Amendment__3__F10B6600001_.04_AGY-24-026-SR-A__BPM051063_RFP__9.22.2025.pdf

AMENDMENT #3

TO

DEPARTMENT OF BUDGET AND MANAGEMENT, OFFICE OF PERSONNEL

SERVICES AND BENEFITS (DBM OPSB)

Health Plan Administration and Services

[PREFERRED PROVIDER ORGANIZATION, SELF-FUNDED (PPO-SF) AND EXCLUSIVE

PROVIDER ORGANIZATION, SELF-FUNDED (EPO-SF); INTEGRATED HEALTH MODEL,

FULLY-INSURED (IHM-FI); AND POINT SOLUTIONS]

RFP NO.: F10B6600001 / BPM051063

AND

State Law Enforcement Officers Labor Alliance (SLEOLA) Medical Plan Administration And Services (PPO, EPO, & POS, Self-Funded)

RFP NO.: F10B6600004 / BPM051063

AND

MARYLAND DEPARTMENT OF TRANSPORTATION MARYLAND TRANSIT

ADMINISTRATION (MDOT-MTA)

MDOT-MTA Represented Medical & Stop Loss Insurance (PPO-SF And HMO-SF) And Vision (Self-Funded) Plan Health Benefits Administration And SERVICES

[PREFERRED PROVIDER ORGANIZATION, SELF-FUNDED (PPO-SF) AND HEALTH

MAINTENANCE ORGANIZATION, SELF-FUNDED (HMO-SF)]

RFP NO.: AGY-24-026-SR-A / BPM051063

September 22, 2025

Dear Prospective Offeror:

The following Amendment is being issued to amend language and clarify information contained in the above-named RFP. All information contained herein is binding on all Offerors who respond to this RFP. The following change is listed below; new language has been double underlined and marked in yellow highlighted red bold (ex. new language) and language deleted has been marked with a yellow highlighted bold double strikeout (ex.

strike out).

1. Revise the Key Information Summary Sheet on Page 4, to read as follows

Amendment #3 RFP No. F10B6600001 / F10B6600004

AGY-24-026-SR-A / BPM051063

Proposal Due (Closing) Date and Time:

October 6, 2025 @ 3 PM Local Time

September 23, 2025 @ 10 AM Local Time Offerors are reminded that a completed Feedback Form is requested if a no-proposal decision is made

(see Attachment 1 - No Proposal Notice/Vendor Feedback Form).

2. Replace the language for PG-1, PG-12, PG-13, and PG-19 of FA5 Exhibit 7:

Performance Guarantees in Exhibit 5 Technical Proposal FA5 Medical HN=MO-PPO Plans) on page 29, as follows:

PG-1 Telephone Call Availability

Measurements must be MTA-specific or for only the service center handling the MTA account.

Average speed of answer by a live service representative is thirty (30) seconds or less during call center live hours. 98% of telephone calls are answered by a live service representative within 30 seconds.

The representative must have knowledge of the MTA account and be able to address the member's issue/question.

Quarterly Plan Performance Measurement Report Card (Report Card to be submitted by the Contractor).

Frequency of report: Quarterly

0.10% of admin fees for each percentage point, or fraction thereof, below 98%.

Choose an item.

PG-12 Annual

Hospital Records Claims Audit

Conduct hospital records (including clinical and billing issues) audits for every admission with paid claims in excess of $100,000, subject to a minimum of 2% of all hospital claims. Audits are to be conducted on-site or remotely to ensure accuracy of billed charges in relation to the clinical services delivered.

Provide quarterly reporting of the number of audits conducted, the amount of recoveries to the MTA Plan.

3.00% of admin fees if performance is less than standards.

Choose an

AGY-24-026-SR-A / BPM051063

PG-13 Employee Satisfaction

A 90% or higher member satisfaction rate.

Time over which standard is measured:

Annual

Measured through a random sample of 10% of all members enrolled in each respective Plan and assessed by MTA’s annual Customer Satisfaction Survey.

Survey results of MTA’s annual Customer Satisfaction Survey.

A minimum of 20% of surveyed members must respond for the survey results to be valid.

Frequency of report:

Annually

10% of admin fees due as of the month following the survey analysis.

Choose

PG-19 Provider Turnover The turnover rate of less than 3% annually for the HMO, and PPO, and Vision networks.

Self-reported and confirmed by MTA.

3% of admin fees Choose

3. Replace the language in Exhibit 5 Technical Proposal FA6 (Vision Plan) for

Compliance Checklist items #CC-1, CC-27, CC-28, CC-29, CC-38(l), CC-40, CC-43, CC-47, CC-50, CC-55, CC-56 and CC-60; Questionnaire items #Q-9 [formerly Q-10], Q-18 [formerly Q-20], Q-25 [formerly Q-27], Q-26 [formerly Q-28], Q-31 [formerly Q-33] and Q-42 [formerly Q-45], and Performance Guarantees items #PG-10, as follows:

CC-1 Contractor agrees to permit all eligible Members, as determined by MTA, to obtain vision plan dental benefits for themselves and their Dependents.

