Attachment_A.1_-_Worksheet_Health_Plan_Administrative_Services_FINAL.docx

25-P-115TF Attachment A.1 – Worksheet Health Plan Administrative Services

Section 1 - General Information and Administrative Services - Complete the section below using the information and instructions found in Section 2.0 (General Services) and Section 3.0 (Administrative Services) of Exhibit A - Scope of Services.

Contractor Information

Contractor Legal Name

Primary Contact Person Name:

Phone No:

E-mail Address:

Plan Administration

Provider Network(s)

Pharmacy Benefit Manager

Telemedicine

Employee Assistance Program

Other

Number of Years Providing Health Plan Self-Funded Administrative Services in Volusia County

Number of Employer Groups (Self-Funded) in Volusia County Area (Volusia, Flagler, Lake, Seminole, Orange, and Osceola Counties) over 1,000 Lives

Total # Covered Lives in Volusia County Area

Number of Employer Groups in Florida over 1,000 Lives

Total # Covered Lives in State of Florida

Health Plan Financial Status Response:

Current Financial Strength Rating from A. M. Best

Current Financial Size Class Category from A. M. Best

Include documentation of your Company’s current A. M. Best strength and size in the appropriate RFP Vendor Questionnaire Section in the County’s eProcurement system, as requested.

List below references for Contractor where Administrative Services Only (ASO) are or were provided to employers with 3,000 or more subscribers within the past five (5) years.

List the name of each employee that Contractor will assign to help administer the County’s Plan.

Account Executive

Account Service Manager

Medical Director

Health Management and Wellness Contact

Pharmacy/Clinical Director

Implementation Manager

Finance and Reporting Contact

Complete the following questions and be as clear and succinct as possible:

1. Confirm that Contractor has experience providing ASO services to four (4) or more employers, each having three thousand (3,000) or more subscribers, within the past five (5) years.

2. Confirm that Contractor shall include medical, pharmacy, and Employee Assistance Program (EAP) services; claims administration and customer services; utilization management, regional, state, and national provider Networks; and medical and pharmacy plan management.

3. Confirm that Contractor shall possess accreditation by the National Committee for Quality Assurance (NCQA), as applicable.

4. Confirm that Contractor agrees to provide an annual third-party attestation report in accordance with the most current auditing standards for service organizations. Specifically, the Contractor shall submit a System and Organization Controls (SOC) 1 Type II report, conducted in accordance with the Statement on Standards for Attestation Engagements (SSAE) No. 18 (or its successor standard). The report must evaluate the design and operational effectiveness of controls relevant to the services provided under this Agreement.

5. Confirm that Contractor shall complete medical claims re-pricing on the sample claims presented in the RFP Exhibits K, L, and M based on Contractor’s current Network discounts under contract with the applicable aggregate amounts as requested and the provider specific claims discount information shall be subject to on-site verification of accuracy at Contractor’s facility as a part of the evaluation process. Specific provider contract discount information will be used for verification and will be treated as proprietary pursuant to Florida Statutes 119.07, 286.011, 812.081, and 815.045, including any other applicable Florida and federal statutes and only used to validate the aggregate amounts.

6. Confirm that Contractor shall provide health plan services for active employees, COBRA participants, Transportation Planning Organization (TPO), retirees, and their eligible dependents.

7. Confirm that all customer service support involving interaction with Members will be handled within the territorial limits of the United States of America.

8. State your member call in medical customer service location and hours of operation.

9. State your member call in pharmacy customer service location and hours of operation.

10. List the percentage of customer service calls for 2024 that resulted in problem resolution on the initial call.

11. For 2024, indicate your medical performance results in the following categories (format indicated in parenthesis):

a. Clean claims processed within ten (10) days (percentage);

b. Clean claims processed within thirty (30) days (percentage);

c. Average claims turnaround time (number of days);

d. Claims coding accuracy (percentage);

e. Claims dollar accuracy to include over and under payments (percentage);

f. Average speed of telephone answer (number of seconds);

g. Average telephone call abandonment rate (percentage) a

18. Confirm that Contractor agrees to process and adjudicate all medical and prescription drug claims in accordance with the Plan document. Contractor shall be held liable for claims adjudicated outside the Plan document.

