Attachment_E_-_Performance_Standards_(new).pdf
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- Solicitation number
- 017-202406-MC
- Issued by
- Orange County, San Diego City, California
About this file
Attachment E is a comprehensive Performance Standards document for the County of Orange's Health Reimbursement Arrangement (HRA) Plan Administration and Investment Services contract, detailing 35 specific performance metrics and requirements for the selected contractor. The document outlines rigorous standards across multiple operational domains including standard accounting activities, claims processing, automated communications, manual and systems processes, participant education and outreach, and other administrative functions. Key performance requirements include processing contribution postings within one business day, ensuring 99.9% claims processing accuracy, providing participant confirmations within two business days, maintaining dedicated local educators, conducting annual participant surveys, and holding monthly plan sponsor status meetings.
The performance standards establish precise operational expectations with specific measurement criteria, such as maintaining 25% excess system capacity across web, voice response unit, and processing platforms, responding to written complaints within 10 business days, and providing quarterly and annual financial reconciliations. The contractor must also submit various reports including SOC 1, SOC 2, and financial audit reports within 180 days of their fiscal year-end, produce and update administrative manuals, monitor tax and legal compliance, and attend quarterly advisory committee meetings. These comprehensive standards are designed to ensure high-quality, efficient, and transparent administration of the County of Orange's HRA program, with clear mechanisms for monitoring and reporting performance across multiple critical service dimensions.
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Text version
County of Orange HRS Employee Benefits
RFP # 017-202406-MC
HRA Plan Administration and Investment Services
File Folder No.: 017-2700201
ATTACHMENT E
PERFORMANCE STANDARDS
(Complete and submit as Part 5 of the Proposal in Response to Offeror’s Proposal Questionnaire #35, Proposed Performance Standards.)
Contractor shall report to the County quarterly or upon other frequency if noted below, within 45 days after the close of the reporting period, on its satisfaction of each of the following performance standards.
Activity Performance Standard/Activity Requirement Standard Accounting Activity
1. Contribution limit monitoring Monitor contributions to ensure that all contributions are properly credited to participant accounts and checked for compliance with all IRS and State rules including annual limits.
2. Contribution posting For contribution, remissions shall be posted the next business day and the County must be notified the same business day of all contributions that cannot be posted.
3. Changes in investment elections 100% of all changes in investment elections received by 4 pm EST/1 pm PST, requested by participants shall be processed on the next calendar day.
4. Transfers/reallocations (daily traded funds)
100% of all fund transfers (purchases and redemptions) requested by participants shall be executed within the investments at that day’s closing NAV or price, providing the request was entered by close of NYSE and all of the investment option providers associated with the Plan meet the “late day” trading requirements.
5. Speed in correcting transaction errors Transaction errors shall be rectified within 5 business days of a participant’s notification of such error if received at the home office within 180 days after the statement date. However, should errors not be identified within 180 days of the statement date, or the errors have been made by the Participant, the County or other third party, the error(s) will be corrected within the 5 business day period, but not made effective retroactively.
Claims Processing
6. Claim reimbursements paid following receipt of request (forms)
Mail or electronically deposit all claims payments no later than fifteen (15) calendar days following the receipt of completed claim form and sufficient materials to substantiate the claim.
7. Claims processing accuracy Process and pay accurately 99.9% of claims based on the plan requirements. Calculated as the number of claims audited and found to be processed and paid without error divided by the total number of claims paid during the quarter.
RFP # 017-202406-MC
HRA Plan Administration and Investment Services
Activity Performance Standard/Activity Requirement
8. Written denial notice Provide participants with written denial notice for any claim denied for payment within fifteen (15) calendar days of receipt of the claim.
9. Appeal response Make determination and notify participant of decision regarding any claim denial appeal within 60 days after receipt of the appeal request.
Automated Communications
10. Confirmations of financial transactions Each participant will receive a confirmation of transfers (including dollar cost averaging and rebalancing), allocation changes and, deferral changes. 95% of participant confirmation statements shall be produced and mailed within two business days after transaction. None shall be mailed any later than 5 days after the transaction.
11. Confirmations of demographic data changes
95% of participant confirmation statements shall be produced and mailed within two business days after change. None shall be mailed any later than 5 days after the change. Each participant will receive a confirmation of the initial Participant account establishment and indicative data (including name and beneficiary changes).
