CFHRB-15-SO-0132_A001.pdf

CFHRB-15-SO-0132 A001

CONTINUATION PAGE

The purpose of this amendment is to change the terms and conditions of Request For Proposals (RFP) CFHRB-15-SO-0132 and to provide answers to questions received. This amendment also extends the due date for receipt of proposals.

Accordingly;

1. The due date and time for receipt of proposals is hereby extended to July 6, 2015, at 12:00 p.m. local

(Washington, DC) time. All references in the RFP to the due date and time for receipt of proposals are hereby changed to reflect this new date and time.

2. Under RFP Part I “STATEMENT OF WORK”, “Requirements”, subsection 1 “Administrative and

Enrollment Services” (RFP pg. 3) is hereby amended to incorporate the following change.

Delete:

• As requested by CFTC, assist in the communication to employees regarding benefits, including initial employee meetings at Headquarters in Washington, DC; Chicago, IL; Kansas City, MO;

and New York, NY.

Insert:

• As requested by CFTC, assist in the communication to employees regarding benefits, including initial employee meetings at Headquarters in Washington, DC, as well as at CFTC’s Regional Offices in Chicago, IL; Kansas City, MO; and New York, NY. CFTC anticipates that the contractor will be required to provide one on-site briefing at each of CFTC’s Regional Offices.

Additionally, CFTC anticipates requiring the contractor to provide 2 – 3 on-site briefings at CFTC’s Headquarters, with the Regional Offices also participating in the Headquarters sessions via video teleconferencing.

3. Clause II.12 “NON-DISCLOSURE OF CONFIDENTIAL INFORMATION – DENTAL

INSURANCE PLAN” is hereby amended to incorporate the following changes.

Insert: “ (f) Within thirty (30) days of the conclusion of all services under the contract, the contractor shall securely destroy or return to the CFTC all CFTC confidential information, at the CFTC’s election, except that the contractor may retain one (1) copy of records related to the procurement process and written deliverables if necessary for the contractor’s recordkeeping purposes. If the CFTC elects for the contractor to destroy the CFTC confidential information, the contractor shall confirm secure destruction in writing within thirty (30) days of the CFTC’s request.”

The existing paragraph (f) in the clause is hereby changed to paragraph (g).

4. Clause II.17 “MINIMUM INSURER FINANCIAL RATING / PREMIUM SIZE” (RFP pg. 20) is hereby amended to incorporate the following change.

Delete: “In lieu of being rated by one or more of these financial agencies, the contractor must have an annual premium volume of $1 billion or more as documented in the contractor’s annual report.”

Insert: “In lieu of being rated by one or more of these financial agencies, the contractor must have an annual premium volume of $1 billion or more as documented in the contractor’s annual report or other sources deemed acceptable by the Contracting Officer (e.g., audited financial statements).”

5. Provision III.2 “ADDENDUM TO FAR 52.212-1 ‘INSTRUCTIONS TO OFFEROR—

COMMERCIAL ITEMS (APR 2014)’” (RFP pg. 29) is hereby amended to incorporate the following change.

Delete: “The following provisions are incorporated into this solicitation as addenda to FAR provision 52.212-1, “Instructions to Offerors–Commercial Items (Apr 2014)”. These provisions replace sections (b), (c), (e) and (f) of provision 52.212-1.”

Insert: “The following provisions are incorporated into this solicitation as addenda to FAR provision 52.212-1, “Instructions to Offerors–Commercial Items (Apr 2014)”. These provisions replace sections (b), (c) and (e) of provision 52.212-1.”

6. Subsection 2.2 “TIME, DATE AND PLACE PROPOSALS ARE DUE” of provision III.2

“ADDENDUM TO FAR 52.212-1 ‘INSTRUCTIONS TO OFFEROR—COMMERCIAL ITEMS

(APR 2014)’” (pg. 30) is hereby amended to incorporate the following change.

Delete: “ (c) Proposals received after the time and dates specified above will not be accepted unless the Contracting Officer determines that acceptance of the proposal is in the Government’s best interest and will not unduly delay the acquisition.”

Insert: “ (c) Proposals received after the time and date specified above will not be considered unless the requirements specified in paragraph (f) “Late submissions, modifications, revisions, and withdrawals of offers” of FAR provision 52.212-1 are met. For proposals submitted by email, CFTC reserves the right to remove the proposal from further consideration if the content of the email is not retrievable and /or the hard copy package [i.e., one (1) full set of all proposal volumes, and two (2) original-signed copies of the Standard Form 1449] is not received at the location shown above within three (3) business days after the proposal due date. Emailed proposals shall not require CFTC to install/execute any programs to view the information, and shall be in a format viewable by CFTC. CFTC is able to view information using the Microsoft Office suite of software, as well as in .pdf format.

7. List of attachments for this amendment:

Attachment I – Current Dental Plan Certificate

Attachment II – Updated Claims (Monthly Utilization) with In and Out-of Network Usage

8. Questions and answers are as follows:

Q1. I am a broker that represents several large insurance carriers, and would like to bid on this project. Do I need to meet the minimum financial/premium requirements of the RFP, or is it sufficient for the underlying insurance provider to meet them?

A. The concern that is awarded the contract shall meet the minimum financial rating and/or premium size requirements stated in solicitation clause II.17 “Minimum Insurer Financial Rating / Premium Size”. “[C]oncern that is awarded the contract” means the entity that directly enters into the contract with the Government (i.e., the prime contractor).

Q2. Why is CFTC out to bid?

