Attachment_A__Mandatory_Requirements__Proposal_Worksheet_revised_6.4.26.docx

ATTACHMENT A - MANDATORY REQUIREMENTS AND PROPOSAL WORKSHEET

Brevard County Board of County Commissioners Group Term Life/AD&D, Short-Term, Long-Term Disability, and Supplemental Health Effective January 1, 2027

Carrier Name:

Carrier Address:

Carrier Contact:

Telephone:

Contact email:

Fax:

IMPORTANT NOTE: Proposers that do not meet the following Mandatory Requirements will be deemed non-responsive and will not be considered for further evaluation.

MANDATORY REQUIREMENTS CHECKLIST

1. Proposer must have a current financial strength rating of A- (Excellent) or higher as issued by A.M. Best. Proposer must provide evidence of the current rating with submission.

2. Proposer must demonstrate experience within the past five (5) years administering at least three (3) public-sector employer groups, each with 3,000 or more eligible employees, for one or more of the requested lines of coverage.

3. Proposer must submit a proposal that includes all required lines of coverage under a single carrier/administrator arrangement:

· Group Term Life

· AD&D

· Short-Term Disability (STD)

· Long-Term Disability (LTD)

· Accident

· Hospital Indemnity

· Critical Illness/Cancer Optional offerings (e.g., Life + Long-Term Care) may be included but will not be evaluated or scored.

4. Proposer must guarantee rates for a minimum of three (3) years for all proposed lines of coverage, except where a shorter guarantee period is required by applicable law (i.e. For Critical Illness coverage issued in Florida, proposers must comply with Florida Administrative Code Rule 69O-149.005(14), which limits rate guarantees to a maximum of twenty-four (24) months).

5. Proposer must agree to waive all minimum participation requirements for all lines of coverage.

6. Proposer must agree to a true open enrollment effective January 1, 2027, allowing eligible employees to enroll in:

· Life/AD&D

· STD

· LTD

· Accident

· Hospital Indemnity

· Critical Illness/Cancer without Evidence of Insurability (EOI), including individuals previously declined for coverage. Any limitations (e.g., guarantee issue caps) must be explicitly disclosed.

7. Proposer must agree to administer coverage on a no loss, no gain basis for currently insured employees and retirees, including:

· Continuity of coverage for in-force insureds

· Recognition of prior service, waiting periods, and eligibility

· No new pre-existing condition limitations or EOI requirements for transferring members, except where required by law

PROPOSAL WORKSHEET

I. ADMINISTRATIVE SERVICES & REFERENCES

1. Do you agree to implement the life, disability, and supplemental health programs for an initial term of January 1, 2027 through December 31, 2029 with the option to extend the agreement for two (2) additional 1-year terms with mutual agreement of the parties?

2. How long has your company been administering Life, Disability, and Supplemental Health plans in Florida?

3. How long has your company been administering Life + Long Term Care plans in Florida? (if applicable)

4. Identify and briefly describe any additional product lines offered as optional, non-scored benefits included within your proposal for the County’s consideration.

5. Identify the team of individuals assigned to provide support to the County account, including duties and responsibilities and length of service.

6. Will you agree to notify the County in the event there is a change in the account management team?

7. Indicate location of the local office that will be servicing the County, including hours of operation.

8. Indicate location of claims office, including hours of operation and toll-free telephone number.

9. Describe your company’s third-party enrollment services for all proposed product lines, including on-site counselors for up to twelve (12) meetings, call center resources, virtual enrollment support, decision support tools? Identify any preferred or affiliated enrollment firm arrangements and any fees associated.

10. If the County elects to use a designated enrollment firm or independent benefit counselors, describe how your organization would coordinate with, train, equip, and support those resources to ensure effective implementation, accurate enrollment, and a positive member experience. Disclose any offset or change to proposed fees if the County’s utilizes their own designated enrollment firm or independent benefit counselors.

11. Will you match and administer the County’s current class descriptions, eligibility and waiting period definitions and Actively at Work provisions as defined in Exhibit “B”- Certificates of Coverages?

12. Describe the procedures your company uses to obtain medical information from claimants, including any differences by product line (STD, LTD, Life, and Supplemental Health).

13. Describe your company’s capabilities to administer automated claims adjudication using external data feeds from a medical carrier and/or third-party administrator.