19. List the percent of medical claims in 2024 that were received electronically and claims completely adjudicated electronically versus manually.

20. Indicate whether your claims processing system or patient record captures and can report on the following:

a. Laboratory values specific to the member;

b. Compliance with periodic physicals and preventive diagnostic services specific to the member;

c. Plan sponsored biometric screening values specific to the member performed by a third party vendor selected by the County;

d. Prescription medication adherence and compliance.

a.

b.

c.

d.

21. Confirm that Contractor agrees to participate and attend the County’s Annual Benefits Fair. Confirm that representatives from the following areas shall attend: medical, pharmacy, and Employee Assistance Program (EAP), at no cost to the County.

22. Confirm that Contractor agrees to attend quarterly meetings to review plan performance; to meet monthly to review ongoing administrative, service, and plan management issues; and to make available a Medical and Pharmacy Director for ongoing involvement in Plan performance initiatives.

23. Confirm Contractor shall allow retroactive eligibility and claims adjudication at no additional cost to the County.

24. Confirm that secure web-based eligibility administration shall be available to the County’s benefits department on an ongoing basis.

25. Confirm that Contractor shall assist the County in reconciling eligibility discrepancies between what is being reported and what is contained in Contractor’s eligibility files.

26. List the online consumer tools Contractor shall provide to assist members with obtaining claims information, health and wellness topics, provider quality, medication information, medical and pharmacy pricing calculators, and Plan information. Confirm these tools will provide information to members specific to the County’s Plan and Plan design.

27. Confirm Contractor shall assist in preparing and maintaining the Summary Plan Description (SPD) and Summary of Benefits and Coverage (SBC) annually on behalf of the County and provide these documents electronically for posting on the County’s website.

28. Confirm that Contractor shall allow the County, or a mutually agreeable firm selected by the County, to conduct annual medical and pharmacy claims audits. Contractor shall provide access to applicable records, files, and documents related to all medical and pharmacy claims, administrative fees and other elements of the Contract in order to conduct the annual audit. List any specific limitations with respect to audits that Contractor will impose for the scope of the audit, audit periods, and access to data.

29. Confirm that Contractor shall permit additional audits that may be imposed on the County by a regulatory agency, at no additional cost to the County.

30. Describe the audit adjustment process used in instances where claim errors are noted during an audit. This description will include whether the identified claim paid in error and related claims for that member or members are reimbursed to the County regardless of whether the claims can be reprocessed.

31. Confirm that Contractor shall assist the County with annual enrollment by training the benefits staff on the health plan; creating County specific enrollment and educational materials; attending a minimum of five (5) full day on-site enrollment meetings and monthly new hire orientations; providing secure web portal assistance for annual enrollment; and agreeing to accept the County’s benefits enrollment files electronically on an ongoing basis.

32. Confirm that Contractor shall have contractual arrangements in place with external claims review companies that will be made available to the County’s members. Contractor shall be responsible for facilitating all aspects of the external review process and shall provide the external review company with the claims and information needed for an appropriate determination to be made.

33. Confirm that Contractor agrees to accept payment for administrative fees through self-billing practices by the County.

34. Describe the methods Contractor uses to identify claims with potential third party liability such as workers compensation, auto accident, and coordination of benefits with other primary insurance and seek reimbursements for such services.

35. Confirm that Contractor agrees to be the claims fiduciary and accept fiduciary responsibility for claims payment decisions and for defense of actions taken for claims adjudicated and related appeals, including legal defense of claims and medical and pharmacy claims decisions. The County will be responsible for the legal defense of claims for which the County made the choice as to the determination of coverage. The Contractor shall be responsible for the legal defense of claims that involve the claim determination based on the Contractor’s medical, pharmacy, and authorization standards for Level 1, Level 2, and external appeals. The County will be informed of all levels of appeals and Contractor’s decisions on appeals but will not be responsible for any claim’s determination matters or appeals.

