Benefits Adm Solution Price Proposal Worksheet Final.xlsx
XLSX spreadsheet 81 KB Posted
- Contract number
- 24-416CMS-BENF4-P-77070
- Issued by
- Illinois
About this file
This document is a Benefits Administration Solution Price Proposal Worksheet for the State of Illinois, prepared as part of a Request for Proposal (RFP) for benefits administration services. The spreadsheet provides a detailed pricing template for a potential vendor to outline their costs for implementing and managing benefits administration services across various categories and service tiers.
The proposal covers a comprehensive range of services including FSA administration, COBRA administration, QMCSO services, call center operations, annual enrollment, and ACA form preparation. The contract term is structured for an initial 5-year period with potential renewal options for an additional 5 years. Pricing is based on a tiered PMPM (Per Member Per Month) model, with the current population estimated at 277,300 members. Renewal rates are capped at either 3% or the Consumer Price Index Inflation factor. The document includes provisions for one-time, periodic, recurring, and per-transaction costs, with an emphasis on transparency and detailed cost breakdown across multiple service categories and implementation phases.
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Instructions
| Fee Proposal Instruction Sheet | |||
| Assumptions to be considered while preparing your fee proposal: | |||
| Fee Proposal Requirements | Please provide pricing that assumes the inclusion of all services described in the RFP and all appendices. Please be specific and comprehensive - this fee template will be included as a contract addendum. | ||
| Contract Term | Contract Term should cover the Transition Period (from Start Date to final Go-Live Date) and include pricing for the initial 5-year contract period. | ||
| Pricing Validity | Quoted pricing should be valid up to contract execution. | ||
| Pricing for Performance Guarantees | Pricing should assume that your organization can meet or exceed the performance standards as stated in Exhibit A - Performance Guarantees. | ||
| Pricing for Services | Pricing should assume that your organization can meet or exceed the servicing expectations as stated in your proposed Statement of Work. Any and all exceptions must be noted. Fees should exclude commissions or other direct or indirect compensation as applicable. | ||
| Populations and Assumptions | Current population, transaction, and other landscape information has been provided within B2 - Volumes & Quantities. Please list any assumptions relevant to your proposal and fees in this fee response. | ||
| Pass-Through Expenses | Specify all expenses included as 'pass-through' within your fee proposal (e.g., postage, travel, telecom, etc.). | ||
| Inflation | Do not include any assumptions regarding inflation within your fee estimate. | ||
| Taxes | Do not include any taxes (federal, state, or otherwise) within your fee estimate. | ||
| Data History Conversion | |||
| and Retention | Assume historical data conversion lookbacks commensurate with items F.2.12 and F.2.13 of the RFP. Minimum retention of 8 years of data and documentation beginning with Go-Live date. |
Definitions
| Terms and Definitions | |
| Please complete each worksheet by inputting the total costs in each of the shaded cells. The costs should be entered into the appropriate column based on the following: | |
| One Time | Costs that will occur only once. If the timing of these fees is other than the commencement of the implementation services, please indicate the timing. |
| Periodic | Costs that may occur on some routine or non-routine basis, but are not part of the recurring costs. Examples include software maintenance costs, changes to systems or operations due to plan changes, and new legislation. If you have periodic charges that are part of your ongoing service delivery (such as software maintenance), please indicate the nature, frequency and timing of this type of charge. |
| Recurring | Includes all of the administrative services that will be provided on an ongoing (annual) basis. Unless otherwise noted it will be assumed that all fees identified as 'Recurring' will be incurred in each year of the contract term. |
| Per Transaction | Indicate any transaction-based costs that may occur as a result of client or Participant requests. These amounts will be multiplied by the estimated volumes indicated in the pricing template counts column of the fee template. |
| Per Member | Fees that are based off of member counts. These fees should be expressed as a Per Member Per Month (PMPM) figure. |
| Comments | Include any specific assumptions used in fees quoted for any particular line item(s). If any of the above listed fees are variable during the course of the proposed contract term, specify the time period for which they will be held constant as well as a description of proposed variations. |
| For the purposes of this Fee Response Schedule the following definitions are provided: | |
| Transition, Conversion and Implementation | Refers to all activities required to support the transition of services onto your organization's administration platform. |
| Ongoing Administration | Refers to all benefits administration activities defined within the Statements of Work to be provided to the State of Illinois. |
Initial Term Fees
Request for Proposal - Benefits Administration Solution
| Fees | ||||||||||
| ONE TIME | Recurring | Frequency (select from dropdown) | TOTAL RECURRING | Per Transaction (PT) | Counts | TOTAL PT | Per Member Per Month (PMPM) | Counts | TOTAL PMPM | |
| Transition, Conversion, and Implementation | ||||||||||
| The State of Illinois desires transparency on implementation costs. Please provide your costs here, and show Recurring fees below. |
Note that the State of Illinois expects that you will maintain dedicated resources for the implementation duration without change orders being assessed for any delays.
