Attachment_8_-_Dental_Insurance_Price_Proposal_Spreadsheet_(revised).xlsx

XLSX spreadsheet 30 KB Posted Jun 24, 2014

Attached to: Dental Insurance Program Federal contract opportunity
Solicitation number: CC14HQR0010
Issued by: Department of the Treasury Office of the Comptroller of the Currency

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Attachment 6 - RFP ATtachment 8 - Price Proposal Spreadsheet (revised)

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Other files for this federal contract opportunity

Other files attached to Dental Insurance Program, newest first.
File	Type	Posted
Dental_Insurance_RFP_Amendment_0001.pdf	PDF	Jun 24, 2014
Government_response_to_offeror_questions.pdf	PDF	Jun 24, 2014
Attachment_1_-_PWS_Exhibit_1_-_Census_Data_(revised).xlsx	XLSX spreadsheet	Jun 24, 2014
Dental_Insurance_RFP_Amendment_0001_(with_track_changes).pdf	PDF	Jun 24, 2014
Attachment_10_-_2014_Dental_PPO_Summary.pdf	PDF	Jun 24, 2014
Attachment_11_-_2014_Dental_DHMO_Fee_Schedule.pdf	PDF	Jun 24, 2014
CC14HQR0010_Amendment_0001 _Dental_Insurance _SF_30.pdf	PDF	Jun 24, 2014
Attachment_3_-_PWS_Exhibit_3_-_Claims_History_(Revised).xlsx	XLSX spreadsheet	Jun 24, 2014
Attachment_12_-_2014_Dental_DPPO_Coverage_Certificate.pdf	PDF	Jun 24, 2014
Attachment_8_-_Dental_Insurance_Price_Proposal_Spreadsheet.xlsx	XLSX spreadsheet	Jun 12, 2014
Attachment_9_-_Annual_NIST_800-53_Security_Self-Assessment.pdf	PDF	Jun 12, 2014
Attachment_2_-_PWS_Exhibit_2_-_PSR_Agreement.pdf	PDF	Jun 12, 2014
Attachment_5_-_IT_Accessibility_Questionnaire.pdf	PDF	Jun 12, 2014
Attachment_3_-_PWS_Exhibit_3_-_Claims_History.pdf	PDF	Jun 12, 2014
Attachment_7_-_Past_Performance_Questionnaires.pdf	PDF	Jun 12, 2014
Attachment_1_-_PWS_Exhibit_1_-_Census_Data.pdf	PDF	Jun 12, 2014
Attachment_6_-_Questions_Form.docx	DOCX document	Jun 12, 2014
Attachment_4_-_Non-Disclosure_Agreement.pdf	PDF	Jun 12, 2014
Dental_Insurance_RFP_CC14HQR0010.pdf	PDF	Jun 12, 2014

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Rate Proposal Attachment 8 - Price Proposal Spreadsheet

Transition Period: Date of award through December 31, 2014
CLIN	Description	Price
0001	Transition Period - Enrolling employees into plan	Not separately priced

