BENEFEDS draft QASP.pdf

Last updated 8/25/2020

BENEFEDS Quality Assurance Surveillance Plan

# Performance Standards

Time Period

Monitoring (Measurement)

Method

Minimum Acceptable Quality Level

(AQL)

1 Customer Service

1.1 Calls answered Call center

reports within 30 seconds (excludes Open Season)

Q1-Q3 Call center reports

95% within 90 seconds (excludes last day of Open Season)

Q4 Call center reports

95%

1.2 Timely response to

email inquiries (excludes auto-replies)

Customer service reports within 3 business days

Q1-Q3 99% within 5 business days

Q4 99%

1.3 Accurate projections for

calls received each quarter, not exceeding 110% for the quarter

Q1-Q4 Call/email projection vs.

actual quarterly report

98% Projections not to exceed 110% or be less than 90% each quarter

1.4 Prompt, accurate

and appropriate correspondence is generated and sent to enrollees, including but not limited to:

- Open Season information

- changes to enrollment (child aging up)

- changes to premium or allotment amounts

Q1-Q4 Sampling of correspondence

95%

1.5 Customers are

Satisfied/Very Satisfied with

BENEFEDS

Q1-Q4 Contractor survey

95%

1.6 Problem resolution Q1-Q4 Contractor

report

98%

Time Period

Monitoring (Measurement)

Method

Minimum Acceptable Quality Level

(AQL)

2 System Architecture

2.1 Systems that

support carriers, customer service representatives, and telephonic enrollments are available during stated hours

Q1-Q4 Contractor reports

100%

2.2 BENEFEDS.com

(including carrier views) is available 24/7

Q1-Q4 Website reports 99% uptime

2.3 System dynamically

scales to successfully support significant capacity surges during Open Season with no deviation in response time and without failure

Q4 Contractor’s report on performance

2 million concurrent users

5 page load limit

2.4 System provides for

continuous availability of critical functions and data

Q1-Q4 Contractor’s report on performance

24 hours for critical functions

99.9 percent of data available within 24 hours

2.5 Usability

improvements are developed and prioritized based on feedback from customer surveys, OPM feedback, and analysis of web enrollments patterns as well as customer service questions, and enrollment/premium administration errors

Q1-Q4 Contractor survey of enrollees’ rate overall satisfaction and usability very satisfied or satisfied

Time Period

Monitoring (Measurement)

Method

Minimum Acceptable Quality Level

(AQL)

3 Premium Administration

3.1 Payroll bill files sent

accurately and timely

- files sent by payroll provider-specific cutoff date

Q1-Q4 BENEFEDS

Report

99%

3.2 Payroll payments

posted timely

- payments posted within 2 business days of receipt

Q1-Q4 BENEFEDS

Report

99%

3.3 Carrier Manual

reviewed, revised and distributed at least once per year

- FEDVIP

- FSAFEDS

- FLTCIP

Q1-Q4 Updated carrier manual

100%

3.4 Post-tax Refunds

processed timely

- approved refunds mailed within 15 business day

Q1-Q4 BENEFEDS

Report

99%

3.5 Pre-Tax Refunds

submitted timely to payroll providers and monitored through disbursement to enrollee (processed within 3 days)

Q1-Q4 BENEFEDS

Report

99%

3.6 FSAFEDS Account

Funds Transfers (AFTs) processed timely in

BENEFEDS

Q1-Q4 BENEFEDS

Report

99%

3.7 Enrollees with no

premium payment/ no allotment are resolved within two pay cycles

- FSAFEDS

participants

- FEDVIP enrollees

- FLTCIP

enrollees

Q1-Q4 BENEFEDS

Report

99.5%

4 Financial Management

4.1 Funds on hand

transmitted accurately and timely to

FEDVIP

carriers and OPM, when required

Q1-Q4 Contractor’s report

100%

4.2 Contractor

accounting, bank statements and reports to carriers regarding funds match

Q1-Q4 Contractor’s report

100%

5 Stakeholder and Carrier Relationship Management

5.1 Timely response to

FEDVIP carrier and FSAFEDS and FLTCIP administrator emails

- within 3 business days

Q1-Q3 BENEFEDS

Report

99%

Timely response to FEDVIP carrier and FSAFEDS and FLTCIP administrator emails

- within 3 business days

- within 5 business days

Q4 BENEFEDS

95%

99%

5.2 Accurate daily

enrollment files processed and sent within 2 business days. Outliers not included in this measurement are full files, such as end of Open Season file and regular full file reconciliations.