36. Confirm that Contractor agrees to use the care, skill, prudence and diligence under the circumstances then prevailing that a prudent claims administrator/fiduciary acting in a like capacity, and familiar with such matters, would use under similar circumstances as the standard of care for medical and pharmacy services.

37. If an agent or broker is included for administrative service assistance, Contractor shall identify the standard commissions included, along with the administrative services that will be provided by the agent or broker.

Section 2 - Plan Design– Complete the section below using the information and instructions found in Section 4.0 (Plan Design) of Exhibit A – Scope of Services.

1. Confirm that the medical plan includes an open-access (non- Gatekeeper) model option.

2. Confirm Contractor has the ability to administer the current plan design and list any deviations of coverage comparing your administrative capabilities to the health plan Summary Plan Description is included as Exhibit A – Scope of Services.

3. Confirm that Contractor has discount arrangements for Complementary and Alternative Medicine (CAM) services not covered under the Plan.

4. Confirm Contractor has the ability to accumulate medical and pharmacy member costs toward the medical deductible and the medical and pharmacy out-of-pocket maximums and that any overpayments by members shall be reconciled by Contractor and reimbursed to the member.

5. Confirm that Contractor has completed the spreadsheet labeled Attachment A.2 - Network and Formulary Disruption and has provided to the County in MS-Excel format as requested.

6. Regarding Contractor’s drug formulary list, indicate:

a. Frequency and timing of formulary changes

b. Method to notify employer, including summary of member impact

c. Method to notify specific members impacted

d. Method to notify providers

e. Availability of formulary via hard copy and on website

A

11. Confirm that Contractor can administer the Plan on a secondary basis when a retiree or their enrolled dependent is eligible for Medicare, regardless of whether they have enrolled in Medicare Part B.

12. Confirm that Contractor shall identify and assist members with End Stage Renal Disease in applying for Medicare benefits.

13. Confirm that Contractor shall include pharmacy services for the County’s Human Services division, which offers medications and emergency prescription assistance to low income citizens of Volusia County, in accordance with the County’s contract.

14. Confirm that Contractor shall perform all required testing and analysis to ensure the County’s group health plan complies with the Mental Health Parity and Addiction Equity Act (MHPAEA), including comparative analysis of nonquantitative treatment limitations (NQTLs), as required under current federal guidance. If your organization is unable to perform this testing and provide the required certification, please confirm that Contractor shall provide the necessary data for the testing and contribute funds or reimburse the County for the reasonable costs associated with engaging a qualified third-party vendor to conduct the testing and provide compliance recommendations.

Section 3 - Network Services– Complete the section below using the information and instructions found in Section 5.0 (Network Services) of Exhibit A - Scope of Services.

9. Confirm that the Volusia County Area Provider Network has eighty-five percent (85%) of providers Board Certified/Board Eligible.

10. Confirm that the Volusia County Area Provider Network will have an annual turnover rate of less than three percent (3%).

11. Confirm that Contractor’s local hospital Network shall include coverage, at a minimum, access to in-Network benefits is available at Halifax and Advent Health hospitals. Contractor may provide client specific networks to meet this requirement.

12. Confirm that Contractor’s provider Network includes a comprehensive Network of hospitals, outpatient facilities, physicians, other healthcare providers, including chiropractic, and pharmacies specifically in Volusia, Flagler, Lake, Orange, Seminole, and Osceola Counties.

13. Confirm that Contractor’s provider Network includes a comprehensive Network of hospitals, outpatient facilities, physicians, other healthcare providers, including chiropractic, and pharmacies throughout Florida and nationally.

14. Confirm that Contractor’s Network will include state and national open access for non-emergency care, including services provided at Centers of Excellence.

15. Confirm that all hospital based providers (i.e., hospitalists, pathology, radiology, emergency, anesthesia and assistants to surgeons) at Volusia County Area Network hospitals are under Network contracts with Contractor.