A. The incumbent contract with MetLife will expire on January 9, 2016.

Q3. How long has Commodity Futures Trading Commission been with MetLife?

A. MetLife has been CFTC’s dental insurance provider since January 2, 2011.

Q4. Are any commissions requested?

A. No. The contract will be net of commissions.

Q5. Is Commodity Futures Trading Commission ERISA or Non-ERISA?

A. Per the Office of Personnel Management, CFTC is exempt from ERISA.

Q6. Have you had any plan changes in the past 12 months?

A. No.

Q7. Please provide the current and renewal rates.

A. The rate increases and claims experience were included in the “Enroll_Claims” worksheet tab of RFP Attachment A (“Dental Plan Proposal Package”). CFTC will not release the premium rates of the incumbent contract.

Q8. What is the CFTC SIC code?

A. North American Industry Classification System (NAICS) codes have replaced the Standard Industrial Classification (SIC) codes. The NAICS code that CFTC would most logically fit within is 926140 – Regulation of Agricultural Marketing and Commodities.

Q9. The RFP indicates enrollment meetings will be held in several cities. How many meetings will be held in each city? What is the average attendance to meetings held in various locations?

A. CFTC anticipates that the contractor will be required to provide one on-site briefing at

CFTC’s Regional Offices in Chicago, IL; Kansas City, MO; and New York, NY. CFTC also anticipates requiring the contractor to provide 2 – 3 on-site briefings at CFTC’s Headquarters in Washington, DC, with the Regional Offices also participating in the Headquarters sessions via video teleconferencing. Please see the applicable change to the Statement of Work described earlier in this amendment. CFTC does not have anticipated average attendance projections for each location. However, the CFTC census data identifies the duty location for each employee.

Q10. In the questionnaire section of the RFP’s Attachment A (Dental Plan Proposal Package), the below contract dates are specified. These appear to be incorrect. Can you please clarify?

Projected contract terms shall be as follows:

Year 1: 01/10/2016 - 01/07/2017 Year 2: 01/08/2017 - 01/06/2018 Year 3: 01/07/2018 - 01/05/2019 Year 4: 01/06/2019 - 01/04/2020 Year 5: 01/05/2020 - 01/02/2021

A. The effective dates for the five years contained in RFP Attachment A (“Dental Plan

Proposal Package”) are correct. The contract periods will track the Federal leave year. The first day of pay period 1 of the 2016 Federal leave year is January 10, 2016. That is also the first day after the January 9, 2016, expiration date of the incumbent MetLife contract.

The dates described above for the subsequent contract years also track the respective succeeding Federal leave year dates.

Q11. We are confused by the dates set below in the grid for contract years 1-5. They do not seem to be correct. We have highlighted a few as an example. Please clarify these dates. Also, what is meant by “Estimated Total”?

CONTRACT YEAR 1*: Effective Date of Award through January 7, 2017 Fixed Unit Price (individual only) $_____ per employee / biweekly Fixed Unit Price (individual & family) $_____ per employee / biweekly BASE PERIOD: Effective Date of Award through September 30, 2016 Estimated Total: _____________ (Actual will be determined based on enrollment) OPTION PERIOD I: October 1, 2016 through January 7, 2017 Estimated Total: _____________ (Actual will be determined based on enrollment)

CONTRACT YEAR 2: January 8, 2017 through January 6, 2018

A. Please see the answer to question no. Q10. The contract periods will track the Federal leave year. For contract funding purposes, each contract year is separated into two periods to account for the Federal fiscal year annual start date of October 1st.

Q12. The RFP states that coverage begins a few days after January 1st of each year. Would it be acceptable for coverage to begin on January 1st of each year and continue through December 31st of that same year (a 12 month period)?

A. No. CFTC will not consider proposals where the coverage periods are not aligned with the contract years identified in the RFP (i.e., the Federal leave years). CFTC has determined this to be necessary because the selected contractor will be paid on a bi-weekly (i.e., pay period) basis. Additionally, the plan design requires the effective date of coverage for employee enrollment status changes to be the first pay period following the status change.

Converting to a calendar year basis is not possible, given these requirements.

Q13. How does the self-billed premium remittance work? We understand that employees are enrolled by CFTC. If the employee elects family coverage, he/she must complete an enrollment form and submit it to the contractor. How does CFTC know to send a family premium to the contractor? Is there a defined reconciliation process with CFTC?

A. Any employee enrolling or changing enrollment tier must submit an enrollment form to

CFTC’s Human Resources Branch (HRB). CFTC’s HRB then processes the election. For all new enrollments and enrollment tier changes, a second action is processed by CFTC’s payroll provider (USDA’s National Finance Center) to implement the change for payment purposes. The dental plan contractor will be required to provide CFTC with a monthly enrollment report that accounts for the covered participants in the plan, including enrollment tier. CFTC will monitor these reports for reconciliation purposes.

Q14. Please confirm that a non-officer individual with the authority to bind a contract is sufficient to sign all applicable signature documents required for this RFP submission.

A. Applicable signature documents required by the RFP (e.g., SF 1449) shall be signed by a person authorized to bind the offeror. Please see Federal Acquisition Regulation (FAR) Section 4.102 for the contractor’s signature requirements.

Q15. Reference section 2.4 Proposal Form and Content on page 31 – Please confirm that if we choose to email the proposal, we can provide all 3 volumes in 1 binder.

A. CFTC requires proposals to be submitted in three physically separate written volumes.

Email submissions of proposals shall contain separate files for each written volume.