Base Period: January 1, 2015 through December 31, 2015
CLIN	Description	Estimated # of employees/ retirees (Qty)	Firm-fixed rate	Estimated Monthly Premium	Estimated Annual Premium (12 months)
PPO COMPOSITE RATES
0002	PPO OCC and OFR active employees, OCC disabled retirees - Composite	3877		$ - 0	$ - 0
PPO Composite Rate Total					$ - 0
PPO 2-TIER RATES
0003	PPO OCC and OFR Active Employees, OCC disabled retirees - Employee only	1280		$ - 0	$ - 0
0004	PPO OCC and OFR Active Employees, OCC disabled retirees - Family	2784		$ - 0	$ - 0
PPO 2-Tier Rate Total					$ - 0
PPO 3-TIER RATES
0005	PPO OCC non-disabled retirees - Employee only	195		$ - 0	$ - 0
0006	PPO OCC non-disabled retirees - 2 person	278		$ - 0	$ - 0
0007	PPO OCC non-disabled retirees - Family	41		$ - 0	$ - 0
PPO 3-Tier Rate Total					$ - 0
DHMO COMPOSITE RATES
0008	DHMO OCC and OFR active employees, OCC disabled retirees - Composite	207		$ - 0	$ - 0
DHMO Composite Rate Total					$ - 0
DHMO 2-TIER RATES
0009	PPO OCC and OFR Active Employees, OCC disabled retirees - Employee only	83		$ - 0	$ - 0
0010	PPO OCC and OFR Active Employees, OCC disabled retirees - Family	124		$ - 0	$ - 0
DHMO 2-Tier Rate Total					$ - 0
Option Period 1: January 1, 2016 through December 31, 2016
CLIN	Description	Estimated # of employees/ retirees (Qty)	Firm-fixed rate	Estimated Monthly Premium	Estimated Annual Premium (12 months)
PPO COMPOSITE RATES
0011	PPO OCC and OFR active employees, OCC disabled retirees - Composite	3877		$ - 0	$ - 0
PPO Composite Rate Total					$ - 0
PPO 2-TIER RATES
0012	PPO OCC and OFR Active Employees, OCC disabled retirees - Employee only	1280		$ - 0	$ - 0
0013	PPO OCC and OFR Active Employees, OCC disabled retirees - Family	2784		$ - 0	$ - 0
PPO 2-Tier Rate Total					$ - 0
PPO 3-TIER RATES
0014	PPO OCC non-disabled retirees - Employee only	195		$ - 0	$ - 0
0015	PPO OCC non-disabled retirees - 2 person	278		$ - 0	$ - 0
0016	PPO OCC non-disabled retirees - Family	41		$ - 0	$ - 0
PPO 3-Tier Rate Total					$ - 0
DHMO COMPOSITE RATES
0017	DHMO OCC and OFR active employees, OCC disabled retirees - Composite	207		$ - 0	$ - 0
DHMO Composite Rate Total					$ - 0
DHMO 2-TIER RATES
0018	PPO OCC and OFR Active Employees, OCC disabled retirees - Employee only	83		$ - 0	$ - 0
0019	PPO OCC and OFR Active Employees, OCC disabled retirees - Family	124		$ - 0	$ - 0
DHMO 2-Tier Rate Total					$ - 0
Option Period 2: January 1, 2017 through December 31, 2017
CLIN	Description	Estimated # of employees/ retirees (Qty)	Firm-fixed rate	Estimated Monthly Premium	Estimated Annual Premium (12 months)
PPO COMPOSITE RATES
0020	PPO OCC and OFR active employees, OCC disabled retirees - Composite	3877		$ - 0	$ - 0
PPO Composite Rate Total					$ - 0
PPO 2-TIER RATES
0021	PPO OCC and OFR Active Employees, OCC disabled retirees - Employee only	1280		$ - 0	$ - 0
0022	PPO OCC and OFR Active Employees, OCC disabled retirees - Family	2784		$ - 0	$ - 0
PPO 2-Tier Rate Total					$ - 0
PPO 3-TIER RATES
0023	PPO OCC non-disabled retirees - Employee only	195		$ - 0	$ - 0
