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Appendix B1
| APPENDIX B1 |
| LONG TERM DISABILITY |
| PRICE PROPOSAL PAGES |
| RFP NO. 26-042/DJ |
ALSO PROVIDED AS A SEPARATE ATTACHMENT (WORD format) ON THE
PURCHASING DEPARTMENT’S VENDOR SELF-SERVICE (VSS) SYSTEM WEBSITE:
https://pbcvssp.co.palm-beach.fl.us/webapp/vssp/AltSelfService
| THE PROPOSER SHALL ANSWER ALL QUESTIONS BELOW. IT IS THE COUNTY’S PREFERENCE TO RECEIVE MULTI YEAR RATE GUARANTEES. | | |
| RESPONDING CARRIER NAME: | ENTER CARRIER NAME HERE |
| BASIC CORE PROGRAM | |
| 50% TO $1,000 | |
| COMPOSITE RATE PER $100 OF COVERED PAYROLL | $0.000 |
| ESTIMATED “ELIGIBLE” MONTHLY PAYROLL | $6,130,000 |
| ESTIMATED NUMBER OF COVERED LIVES | 3,067 |
| ESTIMATED ANNUAL PREMIUM | $0 |
| RATE IS GUARANTEED FOR MONTHS | |
| (FROM JANUARY 1, 2027 THROUGH___________________) | |
| Item | Question | Carrier Response |
| 1. | Are you offering any pre-defined rate formulas or caps beyond the rate guaranteed above? (Yes/No) | |
| 1.a. | If Yes, fully describe. | |
| 2. | Does this rate duplicate the current benefit levels? (Yes/No) | |
| 2.a. | If No, fully describe all deviations. | |
| 3. | Does this rate offer additional benefits above the current benefit levels? (Yes/No) | |
| 3.a. | If Yes, fully describe these benefits. | |
| 4. | Is the rate inclusive of all services and materials? (Yes/No) | |
| 4.a. | If No, fully describe cost. | |
| 5. | Are you offering Conversion notification services for LTD at no cost? | |
| 5.a. | If No, fully describe cost. | |
| ALTERNATIVE CORE PROGRAM | |
| 50% TO $2,000 | |
| OR _______ % TO $ __________ | |
| COMPOSITE RATE PER $100 OF COVERED PAYROLL | $0.000 |
| ESTIMATED “ELIGIBLE” MONTHLY PAYROLL | $0 |
| ESTIMATED NUMBER OF COVERED LIVES | 0 |
| ESTIMATED ANNUAL PREMIUM ($) | $0 |
| RATE IS GUARANTEED FOR MONTHS | |
| (FROM JANUARY 1, 2027 THROUGH___________________) | |
| Item | Question | Carrier Response |
| 1. | Are you offering any pre-defined rate formulas or caps beyond the rate guaranteed above? (Yes/No) | |
| 1.a. | If Yes, fully describe. | |
| 2. | Fully describe all deviations from the current provisions and benefit levels. | |
| 3. | Please explain how this alternative plan would benefit the County. | |
| 4. | Please explain how this alternative plan would benefit employees. | |
| 5. | Is the rate inclusive of all services and materials? (Yes/No) | |
| 5.a. | If No, fully describe cost. | |
| 5. | Are you offering Conversion notification services for LTD at no cost? | |
| 5.a. | If No, fully describe cost. | |
| BUY-UP / UPGRADE PROGRAM | |
| 60% TO $5,000 | |
| COMPOSITE RATE PER $100 OF COVERED PAYROLL | $0.000 |
| ESTIMATED “ELIGIBLE” MONTHLY PAYROLL | $6,577,200 |
| ESTIMATED NUMBER OF COVERED LIVES | 1,089 |
| ESTIMATED ANNUAL PREMIUM | $0 |
| RATE IS GUARANTEED FOR MONTHS | |
| (FROM JANUARY 1, 2027 THROUGH___________________) | |
| Please note: The current buy-up/upgraded program premiums are $.45/100 of covered payroll (INCLUSIVE of core). Standalone premium is $.23/$100 of covered payroll. The employer funds the first $4.60 per month of buy-up/upgraded coverage to fund the core benefit and the employee funds the additional premiums. | |
| Item | Question | Carrier Response |
| 1. | Are you offering any pre-defined rate formulas or caps beyond the rate guaranteed above? (Yes/No) | |
| 1.a. | If Yes, fully describe. | |
| 2. | Does this rate duplicate the current benefit levels? (Yes/No) | |
| 2.a. | If No, fully describe all deviations. | |
| 3. | Does this rate offer additional benefits above the current benefit levels? (Yes/No) | |
| 3.a. | If Yes, fully describe these benefits. | |
| 4. | Is the rate inclusive of all services and materials? (Yes/No) | |
| 4.a. | If No, fully describe cost. | |
| 5. | Are you offering Conversion notification services for LTD at no cost? | |
| 5.a. | If No, fully describe cost. | |
| ALTERNATIVE BUY-UP / UPGRADE PROGRAM |
| 60% TO $7,000 per month or other proposed alternative |
| OR ___________ % to $ __________ per month |
| COMPOSITE RATE PER $100 OF COVERED PAYROLL | $0.000 |
| ESTIMATED “ELIGIBLE” MONTHLY PAYROLL | $0 |
| ESTIMATED NUMBER OF COVERED LIVES | 0 |
| ESTIMATED ANNUAL PREMIUM | $0 |
| RATE IS GUARANTEED FOR MONTHS | |
| (FROM JANUARY 1, 2027 THROUGH___________________) | |
| Item | Question | Carrier Response |
| 1. | Are you offering any pre-defined rate formulas or caps beyond the rate guaranteed above? (Yes/No) | |
| 1.a. | If Yes, fully describe. | |
| 2. | Fully describe all deviations from the current provisions and benefit levels. | |