| Ongoing Administration | Population Range | PMPM Rate | Comments (if applicable) | ||||
| All required services (as specified in the Statement of Work) | x | = | $ - 0 | Tier 1 | XXX,000 - YYY,000 | ||
| Tier 2 | XXX,000 - YYY,000 | ||||||
| Tier 3 | XXX,000 - YYY,000 | ||||||
| Tier 4 | XXX,000 - YYY,000 | ||||||
| Tier 5 | XXX,000 - YYY,000 |
| Tier 3 Rate at Contract Outset: | ||
| $ - 0 | x | 277,300 |
Sestak, Tom J: Sestak, Tom J:
Approximate Member count as of April 1, 2024.
McIlhenny, Shane: PMPM Tiered Pricing Provide tiered pricing based on population ranges. State of IL expects to be charged for the full population within one tier, with Tier 3 as the tier for the population at contract outset. = $ - 0
| Additional Fees | |||||||||
| FSA Administration - Health Care | x | = | $ - 0 | x | = | $ - 0 | x | = | $ - 0 |
| FSA Administration - Dependent Care | x | = | $ - 0 | x | = | $ - 0 | x | = | $ - 0 |
| FSA Administration - Transportation | x | = | $ - 0 | x | = | $ - 0 | x | = | $ - 0 |
| COBRA Administration | x | = | $ - 0 | x | = | $ - 0 | x | = | $ - 0 |
| QMCSO Services | x | = | $ - 0 | x | = | $ - 0 | x | = | $ - 0 |
| Call Center | x | = | $ - 0 | x | = | $ - 0 | x | = | $ - 0 |
| Call Center - Language Line | x | = | $ - 0 | x | = | $ - 0 | x | = | $ - 0 |
| Call Center - Chat | x | = | $ - 0 | x | = | $ - 0 | x | = | $ - 0 |
| Call Center - Advocacy | x | = | $ - 0 | x | = | $ - 0 | x | = | $ - 0 |
| Additional Ongoing Administration | |||||||||
| Annual Enrollment - Active Full Enrollment | x | = | $ - 0 | x | = | $ - 0 | x | = | $ - 0 |
| Direct Billing Administration | x | = | $ - 0 | x | = | $ - 0 | x | = | $ - 0 |
| ACA Form Preparation and Filing | x | = | $ - 0 | x | = | $ - 0 | x | = | $ - 0 |
| Other Services and Fees (please specify) | |||||||||
| Other 1 | x | = | $ - 0 | x | = | $ - 0 | x | = | $ - 0 |
| Other 2 | x | = | $ - 0 | x | = | $ - 0 | x | = | $ - 0 |
| Other 3 | x | = | $ - 0 | x | = | $ - 0 | x | = | $ - 0 |
| Billing Rates (for any hourly/time-and-materials work) | |
| ` | Leadership/Implementation Management |
| Project Management | |
| Technology | |
| Business Analyst/Operations | |
| Customer Service, Processing Assistants | |
| Other Role 1 | |
| Other Role 2 | |
| Other Role 3 | |
| Change Order Fee (if any) | |
| Are these rates guaranteed for the life of the contract? Please respond below. |
| TOTALS | Total One-Time | Total Recurring | Total PT | Total PMPY | Total By Fee Category |
| Total Transition, Conversion, and Implementation | $ - 0 | $ - 0 | |||
| Total Ongoing Administration | $ - 0 | $ - 0 | $ - 0 | ||
| Total Additional Fees | $ - 0 | $ - 0 | $ - 0 | $ - 0 | |
| Total Other Services and Fees | $ - 0 | $ - 0 | $ - 0 | $ - 0 |
Total By Fee Type $ - 0 $ - 0 $ - 0 $ - 0
| Fees by Contract Year | |||||
| Year 1 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 |
| Year 2 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | |
| Year 3 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | |
| Year 4 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | |
| Year 5 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | |
| CONTRACT TOTALS | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 |
Comments/Clarifications
Renewal Fees
Request for Proposal - Benefits Administration Solution
| Renewal Fees - For each contract renewal year the maximum renewal rates will be calculated as the applicable rate for the immediately preceding contract year times the lesser of (a) 3% or (b) the annual Consumer Price Index Inflation factor. For the purpose of this Contract, the Consumer Price Index Inflation factor shall be developed from the “Consumer Price Index Urban Wage Earners and Clerical Workers”: All items are as published by the U.S Department of Labor, Bureau of Labor Statistics. | |||||||||||||
| Recurring | Frequency (select from dropdown) | TOTAL RECURRING | Per Transaction (PT) | Counts | TOTAL PT | Per Member Per Month (PMPM) | Counts | TOTAL PMPM | |||||
| Ongoing Administration | Population Range | PMPM Rate | Comments (if applicable) | ||||||||||
| All required services (as specified in the Statement of Work) | x | = | $ - 0 | Tier 1 | XXX,000 - YYY,000 | ||||||||
| Tier 2 | XXX,000 - YYY,000 | ||||||||||||
| Tier 3 | XXX,000 - YYY,000 | ||||||||||||
| Tier 4 | XXX,000 - YYY,000 | ||||||||||||
| Tier 5 | XXX,000 - YYY,000 |
| Tier 3 Rate at Contract Outset: | ||
| $ - 0 | x | 277,300 |
Sestak, Tom J: Sestak, Tom J:
Approximate Member count as of April 1, 2024.