0024	PPO OCC non-disabled retirees - 2 person	278		$ - 0	$ - 0
0025	PPO OCC non-disabled retirees - Family	41		$ - 0	$ - 0
PPO 3-Tier Rate Total					$ - 0
DHMO COMPOSITE RATES
0026	DHMO OCC and OFR active employees, OCC disabled retirees - Composite	207		$ - 0	$ - 0
DHMO Composite Rate Total					$ - 0
DHMO 2-TIER RATES
0027	PPO OCC and OFR Active Employees, OCC disabled retirees - Employee only	83		$ - 0	$ - 0
0028	PPO OCC and OFR Active Employees, OCC disabled retirees - Family	124		$ - 0	$ - 0
DHMO 2-Tier Rate Total					$ - 0
The price cap for option period 2 is ____%.
Option Period 3: January 1, 2018 through December 31, 2018
CLIN	Description	Estimated # of employees/ retirees (Qty)	Firm-fixed rate	Estimated Monthly Premium	Estimated Annual Premium (12 months)
PPO COMPOSITE RATES
0029	PPO OCC and OFR active employees, OCC disabled retirees - Composite	3877		$ - 0	$ - 0
PPO Composite Rate Total					$ - 0
PPO 2-TIER RATES
0030	PPO OCC and OFR Active Employees, OCC disabled retirees - Employee only	1280		$ - 0	$ - 0
0031	PPO OCC and OFR Active Employees, OCC disabled retirees - Family	2784		$ - 0	$ - 0
PPO 2-Tier Rate Total					$ - 0
PPO 3-TIER RATES
0032	PPO OCC non-disabled retirees - Employee only	195		$ - 0	$ - 0
0033	PPO OCC non-disabled retirees - 2 person	278		$ - 0	$ - 0
0034	PPO OCC non-disabled retirees - Family	41		$ - 0	$ - 0
PPO 3-Tier Rate Total					$ - 0
DHMO COMPOSITE RATES
0035	DHMO OCC and OFR active employees, OCC disabled retirees - Composite	207		$ - 0	$ - 0
DHMO Composite Rate Total					$ - 0
DHMO 2-TIER RATES
0036	PPO OCC and OFR Active Employees, OCC disabled retirees - Employee only	83		$ - 0	$ - 0
0037	PPO OCC and OFR Active Employees, OCC disabled retirees - Family	124		$ - 0	$ - 0
DHMO 2-Tier Rate Total					$ - 0
The price cap for option period 3 is ____%.
Option Period 4: January 1, 2019 through December 31, 2019
CLIN	Description	Estimated # of employees/ retirees (Qty)	Firm-fixed rate	Estimated Monthly Premium	Estimated Annual Premium (12 months)
PPO COMPOSITE RATES
0038	PPO OCC and OFR active employees, OCC disabled retirees - Composite	3877		$ - 0	$ - 0
PPO Composite Rate Total					$ - 0
PPO 2-TIER RATES
0039	PPO OCC and OFR Active Employees, OCC disabled retirees - Employee only	1280		$ - 0	$ - 0
0040	PPO OCC and OFR Active Employees, OCC disabled retirees - Family	2784		$ - 0	$ - 0
PPO 2-Tier Rate Total					$ - 0
PPO 3-TIER RATES
0041	PPO OCC non-disabled retirees - Employee only	195		$ - 0	$ - 0
0042	PPO OCC non-disabled retirees - 2 person	278		$ - 0	$ - 0
0043	PPO OCC non-disabled retirees - Family	41		$ - 0	$ - 0
PPO 3-Tier Rate Total					$ - 0
DHMO COMPOSITE RATES
0044	DHMO OCC and OFR active employees, OCC disabled retirees - Composite	207		$ - 0	$ - 0
DHMO Composite Rate Total					$ - 0
DHMO 2-TIER RATES
0045	PPO OCC and OFR Active Employees, OCC disabled retirees - Employee only	83		$ - 0	$ - 0
0046	PPO OCC and OFR Active Employees, OCC disabled retirees - Family	124		$ - 0	$ - 0
DHMO 2-Tier Rate Total					$ - 0
The price cap for option period 4 is ____%.
Option Period 5: January 1, 2020 through December 31, 2020
