution on page 109 of the RFP, can electronic signature be used in leu of handwritten/ink signature as required on the

Transmittal Letter, Vendor Oath and Certification, Certification of contractor’s best efforts and Certificate of compliance regarding fair labor standards act?

Yes, Offerors may use an electronic signature.

No, Attachment F Certification of Contractor’s Best Effort requires a notary to be deemed complete and responsive.

Are you willing to waive notary on attachment F-

Certification of contractor’s best efforts?

Yes, a duly authorized corporate officer (e.g. , President, Vice

President) can sign the Vendor Oath and Certification and

Certificate of compliance regarding fair labor standards act forms on the company’s behalf.

Please confirm that a duly elected Vice President of our corporation can sign the Vendor Oath and Certification and

Certificate of compliance regarding fair labor standards.

act forms?

77 The current Administrative Services Only (ASO) fees will not be provided. The County asks that

Offerors propose the best/most competitive rates to provide the services requested in the RFP equivalents. The County expects vendors to quote

ASO fees irrespective of the internal rate setting process.

Please provide the current ASO fee.

Yes Will Prince George’s County pay premiums within a 30-day grace period?

79 Plan Design information is contained in the various technical questionnaires. For additional Vision plan SPDs, see the attached file in this addendum starting on page 38.

“Evidence_Certificate_of_Coverage_January_1_2023”.

Please provide the current SPDs describing the full current plan design?

80 No, there are no plan design changes from 2022 through 2025.For additional Vision plan SPDs, please see the attached file in this Addendum starting on page 38.

"Evidence_Certificate_of_Coverage_January_1_2023”

Have there been any vision plan design changes over the past

36 months? If so, please provide the details and dates of any change(s). Are the plan summaries for 2022 and 2023 available showing any changes?

81 Thank you for the experience reports. Is the experience data available for 2022-2024 by plan?

No additional experience data will be provided.

82 Please provide a census file that includes the run date as well as the following key information:

Gender

Zip Code

State of Residence

Plan election (if multiple plans are offered)

Utilization data has been provided with exhibits. Census shall be provided by Monday, January 6th

Tier enrollment (such as Employee Only, Employee +1, Family, etc.)

Active/Retired status

Date of birth Population identifier (if distinct groups have distinct rates and/or plan design, e.g.

hourly/salaried) Descriptions of abbreviations in any of the provided fields (such as "Status", "Coverage

Option", etc.)

Does the customer currently partner with or have plans to partner with a third-party entity that will assist in their benefit administration? Please include the name(s) of the entity partner(s) being considered and explain the scope of services they will provide.

Please see response provided for Question #72.

What specific services would the requested

Please see response provided for

Question #73.

credit(s) funds would be covering? Who will be performing the services

(customer, TPA)?

85 Please provide annual utilization experience by plan by population if applicable, including number of:

Exams (are Refractions included under Exam codes or separately under another category?)

Contact Lens, Exam & Fitting Frames, Single lenses, Bifocal lenses, Trifocal lenses, Progressive lenses, (If available Standard

Progressives, Premium Progressive) Contacts.

If available, please also provide utilization of lens enhancements such as anti- reflective coating, scratch resistant coating, ultra-violet coating, and tints.

This requested level of detailed claims information will not be shared.

Medical Plans, Pharmacy Benefit Management, and Vision

Services

Request for Proposal – WS1381744989

December 16, 2024

IMPORTANT DATES AND INFORMATION

• Solicitation Name: Medical Plans, Pharmacy Benefit Management, and Vision Services

• Solicitation Number: WS1381744989

• Issuance Date: December 11, 2024

• Pre-Proposal Conference: December 16, 2024 at 10:00 a.m.

• Question Due By: December 20, 2024, at 2:00 p.m.

• Proposal Closing: January 24, 2025, at 2:00 p.m.

• Procurement Contact: Christian Sutton, clsutton@co.pg.md.us

The solicitation can be found on the following platforms:

• SPEED eProcurement Platform - http://discovery.ariba.com/profile/AN01496591158

• eMaryland Marketplace Advantage (eMMA) - https://emma.maryland.gov/

Questions shall be submitted in SPEED eProcurement Platform: https://www.princegeorgescountymd.gov/3576/Finding-Opportunities Responses will be sent to the bidder’s email as an Addendum to the Bid Document.