14. Indicate the Medical Underwriting approval rate of your company, the timelines leading to approval or denial and any automated features that may be beneficial to the County and employees.

15. Describe the methods, controls, and investigative practices used to identify, prevent, and manage fraudulent claims across all products.

16. Describe claim payment methods, payment cycles, and average turnaround times for all proposed product lines.

17. Indicate how claim approvals, denials, and appeals, including timelines and delivery methods, are communicated:

a. To the employee/beneficiary?

b. To the employer/participating agency?

18. Provide your company’s actual claims office performance in 2025 for the following:

a. Average speed of answer

b. Call abandonment rate

c. Claim turnaround time

19. List the reports that you will be providing to the County, including the quarterly experience report, annual reports, and performance guarantee results. Please include sample reports with your proposal.

20. Do you offer a choice of self-billing or list-billing for all products?

21. Will you agree to accept separate billing and premium remittance as specified in the Scope of Services?

22. Indicate whether conversion and/or portability options are available for each product line and describe key terms.

23. Will you agree that either party may terminate the contract at any time, without cause, with no fewer than 90 days written notice by you and no fewer than 60 days written notice by the County?

24. Are customer service calls recorded for quality assurance and to maintain information regarding member service issues or other complaints?

1. Will the County have access to on-line administration to view claim status, eligibility status, and run reports?

2. Will members have access to on-line tools to view claim status?

3. Will you match the employer’s share of FICA taxes and prepare W-2’s for STD and LTD?

4. Will you provide claim forms in both paper and PDF formats? Online submission?

5. Will you allow the County to review and customize enrollment, general marketing and informational materials prior to distribution?

6. Will you incur all costs of producing, printing and mailing/distributing Certificates of Coverage?

7. Will a dedicated representative be assigned to the group to provide ongoing account support, attend quarterly service/performance review meetings, and promptly address questions and service issues?

8. Will you participate in a minimum of four (4) employee health fairs at locations throughout Brevard County?

9. Will you provide third-party enrollment services for all proposed product lines, including on-site counselors for up to twelve (12) meetings, call center resources, virtual enrollment support, decision support tools? Identify any preferred or affiliated enrollment firm arrangements and any fees associated.

10. When Evidence of Insurability is required during the annual enrollment period, will you provide medical underwriting? Describe the electronic/online and paper methods included in your proposal.

11. Will you agree to provide paper, telephonic, facsimile and web-based intake for all products?

12. Does your organization support automated claims adjudication through external data feeds from a medical carrier and/or third-party administrator (TPA)?

13. Do all your products offer HIPAA Compliant EDI or API compatibility with the CBIZ benefit administration system?

14. Confirm that your proposal includes a deviation/exception matrix; specimen certificates or policies for each proposed line of coverage; an implementation project plan; and CBIZ interface/EDI requirements and related assumptions.

REFERENCES

Provide at least three (3) references for which you currently provide services similar to those requested by Brevard County (At least one reference must be for a public-sector group of 3,000 or more eligible employees for which one (1) or more of the requested lines of insurance have been provided in the last five (5) years):

Name of Organization

You Provide Contact Person, Title & Phone Number

II. GROUP TERM LIFE AND AD&D INSURANCE

1. Confirm that your proposal matches the County’s current coverage limits and contract provisions as outlined in Exhibit B (Certificates of Coverage), with the exception of any proposed enhancements to the Group Term Life and AD&D age reduction schedule. If proposing changes to the age reduction schedule, describe the alternative structure, including impact on member value, administration, and pricing (indicate whether included in base rates or additional cost).

All deviations and/or enhancements must be clearly disclosed and outlined in Attachment B – Plan Design Worksheet. If no changes are proposed, confirm the current schedule will be maintained.

2. Pursuant to your Life Waiver of Premium provision:

a. Will the elimination periods for the Life waiver of premium and LTD be the same?

b. Describe the process for reviewing and approving waivers of premium.

c. If approved for LTD, will you automatically initiate Waiver of Premium on behalf of the claimant?

3. If an employee is called to active military duty, will you allow spouse and child life coverage to be continued?

4. Can Basic and Additional life insurance coverage be ported and/or converted? If so, indicate the impact this will have on the employer’s premium and/or experience.

5. How are the ported rates determined and when does ported coverage terminate?

6. How are converted rates determined and does the coverage terminate?

III. SHORT TERM DISABILITY

1. What is your definition of disability?

2. Describe the process and timeline for initial STD disability claims reporting, including the use of telephonic intake.