12. Statements on demand Statements on demand shall be produced and mailed within 2 business days after participant request is affected.
13. Employer Plan Summary Report Employer Plan Summary Report will be available within 30 business days from the quarter end.
14. PIN mailings PIN requests shall be produced and mailed within 2 business days after participant request is effected
Controls for Manual & Systems Processes & Procedures
15. Transaction accuracy (participant requested transactions) 99% accuracy on processing rate measured by calculating as the total number of transactions processed without errors by the total number of transactions processed; errors defined through audit and as reported
16. Distribution of enrollment material 100% of enrollment materials shall be mailed within 2 business days after request is made
17. Distribution upon request of generic documents (including administrative forms, prospectuses, plan document, etc.)
95% of the documents made available shall be mailed within 2 business days of the request; 100% of the documents to be faxed shall be faxed the day of the request
18. Excess system capacity requirements – web
Average of 25% excess capacity shall be maintained.
19. Excess system capacity requirements –
VRU
Average of 25% excess potential/flexibility capacity shall be maintained.
20. Excess system capacity requirements – processing
Average of 25% excess potential/flexibility capacity shall be maintained.
21. Maximum lead time for adding a new fund (for system changes)
For alliance funds, 20 business days after approval by the County of the new fund implementation plan.
For funds that are not part of the Contractor’s alliance, 20 days after the fund company agrees to appropriate operational agreements. The Contractor
RFP # 017-202406-MC
HRA Plan Administration and Investment Services must notify the County within 15 days if the fund company appears to be unable or unwilling to execute the appropriate operational agreements
22. Maximum black out period for adding new fund
3 business days, if 2 step fund transition process is not used.
23. Response time for resolving issue when research is required (contact initiated through service reps)
Written complaints will be responded to within 10 business days. Will report unresolved complaints to the County after 30 days.
24. Fulfillment (acceptable error rates & turnaround times)
99% accuracy on fulfillment of mailed materials.
25. System recovery following disaster 72 hours
Participant Education & Outreach
26. Dedicated staffing The contractual level of 2 dedicated, local, in-person educators (or its full-time equivalent) shall be maintained. Lack of required staffing levels for a period of more than 2 consecutive weeks or more than 3 cumulative weeks over a period of 3 months shall be reported to the County accompanied by an action plan for rectifying the staffing deficiency.
27. Consistency of dedicated staff Within 10 days of the loss of one of the required core dedicated staff members (other than scheduled vacation or approved leaves of absence), notify the County of the loss and present a preliminary action plan for remedying the staffing deficiency.
28. Participant survey Conduct annual participant survey via web, email and phone. Paper survey distribution will be mutually agreed upon between the parties. Tabulate and share results with the County. Annual results shall be presented no later than 60 days after the end of the contract year.
29. Targeted communication campaigns Prepare an annual target communication plan within 45 days of the beginning of the contract year.
Results of the campaigns shall be presented to the County within 30 days of the close of each target communication campaign.
Other
30. Technology road map Provide and review with the County the firm’s technology roadmap at least once per year
31. Plan sponsor status meetings Schedule and conduct monthly plan sponsor status meetings and telephone conferences that shall document plan activity for the prior month, plan and participant level service issues, and updates on legislative and industry developments.
RFP # 017-202406-MC
HRA Plan Administration and Investment Services
32. Quarterly fee reconciliation Within 30 days of the end of each quarter, prepare a quarterly report of revenue received by the Plans against the agreed upon fee cap for the Contractor’s services and present the results to the County and to the Plans’ advisory committee if requested by the County. When the quarterly report shows a material surplus, the Contractor shall provide analysis of whether the surplus is expected to continue and recommendations for minimizing the surplus above agreed upon accumulation guidelines. Annually within 45 days after the end of the contract year the Contractor shall prepare the year-end reconciliation and return to the Plans the surplus as indicated under Fees.
33. SOC and financial audit reports Annually provide a copy of the Contractor’s SOC 1, SOC 2 and financial audit reports within 180 days of the end of the Contractor’s fiscal year. Audits shall be prepared by an independent certified public accountant.
34. Administrative Manual and Plan Documents
Produce administrative manual and update as necessary on a timely basis. Monitor tax and legal compliance of administrative policies and plan documents and provide suggested compliance updates on a timely updates to Plan Documents.
35. Attend quarterly advisory committee meetings
One of more representatives of Contractor shall attend the quarterly advisory committee meetings.
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