Attachment_A-RFP_Proposal_Worksheet_REVISED.docx

School Board of Polk County Group Dental Plan, RFP #048-PLA-0515 Attachment A– RFP Proposal Worksheet (REVISED)

Proposer must complete all questions in full and return as outlined in the Request for Proposal.

1. General and Administrative

1. Company Contact Information.

Company Name

Corporate Headquarters Address

Local Office Address

Company Contact

Telephone

Contact e-mail

Fax

2. List the number of covered dental lives your company insures.

Covered Lives

3. Provide a list of at least three (3) current clients and one (1) former client of your Company having 3,000 + employees. Public sector clients are preferred. For purposes of this section, “current” is defined as January 1, 2012 to present. The District reserves the right to contact any client, whether or not listed in this section, to obtain information regarding services that the vendor has performed.

Client Name and

4. Indicate your Company’s retention of clients for the past 3 years.

5. Describe the responsibilities of the Account Manager assigned to Polk Schools. Give a brief biography of the person to be assigned. Also include the reporting structure within the organization.

6. Provide the following information regarding the personnel your Company will assign to Polk Schools.

Dental Medical Director

Account Management

Provider Relations

Implementation Manager

Annual Enrollment Support

7. Please respond to the following questions regarding your proposal. Please provide an explanation for any “No” responses.

1. Does your Company have at least three (3) years of experience servicing dental plans for groups of 3,000 or more employees?

2. Has your Company been licensed to provide dental insurance products for at least five (5) years in the state of Florida?

3. Does your Company agree that the account will have no minimum participation requirements?

4. Does your Company guarantee rates for a minimum of two (2) years?

5. Will your Company generate identification cards for each dental plan subscriber that includes a unique identification number other than a social security number?

6. Will your Company agree to negotiate performance guarantees with financial penalties if your Company is selected via this solicitation?

7. Indicate location of customer service office, and hours of operation.

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

9. Confirm that online web-based administrative services for eligibility are to be included.

10. Confirm that on line web based dental consumer tools shall be made available to plan members to help: understand dental procedures and their cost; locate network general dentists and specialists; review claims history and current status of claims processing; and determine annual deductibles and annual maximums.

11. Confirm that your Company will develop, design, print and distribute Certificates of Coverage in a design and format acceptable to Polk Schools while meeting all filing requirements. The Company must provide the Certificate in PDF format for placement on the District’s benefits website. Your Company must agree to mail a Certificate of Coverage to a participant’s home address upon request.

12. Provide your company’s most current customer service performance for the following:

a. Average speed of answer;

b. Call abandonment rate;

c. Claim turnaround time.

13. Provide details on your Company’s Dental Claims Review Process. Include information on ADA Procedure audits, Dental Director claims review, dentist profiling, and percentage of claims reviewed.

14. Please disclose deviations and/or exceptions your Company has with any specific requirements outlined in this Request for Proposals.

15. If the District wanted to add implants to its coverage in the High PPO plan, please indicate the percent increase to the premium tiers and list any coverage limitations.

16. List any underwriting assumptions that would impact your proposed rates.

17. Confirm your proposal includes an administrative fee of $1.00 per subscriber per month is included as a part of the dental premium to off-set administrative expenses incurred by the District for items such as printing, enrollment, marketing, and other related expenses

18. Are there commissions included in your premium proposal? If yes, please indicate the percentage and to whom commissions will be paid, and the specific duties the named agent of record will perform.

19. Provide details on the premium breakdown assumptions used for the years your Company’s rates are guaranteed. Use the percent of total premiums and apply to each category.

Claims Expenses

Paid

Incurred

Total Claims

Administrative Expenses

Administrative functions

Materials to be supplied

Annual Enrollment Personnel

Company

Independent Agency

Margin

Commission

Other (Please specify)

Total Administrative

20. Describe the underwriting formula to be used by your Company to determine the renewal premiums following the rate guarantee.