CLIN	Description	Estimated # of employees/ retirees (Qty)	Firm-fixed rate	Estimated Monthly Premium	Estimated Annual Premium (12 months)
PPO COMPOSITE RATES
0047	PPO OCC and OFR active employees, OCC disabled retirees - Composite	3877		$ - 0	$ - 0
PPO Composite Rate Total					$ - 0
PPO 2-TIER RATES
0048	PPO OCC and OFR Active Employees, OCC disabled retirees - Employee only	1280		$ - 0	$ - 0
0049	PPO OCC and OFR Active Employees, OCC disabled retirees - Family	2784		$ - 0	$ - 0
PPO 2-Tier Rate Total					$ - 0
PPO 3-TIER RATES
0050	PPO OCC non-disabled retirees - Employee only	195		$ - 0	$ - 0
0051	PPO OCC non-disabled retirees - 2 person	278		$ - 0	$ - 0
0052	PPO OCC non-disabled retirees - Family	41		$ - 0	$ - 0
PPO 3-Tier Rate Total					$ - 0
DHMO COMPOSITE RATES
0053	DHMO OCC and OFR active employees, OCC disabled retirees - Composite	207		$ - 0	$ - 0
DHMO Composite Rate Total					$ - 0
DHMO 2-TIER RATES
0054	PPO OCC and OFR Active Employees, OCC disabled retirees - Employee only	83		$ - 0	$ - 0
0055	PPO OCC and OFR Active Employees, OCC disabled retirees - Family	124		$ - 0	$ - 0
DHMO 2-Tier Rate Total					$ - 0
The price cap for option period 5 is ____%.
Option Period 6: January 1, 2021 through December 31, 2021
CLIN	Description	Estimated # of employees/ retirees (Qty)	Firm-fixed rate	Estimated Monthly Premium	Estimated Annual Premium (12 months)
PPO COMPOSITE RATES
0056	PPO OCC and OFR active employees, OCC disabled retirees - Composite	3877		$ - 0	$ - 0
PPO Composite Rate Total					$ - 0
PPO 2-TIER RATES
0057	PPO OCC and OFR Active Employees, OCC disabled retirees - Employee only	1280		$ - 0	$ - 0
0058	PPO OCC and OFR Active Employees, OCC disabled retirees - Family	2784		$ - 0	$ - 0
PPO 2-Tier Rate Total					$ - 0
PPO 3-TIER RATES
0059	PPO OCC non-disabled retirees - Employee only	195		$ - 0	$ - 0
0060	PPO OCC non-disabled retirees - 2 person	278		$ - 0	$ - 0
0061	PPO OCC non-disabled retirees - Family	41		$ - 0	$ - 0
PPO 3-Tier Rate Total					$ - 0
DHMO COMPOSITE RATES
0062	DHMO OCC and OFR active employees, OCC disabled retirees - Composite	207		$ - 0	$ - 0
DHMO Composite Rate Total					$ - 0
DHMO 2-TIER RATES
0063	PPO OCC and OFR Active Employees, OCC disabled retirees - Employee only	83		$ - 0	$ - 0
0064	PPO OCC and OFR Active Employees, OCC disabled retirees - Family	124		$ - 0	$ - 0
DHMO 2-Tier Rate Total					$ - 0
The price cap for option period 6 is ____%.
Option Period 7: January 1, 2022 through December 31, 2022
CLIN	Description	Estimated # of employees/ retirees (Qty)	Firm-fixed rate	Estimated Monthly Premium	Estimated Annual Premium (12 months)
PPO COMPOSITE RATES
0065	PPO OCC and OFR active employees, OCC disabled retirees - Composite	3877		$ - 0	$ - 0
PPO Composite Rate Total					$ - 0
PPO 2-TIER RATES
0066	PPO OCC and OFR Active Employees, OCC disabled retirees - Employee only	1280		$ - 0	$ - 0
0067	PPO OCC and OFR Active Employees, OCC disabled retirees - Family	2784		$ - 0	$ - 0
PPO 2-Tier Rate Total					$ - 0
PPO 3-TIER RATES
0068	PPO OCC non-disabled retirees - Employee only	195		$ - 0	$ - 0