16. Indicate any Network gaps (no provider contracts) in Volusia and Flagler Counties for services such as hospital based physician services, pediatric subspecialties, and neurosurgical specialists. Indicate how these services will be provided if no Network contracts exist on January 1, 2027.

17. List any provider contracts with Volusia County area hospitals, free standing facilities, and large physician groups that expire or will be renegotiated for the 2027 calendar year.

18. List the contracted services where a capitation fee is applied. Confirm that you provide encounter data for services covered under the capitation arrangement.

19. Confirm that Contractor’s contracts with providers include language that protects the Member from balance billing when using in-Network providers, when being referred for specialty services by an in-Network provider, and for services provided by an in-Network providers that are not approved by the Contractor.

20. Confirm that Contractor shall monitor network performance based on nationally recognized quality standards and take action when standards are not being met.

21. Confirm that Contractor shall notify the County of any pending Volusia County area facility and large provider group terminations.

22. Confirm that Contractor shall include ninety (90) day retail pharmacy services.

23. Provide the name, location, and years Contractor has used the current mail order pharmacy facility.

24. Provide Contractor’s specialty pharmacy facility name, location, and years of service for Contractor.

25. Describe Contractor’s normal delivery service of mail order and specialty medication, including delivery method and delivery timelines, and expedited service options.

26. Will Contractor be able to provide access to Patient Centered Medical Home(s) in the Volusia County area? If so, when do you anticipate this model would be available to the County?

27. Does Contractor have a high performance Network in the Volusia County area that the County could consider?

28. Confirm that Contractor’s plans would be able to include two levels of copayments with lower copayments for Network physicians in a high performance limited network.

29. Confirm that telemedicine service for Members is included in the proposal. Briefly describe the process a Member would follow to access the service, and how the service would be billed.

30. Confirm Contractor has completed the Network analysis included in the tabs labeled “Facilities”, “Physicians” and “Pharmacy” in Attachment A.2 - Network and Formulary Disruption and has provided it to the County in MS-Excel format, as requested. Confirm that providers in your high performance Network, Patient Center Medical Homes, and ninety (90) day retail pharmacy network are listed as well.

Section 4 - Health Management– Complete the section below using the information and instructions found in Section 6.0 (Health Management) of Exhibit A – Scope of Services.

1. Confirm that Contractor shall include an online Health Risk Assessment (HRA) tool, accessible to Members, capable of having biometric screening results loaded into an individual’s HRA and shall provide an aggregate report to the County on the responses, including the changes in risk factors.

2. Does Contractor provide onsite biometric screenings, health risk assessments and onsite personal health coaches for wellness and health improvement related initiatives? The biometric screenings shall be priced separately.

3. Describe how Contractor shall increase preventive care utilization for the County.

4. Confirm that Contractor shall identify large case and high risk Plan Members and assist them in managing their health. What proactive steps will Contractor take?

5. Confirm that Contractor shall have a dedicated case management team assigned to the County to address the specific needs of seriously ill Members.

6. List the disease management programs Contractor shall include as a part of the premiums and ASO fees, and indicate Contractor’s average active engagement rate in each program...

7. Confirm that Contractor’s disease management programs shall have demonstrated success in participation, care outcomes, and include condition specific online health coaching for Members.

8. Confirm that Contractor shall track and manage health and wellness activities, and report performance to the County.

9. Confirm that Contractor has the ability to administer co-payment incentives specifically for Members participating in and adhering to the qualifications of health and wellness activities and targeted initiative programs.

10. Confirm that the Contractor can administer the pharmacy incentive for the Volusia County Diabetes Management Program

11. Confirm that Contractor shall assist the County with customized, targeted initiatives to improve the health of the population. Indicate whether the comprehensive initiatives include the following optional programs:

a. Weight management for overweight, obese and morbidly obese Members;

b. Diabetes control and prevention;

c. Tobacco cessation

d. Comprehensive cardiology program, including hypertension control and prevention;

e. Chronic Obstructive Pulmonary Disease (COPD);

f. Healthy pregnancy;

g. Compliance with preventive screening guidelines; and

h. other a.