Q16. Please confirm that the 2-page limit on page 33 is only specific to the section (i) Corporate Experience and Past Performance.

A. The 2-page limit on page 33 is specific to section (i) Corporate Experience and Past

Performance. Information provided on the five allowed clients (i.e., projects) shall be limited to 2 pages each. Offerors are reminded that information contained on a partial page will be counted as a full page toward the applicable page limit.

Q17. Please confirm that in order to minimize printing, we can provide large attachments and requested samples and brochures on CD-ROM (e.g., GeoAccess Reports, Disruption Report).

A. Large attachments and requested samples and brochures may be provided on a CD-ROM, provided that CFTC is not required to install/execute any programs from the CD-ROM to view the information. CFTC is able to view information using the Microsoft Office suite of software, as well as in .pdf format.

Q18. Please provide a complete SPD document for the current dental benefit program. This will help us complete our deviations review.

A. The current dental plan certificate is furnished as Attachment I to this amendment.

Q19. What percent of claims paid are being paid to in-network providers? I.E., what is the in-network utilization for the current plan?

A. The requested information is included in Attachment II to this amendment.

Q20. The plan design summary lists periodontal prophylaxis as a covered benefit in the Class I category. Is there any annual limit on the number to be received in a calendar year? Is the number of perio prophies combined with the number of regular prophylaxis visits per calendar year?

A. Periodontal maintenance is limited to two times in any year, less the number of teeth cleanings received during such year.

Q21. Are posterior composite restorations (white fillings on rear molars) a covered benefit? Or, are composite restorations limited to the anterior teeth?

A. The current dental plan certificate does not distinguish between anterior versus exterior, but composite fillings are covered as class II. The certificate notes that when an amalgam filling and a composite filling are both professionally acceptable methods for filling a molar, the plan may base the benefit determination upon the amalgam filling which is the less costly.

Q22. Is orthodontic care a covered benefit for adults? Or, is orthodontic care limited to children only?

A. Adult orthodontia is a covered benefit under the plan.

Q23. Attachment A has 3 Reimbursement tabs labeled: Best Discount, Lesser Discount and No Discount. What are the requested differences between these 3 tabs and how would you distinguish the difference?

A. The Best Discount is the offeror’s best network which it is quoting. The Lesser Discount only applies if the offeror supplements its primary network with a secondary network with lesser discounts. No discount is for non-participating providers.

Q24. Could you please provide the updated claims for April and May?

A. The requested information is included in Attachment II to this amendment.

Q25. Please confirm the out of network Reasonable and Customary (R&C) reimbursement percentage level.

A. The out of network R&C (i.e., usual and customary) reimbursement percentage level is

90% of allowable expenses. Please see the Plan Design tab of RFP Attachment A (“Dental Plan Proposal Package”), which states the following for “Plan Reimbursement”:

Plan reimburses specified percentage of allowable expenses, based on class of expense.

Allowable expenses will be based on the 90th percentile of Usual and Customary. In-network reimbursement will be based on negotiated fee schedules.

Q26. Attachment A, Questionnaire Section V, question 13 – “Percent of specialists who are board certified in network by type.” Is this asking for the percentage of specialists in our network that are board certified or the percentage of each specialist type that are in our network? For example, if we have a specialist network of 100 specialists that contains 20 endodontists, who are all board certified, should we put 100% (because all endodontists are board certified) or should we put 20% because 20% of our specialist network contains board certified endodontists?

A. The cited question is seeking to know the percentage of specialists in the network that are board certified. Therefore, the maximum total across all specialist types should not exceed 100%. In the example provided above, the answer would be 20%.

Q27. Is it possible to receive reports on maximum usage by range of dollars for the corresponding period?

A. The requested information is not available. However, provided below is information on the status of enrollees with respect to the annual maximums.

Reached $1,401 to $1,500 of $1,500 Annual Maximum

Reached Lifetime $1,500 Ortho Maximum

Employee 31 Employee 17 Spouse 8 Spouse 9

Dependent 6 Dependent 94

TOTAL 45 TOTAL 120

END OF AMENDMENT A001 TO SOLICITATION CFHRB-15-SO-0132

Certificate Number 1

YOUR BENEFIT PLAN

Commodity Futures Trading Commission (CFTC)

All Employees

Dental Insurance for You and Your Dependents

Certificate Date: January 2, 2011 wroberson Typewritten Text Attachment I to Amendment A001 of CFHRB-15-SO-0132

1155 21st Street, N.W.

Washington, DC 20581

TO OUR EMPLOYEES:

All of us appreciate the protection and security insurance provides.

This certificate describes the benefits that are available to you. We urge you to read it carefully.

GCERT2000

fp 1

Metropolitan Life Insurance Company 200 Park Avenue, New York, New York 10166

CERTIFICATE OF INSURANCE

Metropolitan Life Insurance Company (“MetLife”), a stock company, certifies that You and Your Dependents are insured for the benefits described in this certificate, subject to the provisions of this certificate. This certificate is issued to You under the Group Policy and it includes the terms and provisions of the Group Policy that describe Your insurance. PLEASE READ THIS CERTIFICATE CAREFULLY.

This certificate is part of the Group Policy. The Group Policy is a legal contract between MetLife and the Policyholder and may be changed or ended without Your consent or notice to You.

Policyholder: Commodity Futures Trading Commission (CFTC)

Group Policy Number:

146197-1-G

Type of Insurance: Dental Insurance

MetLife Toll Free Number(s):

For Claim Information FOR DENTAL CLAIMS: 1-800-942-0854

THIS CERTIFICATE ONLY DESCRIBES DENTAL INSURANCE.