*Please note that all Addenda MUST be acknowledged and returned with the response to the proposal. Failure to do so may result in being deemed non-responsive.

mailto:clsutton@co.pg.md.us http://discovery.ariba.com/profile/AN01496591158 http://www.princegeorgescountymd.gov/3576/Finding-Opportunities

IMPORTANT DATES AND INFORMATION - continued

• Vendors must be registered in SAP - https://erpvendorapp.sap.mypgc.us/registration

• Or you may contact Betty Nealy-Carter at bcarter@co.pg.md.us

The successful Bidder shall be current and in compliance with applicable tax filings and licensing requirements of the Prince George’s County Government;

If a Corporation conducting business in Prince George’s County or the State of Maryland, then they must be registered and in “Good Standing” with the Maryland State Department of Assessment and Taxation.

**Please note that this Request for Proposal does not contain a mandatory participation by Certified County-Based Small Business

(CBSB).

The Contractor shall provide the County with evidence of its Contractor’s commercial insurance coverage's as stated in the RFP.

Prince George’s County, Maryland must be included as an additional insured under the general liability insurance coverage with respect to activities related to this Contract.

mailto:bcarter@co.pg.md.us

COMPLIANCE

Prevailing Wages:

This solicitation is subject to the County’s Wage Requirements law for service contracts. Information pertaining to the Wage Requirements law is attached. The “Wage Requirements for service contracts (Attachment J) and, if applicable, the “501(c)(3) Nonprofit Organization’s Employee’s Wage and Health Insurance Form” (Attachment K) that are included with this solicitation must be completed and submitted with your Proposal response. Failure to complete and submit the required certification and pricing material on the form(s) will render your Proposal unacceptable under County law and the Proposal will be rejected for non-responsiveness.

NOTE: The Wage Requirements for service contracts may change during the Contract period. The Contract price shall not adjust due to Wage increase or decrease.

PROHIBITION OF CONTRACTORS IN ENGAGING IN SEX AND LABOR TRAFFICKING

During the performance of any contract, no Contractor, through its employees or agents, shall engage in human sex trafficking or human labor trafficking as defined by Section 14-191, Subtitle 14 of The Prince George’s County Code.

If any person believes that a Contractor or a Contractor’s employees or agents does not comply with the prohibitions against human sex trafficking and human labor trafficking, they may file a complaint with the Office of Human Rights

Background and Purpose

Prince George’s County, Maryland (hereafter, “the County”) has a population of over 946,000 ethnically diverse residents. The County comprises 27 departments, agencies, and boards with approximately 7,000 employees.

The Office of Human Resources Management (OHRM) is the agency responsible for a variety of human resource- related services to over 6,500 active employees and 6,500 retirees in all County departments and agencies. Additionally, each department and agency has a human resources representative to assist OHRM with various decentralized functions.

The County intends toenter into a contract with qualified contractors to provide all necessary personnel, management, and supervision for Medical Plans, Pharmacy Benefit Management, and Vision Services

Background and Purpose

County is committed to providing a comprehensive/competitive employee benefit plan for its employees, retirees and their covered dependents. This includes Medical Plan Administration (Self -Insured PPO and HMO, and fully insured Staff Model HMO), Pharmacy Benefit Management Services, and Vision Plan Services. Note: the solicitation outlines the requirements that must be met for proposers to be considered.

Scope of Work and Requirement

3.2.1 Offeror Requirements - Medical

3.2.1.1 Minimum Requirements

a. Offeror(s) must have at least ten years of experience administering plans as outlined in this RFP, with multiple clients covering at least 15,000 enrolled employees/retirees.

b. Offeror(s) must have experience with a minimum of three public sector clients.

c. Offeror(s) must have at least two million covered lives across their plan book of business.

d. Offeror(s) must have a current license and/or other required certifications necessary to operate in the locations of business operations.

e. No broker commissions will be allowed in connection with this solicitation.

f. Offeror(s) must, at a minimum be able to produce monthly and quarterly experience reports by plan (preferably in excel format) that separates out employees, retirees (pre and post Medicare) and twice-yearly reports related to utilization, plan performance and comparing the County to industry norms. In addition, separate reporting for the County Government population and Public Library System population will be required.