12.

b.

15.

e.

19. Confirm the Contractor shall provide a full-time on-site clinical care coordinator (Registered Nurse or clinical equivalent) within forty-five (45) days at no additional cost other than the established ASO fees. . The clinical care coordinator shall assist Members in achieving optimal health through identification of risks, closing gaps in care, assisting with County wellness initiatives, conducting educational sessions at various locations, and developing health improvement strategies. County will provide, network access, internet access, and workspace as detailed in Exhibit A – Scope of Services, Section 11.0. This is an optional service and will be priced separately below.

20. Confirm the Contractor shall provide a full-time on-site health engagement senior analyst withing forty-five (45) days at no additional cost other than the established ASO fees. The analyst’s primary responsibility is to support and develop health promotion strategies that influence the organization’s overall wellbeing and drive engagement and adoption of healthy behaviors. County will provide, network access, internet access, and workspace ad detailed in Exhibit A – Scope of Services, Section 11.0.

21. Describe how Contractor shall assist the County in reducing or modifying utilization where medically appropriate.

22. Confirm that Contractor shall provide the County with consumer educational material in both hard copy and via web-based tools for members on general health issues and specific initiatives and identified disease states

23. Confirm that Contractor shall identify Members who may be fraudulently using and/or abusing benefits and that Contractor has a Fraud, Waste and Abuse program that will be provided to the County if requested.

24. Describe how Contractor identifies Members and physicians who may be fraudulently using and/or abusing benefits or medications. What action would Contractor take once identified?

Section 5 – Financial Services, Reporting and Data Interface – Complete the section below using the information and instructions found in Section 7.0 (Financial Services, Reporting and Data Interface) of Exhibit A - Scope of Services.

1. Indicate the timeline for payment ASO fees under Contractor’s proposal.

2. Confirm that the finance and banking arrangements for the self-funded health plan will include documentation for claims reimbursement and will meet the accounting needs of the County, as determined by the County.

3. Describe the self-funded banking arrangement for medical claims Contractor is proposing for the payment of claims, and indicate the supporting documentation that will accompany the request for payment.

4. Describe the self-funded banking arrangement for pharmacy claims Contractor is proposing for the payment of claims, and indicate the supporting documentation that will accompany the request for payment.

5. Confirm that Contractor shall accept self-billing by the County for administrative fees which is based on payment of the invoice as presented and retroactive adjustments made by the County in the following month.

6. Confirm Contractor shall establish a mutually agreeable funding mechanism for claims payment that includes regular reporting and notification to the County regarding required funding amounts. Contractor shall implement a claims payment system that allows for timely processing of provider and member payments while providing the County with appropriate controls and visibility. The County will fund claims payments on a check clearing basis (not on an issued check or accounting basis), meaning the County will reimburse only for payments that have actually cleared the bank account. The County will fund claims payments on a regular basis according to a mutually agreed upon schedule and mechanism that maintains adequate funding levels while minimizing excess cash balances.

7. Confirm that Contractor agrees to the following:

Preference for claims payments made by the County for the self-funded health plan will be on a check clearing the bank basis. The County will transfer money into Contractor’s bank account for the reimbursement of claims at least one (1) time per week.

8. Indicate the pre-funding requirements of Contractor for claims payments.

9. Confirm that Contractor shall agree to payment via wire transfer as the initial payment methodology and move to ACH once the County has a comfort with the claims adjudication and funding process.

10. List the standard reports that will be available to the County on a daily, weekly, monthly, quarterly or annual basis, and include sample reports with the proposal submission. (Submit in the appropriate RFP Vendor Questionnaire Section in the County’s eProcurement system as requested.)

11. Confirm that Contractor agrees to provide eligibility, claims and utilization data on a monthly basis; and eligibility discrepancy reporting on a weekly basis via a web-based portal.

12. Confirm that Contractor agrees to provide comprehensive medical and pharmacy claims and eligibility in secure file downloads (data dumps), preferably provided via SFTP, in a HIPAA compliant, standard industry format, to the County’s benefits consultant on a monthly basis including all fields listed in Exhibit A.3 - Claims Reporting Fields.

