Attachment B - Billing and COBRA RFP Financial Proposal.xlsx
XLSX spreadsheet 30 KB Posted
- Attached to
- DBM Billing and COBRA Administration System
- Solicitation number
- BPM057552
- Issued by
- Maryland
About this file
This is a Financial Proposal Instruction document for the State of Maryland's Billing and COBRA Administration Services contract (BPM 057552). The solicitation requests offerors to complete comprehensive financial exhibits for the program, including a Financial Compliance Checklist, Explanations and Deviations worksheet, and Administrative Fees schedule. The contract term is ten years, with offerors required to provide pricing for all ten contract years. Key compliance requirements include guaranteeing maximum administration rates regardless of enrollment, confirming that quoted fees exclude commissions to outside consultants or brokers, and certifying that all Per Employee Per Month (PEPM) rates are quoted on a fully-loaded basis encompassing direct and indirect costs, communications, overhead, purchasing burden, profit, and state regulatory assessments. Additionally, offerors must commit to flat rates for the first five contract years.
Pricing shall be structured as firm, fixed, fully-loaded PEPM rates representing the cost for each eligible employee on a monthly basis, with no guarantee of enrollment and all fees guaranteed regardless of actual enrollment levels. The proposal requires offerors to specify one-time implementation fees, annual communications allowances, and other allowances across the ten-year period, with cumulative pricing calculated for years one through ten. Offerors must confirm that administrative fees include all costs for program administration, including start-up fees, system or programming costs, reporting fees, notice fees, premium billing and remittance, and data file exchange and processing. The document permits offerors to identify and price any additional services available beyond those described in the RFP, provided they are detailed with associated fees or costs.
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Text version
B-1 Instructions
| State of Maryland |
| Billing and COBRA Administration Services (BPM 057552) |
| Attachment B-1: Financial Proposal Instructions |
Solicitation No. XXX
| Instructions: | |
| 1. | Complete all the attached financial exhibits for the Program. Complete file electronically. |
| Attachment B-2: Financial Compliance Checklist | |
| Attachment B-3: Explanations and Deviations | |
| Attachment B-4: Administrative Fees |
| 2. | Attachment B-2: Financial Compliance Checklist |
| Financial Compliance Checklist: Please indicate your willingness to comply with each requirement by | |
| placing a "Yes" or "No" in the response column of each item. |
| If you provide a "No" response, or a "Yes" response with a qualifier, please provide an explanation |
| for why you cannot comply with the requirement in full in the Attachment B-3 tab, Explanations |
| and Deviations. All responses that are not "Yes" must have a corresponding explanation |
| or alternative. All explanations must be numbered to correspond to the questions to which |
| they pertain and they must be brief. |
| 3. | For the Attachment B-3: Explanations & Deviations |
| Use this worksheet to provide additional explanation and deviations that you wish to offer for any questions in B-2 Financial Compliance Checklist for which a "No" response, or a "Yes" response with a qualifier, was given. |
Explanations must be numbered to correspond to the B-2 Financial Compliance Checklist item to which it pertains.
| 4. | Attachment B-4: Administrative Fees |
| All fees are to be quoted on a firm, fixed, fully loaded basis. |
For purposes of Attachment B-4, "Per Employee Per Month (PEPM)" means a price for each eligible employee on a monthly basis which is a fully-loaded fixed administrative fee, for the performance of all services related to the administration of services, including all account management services, participant communications services, and all other administrative services related to the Program.
The Offeror must provide fees for the full ten year contract period (labeled contract years 1 through 10). All Offerors will be evaluated on the total cost of the contract.
The Financial price sheet are used for evaluation purposes only. There is no guarantee of enrollment and all fees must be guaranteed regardless of enrollment.