Claims experience impact

Dental trend

Impact of claims history on future trend

IBNR Calculation

Tolerable loss ratio

Administrative expenses

2. Provider Network

1. Confirm that you have completed Attachment B – Top Dentist List (REVISED) in full.

2. Describe how your Company will target and recruit any dentists on the Top Dentist List who are not currently contracted with your network.

3. Does your company directly contract with your dental PPO providers or do you lease your network? If leased, please provide the name of the entity that holds the actual dental provider contracts. Describe the ability for your Company to take corrective action with a dental provider not meeting your performance standards.

4. Describe how your Company communicates plan changes, administrative and customer service issues, plan limitations and other pertinent information to network providers.

5. Describe how your Company a) selects providers for recruitment; b) credentials and monitors utilization; c) monitors ongoing provider performance; and d) takes corrective action for providers not performing to Company standards.

6. Describe your Company’s service standards and goals used in most recent Polk County provider satisfaction survey of your PPO plans. Confirm and include a copy of the most recent provider satisfaction survey with your proposal. If Polk County is not included in your most recent provider satisfaction survey, please include a provider satisfaction survey from one of the following counties in your response: Hillsborough, Orange, or Osceola county.

7. Indicate your Company’s retention of dentists.

PPO

3. Plan Design

The following PPO plan design should be the minimum basis for your PPO proposal for in-network and out-of-network services.

Calendar Year Deductible

Preventative Services

Space Maintainer (children only)

Basic Services

Major Services

*The frequency is measured forward from the last covered date of service for the procedure.

1. Confirm your proposed PPO plans are based on the above requested plan design. List in detail any deviations (enhancements or reductions) to the above plan design. If deviations are not listed, it is assumed the above plan design is proposed by your company.

2. Confirm that you have completed Attachment C – Top Dental Procedures. On Attachment C you must indicate your PPO network maximum dental fee allowance and benefit type (I, II, III, or IV) for each of the listed procedures. You must include a dollar amount – DO NOT respond with 90th percentile, 80th percentile, etc. Include with your proposal a complete plan design, Schedule of Benefits, and PPO Network Reimbursement amounts.

3. For the Low option PPO, please indicate how the member’s out of pocket costs will be calculated when using an in-network PPO provider.

4. For the Low option PPO indicate how the member’s out of pocket costs will be calculated when using an out of network provider.

5. Confirm that a sample copy of your standard report package is provided as a part of your Company’s proposal.

6. Indicate the following coverage limitations and/or exclusions for your Company’s proposed plan(s).

Out-of area emergency treatment

Prosthetics for previously missing teeth

Access to a pediatric dentist

Teeth Whitening

Implants

Continuation of Orthodontic coverage for treatment in progress

List any other limitations or exclusions

7. List any value added features of your proposed plans that would provide additional benefits to employees, e.g. annual maximum rollover, Type I exclusion from annual maximum, etc.

8. Please indicate the proposed services your Company will provide.

Interface with District for weekly eligibility files in the electronic format established by the District

Provide web-based access to Certificates of Coverage

Print ID Cards and mail to Participants’ home address

Provide claim forms

Attend quarterly administrative meetings to review performance

Attend Health Fairs

Provide representatives for annual open enrollment meetings

Conduct an annual satisfaction survey of Polk County Network Providers

Provide the following reports:

Weekly

Member Discrepancy

Quarterly and Year to Date:

Premium, membership, claims and administrative costs

Utilization Report by service type

Annually:

Participant Satisfaction

Provider Satisfaction

Provider Utilization Reports

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4. Premium Proposal

1. Monthly Premiums are to be presented using the Employee & Retiree Counts in each tier as provided below. These are the counts that will be used to compare costs for each proposal. Pricing is to remain fixed for year 1 (January 1, 2016 – December 31, 2016) and year 2 (January 1, 2017 – December 31, 2017).

Total Annual Premium

Total Annual Premium

Total Annual Premium