AttB.Performance-Guarantees.pdf

ITN No.: DMS-24/25-232 Group Term Life Insurance Page 1 of 9

ATTACHMENT B: PERFORMANCE GUARANTEES

It is critical to the success of the State’s benefits plans that Services be maintained in a timely manner and that the Contr actor operates in a reliable manner. It would be impracticable and difficult to repair the actual damage sustained by the State in the event of c ertain delays or failures in scheduled Services and the provision of Services to Members served by this Contract. The Department and Contracto r, therefore, agree that in the event of certain delays and failures, the amount of damage that will be sustained will be the amount set forth in this

Attachment.

Further, Contractor agrees that in the event of any such failure of performance, Contractor shall pay such amount as financial consequences under section 287.058(1)(h), F.S., and not as a penalty. At its option, the Department may, for any amount due to the State as financial consequences, deduct such an amount from any money payable to Contractor or may bill Contractor as a separate item.

All references to ARs are to the Administrative Requirements of Attachment A.

PG #

Performance

Indicator Standard/Goal Measurement Criteria

Frequency of Measurement

Financial Consequences

Measurement Methodology

I. Implementation

1A Final Implementation Plan

AR-1

The Contractor must submit the Final Implementation Plan to the Department for approval within ten (10) Business Days following the Effective Date of the Contract.

Delivery must occur within ten (10) business Days from the Effective Date of the Contract.

One (1) time measurement

$5,000 per day late beyond the ten (10) Business Days.

Measured as the difference between the due date and the actual date the Final Implementation Plan is received by the Department.

1B Final Implementation Plan

AR-1

If the final Implementation Plan is submitted, but is not subsequently approved by the Department, the Contractor shall submit revisions to the Final Implementation Plan within five (5) Business Days of receiving feedback from the Department setting forth

Revisions to Final Implementation Plan within five (5) Business Days of receiving feedback from the Department.

One (1) time measurement

$2,500 per Business Day beyond the five (5) Business Days.

Measured as the number of days between the due date and the actual date the revised Implementation Plan is received by the Department.

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PG #

Performance

Indicator Standard/Goal Measurement Criteria

Frequency of Measurement

Financial Consequences

Measurement Methodology the reason(s) why the Department did not approve the submitted Plan.

2 Implementation

Status

Meetings

AR-1

The Account Management Team shall schedule and hold weekly Implementation status meetings with the Department.

Must begin within ten

(10) days of contract execution and continue weekly through January 1, 2026.

Weekly $500 for each weekly meeting missed without prior approval from the Department.

Measured as the difference between the total number of weekly meetings held and the number of weekly meetings missed without prior approval.

3 Website

The Contractor shall f inalize the State of Florida Plan specific website by the date specified.

Website must be functional and available to Participants by August 1, 2025.

One (1) time measurement

$1,000 per Calendar Day past the due date.

Measured as the difference between the due date and the date the website is functional and available to Participants.

4 Phone Line

The Contractor shall establish a phone line by the date specified.

Phone line must be functional and available to Participants by August 1, 2025.

One (1) time measurement

$1,000 per Calendar Day past the due date.

Measured as the difference between the due date and the date the phone line is functional and available to Participants.

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PG #

Performance

Indicator Standard/Goal Measurement Criteria

Frequency of Measurement

Financial Consequences

Measurement Methodology

II. Account Management

6 Quarterly

Performance

Review

Meetings

AR-5

The Account Management Team is required to attend and actively participate in all scheduled quarterly performance review meetings, whether in person, via web conferencing, or over the telephone, as outlined in AR-5 of this Contract.

One hundred percent (100%) attendance

Quarterly $500 per occurrence if any member of the Account Management Team is absent from a quarterly meeting without prior approval from the Department.

Measured by determining if the scheduled quarterly meeting was missed by one or more members of the Account Management Team without prior approval.

The Department will verify the attendance of the Account Management Team at each meeting.