13. Confirm that Contractor shall provide the County with comprehensive claims and eligibility data files on a monthly basis including encounter data of any capitated services for the data fields as specified.

14. List the reports Contractor shall provide that will summarize performance in areas such as large case management, disease management, and gaps in care.

15. Indicate the documentation Contractor shall provide for third party Network discount negotiations and indicate how it will be reported to the County.

16. Confirm that Contractor agrees to provide the County access to all records, files and documents related to all medical and pharmacy claims, administrative fees and other elements of the contract. The information is to be provided in an electronic format where possible.

17. Confirm that Contractor shall provide the applicable reports necessary for the County to comply with any requirements of the Affordable Care Act and other related health plan requirements.

Section 6 – Pharmacy Services – Complete the section below using the information and instructions found in Section 8.0 (Pharmacy Services) of Exhibit A - Scope of Services.

Please confirm the following information:

1. Confirm Contractor shall utilize a broad network of pharmacies for pricing guarantees that will include the major chain pharmacies as In Network.

2. Confirm the following as it relates to the pharmacy program pricing and guarantees:

a. Single-Source generic prescriptions, multiple-source generic prescriptions, Maximum Allowable Cost (MAC) and Non-MAC prescriptions shall be included in the generic medication category for discount and fill rate guarantee calculations.

b. Single-source generics will be identified as having two (2) or less manufacturers for discount and fill rate guarantee calculations.

c. Brand drug. The term brand drug shall mean the following: The multisource code field in Medi-Span that contains an “M” (co-branded product), “O” (originator brand), or an “N” (single source brand); however, if the Multisource Code is “O” and there is a DAW Code of 3, 4, 5, 6, or 9, the drug will be considered a generic drug.

d. Usual and Customary (U&C) claims, zero balance claims, compounds and over-the-counter claims shall be excluded for discount and fill rate guarantee calculations.

e. “Ingredient Cost” shall mean the lesser of MAC price, discounted Average Wholesale Price (AWP) or the dispensing pharmacy’s U&C.

f. Contractor shall utilize the most expansive and cost effective MAC list on behalf of the County.

g. Members will always be charged the lesser of their Plan copayment; the PBM’s contracted price; the pharmacy U&C; or the cash price.

h. Contractor shall base AWP on date sensitive, eleven (11) digit National Drug Code (NDC) of the actual product dispensed as supplied by Medi-Span for retail, mail order, and specialty adjudicated claims.

i. Discount guarantees and other guarantees will be the minimum guarantees (not fixed) regardless of whether the County implements any additional specific clinical management programs, such as step therapies or prior authorizations.

j. Rebate revenue that is earned by the County during the term of the Agreement with the Contractor will be paid to the County at least quarterly and shall be paid following termination of the Contract, as long as claims reimbursements remain current.

k. Auditing of all claims will be permitted versus a claims sample.

l. Each distinct pricing guarantee will be measured and reconciled on a component basis (i.e. generic and brand; specialty; rebates; and generic fill rate) with no surpluses in one component offsetting deficits in another component.

m. Guarantee shortfalls will be guaranteed on a dollar-for-dollar basis with one hundred percent (100%) of any shortfall in any component recouped by the County.

n. Contractor shall use the Centers for Medicare and Medicaid Services (CMS) definition of a specialty medication.

a o.

b p.

c q.

d r.

e s.

f t.

g u.

h v.

i w.

j x.

k y.

l z.

m

3. Contractor shall commit to minimum guarantees on retail and mail order generic and brand pharmacy discounts and costs on an annual aggregate basis for a minimum of three (3) years.

4. Contractor shall commit to retail ninety (90) day fill program.

5. Contractor shall commit to minimum guarantees on specialty pharmacy discounts and costs on an annual aggregate basis for a minimum of three (3) years. While specialty drug type and dispensing channel may be on a drug-by-drug basis, the minimum guarantee shall apply.