B-2 Financial Compliance Cklst
| Billing and COBRA Administration Services (BPM 057552) |
| Attachment B-2: Financial Compliance Checklist |
Solicitation No. XXX
| Representations made by the Offeror in this proposal become contractual obligations that must be met for the duration of the contract term. |
| Offeror: |
| Financial Compliance Checklist | Offeror's Response | Offeror Response | |
| Yes or No | |||
| B-1 | Offeror's quoted administration rates are guaranteed maximum rates, regardless of actual enrollment, for the term of the contract. | Select one | Select One |
| B-2 | Offeror's quoted fees exclude commissions / compensation to outside consultants or brokers. | Select One | |
| B-3 | Offeror agrees that all PEPM rates must be quoted on a fully-loaded basis; i.e. fees must include all direct and indirect costs, communications, general and administrative overhead, purchasing burden, profit, and state regulatory assessments. No other fees or charges for the administration of the exchange may be added to the contract after award, nor will the Offeror be compensated by the State on any basis other than the applicable fully-loaded PEPM rate and one-time implementation fee. | Select One | |
| B-4 | Offeror agrees to provide flat rates over the course of the first five years of the contract (contract years 1 through 5). | Select One |
B-3 Explanations & Deviations
| Billing and COBRA Administration Services (BPM 057552) |
| Attachment B-3: Explanations and Deviations |
| Solicitation No. XXX | ||
| Representations made by the Offeror in this proposal become contractual obligations that must be met for the duration of the contract term. | ||
| Offeror: | 0 | |
| Instructions: Use this worksheet to provide additional explanation or deviation for items included in B-2 Financial Compliance Checklist. Offeror responses should be provided for any questions for which a "No" response, or a "Yes" response with a qualifier, was given. | ||
| Explanations must be numbered to correspond to the B-2 Financial Compliance Checklist item to which it pertains. Please keep all explanations brief. | ||
| Section/ Question # | Indicate "Explanation" or "Deviation" | Offeror Response |
| Select One | ||
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B-4 Administrative Fees
| Billing and COBRA Administration Services (BPM 057552) | |
| Attachment B-4: Administrative Fees | |
| Solicitation No. XXX | |
| Representations made by the Offeror in this proposal become contractual obligations that must be met for the duration of the contract term. | |
| Offeror: | |
| Provide PEPM administrative fees for each contract period listed below, as well as a one-time implementation fee associated with the Program. |
| Per Employee Per Month (PEPM) | Eligible Population | Contract Year 1 | Contract Year 2 | Contract Year 3 | Contract Year 4 | Contract Year 5 | Contract Year 6 | Contract Year 7 | Contract Year 8 | Contract Year 9 | Contract Year 10 | ||
| 1 | PEPM Administrative Fee | 86,500 | |||||||||||
| 2 | Total Annual Premium | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | ||
| 3 | One-time Implementation Fee | ||||||||||||
| 4 | Total Price | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | ||
| 5 | Cumulative Price: Years 1-10 | $ - 0 | |||||||||||
| 6 | Annual Communications Allowance ($) | ||||||||||||
| 7 | Other Allowances ($) | ||||||||||||
| Confirm your administrative fee(s) are all inclusive of costs for administration of the program including: | |||||||||||||
| a. | Start-up fees | Select One | |||||||||||
| b. | System or programming costs | Select One | |||||||||||
| c. | Reporting fees | Select One | |||||||||||
| d. | Notice fees | Select One | |||||||||||
| e. | Premium billing and remittance | Select One | |||||||||||
| f. | Data file exchange and processing | Select One | |||||||||||
| Are additional services available beyond what is described within the RFP and/or your proposal? If so, what are these services and the fees/costs for the services in detail? | |||||||||||||
| Notes: | |||||||||||||
| Enrollment referenced above represents a uniform offeror assumption for purposes of projecting total annual premium. The uniform assumption reflects illlustrative enrollment. Offeror must guarantee the rates quoted above regardless of actual enrollment. | |||||||||||||
| Submitted by: | |||||||||||||
| Offeror: | |||||||||||||
| Offeror Name (please print or type) | |||||||||||||
| By: | |||||||||||||
| Signature of Authorized Representative | |||||||||||||
| Printed Name: | |||||||||||||
| Title: | |||||||||||||
| Date: | |||||||||||||
| Company Address: |
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