III. Support Services

7 Open Enrollment Benefit Fairs

AR-6

The Contractor shall ensure that trained and knowledgeable staff are present at each annual Open Enrollment Benefit Fair sponsored by the Department or its designee, as outlined in AR-6 of this Contract.

One hundred percent (100%) of Open Enrollment Benefit Fairs shall be staffed by trained and knowledgeable personnel.

Annually $5,000 for each Open Enrollment Benefit Fair that is not staffed according to the specified requirements.

Measured by verifying the attendance of trained and knowledgeable Contractor staff at each annual Open Enrollment Benefit Fair scheduled by the Department or its designee.

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PG #

Performance

Indicator Standard/Goal Measurement Criteria

Frequency of Measurement

Financial Consequences

Measurement Methodology

IV. Customer Service

8 Average Speed to Answer

AR-13

The Customer Service Unit phone line shall achieve an average response time of thirty (30) seconds, measured from the moment the call is initially placed in the queue.

Ninety-nine percent (99%) of calls shall be answered within an average of thirty (30) seconds or less.

Quarterly $1,000 per percentage point, or fraction thereof, for calls not meeting the ninety-nine percent (99%) requirement.

The calculation of "Average Speed to Answer" involves measuring the total number of seconds from when a caller joins the queue until the call is answered by either a live customer service representative or an Interactive Voice Response Unit (IVRU).

This total duration for all callers within a quarter is then divided by the total number of calls handled by a live customer service representative or IVRU on the member service telephone line within the quarter.

9 Call Abandonment Rate

AR-13

The call abandonment rate of the dedicated toll- free customer service phone line shall not exceed the specified rate.

Less than or equal to three percent (3%).

Quarterly $2,500 per percentage point, or fraction thereof, greater than three percent (3%).

The call abandonment rate percentage is calculated by dividing the number of calls abandoned in the queue in a quarter, where the caller disconnects before reaching a live customer service representative, by the total number of calls in a quarter.

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PG #

Performance

Indicator Standard/Goal Measurement Criteria

Frequency of Measurement

Financial Consequences

Measurement Methodology

10 Unscheduled Toll-Free Phone Lines Downtime

AR-13

The Customer Service Unit toll-free phone lines shall be promptly answered by a live customer service representative or Interactive Voice Response Unit (IVRU) during the hours of 8:00 A.M. to 5:00 P.M. ET, Monday through Friday, excluding State holidays.

Any period of downtime where the phone lines are not functional and prohibits calls from being accepted and answered in excess of two (2) hours from start to finish will be subject to associated Financial Consequences.

Constant $2,000 for each hour the toll-free phone lines are unavailable or non-functional beyond the initial two (2) hours from start to finish.

Measured from the initial two (2) hours of downtime until the toll-free phone lines are fully restored and functional.

11 Unscheduled Plan Website Downtime

AR-15

The Plan specific website must be available seven

(7) days a week, twenty-four (24) hours a day, three hundred sixty-five

(365) days per year.

Any period of downtime where the website is not functional that exceeds twenty-four

(24) hours from start to finish will be subject to associated Financial Consequences.

Constant $5,000 for each greater-than-twenty-four (24) hour period the website is not available and/or functional.

Measured as the start of downtime and ending with the restoration and full functionality of the Plan website.

12 Participant Satisfaction Survey

AR-26

The Contractor shall guarantee that the overall satisfaction of Participants with Services, evaluated using a satisfaction survey instrument approved by the Department, reaches a minimum of ninety percent (90%).

Annual survey performed on statistically valid sample of Participants.

Annually. The data should be reported in the fourth quarter of the Plan Year.

$2,500 per percentage point, or fraction thereof, below ninety percent (90%).

Measurement of the variance between the overall satisfaction level, as indicated by the survey results showing the percentage of satisfied Participants, and the targeted satisfaction rate of ninety percent (90%).