6. Contractor shall commit to minimum rebate guarantees on all brand and specialty drugs dispensed for a minimum of three (3) years.

7. Contractor shall commit to minimum generic dispensing fill rate guarantees for a minimum of three (3) years.

8. Contractor shall notify impacted Members of negative formulary changes that may occur throughout the Plan year.

9. Contractor shall assist the County with Medicare Part D administration, including necessary reports to qualify for Retiree Drug Subsidy (RDS), and interfacing with RDS directly for eligibility and claims submission.

10. Contractor shall include any programs available to impact pharmacy utilization such as step therapy and clinical prior authorizations for consideration by the County. Include return on investment guarantees.

11. Describe how Contractor’s prescription drug program promotes the use of generic drugs in lieu of prescribed brand name.

12. List the step therapy and prior authorization programs Contractor shall include in the premiums and ASO fees for the County.

13. Describe Contractor’s specialty pharmacy clinical support. What plan design strategies would Contractor recommend for the County?

14. Indicate how Contractor monitors medication adherence and what steps Contractor shall take to improve compliance.

15. Indicate how Contractor shall identify high risk pharmacy use and actively manage polypharmacy issues.

Section 7 – Integrated Employee Assistance Program (EAP) Services – Complete the section below using the information and instructions found in Section 9.0 (Integrated Employee Assistance Program (EAP) Services) of Exhibit A - Scope of Services.

Please confirm that your company will provide the following services to the County:

1. Provide EAP services to Members for up to ten (10) face-to-face counseling sessions per incident for conditions such as: marital and family relationships; stress management; alcohol and drug issues; work-related concerns; and bereavement.

2. Provide work/life balance assistance for conditions such as financial and budgeting concerns; legal services; day care and nursing facility selection assistance; and life coaching services.

3. Provide Member tools and online services for obtaining EAP clinical and non-clinical information.

4. Provide EAP telephonic customer service and urgent / crisis response counseling functions, which will be available twenty-four (24) hours seven (7) days a week.

5. Provide timely assistance to Members in scheduling counseling sessions.

6. Provide referrals to EAP Network providers that integrate with health plan Network providers for the behavioral health benefits offered through the County’s health plan.

7. Record and maintain information regarding service-related or other complaints reported by Members.

8. Provide communication materials during the year to educate Members and bring awareness to the EAP and work/life services available.

9. Provide an assigned account manager who shall be available to meet on a quarterly basis with the County and its administrative staff, or more frequently as deemed necessary by the County.

10. Provide quarterly management reports and observations on methods to enhance the behavioral health and EAP benefit for Members.

11. May provide an annual training session for all County supervisors and managers regarding behavioral drug free workplace.

12. Provide a minimum of twenty (20) hours of on-site EAP seminars for County employees annually.

13. Participate and attend the County’s Annual Benefits Fair. Typically, there is an average of three (3) sessions scheduled each year.

14. Provide licensed, professional EAP counselors of varying degrees of professional licensing (e.g., certified psychologist, family, and marriage counselors) and experience in providing EAP services.

15. Provide comprehensive EAP National and Statewide provider Networks.

16. Provide access to quality licensed providers specifically in Volusia, Flagler, Lake, Orange, Seminole, and Osceola Counties.

17. Include the ability for self-referral and supervisor referrals.

18. Provide consultation to supervisors to assist them in resolving workplace issues and in making necessary referrals.

19. Include behavioral health fitness for duty exams for employees, as needed.

20. Include Substance Abuse Professional (SAP) services following U.S. Department of Labor, Commercial Driver License and Florida Drug-Free workplace regulations.

21. Provide on-site intervention incidents (e.g., Critical Incident Stress Debriefing or Emotional Incidence Stress Debriefing).

By completing this document, the Contractor certifies that the information contained herein is accurate and that the Contractor shall be bound by the contents of this Attachment A.1 - Worksheet Health Plan Administrative Services.

Please return this Word document with your answers and a separate PDF file.

Contractor Legal Name: ____________________________________________ Page 1 of 26