Choose an item.

CC-27 Contractor will track Reasonable and Customary (R&C) and claim payment data by most cCurrent Procedural Terminology (CPT) CDT code and zip code.

AGY-24-026-SR-A / BPM051063

CC-28 Contractor agrees to make changes to CPT codes when updated by the American Medical Association (AMA) CDT codes on dental procedures and nomenclature when updated by the American Dental Association. Contractor further agrees to confirm these changes, in writing to MTA, no later than 90 days after the effective date of the changes.

Choose an item.

CC-29 Contractor agrees that all services included in MTA’s benefit program will be covered at the same benefit level regardless of (CPT) CDT procedure code changes.

Choose an item.

CC-38 l.) Contractor shall document and track Disclosures and provide an accounting of Disclosures of PHI to the individual about whom it relates in compliance with 45 CFR §165.528 and the HITECH Act as if the Contractor were the Covered Entity with regard to the Vision Dental plan.

Choose an item.

CC-40 The Contractor shall comply with the limitations on marketing and fundraising communications provided in 45 CFR 164.508(a)(3) and §13406 of the HITECH Act as if it were a covered entity in connection with the Vision and Dental plan.

Choose an item.

CC-43 The Contractor confirms that its proposal, and plan design offered, is in compliance with all federal and state laws and regulations that pertain to Vision and Dental employee benefit plans.

Choose an item.

CC-47 Contractor agrees to retain records in excess of the period required by the Contract, if required by State and Federal regulations for group vision and dental plans.

Choose an item.

CC-50 Contractor agrees to monitor federal and state legislation affecting the delivery of vision and dental benefits under the plan and to report to MTA on those issues in a timely fashion prior to the effective date of any mandated benefit changes.

Choose an item.

CC-55 Contractor agrees to use the NAIC 120-1 Model COB Contract Provisions as applicable for vision and dental plans for determining when to pay as primary coverage.

Choose an item.

CC-56 Contractor agrees to administer the plan to provide Coordination of Benefits (COB) under a “pay and pursue” basis with other employee, retiree, and/or dependent vision and dental coverage.

Choose an item.

CC-60 Contractor certifies that it can and will administer the vision dental plans in compliance with all State laws, regulations, and mandates.

Choose an item.

Q-9 Q-10

Are you anticipating any material changes (+/- 5%) in network size (for either vision providers or general/family dentists and dental specialists) in the network area serving MTA employees and retirees during the next 12 months?

Choose an item.

Q-18 Q-20

Does your organization perform provider profiling or other quality measures to identify vision dental providers with patterns of over/under treatment to members?

Choose an item.

Q-25 Q-27

How are vision dental emergencies (both in and out of area) and accidental vision dental services provided? Choose an item.

AGY-24-026-SR-A / BPM051063

Q-26 Q-28

Outline your recommended transition program for members and dependents who are currently receiving vision dental treatment. Choose an item.

Q-31 Q-33

Does your system track referrals to specialists or non-contracted vision dental providers? Choose an item.

Q-42 Q-45

Please note the source of your vision dental R&C information (e.g. HIAA, MDR, internally developed, other).

Choose an item.

PG-10 Provider Turnover A turnover rate of less than 5% annually will be maintained for vision plan optometrists, ophthalmologists performing routine care, and optical centers, and for the DPPO both the general dentist and specialty network.

Calculation should include all terminations regardless of reason for termination.

Quarterly vendor report

3% of admin fees if turnover is greater than 5%, 6% of fees if greater than 7%.

4. Replace Exhibit 1. MBE, VSBE, and SBR Research Factors Template with the enclosed version, to include research factors for Functional Areas 2 and 4.

5. Replace the language in Exhibit 5 Technical Proposal FA3 (Point Solution) for

Questionnaire item #Q-21, as follows:

Q-21 Physician referrals Choose an item.

Case Management

Other

Click here to enter text.

AGY-24-026-SR-A / BPM051063

Physician referrals

Which of the following types of interventions are utilized? Select all that apply.

Patient education (mailings)

Telephone based health coaching

Online coaching/counseling

Date Issued: September 22, 2025 Authorized By: /s/ Andrea R. Simmons

Andrea R. Simmons Procurement Officer

Enclosure(s):

Exhibit 1: MBE.VSBE.SBR-Research DBM Health_SLEOLA RFP 2025.8.8 (AMEND

3) 2025.9.20

Ext 5.TechProp FA3(PointSol) DBMHealth RFP 2025.8.9 (AMEND 3) 2025.9.22

Ext 5.TechProp FA5 (Medical HMO-PPO Plans) 8.8.2025 (AMEND 3) 2025.9.22

Ext 5.TechProp FA6 (Vision Plan) 8.8.2025 (AMEND 3) 2025.9.22