Attachment_B_-_Proposal_Worksheet.docx

ATTACHMENT B

PROPOSAL WORKSHEET

1. Plan Administration – Qualifications of Staff and Firm (All Proposers must complete)

A. Provide the following information about your Company:

Company Name

Service Center Location

Primary Contact for RFP

Contact Person Address

E-mail Address

Telephone

Fax

B. Indicate the Medicare Plan types you are proposing:

Medicare Supplement Plans

Medicare Part D Employer Group Waiver Plan (EGWP)

C. List the personnel your Company will assign to help administer the County’s Medicare Plans. Personnel is required to have 5 years of experience with retiree benefits.

Client Service Manager

Implementation Manager

D. Indicate approval status by the Centers for Medicare & Medicaid Services (CMS) for the Plans your Company is proposing

Medicare Supplement Plans

Year of Initial CMS Approval

· Plan N

· Plan F

· Plan G

Employer Group Waiver Plans (EGWP)

Year of Initial CMS Approval

E. Indicate the number of Medicare participants currently enrolled in your Company’s plans in the Orange County Area (Brevard, Orange, Seminole, Osceola, Lake and Volusia Counties)

Medicare Supplement Plans

EGWP

F. Provide five (5) references, with a minimum of three (3) from governmental entities of comparable size to the County, (5,000+ employees) where you currently provide Medicare plans similar to those requested.

1.

2.

3.

4.

5.

G. Services

1. Confirm the proposal is for a fully insured Group or fully insured individual plans through group billing Medicare supplement and EGWP.

2. Please address the following regarding your Customer Service Center:

a. Is a Customer Service toll-free number available for retirees?

b. Is the toll-free number a dedicated line?

c. Where is the call center located?

d. What are the hours of operation?

6. Indicate the average turnaround time for claims processing.

7. Indicate your Company’s ability to accept eligibility from the County (currently through Chard-Snyder) on a monthly basis.

8. Confirm eligibility information will be accessible on-line.

9. Confirm eligibility discrepancy reports will be provided to the County’s TPA, currently Chard Snyder, on the monthly basis.

10. Indicate your Company’s ability to accept group premium payments from the County, currently through Chard-Snyder.

11. Confirm your Company will answer benefit questions, be responsible for their plan enrollment, and interface with the County’s TPA, currently Chard Snyder.

12. List the claims and customer service tools that will specifically be available to County plan members through your Company’s interactive tools.

13. Will your Company guarantee issue individual policies in the event the County would cease to offer post-65 retiree coverage with your Company?

14. Confirm your company will be responsible for the Medicare Part A and Part B verification process for individual retirees enrolling in your Company’s plan.

15. If a retiree enrolled in your Company’s plan decides to terminate coverage, what procedure must be followed and when will the termination become effective?

16. Describe your automatic enrollment process as referenced above.

17. Confirm your Company will send all annual and new Retiree enrollment materials, approved by CMS where applicable and reviewed by the County, directly to the County’s TPA for distribution.

18. Confirm your Company will assist the County with annual enrollment by:

a. Training staff on retiree plans;

b. Assisting with annual enrollment, eligibility and premium billing and collection;

c. Attend up to 3 on-site enrollment meetings.

21. Please list the online web based and telephonic customer service and education tools that are made available to plan members.

Technical Approach to Plan Design and Network

2. Medicare Supplement Plan Design and Network Services

A. Medical Issues

1. Confirm your proposal includes the following plans:

a. Plan F

b. Plan G

c. Plan N a.

4. Confirm premiums shall be established on the age of the retiree when the policy is initially issued.

5. Confirm the plans are offered with no pre-existing condition limitations and guaranteed issue for current and future retirees covered under the County’s health plan.

6. Confirm retirees are permitted to change to another plan offered during annual enrollment without pre-existing condition limitations and with guarantee issued?

7. Do all retirees who are listed in the census living outside Orange County but within the State have the option to enroll in your Company plans? If NO, list the exceptions.

8. Are areas outside of Florida where the retirees are unable to enroll in this plan?

9. Confirm pre-65 Medicare eligible retirees are able to enroll in the Medicare Supplement plans? List any limitations.

3. Pharmacy Plan Design and Network Services

A. Pharmacy Issues

1. List any deviations from the current pharmacy plan designs that your Company is proposing that most closely matches the current plans of the County.

2. Complete the pharmacy formulary comparison worksheet that is included in the RFP as Attachment C, with your Company’s formulary information.

3. Complete the network pharmacy comparison worksheet that is included in the RFP as Attachment D, with your Company’s Medicare approved pharmacy network that most closely matches the current network of the County.

4. State your Company’s ability to provide the plan offered with no pre-existing condition limitations and guaranteed issue for current and future retirees covered by the County’s health plan.

5. Confirm the network proposed for both pharmacy plans is a comprehensive network or national pharmacies, specifically in the Orlando area, and have a comprehensive network on a state and national basis.

6. Confirm medication coverage is comprehensive and includes 100% Part D coverage plus the bonus list of medications for the High Plan.

7. Confirm the proposed Low and High plan provides coverage for generic, brand, and specialty drugs and includes full benefits through the coverage gap in the High plan.

8. Confirm all generic drugs in the High plan, including select generic drugs at reduced co-pays, are included in tier 1.

9. Do all retirees listed in the census living outside Orange County have the option to enroll in your Company plan? If NO, list the exceptions.

10. Describe the international coverage that is available to retirees visiting outside the United States.

11. Describe the assistance your Company will make available in administrating Medicare Part D including:

a. low income subsidy payments

b. low income cost sharing; and

c. catastrophic reinsurance.

a.

14. Are pre-65 Medicare eligible retirees able to enroll in the Medicare Part D EGWP plans? If yes, also list any limitations.

4. Medical and Pharmacy Management and Reporting

A. Medical and Pharmacy

1. Identify the Disease Management, case management, step therapy, and prior authorization programs your Company will implement.

2. Describe the wellness support services your Company will provide to improve the overall health of the population.

3. List the reports your Company will provide to the County and the frequency of the reports.

4. Will your Company agree to accept premium remittance by a third party on behalf of the County? If “NO “, indicate the process.

As an officer of the Company, I certify that the information contained in our proposal worksheet is accurate, and our Company will be bound by the contents of our proposal.

Signature: _____________________________ Date: ___________________

Name: ________________________________ Title: _____________________

Company: