Government_response_to_offeror_questions.pdf

*Responses are provided as information only. In the event of any conflict between the information contained in the responses and the solicitation, the terms and conditions contained in the solicitation will prevail.

# RFQ Section Question Response Change to RFP?

Description of Change

1 Attachments For the forms that require completion (example, attachment 9 and 5) do you have writeable versions of the form? The #9 form looks like it requires to be completed on the form but its current file format does not allow the answers to be saved. Also, can you please post an Excel Version of the census? I believe all the replying carriers will require this data in excel in order to run their pricing and also the GEO Access reports.

The Government has posted writeable versions of Attachments 1 and 5 as attachments to this RFP amendment. The version of Attachment 9 that was posted with the RFP is a fillable PDF.

No. N/A

2 B.3 Will the OCC consider a shorter term, firm fixed price contract in lieu of 10-year one?

Typical dental contracts are generally three years in length; however, we are able to offer up to five years. A three-year contract is standard in the dental industry because a lengthy rating period requires the dental insurer to predict rates for an extended period of time.

As this time lengthens, the ability to predict these rates (based on actual utilization experience, economic conditions, etc.)

diminishes significantly and results in higher risk to the insurer. The result is higher rates for the later option periods for the customer. The “negotiated rates” in option periods 2-9 could marginally minimize insurer risk, however; the aforementioned ability to predict rates for later option periods remains. The higher out-year premiums we’ve described as related to a longer contract are essentially unaffected by the “negotiated rates” feature. We can offer the

Based on market research, the OCC believes a ten-year contract is in its best interest.

No. N/A

*Responses are provided as information only. In the event of any conflict between the information contained in the responses and the solicitation, the terms and conditions contained in the solicitation will prevail.

OCC more competitive and accurate rates with a firm, fixed price contract length of five years or less. We are very interested in participating in this procurement, and welcome any conversation regarding this issue.

3 Attachment 2 Would the OCC consider a prospective, fully insured funding arrangement in lieu of the Premium Stabilization Reserve (PSR) requirement for excess margin? United Concordia does not offer this funding arrangement. PSR funding arrangements are options designed to fund medical plans and are not needed for dental insurance because the dental industry does not experience the large, high-cost claims that can be incurred in medical plans. Dental plan maximums negate the need for a PSR arrangement. This type of requirement will reduce procurement competition and the ability for the OCC to benefit from insurer experience, plan options, and competitive rates.

No, the Government will not consider a different funding arrangement.

No. N/A

4 C.2.8 Funding What is the estimated PSR balance as of 1/1/2015 and will the balance, if any, be transferred to a new carrier?

The most current PSR balance that the Government can provide at this time is the latest settlement balance as of 12/31/2012 which is $1,473,016.

Yes, whatever the PSR balance is as a result of the 12/31/2014 settlement will be transferred to the new contract and the Government will transfer the

No N/A

*Responses are provided as information only. In the event of any conflict between the information contained in the responses and the solicitation, the terms and conditions contained in the solicitation will prevail.

amount to the new carrier. In accordance with the PSR agreement between the Government and its current carrier, any balance in the PSR will be transferred within 210 days from the date of contract termination.

5 Attachment 2 – Exhibit 2 of the

PWS PSR

Agreement

If a PSR balance is transferred to a new carrier, will the carrier be able to recoup any base and/or option year deficits from the transferred balance?

No. Any remaining funds from the PSR from this current contract can only be used by the OCC to “buy down” a rate increase.

No. N/A

6 C.2.9 – Plan Design

Will the OCC entertain alternative PPO/DHMO plan designs in addition to the requested plans?

As stated in Section C.2.9 Plan Design of the RFP (page 11), “The contractor must offer a PPO option as designed above and the contractor must offer a DHMO option with a fee schedule or an alternative dental option that will offer employees a “choice” in the type of dental option that will meet their family needs.”

(Emphasis added)

Yes To make it clearer, language about a DHMO alternative has been added to section B.2, Pricing Schedule for Dental Insurance Program and Section L.12.2 Volume 2, Tab B – Price Proposal Spreadsheet.

7 C.2.9 – Plan Design

What is OCC program management’s strategy for offering a “choice” of different options? Is the objective to offer an inexpensive option for Retirees or is there a specific need that the OCC program management has heard from the population?

The Government’s strategy for offering its employees a “choice” in dental options is a result of employee demand.

Retirees are offered the same PPO plan design as active employees.

No. N/A

8 C.2.9 – Plan Design

Can plan certificates be supplied for both plans? The RFP has been updated to include the PPO coverage certificate only. The DHMO

Yes The Government has added this information as an

*Responses are provided as information only. In the event of any conflict between the information contained in the responses and the solicitation, the terms and conditions contained in the solicitation will prevail.

coverage certificate is not available at this time.

attachment to the amended RFP, Attachment 12 – 2014 Dental DPPO Coverage Certificate.

9 Attachment 1 – Exhibit 1 of the PWS, Employee Census

Can the enrolled plan (PPO/DHMO) and an active/retiree (A/R) status indicator be added to the census?

The Government has revised the census data for OCC active employees (only) to include their plan election (PPO/DHMO).

Non-disabled retirees can only enroll in the PPO option.

Yes The Government has revised Attachment 1 to include this information.

10 B.3 CLIN

Description and Arrangement, Attachment 8 – Price Proposal Spreadsheet

Attachment 8 - requests firm fixed prices by PPO & DHMO options for the base period and 9 option periods (pages 1 – 10) and subsequently requests total program cost with rate caps (11 – 13). This seems to be a potential conflict with Section B.3 which states “Contract options 2 through 9 may increase only by mutual agreement of the parties through negotiations, but no higher than the not-to-exceed amount (i.e., price cap)” as well as the PSR Agreement (Attachment 2) which states:

The Contractor will provide a renewal based on the group’s claims experience at least 60 days prior to the end of the policy year. The new renewal rates will take effect at the beginning of the next policy year.

Is it OCC’s intent when carriers complete Attachment 8 that they set firm-fixed rates that generate premium that matches the price caps, or are they to set firm-fixed rates that will generate premium that is their best

The offerors are to establish firm fixed rates based on the estimated number of employees/retirees found in Column C of the worksheet, Rate Proposal, found in Attachment 8 – Dental Insurance Proposal Spreadsheet (e.g., 3877 employees/retirees for PPO composite rates). Beginning with option period 2, the offeror shall set a price cap (in terms of a percentage) for the firm fixed rate (e.g., 2%). Prior to option exercise (if it is to be exercised), the Government and the contractor will negotiate that year’s firm fixed rate, which will not exceed the price cap.

For example, if the offeror proposed a firm fixed rate of $100

*Responses are provided as information only. In the event of any conflict between the information contained in the responses and the solicitation, the terms and conditions contained in the solicitation will prevail.

approximation of needed premium, but will later, during the actual contract period, be allowed to reset those rates higher, up to the price caps?

Can you please clarify the questions above?

We also note that it is generally not customary for a rate cap arrangement to be extended beyond 2 or 3 years. To address this, would it be acceptable for the “cap” and renewal methodology to be formulaic? In other words, may the contractor propose a fixed price for the base period and then propose a specific methodology or formula for how the following option year period premium would be determined? One example of this methodology would be as follows: For each Option Period, the contractor would apply an inflation factor to the prior Option Period rate based on the change in the average Dental Consumer Price Index (CPI) over the preceding 12 months combined with the actual utilization trend over the preceding 12 months (i.e., number of procedures divided by number of members).

Expenses would be determined by using a tolerable loss ratio expressed as a percentage.

The result of this calculation in each option period would serve as the rate “cap.”

Please comment on whether a formulaic renewal methodology such as the one mentioned above would be sufficient to determine either rates, rate caps, or both rates and rate caps for the option period years. If this is acceptable, is it acceptable to use this for the composite PPO and a firm fixed rate cap of 2%, for option 2 the firm fixed rate will be $102 (2% higher than the previous year). Prior to exercising option 2, the Government and contractor will negotiate that year’s firm fixed rate, which cannot exceed $102.

Per the instructions in the RFP for Volume 2, Tab B, the offeror may propose a different pricing methodology, but shall explain the different methodology in its pricing narrative (Volume 2, Tab A).

*Responses are provided as information only. In the event of any conflict between the information contained in the responses and the solicitation, the terms and conditions contained in the solicitation will prevail.

methodology for all option period years?

11 Attachment 3 –

Exhibit 3 of the PWS 5-Year Claims History

Can OCC provide claims paid and premium paid on a monthly basis as well as the associated lives that tie to Attachment 3 – Exhibit 3?

The Government cannot provide data as requested; however, Attachment 3 has been revised to include the headcount as of the end of each year.

Yes The Government has revised Attachment 3 to include this information.

12 Attachment 3 – Exhibit 3 of the PWS 5-Year Claims History

Is exhibit 3 reflecting both PPO and DHMO program experience? If only PPO, can DHMO experience be supplied as well?

Attachment 3 reflects claims experience only for the PPO option. Claims experience is unavailable for the DHMO option.

No. N/A

13 Page 60, #5 of RFP, GEO Access

Can you please provide an excel version of the census

Please see response to question #1.

No N/A

14 Page 60, #5 of RFP, Geo Access

Please confirm you are looking for % of employees with access to 3 in network dentists within 5 miles and % of employees with access to 5 in network dentists within 10 miles.

Please clarify what you mean by “Three Geographical Matches” specific to this request.

Using the census data:

First match: identify the employees (in terms of a percent of the total amount of OCC employees) that have access to at least 3 network providers within a five-mile radius. Second match:

identify the employees (in terms of a percent of the total amount of OCC employees) that have access to at least 6 network providers within a ten-mile radius. Third match: Identify the employees (in terms of a percent of the total amount of OCC employees) that do not meet either criteria.

Yes Additional information added to RFP section Volume 1, Tab B – Contractor’s Experience/Technica l Capability, (Evaluation Factor

1) for clarity.

15 Page 28 or RFP, III. ADDITIONAL

REQUIREMENTS

The RFP makes reference to attachment 10 but the document we received for the security self-assessment is labeled as attachment 9. Is this a typo or does a separate attachment 10 exist?

That was a typo and has been corrected in the amended version of the RFP.

Yes The typo was corrected in the amended RFP.

*Responses are provided as information only. In the event of any conflict between the information contained in the responses and the solicitation, the terms and conditions contained in the solicitation will prevail.

III. ADDITIONAL REQUIREMENTS

(1) The service provider shall have fully completed, attested to, and submitted to the CO the OCC’s Service Provider Self-Assessment (OCC Form CC 9070-02) provided as Attachment 10 of the contract, prior to the execution of the contract.

Attachment 10 – Annual NIST 800-53 Security Self-Assessment

16 Page 10 of RFP, c29 Plan Design

In addition to the price and confirm of matching the current plan design as RFP requests can we also propose a 2nd alternate recommended design that may better promote healthy living and price for the OCC to consider? Can we simply include a 2nd completed pricing file for this alternative?

Yes, in addition to what is required in the RFP, any proposal can include an alternative option to the plan design for consideration by the Government;

however, any narrative to explain this alternative option is included in the page count.

No. N/A

17 G.2(a), P.20

Is it our understanding that the only key personnel identified in the RFP is for the Account Manager?

Yes, the only key personnel for this requirement is the account manager (and its alternate).

No N/A

18 V1.Tab D P. 62

Are the resumes required only for the Account Manager and the alternate?

Yes, résumés are only required for the proposed account manager and the proposed alternate.

No N/A

19 C.2.7 P.8

Is current enrollment by plan design (PPO/DHMO) and by state available? The census provided does not include this information.

The census data contains each person’s home city/state/zip code but it has been revised to include the dental option (PPO/DHMO) in which the employee is currently enrolled.

Yes Attachment 1 has been revised to include this information.

20 C.2.9 P. 10

PPO/DHMO – Can a complete benefit description of the current PPO and DHMO plans including Limitations and Exclusions be provided?

The requested documents are being provided as attachments to the RFP.

Yes A summary of the 2014 Dental PPO has been added as Attachment 10 and

*Responses are provided as information only. In the event of any conflict between the information contained in the responses and the solicitation, the terms and conditions contained in the solicitation will prevail.

the 2014 Dental DHMO Fee Schedule has been added as Attachment 11.

21 ATT 3

For each year of claims history shown, can the total 12 month enrollment or average enrollment for enrolled Active, Disable Retirees and Non-Disabled Retirees be provided? In addition, can the monthly claims data be provided for each year?

Claims history is only captured for the PPO option and the Government can provide the number enrolled as of December of each claims year for OCC active employees, disabled retirees and non-disabled retirees.

The Government cannot provide monthly claims data for each year at this time.

Yes. Attachment 3 has been revised to include the number of people enrolled as of December of each claims year for OCC active employees, disabled retirees, and non-disabled retirees.

22 Attachment1, Exhibit 1

The census file was provided in a pdf file. Please provide the census file in an excel format to include active/retiree status, date of birth, zip codes and enrollment by tier.

Please see response to questions #1.

No N/A

23 Attachment 3, Exhibit 3

Claim data submitted was in aggregate without enrollment. Please provide month by month paid claim and enrollment data for the last 24 months.

The OCC is unable to provide claims data month by month;

however, please refer to the response to question #11.

No N/A

24 Attachment 2, Exhibit 2

Does the participating arrangement apply to the

DHMO?

No. No N/A

25 Please provide the average discount to claims. The average discount is 35 – 40 percent.

No N/A

26 Attachment_8, Dental Insurance Price Proposal

The DHMO headcount differs in C.2.7 Current Participation Headcount than what is shown on Attachment 8 – Price Proposal Spreadsheet. DHMO family coverage in C.2.7 reflects 126 family. DHMO family coverage in Attachment 8 reflects 118. Please advise which

Please use the numbers in the table found in section C.2.7 of the

RFP.

Yes The price spreadsheet has been revised and provided as an attachment to the amended RFP.

*Responses are provided as information only. In the event of any conflict between the information contained in the responses and the solicitation, the terms and conditions contained in the solicitation will prevail.

exhibit is correct.

27 Attachment_8, Dental Insurance Price Proposal

Attachment 8 – Price Proposal Spreadsheet indicates that there are a total of 3948 enrolled in the PPO. The total on the requested 3 tier rates only reflects 514 enrolled. Please provide the correct enrollment by tier for the requested 3 tier rates.

PPO 3-tier rates is for non-disabled retirees only; therefore, the numbers found in Attachment 8 correspond with the numbers found in section C.2.7 of the RFP.

No N/A

28 Please provide the Certificate of coverage for the PPO plan.

Please refer to the response to question #8.

N/A

29 Please advise if Periodontics is covered under Basic or Major services for the PPO plan.

Periodontics is covered under Basic services for the PPO plan.

No N/A

30 Please provide the out of network reimbursement for the PPO plan (i.e. 80th 85th, MAC, etc.).

Out of network reimbursement for the PPO option is at the 90th percentile.

No N/A

31 Please advise if Orthodontia is covered for both child and adult for the PPO plan. Or is Orthodontia for child only?

Orthodontia is covered for both children and adults for the PPO plan.

No N/A

32 L.12.1.2

TECHNICAL,

PAST

PERFORMANCE,

AND KEY

PERSONNEL

(ORAL

PRESENTATION)

VOLUME 2, TAB

A –

TRANSMITTAL

LETTER AND

EXECUTIVE

SUMMARY/PRIC

ING NARRATIVE

EXECUTIVE

1. Signed copies of the SF-1449 and all SF-30s (amendments) We did not find the requested documents in the RFP. Please provide.

The SF-1449 is the first two pages of the RFP. SF-30s are for if the RFP is amended and has been included with this amendment.

*Responses are provided as information only. In the event of any conflict between the information contained in the responses and the solicitation, the terms and conditions contained in the solicitation will prevail.

SUMMARY/

PRICING

NARRATIVE