Attachment_B_-_Proposal_Worksheet.pdf

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ATTACHMENT “B”

Proposal Worksheet

WORKSHEET INSTRUCTIONS: Answer the questions as completely and succinctly as possible. Do not refer the reader to another section of your response. Include this Worksheet in Tab 2.

Company Contact Information:

Company Name:

Corporate Headquarters Address: Local Office Address:

RFP Contact Name: RFP Contact Phone:

Contact E-mail: Contact Fax:

1. General and Administrative

a. Market Presence. List the number of covered lives your Company insures for dental insurance:

Category DHMO PPO Dental

Brevard County

Area State of Florida Brevard County Area State of Florida

Covered Lives

b. Client Retention. Indicate your Company’s retention of dental insurance clients for the past 3 years:

Category DHMO PPO Dental

Brevard County

Area State of Florida Brevard County Area State of Florida

% Retained Past 3 Years

c. Service Team. Provide the following information regarding the personnel your Company will assign to the County:

Function Name Location Years of Experience

Years with Company

Account Manager

Strategic Account Manager

Dental Director

d. Complete the following:

Administrative Services Response

1. Indicate your current financial rating by A.M Best agency. If you are not currently rated by A.M. Best, please indicate this in your response

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

3. Location of claims office, and hours of operation

4. Provide your Company’s most recent service performance for the following:

a) Average speed of answer

b) Call abandonment rate

c) Claim turnaround time a) b) c)

5. Provide your Company’s most recent claims performance for the following:

a) Percent of clean claims processed in 10 calendar days

b) Percent of claims processed in 30 calendar days

c) Percent financial accuracy of claims processed a) b) c)

6. Describe the web-based administrative services for eligibility

7. Do you provide on-line web based dental consumer tools to plan members to help: understand covered dental procedures and their cost; locate network general dentists and specialists; review claims history and current status of claims processing; request ID cards, and determine annual deductibles and annual maximums.

8. Confirm that you will assist the County with annual enrollment by: training the benefits staff on plans;

attending at least 15 on-site enrollment meetings;

providing web portal interface for annual enrollment;

and agreeing to accept the County’s integrated benefits enrollment form and enrollment file

9. Confirm that you will participate in wellness activities as requested by the County, including onsite participation at their annual health fairs.

10. Confirm that you will be responsible for coordinating delivery of all required enrollment and policy materials to the various agencies listed under this RFP. You will be responsible for all costs of producing, printing, and mailing/distributing adequate quantities of marketing and administrative supplies (e.g., claim forms, summary plan booklets, and informational brochures) as designated by the County. The format and content of all materials used must be provided in advance to the County for review

11. Confirm that you will issue ID cards to enrolled employees upon initial enrollment, or when an

- 3 -eligibility transaction changes information on the previously issued card. Permanent ID cards are to be mailed to the employees' home addresses within fourteen (14) days after the Company receives an eligibility update transaction

12. Confirm that you will develop, design, print, and distribute Certificates of Coverage and mail to each participant’s home within any required timeframes

13. Confirm that you will meet quarterly with the County on administrative issues related to the dental plans, review plan performance, and that you will make available a Dental Director for ongoing involvement in clinical, provider, and plan performance issues

14. Confirm that you will absorb a one-time set-up fee with the County enrollment vendor, PlanSource

15. Confirm that you will adhere to the County's billing and invoice practices, which include providing separate billing for each agency and accommodating various payment methods such as wire transfer, check, or online payment.

2. Plan Design and Provider Network

a. Indicate whether your Company’s proposed plans match the benefits and service types as outlined in the RFP

HIGH PPO PLAN

BENEFITS In-Network Out-of-Network Response

Diagnostic and Preventive Benefits 100% 100% Basic Benefits 80% 80% Major Benefits 50% 50% Orthodontic Benefits 50% 50%

DEDUCTIBLES

Per Enrollee per Calendar Year $50 $50 Per Family per Calendar Year $150 $150

MAXIMUM

Per Enrollee per Calendar Year $1,500 Lifetime Orthodontic Benefits $1,000 Per Enrollee (adult and child)

LOW PPO PLAN

BENEFITS In-Network Out-of-Network Response

Diagnostic and Preventive Benefits 100% 100% Basic Benefits 70% 60% Major Benefits 40% 40% Orthodontic Benefits 40% 40%

DEDUCTIBLES

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Per Enrollee per Calendar Year $50 $75 Per Family per Calendar Year $150 $225

MAXIMUM

Per Enrollee per Calendar Year $1,000 $750

Lifetime Orthodontic Benefits $1,000 Per Child Enrollee (19 years old and under)

b. Indicate the following coverage limitations and/or exclusions for your Proposal.