0069	PPO OCC non-disabled retirees - 2 person	278		$ - 0	$ - 0
0070	PPO OCC non-disabled retirees - Family	41		$ - 0	$ - 0
PPO 3-Tier Rate Total					$ - 0
DHMO COMPOSITE RATES
0071	DHMO OCC and OFR active employees, OCC disabled retirees - Composite	207		$ - 0	$ - 0
DHMO Composite Rate Total					$ - 0
DHMO 2-TIER RATES
0072	PPO OCC and OFR Active Employees, OCC disabled retirees - Employee only	83		$ - 0	$ - 0
0073	PPO OCC and OFR Active Employees, OCC disabled retirees - Family	124		$ - 0	$ - 0
DHMO 2-Tier Rate Total					$ - 0
The price cap for option period 7 is ____%.
Option Period 8: January 1, 2023 through December 31, 2023
CLIN	Description	Estimated # of employees/ retirees (Qty)	Firm-fixed rate	Estimated Monthly Premium	Estimated Annual Premium (12 months)
PPO COMPOSITE RATES
0074	PPO OCC and OFR active employees, OCC disabled retirees - Composite	3877		$ - 0	$ - 0
PPO Composite Rate Total					$ - 0
PPO 2-TIER RATES
0075	PPO OCC and OFR Active Employees, OCC disabled retirees - Employee only	1280		$ - 0	$ - 0
0076	PPO OCC and OFR Active Employees, OCC disabled retirees - Family	2784		$ - 0	$ - 0
PPO 2-Tier Rate Total					$ - 0
PPO 3-TIER RATES
0077	PPO OCC non-disabled retirees - Employee only	195		$ - 0	$ - 0
0078	PPO OCC non-disabled retirees - 2 person	278		$ - 0	$ - 0
0079	PPO OCC non-disabled retirees - Family	41		$ - 0	$ - 0
PPO 3-Tier Rate Total					$ - 0
DHMO COMPOSITE RATES
0080	DHMO OCC and OFR active employees, OCC disabled retirees - Composite	207		$ - 0	$ - 0
DHMO Composite Rate Total					$ - 0
DHMO 2-TIER RATES
0081	PPO OCC and OFR Active Employees, OCC disabled retirees - Employee only	83		$ - 0	$ - 0
0082	PPO OCC and OFR Active Employees, OCC disabled retirees - Family	124		$ - 0	$ - 0
DHMO 2-Tier Rate Total					$ - 0
The price cap for option period 8 is ____%.
Option Period 9: January 1, 2024 through December 31, 2024
CLIN	Description	Estimated # of employees/ retirees (Qty)	Firm-fixed rate	Estimated Monthly Premium	Estimated Annual Premium (12 months)
PPO COMPOSITE RATES
0083	PPO OCC and OFR active employees, OCC disabled retirees - Composite	3877		$ - 0	$ - 0
PPO Composite Rate Total					$ - 0
PPO 2-TIER RATES
0084	PPO OCC and OFR Active Employees, OCC disabled retirees - Employee only	1280		$ - 0	$ - 0
0085	PPO OCC and OFR Active Employees, OCC disabled retirees - Family	2784		$ - 0	$ - 0
PPO 2-Tier Rate Total					$ - 0
PPO 3-TIER RATES
0086	PPO OCC non-disabled retirees - Employee only	195		$ - 0	$ - 0
0087	PPO OCC non-disabled retirees - 2 person	278		$ - 0	$ - 0
0088	PPO OCC non-disabled retirees - Family	41		$ - 0	$ - 0
PPO 3-Tier Rate Total					$ - 0
DHMO COMPOSITE RATES
0089	DHMO OCC and OFR active employees, OCC disabled retirees - Composite	207		$ - 0	$ - 0
DHMO Composite Rate Total					$ - 0
DHMO 2-TIER RATES
0090	PPO OCC and OFR Active Employees, OCC disabled retirees - Employee only	83		$ - 0	$ - 0
0091	PPO OCC and OFR Active Employees, OCC disabled retirees - Family	124		$ - 0	$ - 0
DHMO 2-Tier Rate Total					$ - 0
The price cap for option period 9 is ____%.