THE BENEFITS OF THE POLICY PROVIDING YOU COVERAGE ARE GOVERNED PRIMARILY BY THE

LAWS OF A STATE OTHER THAN FLORIDA.

THE GROUP INSURANCE POLICY PROVIDING COVERAGE UNDER THIS CERTIFICATE WAS ISSUED

IN A JURISDICTION OTHER THAN MARYLAND AND MAY NOT PROVIDE ALL THE BENEFITS

REQUIRED BY MARYLAND LAW.

WE ARE REQUIRED BY STATE LAW TO INCLUDE THE NOTICE(S) WHICH APPEAR ON THIS PAGE

AND IN THE NOTICE(S) SECTION WHICH FOLLOWS THIS PAGE. PLEASE READ THE(SE) NOTICE(S)

CAREFULLY.

notice/tx 2

For Texas Residents:

IMPORTANT NOTICE

To obtain information or make a complaint:

You may call MetLife’s toll free telephone number for information or to make a complaint at

1-800-942-0854

You may contact the Texas Department of Insurance to obtain information on companies, coverages, rights or complaints at

1-800-252-3439

You may write the Texas Department of Insurance P.O. Box 149104 Austin, TX 78714-9104 Fax # (512) 475-1771 Web: http://www.tdi.state.tx.us

Email: ConsumerProtection@tdi.state.tx.us

PREMIUM OR CLAIM DISPUTES: Should You have a dispute concerning Your premium or about a claim, You should contact MetLife first. If the dispute is not resolved, You may contact the Texas Department of Insurance.

ATTACH THIS NOTICE TO YOUR CERTIFICATE:

This notice is for information only and does not become a part or condition of the attached document.

Para Residentes de Texas:

AVISO IMPORTANTE

Para obtener información o para someter una queja:

Usted puede llamar al numero de teléfono gratis de MetLife para información o para someter una queja al

1-800-942-0854

Puede comunicarse con el Departamento de Seguros de Texas para obtener información acerca de compañías, coberturas, derechos o quejas al

1-800-252-3439

Puede escribir al Departamento de Seguros de Texas P.O. Box 149104 Austin, TX 78714-9104 Fax # (512) 475-1771 Web: http://www.tdi.state.tx.us

Email: ConsumerProtection@tdi.state.tx.us

DISPUTAS SOBRE PRIMAS O RECLAMOS: Si tiene una disputa concerniente a su prima o a un reclamo, debe comunicarse con MetLife primero. Si no se resuelve la disputa, puede entonces comunicarse con el departamento (TDI).

UNA ESTE AVISO A SU CERTIFICADO:

Este aviso es solo para propósito de información y no se convierte en parte o condición del documento adjunto.

notice/childdef 3

NOTICE FOR RESIDENTS OF LOUISIANA, MINNESOTA, MONTANA, NEW MEXICO,

TEXAS, AND UTAH

The Definition Of Child Is Modified For The Coverages Listed Below:

For Louisiana Residents (Dental Insurance):

The term also includes Your grandchildren residing with You. The age limit for children and grandchildren will not be less than 26, regardless of the child’s or grandchild’s marital status, student status or full-time employment status. Your natural child, adopted child, stepchild or grandchild under age 26 will not need to be supported by You to qualify as a Child under this insurance. In addition, marital status will not prevent or cease the continuation of insurance for a mentally or physically handicapped child or grandchild past the age limit.

For Minnesota Residents (Dental Insurance):

The term also includes Your grandchildren who are financially dependent upon You and reside with You continuously from birth. The age limit for children and grandchildren will not be less than 25 regardless of the child’s or grandchild’s student status or full-time employment status. Your natural child, adopted child or stepchild under age 25 will not need to be supported by You to qualify as a Child under this insurance.

For Montana Residents (Dental Insurance):

The term also includes newborn infants of any person insured under this certificate. The age limit for children will not be less than 25, regardless of the child’s student status or full-time employment status. Your natural child, adopted child or stepchild under age 25 will not need to be supported by You to qualify as a child under this insurance.

For New Mexico Residents (Dental Insurance):

The age limit for children will not be less than 25, regardless of the child’s student status or full-time employment status. Your natural child, adopted child or stepchild will not be denied dental insurance coverage under this certificate because:

• that child was born out of wedlock;

• that child is not claimed as Your dependent on Your federal income tax return; or

• that child does not reside with You.

For Texas Residents (Dental Insurance):

The term also includes Your grandchildren. The age limit for children and grandchildren will not be less than 25, regardless of the child’s or grandchild’s student status, full-time employment status or military service status.

Your natural child, adopted child or stepchild under age 25 will not need to be supported by You to qualify as a Child under this insurance. In addition, grandchildren must be able to be claimed by You as a dependent for Federal Income Tax purposes at the time You applied for Insurance.

For Utah Residents (Dental Insurance):

The age limit for children will not be less than 26, regardless of the child’s student status or full-time employment status. Your natural child, adopted child or stepchild under age 26 will not need to be supported by You to qualify as a Child under this insurance.

DENTAL INSURANCE: PROCEDURES FOR DENTAL CLAIMS

notice/denc/tx 4

NOTICE FOR RESIDENTS OF TEXAS

If You reside in Texas, note the following Procedures for Dental Claims will be followed:

Procedures for Presenting Claims for Dental Insurance Benefits

All claim forms needed to file for Dental Insurance benefits under the group insurance program can be obtained from the Employer who can also answer questions about the insurance benefits and to assist You or, if applicable, Your beneficiary in filing claims. Dental claim forms can also be downloaded from www.metlife.com/dental. The instructions on the claim form should be followed carefully. This will expedite the processing of the claim. Be sure all questions are answered fully.

Routine Questions on Dental Insurance Claims

If there is any question about a claim payment, an explanation may be requested from MetLife by dialing 1-800- 942-0854.

Claim Submission

For claims for Dental Insurance benefits, the claimant must complete the appropriate claim form and submit the required proof as described in the FILING A CLAIM section of the certificate.

Claim forms must be submitted in accordance with the instructions on the claim form.

Initial Determination

After You submit a claim for Dental Insurance benefits to MetLife, MetLife will notify You acknowledging receipt of Your claim, commence with any investigation, and request any additional information within 15 days of receipt of Your claim.

MetLife will notify You in writing of the acceptance or rejection of Your claim within 15 business days of receipt of all information needed to process Your claim.

If MetLife cannot accept or reject Your claim within 15 business days after receipt of all information, MetLife will notify You within 15 business days stating the reason why we require an extension. If an extension is requested, We will notify You of our decision to approve or deny Your claim within 45 days. Upon notification of approval, Your claim will be paid within 5 business days.

If MetLife denies Your claim in whole or in part, the notification of the claims decision will state the reason why Your claim was denied and reference the specific Plan provision(s) on which the denial is based. If the claim is denied because MetLife did not receive sufficient information, the claims decision will describe the additional information needed and explain why such information is needed. Further, if an internal rule, protocol, guideline or other criterion was relied upon in making the denial, the claims decision will state the rule, protocol, guideline or other criteria or indicate that such rule, protocol, guideline or other criteria was relied upon and that You may request a copy free of charge.

Appealing the Initial Determination

If MetLife denies Your claim, You may take two appeals of the initial determination. Upon Your written request, MetLife will provide You free of charge with copies of documents, records and other information relevant to Your claim. You must submit Your appeal to MetLife at the address indicated on the claim form within 180 days of receiving MetLife’s decision. Appeals must be in writing and must include at least the following information:

• Name of Employee

• Name of the Plan

• Reference to the initial decision

• Whether the appeal is the first or second appeal of the initial determination

• An explanation why You are appealing the initial determination.

DENTAL INSURANCE: PROCEDURES FOR DENTAL CLAIMS (continued) notice/denc/tx 5

As part of each appeal, You may submit any written comments, documents, records, or other information relating to Your claim.

After MetLife receives Your written request appealing the initial determination or determination on the first appeal, MetLife will conduct a full and fair review of Your claim. Deference will not be given to initial denials, and MetLife’s review will look at the claim anew. The review on appeal will take into account all comments, documents, records, and other information that You submit relating to Your claim without regard to whether such information was submitted or considered in the initial determination. The person who will review Your appeal will not be the same person as the person who made the initial decision to deny Your claim. In addition, the person who is reviewing the appeal will not be a subordinate of the person who made the initial decision to deny Your claim. If the initial denial is based in whole or in part on a medical judgment, MetLife will consult with a health care professional with appropriate training and experience in the field of dentistry involved in the judgment. This health care professional will not have consulted on the initial determination, and will not be a subordinate of any person who was consulted on the initial determination.

MetLife will notify You in writing of its final decision within 30 days after MetLife’s receipt of Your written request for review, except that under special circumstances MetLife may have up to an additional 30 days to provide written notification of the final decision. If such an extension is required, MetLife will notify You prior to the expiration of the initial 30 day period, state the reason(s) why such an extension is needed, and state when it will make its determination.

If MetLife denies the claim on appeal, MetLife will send You a final written decision that states the reason(s) why the claim You appealed is being denied and references any specific Plan provision(s) on which the denial is based. If an internal rule, protocol, guideline or other criterion was relied upon in denying the claim on appeal, the final written decision will state the rule, protocol, guideline or other criteria or indicate that such rule, protocol, guideline or other criteria was relied upon and that You may request a copy free of charge.

Upon written request, MetLife will provide You free of charge with copies of documents, records and other information relevant to Your claim.

NOTICE FOR RESIDENTS OF ALL STATES WHO ARE INSURED FOR DENTAL

INSURANCE

notice/denrights 6

Notice Regarding Your Rights and Responsibilities

Rights:

• We will treat communications, financial records and records pertaining to Your care in accordance with all applicable laws relating to privacy.

• Decisions with respect to dental treatment are the responsibility of You and the dentist. We neither require nor prohibit any specified treatment. However, only certain specified services are covered for benefits. Please see the Dental Insurance sections of this certificate for more details.

• You may request a pre-treatment estimate of benefits for the dental services to be provided. However, actual benefits will be determined after treatment has been performed.

• You may request a written response from MetLife to any written concern or complaint.

• You have the right to receive an explanation of benefits which describes the benefit determinations for Your dental insurance.

Responsibilities:

• You are responsible for the prompt payment of any charges for services performed by the dentist. If the dentist agrees to accept part of the payment directly from MetLife, You are responsible for prompt payment of the remaining part of the dentist’s charge.

• You should consult with the dentist about treatment options, proposed and potential procedures, anticipated outcomes, potential risks, anticipated benefits and alternatives. You should share with the dentist the most current, complete and accurate information about Your medical and dental history and current conditions and medications.

• You should follow the treatment plans and health care recommendations agreed upon by You and the dentist.

notice/ar 7

NOTICE FOR RESIDENTS OF ARKANSAS

If You have a question concerning Your coverage or a claim, first contact the Policyholder or group account administrator. If, after doing so, You still have a concern, You may call the toll free telephone number shown on the Certificate Face Page.

If You are still concerned after contacting both the Policyholder and MetLife, You should feel free to contact:

Arkansas Insurance Department Consumer Services Division

1200 West Third Street Little Rock, Arkansas 72201

(501) 371-2640 or (800) 852-5494 notice/ca 8

NOTICE FOR RESIDENTS OF CALIFORNIA

TO OBTAIN ADDITIONAL INFORMATION, OR TO MAKE A COMPLAINT, CONTACT THE

POLICYHOLDER OR THE METLIFE CLAIM OFFICE SHOWN ON THE EXPLANATION OF BENEFITS

YOU RECEIVE AFTER FILING A CLAIM.

IF, AFTER CONTACTING THE POLICYHOLDER AND/OR METLIFE, YOU FEEL THAT A SATISFACTORY

SOLUTION HAS NOT BEEN REACHED, YOU MAY FILE A COMPLAINT WITH THE CALIFORNIA

INSURANCE DEPARTMENT AT:

DEPARTMENT OF INSURANCE

300 SOUTH SPRING STREET

LOS ANGELES, CA 90013

1 (800) 927-4357 notice/ga 9

NOTICE FOR RESIDENTS OF GEORGIA

The laws of the state of Georgia prohibit insurers from unfairly discriminating against any person based upon his or her status as a victim of family violence.

notice/id 10

NOTICE FOR RESIDENTS OF IDAHO

If You have a question concerning Your coverage or a claim, first contact the Policyholder. If, after doing so, You still have a concern, You may call the toll free telephone number shown on the Certificate Face Page.

If You are still concerned after contacting both the Policyholder and MetLife, You should feel free to contact:

Idaho Department of Insurance Consumer Affairs

700 West State Street, 3rd Floor PO Box 83720

Boise, Idaho 83720-0043 1-800-721-3272 or www.DOI.Idaho.gov notice/il 11

NOTICE FOR RESIDENTS OF ILLINOIS

To make a complaint to MetLife, You may write to:

MetLife

200 Park Avenue New York, New York 10166

The address of the Illinois Department of Insurance is:

Illinois Department of Insurance

Public Services Division Springfield, Illinois 62767 notice/ma 12

NOTICE FOR MASSACHUSETTS RESIDENTS

CONTINUATION OF DENTAL INSURANCE

1. If Your Dental Insurance ends due to a Plant Closing or Covered Partial Closing, such insurance will be continued for 90 days after the date it ends.

2. If Your Dental Insurance ends because:

• You cease to be in an Eligible Class; or

• Your employment terminates;

for any reason other than a Plant Closing or Covered Partial Closing, such insurance will continue for 31 days after the date it ends.

Continuation of Your Dental Insurance under the CONTINUATION WITH PREMIUM PAYMENT subsection will end before the end of continuation periods shown above if You become covered for similar benefits under another plan.

Plant Closing and Covered Partial Closing have the meaning set forth in Massachusetts Annotated Laws, Chapter 151A, Section 71A.

CONTINUATION OF DENTAL INSURANCE FOR YOUR FORMER SPOUSE

If the judgment of divorce dissolving Your marriage provides for continuation of insurance for Your former Spouse when You remarry, Dental Insurance for Your former Spouse that would otherwise end may be continued.

To continue Dental insurance under this provision:

1. You must make a written request to the employer to continue such insurance;

2. You must make any required premium to the employer for the cost of such insurance.

The request form will be furnished by the Employer.

Such insurance may be continued from the date Your marriage is dissolved until the earliest of the following:

• the date Your former Spouse remarries;

• the date of expiration of the period of time specified in the divorce judgment during which You are required to provide Dental Insurance for Your former Spouse;

• the date coverage is provided under any other group health plan;

• the date Your former Spouse becomes entitled to Medicare;

• the date Dental Insurance under the policy ends for all active employees, or for the class of active employees to which You belonged before Your employment terminated;

• the date of expiration of the last period for which the required premium payment was made; or

• the date such insurance would otherwise terminate under the policy.

If Your former Spouse is eligible to continue Dental Insurance under this provision and any other provision of this Policy, all such continuation periods will be deemed to run concurrently with each other and shall not be deemed to run consecutively.

NOTICE FOR NEW HAMPSHIRE RESIDENTS

notice/coi/nh 13

CONTINUATION OF YOUR DENTAL INSURANCE

If You are a resident of New Hampshire, Your Dental Insurance may be continued if it ends because Your employment ends unless:

• Your employment ends due to Your gross misconduct;

• this Dental Insurance ends for all employees;

• this Dental Insurance is changed to end Dental Insurance for the class of employees to which You belong;

• You are entitled to enroll in Medicare; or

• Your Dental Insurance ends because You failed to pay the required premium.

The Employer must give You written notice of:

• Your right to continue Your Dental Insurance;

• the amount of premium payment that is required to continue Your Dental Insurance;

• the manner in which You must request to continue Your Dental Insurance and pay premiums; and

• the date by which premium payments will be due.

The premium that You must pay for Your continued Dental Insurance may include:

• any amount that You contributed for Your Dental Insurance before it ended;

• any amount the Employer paid; and

• an administrative charge which will not to exceed two percent of the rest of the premium.

To continue Your Dental Insurance, You must:

• send a written request to continue Your Dental Insurance; and

• pay the first premium within 30 days after the date Your employment ends.