| 3. | Please explain how this alternative plan would benefit the County. | |
| 4. | Please explain how this alternative plan would benefit employees. | |
| 5. | Is the rate inclusive of all services and materials? (Yes/No) | |
| 5.a. | If No, fully describe cost. | |
| 6. | Are you offering Conversion notification services for LTD at no cost? | |
| 6.a. | If No, fully describe cost. | |
| VOLUNTARY PROGRAM | |
| 60% TO $5,000 | |
| COMPOSITE RATE PER $100 OF COVERED PAYROLL | $0.000 |
| ESTIMATED “ELIGIBLE” MONTHLY PAYROLL | $1,663,334 |
| ESTIMATED NUMBER OF COVERED LIVES | 277 |
| ESTIMATED ANNUAL PREMIUM | $0 |
| RATE IS GUARANTEED FOR MONTHS | |
| (FROM JANUARY 1, 2027 THROUGH___________________) | |
| Item | Question | Carrier Response |
| 1. | Are you offering any pre-defined rate formulas or caps beyond the rate guaranteed above? (Yes/No) | |
| 1.a. | If Yes, fully describe. | |
| 2. | Does this rate duplicate the current benefit levels? (Yes/No) | |
| 2.a. | If No, fully describe all deviations. | |
| 3. | Does this rate offer additional benefits above the current benefit levels? (Yes/No) | |
| 3.a. | If Yes, fully describe these benefits. | |
| 4. | Is the rate inclusive of all services and materials? (Yes/No) | |
| 4.a. | If No, fully describe cost. | |
| 5. | Are you offering Conversion notification services for LTD at no cost? | |
| 5.a. | If No, fully describe cost. | |
| ALTERNATIVE VOLUNTARY PROGRAM | |
| 60% TO $7,000 OR OTHER PROPOSED ALTERNATIVE | |
| OR ___________ % to $ __________ per month | |
| COMPOSITE RATE PER $100 OF COVERED PAYROLL | $0.000 |
| ESTIMATED “ELIGIBLE” MONTHLY PAYROLL | $0 |
| ESTIMATED NUMBER OF COVERED LIVES | 0 |
| ESTIMATED ANNUAL PREMIUM | $0 |
| RATE IS GUARANTEED FOR MONTHS | |
| (FROM JANUARY 1, 2027 THROUGH___________________) | |
| Item | Question | Carrier Response |
| 1. | Are you offering any pre-defined rate formulas or caps beyond the rate guaranteed above? (Yes/No) | |
| 1.a. | If Yes, fully describe. | |
| 2. | Fully describe all deviations from the current provisions and benefit levels. | |
| 3. | Please explain how this alternative plan would benefit the County. | |
| 4. | Please explain how this alternative plan would benefit employees. | |
| 5. | Is the rate inclusive of all services and materials? (Yes/No) | |
| 5.a. | If No, fully describe cost. | |
| 6. | Are you offering Conversion notification services for LTD at no cost? | |
| 6.a. | If No, fully describe cost. | |
| The Proposer certifies by signature below the following: | The Proposer certifies by signature below the following: |
| a. | This price/ing is current, accurate complete, and is presented as the Total Price/ing, including “out-of-pocket” expenses (if any), for the performance of this Contract in accordance with the Requirements/Scope of Work/Services of this RFP. |
| b. | This Proposal is current, accurate, complete, and is presented to the County for the performance of this Contract in accordance with all the requirements as stated in this RFP. |
| c. | The Proposal is submitted without prior understanding, agreement, or connection with any corporation, firm, or person submitting a Proposal for the same materials, services, and supplies and is, in all respects, fair and without collusion or fraud. |
| d. | The financial stability to fully perform the terms and conditions as specified herein. The County reserves the right to request financial information from the proposer at any time during the solicitation process and in any form deemed necessary by the County. |
| e. | The information in Section 3.3 Commercial Non-Discrimination Certification is true and correct to the best of the Proposer’s knowledge. |
| f. | There are no legal proceedings required to be disclosed, as required by Section 3.3 Commercial Non-Discrimination, except as disclosed in Proposer's proposal, if any. |
| Note: Failure to certify and submit the required information, if applicable, shall deem your proposal non-responsive. | Note: Failure to certify and submit the required information, if applicable, shall deem your proposal non-responsive. |
| IMPORTANT: FAILURE TO SUBMIT THESE PAGES, INCLUDING ALL REQUIRED INFORMATION AND SIGNATURES, WILL BE CAUSE FOR "IMMEDIATE REJECTION” OF THE ENTIRE PROPOSAL RESPONSE. | |
| NAME (PRINT): |
| TITLE: |
| COMPANY: |
| ADDRESS: |
| CITY/STATE/ZIP: |
| TELEPHONE NO. |
| SIGNATURE: |
APPENDIX B1 - LTD PRICE PROPOSAL
RFP 26-042-DJ CONFIDENTIAL AND PROPRIETARY Page &P of &N https://pbcvssp.co.palm-beach.fl.us/webapp/vssp/AltSelfService