Procedure Limitations or Exclusions Pre-Existing Conditions Out-of-area emergency treatment Prosthetics for previously missing teeth Access to a pediatric dentist Continuation of Orthodontic coverage for treatment in progress Referrals to Specialists

c. List any additional limitations that vary from the current benefit limitations in-force. If deviations are not listed, it will be assumed that your proposal adheres to the current plan design.

Limitations or Exclusions

High PPO Low PPO

DHMO

d. List any value-added features of your proposed plans that would provide additional benefits to members that are included in the premiums proposed.

Value Added Benefits

High PPO Low PPO

e. Provide the following information regarding your proposed Plan Design and Network Services.

Plan Design and Network Services Response

1. Confirm that your Company completed

Attachment “C” Network and Procedure Compare and included it with your response.

2. Confirm that the plans being proposed do not include any additional waiting periods or reduction in services for initial plan entrants and

DHMO PLAN Response Confirm that the current plan design is the minimum basis for your proposal. List any deviations in the plan DHMO design.

How many dental procedures (covered ADA codes) are included in the proposed DHMO plan? List the # Covered ADA Codes.

Does your proposed plan have an Office visit fee (Per patient, per office visit in addition to any other applicable patient charges)? If yes, please list the patient copay.

- 5 -also for late entrants selecting coverage during annual enrollment and/or mid-year election Section 125 changes in status.

3. Confirm that you have included a complete copy of your dental plan designs with your proposal.

4. Confirm that your provider network includes statewide and national coverage.

5. Confirm that your Company’s Brevard County Area network is to have less than a 3% turnover of network providers in any year.

6. Explain how you Company determines the out of Network Usual and Customary allowances for the High and Low PPO plans.

7. Explain how your Company will eliminate any inconvenience that a member may experience for lack of provider network coverage in the Brevard County Area.

f. Indicate your Company’s number contracted dentists in your network having offices in Brevard

County. Count a dentist with multiple offices only once.

General Periodontics Endodontist Oral Surgeon Orthodontist

PPO

g. Indicate your Company’s percent retention of dentists in your network in the following.

General Periodontics Endodontist Oral Surgeon Orthodontist

PPO

3. Financial, Reporting and Data Interface

a. Please complete the following:

1. Confirm that the eligibility for the County’s Group

Dental Insurance is to be calculated on a monthly basis and premiums are to be due and payable on a monthly basis.

2. Confirm that you will allow the County and its affiliated agencies the option of either self-administration of the premium bill or payment from the Company’s list bill.

3. Confirm that you will agree to work with the County and its affiliated agencies to receive eligibility either electronically or via paper in the

- 6 -format provided by the County and/or affiliated agencies.

4. Confirm that you will complete eligibility discrepancy reporting on a monthly basis.

5. Confirm that you will report eligibility, claims and utilization data on a quarterly basis. The utilization report is to provide, at a minimum: Monthly plan membership, Paid premiums, Amount of paid claims broken down by service type, and network

vs. non-network utilization.

6. Confirm that you are capable of recording and maintaining information regarding County specific service-related calls and complaints reported by members and County representatives. Reports on the information are to be given to the County quarterly.

Disclose any underwriting assumptions that would impact your proposed premium rates.

Assumption Impact

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 it to each category.

Category Assumptions

Annual Incurred Claims Expenses

Administrative Expenses

Margin

Other (Please specify)

TOTAL 100%

Please provide the following information.

Issue Response

1. Confirm that your premiums are net of agent/broker commissions. If agent commissions are included, list

- 7 -the agent name and the proposed services that will be provided by the agent.

Indicate the Performance Standards and Financial Penalties your Company will include in your contract with the County.

Performance Standard Response Financial Penalty

1. Plan Implementation to include: Plans loaded and tested within 14 days of receipt of enrollment data;

staff trained by November 20; and ID cards issued by December 20

2. Network utilization standard of at least 70% of procedures rendered by network providers

3. Of the total allowable claims submitted for payment, at least 70% of the claims are attributable to network providers

4. Network Stability with a 3% or less annual turnover

5. Claims Processing Accuracy of at least 99% of the total number of correct claims divided by the total claims processed

6. Claims Turnaround Time of at least 90% of clean claims processed in 14 calendars days and 100% all claims in 30 days

7. Accurate and Timely Reporting with Quarterly and Annual reporting due by the 15th of the month and reports to be error free

8. Telephone Answering Time minimum of 90% calls answered in less than 20 seconds

9. Telephone Abandonment Rate of 2% or less

10. Return Call Response Rate minimum of 95% in 24 hours

11. Web Inquiry Response Time minimum of 95% in 24 hours

12. Other

Maximum Annual Aggregate Penalty