The maximum continuation period will be the longest of:

• 36 months if Your employment ends because You retire, and within 12 months of retirement You have a substantial loss of coverage because the employer files for bankruptcy protection under Title 11 of the United States Code;

• 29 months if You become entitled to disability benefits under Social Security within 60 days of the date Your Employment ends; or

• 18 months.

Your continued Dental Insurance will end on the earliest of the following to occur:

• the end of the maximum continuation period;

• the date this Dental Insurance ends;

• the date this Dental Insurance is changed to end Dental Insurance for the class of employees to which You belong;

• the date You are entitled to enroll for Medicare;

• if You do not pay the required premium to continue Your Dental Insurance; or

• the date You become eligible for coverage under any other group dental coverage.

NOTICE FOR NEW HAMPSHIRE RESIDENTS (continued) notice/coi/nh 14

CONTINUATION OF YOUR DEPENDENT’S DENTAL INSURANCE

If You are a resident of New Hampshire, Your Dental Insurance for Your Dependents may be continued if it ends because Your employment ends, Your marriage ends in divorce or separation, or You die, unless:

• Your employment ends due to Your gross misconduct;

• this Dental Insurance ends for all Dependents;

• this Dental Insurance is changed, for the class of employees to which You belong, to end Dental Insurance for Dependents;

• the Dependent is entitled to enroll in Medicare; or

• Your Dental Insurance for Your Dependents ends because You fail to pay a required premium.

If Dental Insurance for Your Dependents ends because Your marriage ends in divorce or separation, the party responsible under the divorce decree or separation agreement for payment of premium for continued Dental Insurance must notify the employer, in writing, within 30 days of the date of the divorce decree or separation agreement that the divorce or separation has occurred. If You and Your divorced or separated Spouse share responsibility for payment of the premium for continued Dental Insurance, both You and Your divorced or separated Spouse must provide the notification.

The Employer must give You, or Your former Spouse if You have died or Your marriage has ended, written notice of:

• Your right to continue Your Dental Insurance for Your Dependents;

• the amount of premium payment that is required to continue Your Dental Insurance for Your Dependents;

• the manner in which You or Your former Spouse must request to continue Your Dental Insurance for Your Dependents and pay premiums; and

• the date by which premium payments will be due.

The premium that You or Your former Spouse must pay for continued Dental Insurance for Your Dependents may include:

• any amount that You contributed for Your Dental Insurance before it ended; and

• any amount the Employer paid.

To continue Dental Insurance for Your Dependents, You or Your former Spouse must:

• send a written request to continue Dental Insurance for Your Dependents; and

• must pay the first premium within 30 days of the date Dental Insurance for Your Dependents ends.

If You, and Your former Spouse, if applicable, fail to provide any required notification, or fail to request to continue Dental Insurance for Your Dependents and pay the first premium within the time limits stated in this section, Your right to continue Dental Insurance for Your Dependents will end.

NOTICE FOR NEW HAMPSHIRE RESIDENTS (continued) notice/coi/nh 15

CONTINUATION OF YOUR DEPENDENT’S DENTAL INSURANCE (Continued)

The maximum continuation period will be the longest of the following that applies:

• 36 months if Dental Insurance for Your Dependents ends because Your marriage ends in divorce or separation, except that with respect to a Spouse who is age 55 or older when your marriage ends in divorce or separation the maximum continuation period will end when the divorced or separated Spouse becomes eligible for Medicare or eligible for participation in another employer’s group plan;

• 36 months if Dental Insurance for Your Dependents ends because You die, except that with respect to a Spouse who is age 55 or older when You die, the maximum continuation period will end when Your surviving Spouse becomes eligible for Medicare or eligible for participation in another employer’s group dental coverage;

• 36 months if Dental Insurance for Your Dependents ends because You become entitled to benefits under Title XVIII of Social Security, except that with respect to a Spouse who is age 55 or older when You become entitled to benefits under Title XVIII of Social Security, the maximum continuation period will end when the divorced or separated Spouse becomes eligible for Medicare or eligible for participation in another employer’s group dental coverage;

• 36 months if You become entitled to benefits under Title XVIII of Social Security while You are already receiving continued benefits under this section, except that with respect to a Spouse who is age 55 or older when You first become entitled to continue Your Dental Insurance the maximum continuation period will end when the divorced or separated Spouse becomes eligible for Medicare or eligible for participation in another employer’s group dental coverage;

• 36 months with respect to a Dependent Child if Dental Insurance ends because the Child ceases to be a Dependent Child;

• 36 months if Your employment ends because You retire, and within 12 months of retirement You have a substantial loss of coverage because the employer files for bankruptcy protection under Title 11 of the United States Code;

• 29 months if Dental Insurance for Your Dependents ends because Your employment ends, and within 60 days of the date Your employment ends you become entitled to disability benefits under Social Security;

or

• 18 months if Dental Insurance for Your Dependents ends because Your employment ends.