Summary Price Sheet

Scenario 1 - PPO composite, PPO 3-tier, DHMO composite
Year	Previous Year's Cost	Price Cap (%)	Price Cap ($)	Estimated Annual Premium
Base - 2015
Option 1 - 2016
Option 2 - 2017	$0.00		$0.00	$0.00
Option 3 - 2018	$0.00		$0.00	$0.00
Option 4 - 2019	$0.00		$0.00	$0.00
Option 5 - 2020	$0.00		$0.00	$0.00
Option 6 - 2021	$0.00		$0.00	$0.00
Option 7 - 2022	$0.00		$0.00	$0.00
Option 8 - 2023	$0.00		$0.00	$0.00
Option 9 - 2024	$0.00		$0.00	$0.00
Total 10-Year NTE Price				$ - 0

Scenario 2 - PPO composite, PPO 3-tier, DHMO 2-tier
Year	Previous Year's Cost	Price Cap (%)	Price Cap ($)	Estimated Annual Premium
Base - 2015
Option 1 - 2016
Option 2 - 2017	$0.00		$0.00	$0.00
Option 3 - 2018	$0.00		$0.00	$0.00
Option 4 - 2019	$0.00		$0.00	$0.00
Option 5 - 2020	$0.00		$0.00	$0.00
Option 6 - 2021	$0.00		$0.00	$0.00
Option 7 - 2022	$0.00		$0.00	$0.00
Option 8 - 2023	$0.00		$0.00	$0.00
Option 9 - 2024	$0.00		$0.00	$0.00
Total 10-Year NTE Price				$ - 0

Scenario 3 - PPO 2-tier, PPO 3-tier, DHMO composite
Year	Previous Year's Cost	Price Cap (%)	Price Cap ($)	Estimated Annual Premium
Base - 2015
Option 1 - 2016
Option 2 - 2017	$0.00		$0.00	$0.00
Option 3 - 2018	$0.00		$0.00	$0.00
Option 4 - 2019	$0.00		$0.00	$0.00
Option 5 - 2020	$0.00		$0.00	$0.00
Option 6 - 2021	$0.00		$0.00	$0.00
Option 7 - 2022	$0.00		$0.00	$0.00
Option 8 - 2023	$0.00		$0.00	$0.00
Option 9 - 2024	$0.00		$0.00	$0.00
Total 10-Year NTE Price				$ - 0

Scenario 4 - PPO 2-tier, PPO 3-tier, DHMO 2-tier
Year	Previous Year's Cost	Price Cap (%)	Price Cap ($)	Estimated Annual Premium
Base - 2015
Option 1 - 2016
Option 2 - 2017	$0.00		$0.00	$0.00
Option 3 - 2018	$0.00		$0.00	$0.00
Option 4 - 2019	$0.00		$0.00	$0.00
Option 5 - 2020	$0.00		$0.00	$0.00
Option 6 - 2021	$0.00		$0.00	$0.00
Option 7 - 2022	$0.00		$0.00	$0.00
Option 8 - 2023	$0.00		$0.00	$0.00
Option 9 - 2024	$0.00		$0.00	$0.00
Total 10-Year NTE Price				$ - 0

Example Summary Price Sheet

Year	Previous Year's Cost	Price Cap (%)	Price Cap ($)	Estimated Maximum Annual Premium
Base - 2015				$5,000,000.00
Option 1 - 2016				$5,000,000.00
Option 2 - 2017	$5,000,000.00	2%	$100,000.00	$5,100,000.00
Option 3 - 2018	$5,100,000.00	2%	$102,000.00	$5,202,000.00
Option 4 - 2019	$5,202,000.00	2%	$104,040.00	$5,306,040.00
Option 5 - 2020	$5,306,040.00	2%	$106,120.80	$5,412,160.80
Option 6 - 2021	$5,412,160.80	2%	$108,243.22	$5,520,404.02
Option 7 - 2022	$5,520,404.02	2%	$110,408.08	$5,630,812.10
Option 8 - 2023	$5,630,812.10	2%	$112,616.24	$5,743,428.34
Option 9 - 2024	$5,743,428.34	2%	$114,868.57	$5,858,296.91
Total 10-Year NTE Price				$53,773,142.16

File details come from the government source that posted it. Updated Nov 14, 2017.