Scope of Work and Requirement – (continued)

3.2.2 Offeror Requirements - Pharmacy Benefit Management

3.2.2.1 Minimum Requirements

a. Offeror must have a minimum of five years experience providing pharmacy benefit management services, including network management, claims administration and oversight, member services, and clinical management programs to self-funded plan sponsors.

b. Offeror must have experience with a minimum of three public sector commercial, self-funded Pharmacy clients with over 400,000 enrolled lives (i.e., belly buttons) and b) have a total client volume of 5 million enrolled lives or greater with a minimum client size of 400,000 enrolled Pharmacy lives.

c. Offeror(s) must have a current business license and/or other required certifications necessary to operate in the locations of business operations and must comply with all applicable state and federal laws effective during the term of the

Contract.

d. Offeror must propose a network of pharmacies that represents the offeror’s broadest retain network.

e. Offeror must offer a self-insured pharmacy benefit plan.

a. All pharmacists, registered nurses, care managers, physician reviewers, and other providers of clinical services must be appropriately licensed.

b. Offeror must have current accreditation by the Utilization Review Accreditation Committee (URAC).

c. Offeror’s current membership in Bidders Book of Business must be a minimum of three (3) million participants.

a. The ideal pharmacy solution must provide access to a state-of-the-art mail order and specialty pharmacy solution.

b. Offeror must coordinate payments for Medicare Part B drugs directly with Medicare for both retail and mail order pharmacy claims.

c. Offeror must maintain a retail pharmacy network subject to periodic review for network agreement compliance, including fraud, waste and abuse.

d. Offeror must provide a portfolio of formulary strategies, including a formulary that aligns with PGCs existing formulary.

e. Offeror must offer an Employer Group Waiver Plan (EGWP) solution with a minimum of three (3) referenceable EGWP plans for public sector employees that approximates PGC’s current EGWP offering and minimizes changes in benefits for PGC retired members.

Offeror Requirements – Vision Plan

3.2.3.1 Minimum Requirements:

a. Proposed vision networks must allow 50% or more in-network accessibility to covered participants based on PGCG's criteria of 1 Optometrist within 10 miles.

b. Offeror(s) must have at least ten years of experience administering vision plans as requested in this RFP with multiple clients covering at least 15,000 enrolled employees/retirees.

c. Offeror(s) must have a minimum of three current public sector clients.

d. Offeror(s) must propose a network that includes at least 30% of the top 100 optometrists most frequently utilized by

PGCG members.

e. Offeror(s) must have at least 25,000 covered lives in vision benefit plan services (excluding discount only plans).

f. Offeror(s) must have a current license and/or other required certifications necessary to operate in the locations of business operations.

g. No broker commissions will be allowed in connection with this solicitation.

a. Offeror(s) must, at a minimum, be able to produce monthly and quarterly experience reports by plan (preferably in excel format) that separates out employees, retirees (pre and post Medicare) and twice-yearly reports related to utilization, plan performance and comparing the County to industry norms. In addition, separate reporting for the County Government population and Public Library System population will be required.

b. Offeror(s) account services team must have a minimum of 5 years public sector account management experience, servicing medium to large public sector clients.

Questionnaires

There will be a Technical and Financial Questionnaire in excel for each line of coverage.

Scope of Work and Requirement–

Requesting Data/Exhibits

Mandatory Letter of Intent Offerors must submit a letter of intent/Non-Disclosure Agreement by the time and date specified in Timetable. The signed letter should be emailed to Natasha Dorsey (natasha.dorsey@aon.com) and Anna Cruser (anna.cruser2@aon.com)and carbon copy Nena Charity nlcharity@co.pg.md.usand Christian Suttonclsutton@co.pg.md.us state your firm’s name, and address, your intention to prepare a proposal for this RFP and the name, title, and contact information of the person signing the letter.

Please copy on your company letterhead and indicate which components you will be submitting.

This Letter of Intent includes a Non-Disclosure Agreement. The information that is released by AON is proprietary. AON will release the information upon receipt of the signed Letter of Intent/Non-Disclosures from you mailto:(natasha.dorsey@aon.com mailto:nlcharity@co.pg.md.usand mailto:clsutton@co.pg.md.us

WS PROPOSAL SUBMISSION REQUIREMENTS

Proposals must be submitted via SPEED For assistance with registering for SPEED (No Hand-Deliveries Will be Accepted) or to access a listing of FAQ, please visit SPEED eProcurement Platform https://www.princegeorgescountymd.gov/3576/Finding-Opportunities

Organize your Bid well. There should be two (2) Attachment in SPEED:

Attachment One (1) is the Technical Response , Attachment Two (2)is the Financial Questionnaire(s), The signed/acknowledged signature pages of all Addendums, and All required Attachments are fully completed and signed including Attachment H Cost Proposal Sheet which is an acknowledgement to the Financial Questionnaire.

Remember: Do not wait for the last hour prior to closing to submit the bid. If you experience issues with the submittal, print screen any error message received and contact the Procurement Officer via email for assistance. Please respond / bid on all items requested on Attachment H. Leaving any area blank will indicate the offeror is not prepared to provide all required services.

http://www.princegeorgescountymd.gov/3576/Finding-Opportunities

WS1242792215 PROPOSAL SUBMISSION REQUIREMENTS

Technical Proposal Format Outline

Each technical proposal shall have the following sections prominently displayed and separated by marked tabs:

1. Transmittal Letter

2. Title Page

3. Table of Contents

4. Statement of Qualifications

5. Proposal Responses

6. Supplier Participation Plan

7. Exceptions or Restrictions

8. References

9. Annual Financial Report

10. Affidavits, Addendums, Certifications and Affirmations

QUESTIONS?

Client Vision Care Plan

Vision Care for Life

Client Name: PRINCE GEORGE'S COUNTY, MD Client Number: 40149611 Effective Date: JANUARY 1, 2023

EVIDENCE OF COVERAGE

Provided by:

VSP VISION CARE, INC.

3333 Quality Drive, Rancho Cordova, CA 95670

(916) 851-5000 (800) 877-7195

The insurance policy under which this Evidence of Coverage is issued is not a policy of worker’s compensation insurance. You should consult your employer to determine whether your employer is a subscriber to the worker’s compensation system.

EOC 0413 12/03/22 Dxp

Notice to Client: In the event this document is used to develop a Summary Plan Description, complete the information below, as applicable.

NAME OF CLIENT:

NAME OF PLAN:

PRIMARY ADDRESS OF CLIENT:

PLAN ADMINISTRATOR:

ADDRESS:

PHONE NUMBER:

This Evidence of Coverage is a summary of the Policy provisions and is presented as a matter of general information only. It is not a substitute for the provisions of the Policy itself. In the event of any dispute between this Evidence of Coverage and the Policy, the provisions of the Policy will prevail. A copy of the Policy will be furnished on request. If any changes are made to this document by anyone other than VSP, VSP disclaims responsibility for such changes and cannot guarantee this document will comply with any statutory requirements including but not limited to ERISA.

ELIGIBILITY FOR COVERAGE

Enrollees: To be covered, a person must currently be an employee or member of the Client, and meet the coverage criteria established by Client.

Eligible Dependents: Any dependent of an Enrollee of Client who meets the eligibility criteria established by Client, if such dependent coverage is provided.

This Policy shall provide continuous open enrollment for the purpose of allowing a married employee who is enrolled under this Policy to alter the terms of the employee's coverage to include the employee's spouse or children if the employee's spouse loses coverage under another group health insurance contract or policy because of the involuntary termination of the spouse's employment other than for cause.

If a parent eligible for family members’ coverage is required under an order to provide health insurance coverage for a child, a parent may enroll in family members’ coverage and include the child in that coverage regardless of enrollment restrictions. If the insuring parent is enrolled in health insurance coverage but does not include the child in the enrollment, the noninsuring parent, child support enforcement agency, or Department of Health and Mental Hygiene shall be allowed to apply for enrollment on behalf of the child and include the child in the coverage regardless of enrollment period restrictions. VSP shall not terminate coverage provided pursuant to this paragraph unless written evidence is provided to VSP that the order is no longer in effect, or the child has been or will be enrolled under other reasonable health insurance coverage that will take effect on or before the effective date of termination, or the employer has eliminated family members’ coverage for all of its employees, or the employer no longer employs the insuring parent, except that if the parent elects to exercise the provisions of COBRA coverage shall be provided for the child consistent with the employer’s plan for postemployment health insurance coverage for dependents.

HOW TO USE THIS PLAN

VSP provides Plan Benefits to Covered Persons based on the level of coverage purchased by the Client. Refer to the Schedule of Benefits and Additional Benefit Rider (if applicable) for specific Plan Benefits.

1. Contact VSP to obtain a list of participating providers, and/or to view available benefits, (see below for contact information).

2. Contact a VSP Preferred Provider’s office to schedule an appointment and indicate that Covered Person is a VSP member. Should Covered Persons fail to identify themselves as VSP members, Plan Benefits shall be limited to those of an Open Access Provider, if such Plan Benefits are available.

3. Once the appointment is made, the VSP Preferred Provider will obtain benefit verification from VSP. The VSP

Preferred Provider will bill VSP directly and the Covered Person is responsible for payment of any applicable Copayments, non-covered services or materials, or amounts which exceed plan allowances, and annual maximum benefits.

4. If the Policy includes Plan Benefits for Open Access Providers, Covered Person may be responsible for paying for all services and/or materials in full and submitting a claim to VSP. All reimbursement will be determined applying Coinsurance, less any applicable Copayment. Obtaining services from an Open Access Provider will typically result in higher out of pocket expenses for Covered Persons.