3. Can STD claim payments be released with an employer authorization during an initial period while you wait for full documentation? If so, how long can claims be paid in this manner?

4. What is the average turnaround time for making STD claim determinations?

5. Describe the actions your company takes regarding return to work initiatives.

6. Indicate your residual/partial benefit calculation formula and if your plan offers a return to work incentive provision, please describe and provide the benefit calculation formula.

7. Does the STD plan include a recurrent disability provision?

IV. LONG TERM DISABILITY

Question Response

1. What is your definition of disability?

2. Describe information needed for your LTD claims adjudication process.

3. Is there a streamlined process for moving an employee from STD to LTD benefits?

4. What is the average turnaround time for making LTD claim determinations?

5. Describe the process used to identify claims for case management.

6. Describe your process for identifying rehabilitation cases.

7. Is participation in your rehabilitation program mandatory or voluntary?

8. What criteria is used to initiate the following:

a. Independent Medical Examination (IME)

b. Functional Capacity Evaluation (FCE)

c. Neuropsychic Test (NPT)

9. Indicate your residual/partial benefit calculation formula and if your plan offers a return to work incentive provision.

10. Does your LTD plan include self-reported contract language?

11. Indicate how your company assists claimants in applying for Social Security?

12. Provide your Social Security approval percentage.

13. How do you handle reimbursement of overpayments following Social Security approval?

V. SUPPLEMENTAL HEALTH

Question Response

1. Upon receipt of a claim, do you review all active coverages held by the member to ensure no eligible benefits are missed?

2. Does your plan include a conversion provision?

3. Are benefit payments issued directly to employees for unrestricted personal use?

4. Briefly describe the procedures, submission methods, and documentation required for wellness benefit claim submission.

5. Do your plans provide coverage for incidents that occurred both on and off the job?

6. Can the supplemental health products be ported and/or converted? If yes, how are the ported/converted rates determined and when does ported coverage terminate? Please confirm for each proposed product line.

7. What distinguishing features, value-added services, or enhancements do your supplemental health plans offer compared to competing carriers?

VI. PREMIUM RATES AND PERFORMANCE GUARANTEES

Proposers are to complete Attachment “C” – Premium Worksheet and return it with your submission. The worksheet includes counts, volumes, current premiums, plan design requirements, and rate entry fields that should not be modified except where proposer input is requested. Proposed rates are to be guaranteed for three (3) years (plan years 2027, 2028, and 2029).

1. Confirm you have completed Attachment “C” – Premium Worksheet and have included a hard copy and electronic copy in Microsoft Excel format with your submission.

2. Confirm rates are guaranteed for a minimum of three (3) years for all proposed lines of coverage, except where a shorter guarantee period is required by applicable law (i.e. For Critical Illness coverage issued in Florida, proposers must comply with Florida Administrative Code Rule 69O-149.005(14), which limits rate guarantees to a maximum of twenty-four (24) months).

3. Indicate if you are proposing rate guarantees or maximum increases for any or all lines of coverage beyond three (3) years.

4. Indicate your tolerable claims loss ratio for any future premium adjustments for years beyond the rate guarantees.

5. Will you agree to provide renewal proposals no later than April 1 each year following expiration of any rate guarantees?

6. For each proposed product line, describe the pricing basis and expected performance, including:

a. the rating methodology used (i.e. community rated, issue-age, attained-age, composite, tiered, experience rated, etc.)

b. the primary factors that may influence future rate changes; and

c. your average, expected, or target loss ratio.

Basic Life & AD&D

15.

16. If any of the proposed product lines are experience rated, please disclose the timing of reconciliation and experience refund to the County.

17. Confirm that Voluntary Spouse Life rates and spouse age reductions will be based on the age of the Employee (not the spouse). For Critical Illness, state the age-basis methodology, including whether spouse rates, if applicable, are based on employee age or spouse age.

18. Confirm implementation and technology credits are included along with amounts.

19. Confirm you will not charge the County additional fees to develop the enrollment system interface with CBIZ, printed materials, or ongoing administrative services related to the life, disability, and supplemental health coverages.

PERFORMANCE GUARANTEES

Indicate if you will provide performance guarantees in the following categories. List any additional standards you will include in your performance guarantees.