Attachment_B_-_Disability_Questionnaire.pdf
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- Attached to
- Short- and Long-Term Disability
- Solicitation number
- 2024-335
- Issued by
- Collin County, Texas
About this file
This document is Attachment B - Disability Questionnaire for Collin County, Texas, detailing a comprehensive Request for Proposal (RFP) for short-term and long-term disability insurance services. The questionnaire requires potential vendors to provide extensive information about their disability program, including financial strength, claims processing, security protocols, customer service capabilities, implementation timelines, and transition procedures. The document is designed to thoroughly evaluate potential providers' ability to administer disability benefits for Collin County employees, with vendors expected to answer detailed questions across six primary sections: General Questions, Security, Disability Processes and Definitions, Employee Assistance Program (EAP), Customer Service, and Transition Questions.
The questionnaire indicates that Collin County is seeking a comprehensive disability insurance solution with specific requirements around data security, HIPAA compliance, claims processing efficiency, and robust reporting capabilities. While specific pricing details are not included in this attachment, the document references Attachment C - Disability Pricing Information, suggesting that cost proposals will be submitted separately. The RFP emphasizes the importance of secure data handling, fraud detection, performance guarantees, and seamless transition processes for existing disability benefit recipients. Vendors are required to provide detailed responses about their organizational capabilities, including average claim processing times, appeal procedures, and methods for handling complex disability scenarios.
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ATTACHMENT B – DISABILITY QUESTIONNAIRE
COLLIN COUNTY, TEXAS
INSTRUCTIONS
Answer all questions fully, clearly, and concisely unless a specific question is not applicable to the service you are proposing to provide. Should there be instances where certain questions are not applicable to your organization or its operations, please indicate this by selecting "N/A". All "No" or "N/A" answers recorded in this questionnaire require additional information. Additional information to accompany those answers MUST be detailed in the Exceptions section (7.0) of your response. If no exceptions are listed in the Exceptions section, it is understood that the Offeror has agreed to all requests as listed in the RFP even if discrepancies are listed in other sections. The Offeror will be held strictly responsible for all items contained in the specific requirements.
If you are selected to administer this plan, your responses to the questionnaire will be considered part of your contractual responsibilities.
Each response must immediately follow the respective question. Do not refer to other parts of your proposal for the answers. You may not modify either the order or language of the question.
1. GENERAL QUESTIONS
1.1 Provide the following financial information:
Financial Strength
S/P Rating
AM Best Rating
1.2 Identify by court and case number any litigation against your organization, or in which your organization is a party, involving the same or similar services your organization would be providing to Collin County, which have been filed in the last five years.
Answer:
1.3 List and describe any programs that are available as part of your short-term and long-term disability programs such as retraining, return to work, or vocational or physical rehabilitation programs that are either mandatory or voluntary. If there is a cost associated with the program, please list the cost in Attachment C – Disability Pricing Information.
1.3.1 Include any supplemental documents/brochures about the programs.
1.4 Detail information you would require from Collin County in order to provide SPD booklets and certificates of insurance. If there is an additional cost, that must be notated in Attachment C – Disability Pricing Information.
1.5 The County will establish a banking account for short-term disability claims and the Offeror will be given authority to draw funds for benefit payment from this account. The County will keep one week of funds, based upon previous claim levels, in the account. Please state any special banking arrangements required.
2. SECURITY
2.1. How does your organization ensure secure e-mail exchanges, especially when pertaining to confidential health information?
2.2. Describe your process for vetting the privacy, security, HIPAA compliance and readiness of your organization.
2.3. Describe your process for vetting the privacy, security, HIPAA compliance and readiness of your subcontractors.
2.4. Describe your process for notifying the County and affected individuals of a data breach of Collin County insured’s confidential health data.
2.5. Describe where you will store Collin County insured’s confidential health information (in the United States of America, cloud, local data center, etc.) and how confidentiality will be assured both on and off site.
2.6. Describe how you will secure Collin County insured’s confidential health data while being stored at your facility.
2.7. Are the backups of Collin County insured’s confidential health data encrypted, and if so, what type of encryption is used?
2.8. Describe how you will ensure Collin County insured’s confidential health information is encrypted while data is being transferred.
Answer:
2.8.1. What versions of Secure Socket Layer/TLS does your system support that the County will use to access insured’s confidential health data?
2.9. Describe how you handle password resets for Collin County insured’s who access their confidential health data.
2.10. In the event access to your site is unavailable, what steps will you take to notify the insured of progress towards resolving the issue?
2.10.1. What steps should the insured take during this time?
2.11. In the event that Collin County selects a different administrator for these services in the future, how will you securely transfer the Collin County insured’s data to the new administrator?
2.12. If you assume these services for an existing administrator, how will you securely receive Collin County insured’s data from the current provider?
3. DISABILITY PROCESSES AND DEFINITIONS QUESTIONS
3.1. Specify your average claim processing time.
3.2. Specify the average time between when a claim is approved and the first benefit payment is issued to the claimant.
3.3. Describe how you determine if a claimant is eligible for benefits.
3.3.1. Do these procedures differ between short-term and long-term disability claims? If so, describe the differences.
3.3.2. Describe how you would handle a claim where the insured was released to perform their job on a part-time basis for a limited period.
3.3.3. Describe how you would handle a claim where the insured was released to perform their job on a part-time basis permanently.
3.3.4. Are there any limitations which apply to short or long-term disability coverage due to a mental health incapacity?
3.3.5. Describe how you would handle a claim where the insured was diagnosed with a disability before their short-term disability coverage was effective but their first day missed was after the coverage effective date. (Please assume the disability is one that would be covered by your plan.)
