Attachment B - Questionnaire.pdf

RFP 2025-P09 Workers Compensa�on Insurance & Administra�on Services Atachment B: Ques�onnaire

(This form MUST be completed and returned for your proposal to be considered responsive.

Failure to complete and return will result in the rejec�on of the proposal.)

General Proposer Ques�onnaire

1. Please describe the governing structure of the program.

2. How are policy decisions and other opera�onal maters determined for the program?

3. How many years has the proposing company been in the business of workers' compensa�on administra�on? Please note the number of years providing workers' compensa�on benefits in Texas.

4. Does the program have its own staff, or are services provided by a broker or other third-party vendor? List all providers associated with the program and any associated rela�onships.

5. How many County programs do you serve in Texas?

6. Does the program have legal counsel available to Hays County for general legal ques�ons regarding workers' compensa�on? If yes, what is the charge for this service? (i.e., per call, per hour, other...) If yes, ensure it is list in your cost proposal as well.

Claims Administra�on Ques�onnaire

1. Who administers your Bill Review? What is the cost for Bill Review, ensure it is list in your cost proposal as well.?

2. List the address and phone number of the claims office that will provide the administra�on of claims for the County.

3. Does the company have an "800" toll free number that can be used to answer general ques�ons concerning workers' compensa�on claims?

4. Describe the method(s) u�lized in educa�ng the County personnel regarding changes and/or interpreta�on of the worker's compensa�on law?

5. How are reserves established and monitored?

6. How are allocated expenses monitored and adjusted?

7. Will you subcontract any por�on of the services you propose to furnish? Yes or No

a. If “yes”, give full details.

8. Are you aware of any complaints filed with State Insurance Board of other agencies regarding claims that you have paid or denied? Yes or No

a. If “yes”, give full details.

9. How many adjusters will be assigned to the County?

a. Years of adjus�ng experience:

b. Length of adjus�ng service with your firm:

c. Length of public en�ty adjus�ng experience:

d. Languages spoken:

e. Atach adjusters’ resume.

10. Will the County be assigned a dedicated claims adjuster or account manager?

11. If yes, provide the loca�on for the dedicated adjuster/account manager.

12. Describe the scope of responsibili�es for the dedicated adjuster/account manager, including availability, caseload size, and authority in decision-making.

13. Provide the name and address of the Cer�fied Public Accoun�ng firm that prepares the program's annual financial audit.

14. Are the program's financial statements prepared in adherence with GAAP, GASB, GASB 10, and

FASB? If not, please explain.

15. Please provide a copy of the program's most recent financial audit.

16. Please indicate any �me limita�ons associated with the contribu�ons, premiums, rates or fees quoted in this proposal. Can the contribu�ons, premiums, rates or fees change mid-year or mid-contract? Are any assessment fees associated with your proposal? If yes, ensure it is list in your cost proposal as well.

17. Describe in detail any assessment provisions. Can the County be retroac�vely assessed for any claims incurred by another program par�cipant?

18. Please indicate how the County will be billed?

Claims Report Ques�onnaire

1. Describe the types of standard reports that are available to the County for analyzing claims.

Atach samples and list any addi�onal charges for these reports. Ensure charges are listed in your cost proposal as well.

2. Please describe the frequency of these reports. Are they available online?

3. Is ad-hoc repor�ng available on request? Is there a charge for ad-hoc reports? Ensure charges are listed in your cost proposal as well.

4. What is the turnaround �me for special reports when requested?

5. Describe your capabili�es for providing customized claims reports (content, format, filtering op�ons, and data fields).

6. Can customized reports be scheduled for automa�c delivery? If so, specify the frequency op�ons and formats available.

7. Are customized reports included in the base contract cost or billed separately?

Technology & Online Services

1. Do you provide an online self-service portal for County staff and/or employees?

2. Describe the portal’s func�onality, including ability to:

• View claim status and history

• Submit or upload claim documenta�on

• Generate standard and custom reports

• Communicate securely with adjusters

3. Describe security protocols in place to protect sensi�ve data in the portal.

4. Is there a cost associated with portal access, setup, or ongoing use?