Q1-Q4 BENEFEDS

Report

95%

5.3 Update files sent

accurately and timely

- within 2 business days

Q1-Q4 BENEFEDS

95%

Time Period

Monitoring (Measurement)

Method

Minimum Acceptable Quality Level

(AQL)

5.4 Quarterly enrollment

reconciliation completed timely

- Initial analysis completed within 7 business days upon receipt of a complete master enrollment file from FSAFEDS carrier.

- Discrepancies resolved within 10 business days upon receipt of analysis verification from FSAFEDS carrier.

Q1-Q4 BENEFEDS

Report

95%

5.5 Enrollment full file

reconciliations are performed and completed for each carrier timely

- FEDVIP =

monthly or quarterly, per carrier preference

- FSAFEDS =

monthly

- FLTCIP =

quarterly

Response provided to the carrier regarding full file discrepancies within 10 business days of receipt of discrepancies from carrier.

Q1-Q4 BENEFEDS

# Performance Standards Time Period

Monitoring (Measurement)

Method

Minimum Acceptable Quality Level

(AQL)

6 Responsiveness to OPM OPM will evaluate BENEFEDS overall responsiveness through measures such as, but not limited to, those listed below.

6.1 A. Incident Reporting

Contractor reports to the Contracting Officer and Program Office (by phone or email) those incidents/potential incidents that Contractor believes could have significant adverse impact to FEDVIP customer service, enrollee satisfaction, or OPM constituencies within two hours of Contractor becoming aware, including weekends.

- Contractor provides the Contracting Officer and Program Office with a preliminary incident report within 24 hours.

- Thereafter, Contractor monitors and tracks the incident, and provides the Contracting Officer and Program Office with updates, new information and corrective plan of action at least weekly until final resolution.

- OPM contractors must report any breach or potential breach to the OPM Situation Room and the Contracting Officer

Q1-Q4 Contractor report and OPM evaluation within 30 minutes of becoming aware of the risk – regardless of the time or day of the week. Breaches should be reported, even if it is believed the breach is limited, small, or insignificant.

6.2 B. Incident Correction

Plan

Detailed plans for correction of deficiencies provided within 7 business days following OPM notification

Q1-Q4 Deficiency tracking and correction in form prescribed by

OPM

100%

6.3 C. General Working

Relationship

As measures of the general working relationship, OPM will consider elements including (but not limited to):

- the volume and validity of complaints received by OPM,

- the timeliness and adequacy of requested reports, Q1-Q4 Documentation of negative performance provided to BENEFEDS by

OPM

Documented inattention or indifference to effective operations and relations will result in subtraction from the point value.

- responsiveness to OPM offices, carriers, enrollees, applicants, OMB, Federal agencies and Congress, etc.,

- action items/deliverables completed in the agreed upon timeframe

6.4 D. Innovation

Successful implementation and use of innovations, especially Contractor-initiated, that enhance the accuracy, timeliness, use, or usability of BENEFEDS for enrollees, carriers and

OPM

Q1-Q4 Ad hoc reports and action items on biweekly call agenda

98%

7 Additional Standards Proposed by Offeror

FEDVIP Notes and Assumptions:

1. An enrollment is defined as one eligible enrollee per program (i.e. an eligible enrollee who is enrolled in Dental and Vision would count as two enrollments).

2. Each performance standard should break out the amount at risk for that standard by program. Total amount profit at risk = 2.70%

3. BENEFEDS provides OPM with proposed call and email projections no later than 1 ½ months before the beginning of the quarter for which the proposed projections apply (i.e.

Q4 2020 projections are provided by August 14th). OPM and BENEFEDS work together to finalize these projections, including OPM‘s approval, no later than the end of the first week of the month prior to the quarter for which the proposed projections apply. Actual numbers from previous quarter should be included with projections from next quarter.

4. If call and email volumes exceed 110% or are less than 90% of that stated in the approved plan projections, the award of all or part of performance standards 1.3 for the period is subject to OPM’s assessment of BENEFEDS response to the actual volumes received.

5. Standards are measured quarterly and evaluated annually. BENEFEDS reports current standing of these measures to OPM monthly by the end of the second full week following that month. A quarterly summary roll-up is provided by the end of the second full week following that. Reports may also be provided more frequently upon OPM’s request.

6. For metric 2.2 “BENEFEDS.com availability”, the phrase “fully functional” refers to the ability for users to access the:

BENEFEDS.com homepage and process complete and successful transactions via the following functions on the website:

a. Login

b. Registration

c. Enrollment

d. Identify all Qualifying Life Events (QLEs)

e. View / Edit Profile (personal information of enrollee & dependents)

f. Change User ID / Password g. Email form