3.4. Describe the information that you will request from Collin County in order to process claims. If there is a specific form, provide a copy of the form.
Answer:
3.4.1. Describe any additional information or materials you may require in order to process claims for payment. If there are specific forms, provide a copy of the forms.
3.5. If you offer a website that Collin County employees can access related to their benefits, please list services that are provided electronically such as covered benefits, eligibility, claim status, and claim history.
3.5.1. Is there a demo site available the County can review? If so, please provide the information for the County to access the demo site. If no demo site is available, please provide detailed screen prints showing the website’s ability to perform the listed tasks.
3.6. If claimants can submit claims information via a website, describe the type of information that can be accessed/updated.
3.7. Describe the waiver of premium process.
3.7.1. Under what circumstances is the premium waived?
3.7.2. What party is responsible for initiating the process?
3.7.3. How will Collin County be notified when waiver of premium for a claimant is approved?
3.8. How often will you recertify a disability for continuation of benefits?
3.8.1. Describe how you determine if it is medically necessary for a claimant to be absent from work.
3.9. If the claimant experiences a subsequent absence due to a recurrent disability, describe how you handle the new claim.
3.9.1. If an individual goes out again for the same medical condition, after what time period would it be considered a new claim?
3.10. Describe the quality controls, auditing, and peer review mechanisms in place for your claim processing departments.
3.10.1. Do you use internal or independent/outside auditors?
3.10.2. How frequently do the audits occur?
3.10.3. What specifically is audited?
3.11. Describe your fraud detection unit or program.
3.11.1. What percent of short-term disability claims submitted were denied as a result of misrepresentation and/or fraud over the last three years?
Claims Denied Due to Misrepresentation/Fraud
Year Percentage
3.11.2. What percent of long-term disability claims submitted were denied as a result of misrepresentation and/or fraud over the last three years?
Claims Denied Due to Misrepresentation/Fraud
3.12. Identify if you have an ‘own occupation’ or ‘any occupation’ provision. Discuss in detail how this provision would impact an employee including time limits.
3.13. Detail the types of wages that are excluded from the short-term and long-term disability calculations.
3.13.1. Detail the plan’s offsets with other benefits.
3.14. How do you avoid making duplicate payments to a participant for the same claim?
3.14.1. If duplicate payments or overpayments are made, what are your procedures for recovery of the overpayments or duplicate payments?
3.14.2. How will Collin County be notified if an overpayment is made?
3.14.3. Are there reports available that identify overpayments? Please provide a sample report.
3.15. Describe the appeal procedures in place for plan participants when a claim is denied.
3.15.1. What percent of short-term disability claims were denied in the last three years?
Short-Term Disability Claims Denied
3.15.2. What percent of long-term disability claims were denied in the last three years?
Long-Term Disability Claims Denied
4. EMPLOYEE ASSISTANCE PROGRAM (EAP)
4.1. Currently, an Employee Assistance Program (EAP) is included in our plan at no additional charge. If you provide access to an EAP, what is the design of the EAP? Provide an overall description of the EAP plan offered. If there is a charge for the EAP, it must be notated in Attachment C – Disability Pricing
Information. NOTE: This is an optional benefit being considered. Collin County reserves the right to elect or decline this benefit after the contract for services has been awarded.
4.2. How does a covered individual contact the EAP if they need assistance?
4.3. What hours is the EAP’s 800 number accessible during the day/week?
4.4. List any topics (marital issues, financial issues, grief, etc.) that are excluded from the EAP program?
4.5. If you are able to provide client-specific aggregate reporting, please provide samples of the reports.
5. CUSTOMER SERVICE
5.1. If you offer a website that Collin County Human Resources staff can access related to employee benefits, please list services that are provided electronically such as covered benefits, eligibility, claim status, ability to update an insured’s status, and claim history.
Answer:
5.1.1. Is there a demo site available the County can review? If so, please provide the information for the County to access the demo site. If no demo site is available, please provide detailed screen prints showing the website’s ability to perform the listed tasks.
5.2. Collin County expects the statistical reports to be provided on at least a monthly basis. These reports include Claims Status, Most Recent Checks Issued, Claims to Pay, Claims in Non-Payment Status, and Payment Detail. List any additional report you provide.
Answer:
5.2.1. Indicate how frequently each of these reports are processed and if it is possible for the County to log onto a secure website and run these reports without assistance from the Offeror.
5.3. How do you communicate business changes including changes in processes and staff?
5.3.1. How far in advance will changes be communicated to Collin County?
5.4. Describe the performance guarantees for short-term disability you will provide to Collin County.
5.5. Describe the performance guarantees for long-term disability you will provide to Collin County.
6. TRANSITION QUESTIONS
6.1. Provide a detailed proposed timeline for each step of implementation that includes the action, the party responsible, member of your account team responsible for each action, and the proposed due date for completion of each action. The Offeror should detail any information required from Collin County in order to provide these. Any additional cost that may be incurred as a result should be notated in Attachment C – Disability Pricing Information.
6.2. What, if any, information is needed from Collin County or the prior carrier to ensure a seamless transition for those individuals that may already be receiving short-term or long-term disability benefit payments?
6.3. What transition challenges would you expect might be encountered, and how do you propose you will handle those challenges?
6.4. List and describe any benefit coverage or payment arrangement responsibilities that would change as a result of transitioning to your organization and when those changes would occur.
6.5. Describe the procedures that are followed when a contract terminates. What additional penalties or charges would apply as a result of a contract termination on the anniversary date? Off anniversary/early termination? Any additional cost that may be incurred as a result should be notated in Attachment C – Disability Pricing Information.
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