The file's text, extracted by GovTribe without its formatting.
RFI Pricing Template VISS
| ATTACHMENT 2 RFI PRICING TEMPLATE VISION INSURANCE SUPPORT SERVICES | | | | | | |
| Transition Period: Date of Award (At Least 6 Months Prior to January 1, 2027) - December 31, 2026 | | | | | | |
| LI # | Description | QTY | UOM | Unit $ | Monthly $ | Annual $ |
| 0004 | Administration Costs Related to Enrollment | 3 | Months | NSP | NSP | N/A |
| Note: Systems must be ready before start of Open Enrollment Period (11/9/2026-12/14/2026 for 2027 VI Plan Start on January 1, 2027) | | | | | | |
| VISS Contract Administrative Support Services | | | | | | |
| Base Period (BP): January 1, 2027 - December 31, 2027 | | | | | | |
| LI # | Description | QTY | UOM | Unit $ | Monthly $ | Annual $ |
| 0001 | ASO Monthly Fee – OCC Employees and OCC Disabled Retirees | 3500 | EA | | | $0.00 |
| 0002 | ASO Monthly Fee – OFR Employees | 180 | EA | | | $0.00 |
| 0003 | Claim Costs - Total In and Out-of-Network | NTE | | | | |
| | BP TOTAL | | | | $0.00 |
| Option Period One (OP1): January 1, 2028 - December 31, 2028 | | | | | | |
| LI # | Description | QTY | UOM | Unit $ | Monthly $ | Annual $ |
| 1001 | ASO Monthly Fee – OCC Employees and OCC Disabled Retirees | 3500 | EA | | | $0.00 |
| 1002 | ASO Monthly Fee – OFR Employees | 180 | EA | | | $0.00 |
| 1003 | Claim Costs - Total In and Out-of-Network | NTE | | | | |
| | OP1 TOTAL | | | | $0.00 |
| Option Period Two (OP2): January 1, 2029 - December 31, 2029 | | | | | | |
| LI # | Description | QTY | UOM | Unit $ | Monthly $ | Annual $ |
| 2001 | ASO Monthly Fee – OCC Employees and OCC Disabled Retirees | 3500 | EA | | | $0.00 |
| 2002 | ASO Monthly Fee – OFR Employees | 180 | EA | | | $0.00 |
| 2003 | Claim Costs - Total In and Out-of-Network | NTE | | | | |
| | OP2 TOTAL | | | | $0.00 |
| Option Period Three (OP3): January 1, 2030 - December 31, 2030 | | | | | | |
| LI # | Description | QTY | UOM | Unit $ | Monthly $ | Annual $ |
| 3001 | ASO Monthly Fee – OCC Employees and OCC Disabled Retirees | 3500 | EA | | | $0.00 |
| 3002 | ASO Monthly Fee – OFR Employees | 180 | EA | | | $0.00 |
| 3003 | Claim Costs - Total In and Out-of-Network | NTE | | | | |
| | OP3 TOTAL | | | | $0.00 |
| Option Period Four (OP4): January 1, 2031 - December 31, 2031 | | | | | | |
| LI # | Description | QTY | UOM | Unit $ | Monthly $ | Annual $ |
| 4001 | ASO Monthly Fee – OCC Employees and OCC Disabled Retirees | 3500 | EA | | | $0.00 |
| 4002 | ASO Monthly Fee – OFR Employees | 180 | EA | | | $0.00 |
| 4003 | Claim Costs - Total In and Out-of-Network | NTE | | | | |
| | OP4 TOTAL | | | | $0.00 |
| BASE + ALL OPTION PERIODS TOTAL | $0.00 |
| Note: The number of eligible employees enrolled in the vision plan is estimated and used for the purpose of establishing a funding amount for each performance period. The OCC employee population may fluctuate within each performance period resulting in an increase or decrease throughout the year (i.e., there may be a variation in quantity). The number of eligible employees enrolled in the vision plan is also subject to change. OCC assumes financial risk/cost for all claims. | |