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PG #

Performance

Indicator Standard/Goal Measurement Criteria

Frequency of Measurement

Financial Consequences

Measurement Methodology

13 Written Inquiry Response Time

AR-14

Ninety-nine percent (99%) of written inquiries related to the Plan will be acknowledged and addressed in twenty-one

(21) Calendar Days.

Written inquires includes communication via mail, email, and fax from Participants.

Quarterly audit performed on written inquiries from Participants.

Quarterly $2,000 per each full percentage point, or fraction thereof, below ninety-nine percent (99%).

Number of written inquiries received from Plan Participants acknowledged and addressed within twenty-one (21) Calendar Days divided by the total number of written inquires received from Plan Participants.

14 Medical Underwriting Timeliness

AR-16

Ninety-nine percent (99%) of medical underwriting determinations shall be completed within ten (10) Business Days of receipt of approved enrollment information.

Measured from the date the evidence of insurability form (form) is received in the Contractor’s office (day

1) to the date it reaches final action determination

The measurement refers to “clean” form only and the required timeframe is paused while the form is pending additional information from the applicant, but calculations resume once the requested information is provided to the Contractor.

Quarterly $2,000 per each percentage point, or fraction thereof, below ninety-nine percent (99%).

Total number of forms processed within ten (10) Business Days divided by the total number of forms received within the quarter.

Pended forms will be measured as the total number of Business Days prior to being pended and the number of Business Days from removal of pending status to completed processing.

Turn-around time for pended forms will be applied to the quarter the form was either approved or denied.

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PG #

Performance

Indicator Standard/Goal Measurement Criteria

Frequency of Measurement

Financial Consequences

Measurement Methodology

15 Notice of Approved Coverage

AR-17

A notice of approved coverage will be distributed to Participants within five (5) Business Days of receipt of approved enrollment information.

One hundred percent (100%) of Participants

Quarterly $2,000 per percentage point, or fraction thereof, below (one hundred percent) 100%.

Measured in Business Days from the date of receipt of approved enrollment information to the date the notification is provided to the Participant.

V. Data and Interface

16 Enrollment Files

AR-19, AR-21

Enrollment files, as described in AR-19 and AR-21, shall be accurately and timely loaded within the time frame specified.

One hundred percent (100%) of enrollment files loaded within two

(2) Business Days of receipt.

Quarterly $2,000 for each Business Day past the deadline, per incident.

Measured from the date/time of receipt of a processable enrollment file until the file is loaded.

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PG #

Performance

Indicator Standard/Goal Measurement Criteria

Frequency of Measurement

Financial Consequences

Measurement Methodology

VI. Reporting and Deliverables

17A Plan Material

AR-7

The Contractor must submit all marketing, promotional, educational, or other Plan-related materials to the Department for review and written approval at least 30 calendar days prior to their planned distribution.

100% of materials must be submitted to the Department for review and approval at least 30 calendar days prior to their planned distribution.

Per Occurrence

$1,000 per occurrence of distributing unapproved materials.

Calculated by the number of instances where unapproved materials are distributed.

17B Plan Material

AR-7

The Contractor shall provide Plan materials in formats widely accepted for participants with hearing or visual impairments within 30 Calendar days of Department’s request.

100% of materials for hearing and visually impaired participants must be delivered within 30 Calendar days of the Department’s request.

Upon request by the Department

$2,500 per instance of not delivering accessible materials within the specified timeframe.

Measured as the difference between the due date and the date the materials for hearing and visually impaired participants are received by the Department.

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PG #

Performance

Indicator Standard/Goal Measurement Criteria

Frequency of Measurement

Financial Consequences

Measurement Methodology

17C Plan Material

AR-7

The Contractor shall submit final materials to the Department electronically within the timelines established by the Department.

100% of f inal materials must be submitted electronically to the Department within the timelines established by the Department.

Per Occurrence

$5,000 for each Business Day the Contractor fails to meet the established deadline.

Measured by calculating the time difference between the established due date for finalized materials and the actual date of electronic submission to the Department, ATTACHMENT B: PERFORMANCE GUARANTEES