McIlhenny, Shane: PMPM Tiered Pricing Provide tiered pricing based on population ranges. State of IL expects to be charged for the full population within one tier, with Tier 3 as the tier for the population at contract outset. = $ - 0
| Additional Fees | |||||||||
| FSA Administration - Health Care | x | = | $ - 0 | x | = | $ - 0 | x | = | $ - 0 |
| FSA Administration - Dependent Care | x | = | $ - 0 | x | = | $ - 0 | x | = | $ - 0 |
| FSA Administration - Transportation | x | = | $ - 0 | x | = | $ - 0 | x | = | $ - 0 |
| COBRA Administration | x | = | $ - 0 | x | = | $ - 0 | x | = | $ - 0 |
| QMCSO Services | x | = | $ - 0 | x | = | $ - 0 | x | = | $ - 0 |
| Call Center | x | = | $ - 0 | x | = | $ - 0 | x | = | $ - 0 |
| Call Center - Language Line | x | = | $ - 0 | x | = | $ - 0 | x | = | $ - 0 |
| Call Center - Chat | x | = | $ - 0 | x | = | $ - 0 | x | = | $ - 0 |
| Call Center - Advocacy | x | = | $ - 0 | x | = | $ - 0 | x | = | $ - 0 |
| Additional Ongoing Administration | |||||||||
| Annual Enrollment - Active Full Enrollment | x | = | $ - 0 | x | = | $ - 0 | x | = | $ - 0 |
| Direct Billing Administration | x | = | $ - 0 | x | = | $ - 0 | x | = | $ - 0 |
| ACA Form Preparation and Filing | x | = | $ - 0 | x | = | $ - 0 | x | = | $ - 0 |
| Other Services and Fees (please specify) | |||||||||
| Other 1 | x | = | $ - 0 | x | = | $ - 0 | x | = | $ - 0 |
| Other 2 | x | = | $ - 0 | x | = | $ - 0 | x | = | $ - 0 |
| Other 3 | x | = | $ - 0 | x | = | $ - 0 | x | = | $ - 0 |
| Billing Rates (for any hourly/time-and-materials work) | |
| ` | Leadership Management |
| Project Management | |
| Technology | |
| Business Analyst/Operations | |
| Customer Service, Processing Assistants | |
| Other Role 1 | |
| Other Role 2 | |
| Other Role 3 | |
| Change Order Fee (if any) | |
| Are these rates guaranteed for the life of the contract? Please respond below. |
| TOTALS | Total Recurring | Total PT | Total PMPY | Total By Fee Category |
| Total Ongoing Administration | $ - 0 | $ - 0 | $ - 0 | |
| Total Additional Fees | $ - 0 | $ - 0 | $ - 0 | $ - 0 |
| Total Other Services and Fees | $ - 0 | $ - 0 | $ - 0 | $ - 0 |
Total By Fee Type $ - 0 $ - 0 $ - 0
| Fees by Contract Year | ||||
| Year 6 | $ - 0 | $ - 0 | $ - 0 | $ - 0 |
| Year 7 | $ - 0 | $ - 0 | $ - 0 | $ - 0 |
| Year 8 | $ - 0 | $ - 0 | $ - 0 | $ - 0 |
| Year 9 | $ - 0 | $ - 0 | $ - 0 | $ - 0 |
| Year 10 | $ - 0 | $ - 0 | $ - 0 | $ - 0 |
| CONTRACT TOTALS | $ - 0 | $ - 0 | $ - 0 | $ - 0 |
Comments/Clarifications image1.png
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