A Dependent's continued Dental Insurance will end on the earliest of the following to occur:

• the end of the maximum continuation period;

• the date this Dental Insurance ends;

• the date this Dental Insurance is changed to end Dental Insurance for Dependents for the class of employees to which You belong;

• the date the Dependent becomes entitled to enroll for Medicare;

• if You do not pay a required premium to continue Dental Insurance for Your Dependents; or

• the date the Dependent becomes eligible for coverage under any other group dental coverage.

notice/nc 16

NOTICE FOR RESIDENTS OF NORTH CAROLINA

UNDER NORTH CAROLINA GENERAL STATUTE SECTION 58-50-40, NO PERSON, EMPLOYER,

PRINCIPAL, AGENT, TRUSTEE, OR THIRD PARTY ADMINISTRATOR, WHO IS RESPONSIBLE FOR THE

PAYMENT OF GROUP HEALTH OR LIFE INSURANCE OR GROUP HEALTH PLAN PREMIUMS, SHALL:

(1) CAUSE THE CANCELLATION OR NONRENEWAL OF GROUP HEALTH OR LIFE INSURANCE,

HOSPITAL, MEDICAL, OR DENTAL SERVICE CORPORATION PLAN, MULTIPLE EMPLOYER

WELFARE ARRANGEMENT, OR GROUP HEALTH PLAN COVERAGES AND THE CONSEQUENTIAL

LOSS OF THE COVERAGES OF THE PERSONS INSURED, BY WILLFULLY FAILING TO PAY THOSE

PREMIUMS IN ACCORDANCE WITH THE TERMS OF THE INSURANCE OR PLAN CONTRACT, AND

(2) WILLFULLY FAIL TO DELIVER, AT LEAST 45 DAYS BEFORE THE TERMINATION OF THOSE

COVERAGES, TO ALL PERSONS COVERED BY THE GROUP POLICY A WRITTEN NOTICE OF THE

PERSON’S INTENTION TO STOP PAYMENT OF PREMIUMS. THIS WRITTEN NOTICE MUST ALSO

CONTAIN A NOTICE TO ALL PERSONS COVERED BY THE GROUP POLICY OF THEIR RIGHTS TO

HEALTH INSURANCE CONVERSION POLICIES UNDER ARTICLE 53 OF CHAPTER 58 OF THE

GENERAL STATUTES AND THEIR RIGHTS TO PURCHASE INDIVIDUAL POLICIES UNDER THE

FEDERAL HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT AND UNDER ARTICLE

68 OF CHAPTER 58 OF THE GENERAL STATUTES.

VIOLATION OF THIS LAW IS A FELONY. ANY PERSON VIOLATING THIS LAW IS ALSO SUBJECT TO A

COURT ORDER REQUIRING THE PERSON TO COMPENSATE PERSONS INSURED FOR EXPENSES

OR LOSSES INCURRED AS A RESULT OF THE TERMINATION OF THE INSURANCE.

notice/pa 17

NOTICE FOR RESIDENTS OF PENNSYLVANIA

Dental Insurance for a Dependent Child may be continued past the age limit if that Child is a full-time student and insurance ends due to the Child being ordered to active duty (other than active duty for training) for 30 or more consecutive days as a member of the Pennsylvania National Guard or a Reserve Component of the Armed Forces of the United States.

Insurance will continue if such Child:

• re-enrolls as a full-time student at an accredited school, college or university that is licensed in the jurisdiction where it is located;

• re-enrolls for the first term or semester, beginning 60 or more days from the child’s release from active duty;

• continues to qualify as a Child, except for the age limit; and

• submits the required Proof of the child’s active duty in the National Guard or a Reserve Component of the

United States Armed Forces.

Subject to the Date Insurance For Your Dependents Ends subsection of the section entitled ELIGIBILITY PROVISIONS: INSURANCE FOR YOUR DEPENDENTS, this continuation will continue until the earliest of the date:

• the insurance has been continued for a period of time equal to the duration of the child’s service on active duty; or

• the child is no longer a full-time student.

NOTICE FOR RESIDENTS OF TEXAS

notice/cong/tx 18

The exclusion of services which are primarily cosmetic will not apply to the treatment or correction of a congenital defect of a newborn child.

NOTICE FOR RESIDENTS OF UTAH

GTY-NOTICE-UT-0710 19

Notice of Protection Provided by Utah Life and Health Insurance Guaranty Association

This notice provides a brief summary of the Utah Life and Health Insurance Guaranty Association ("the Association") and the protection it provides for policyholders. This safety net was created under Utah law, which determines who and what is covered and the amounts of coverage.

The Association was established to provide protection in the unlikely event that your life, health, or annuity insurance company becomes financially unable to meet its obligations and is taken over by its insurance regulatory agency. If this should happen, the Association will typically arrange to continue coverage and pay claims, in accordance with Utah law, with funding from assessments paid by other insurance companies.

The basic protections provided by the Association are:

• Life Insurance o $500,000 in death benefits o $200,000 in cash surrender or withdrawal values

• Health Insurance o $500,000 in hospital, medical and surgical insurance benefits o $500,000 in long-term care insurance benefits o $500,000 in disability income insurance benefits o $500,000 in other types of health insurance benefits

• Annuities o $250,000 in withdrawal and cash values

The maximum amount of protection for each individual, regardless of the number of policies or contracts, is $500,000. Special rules may apply with regard to hospital, medical and surgical insurance benefits.

Note: Certain policies and contracts may not be covered or fully covered. For example, coverage does not extend to any portion of a policy or contract that the insurer does not guarantee, such as certain investment additions to the account value of a variable life insurance policy or a variable annuity contract.

Coverage is conditioned on residency in this state and there are substantial limitations and exclusions. For a complete description of coverage, consult Utah Code, Title 3 lA, Chapter 28.

Insurance companies and agents are prohibited by Utah law to use the existence of the Association or its coverage to encourage you to purchase insurance. When selecting an insurance company, you should not rely on Association coverage. If there is any inconsistency between Utah law and this notice, Utah law will control.

To learn more about the above protections, as well as protections relating to group contracts or retirement plans, please visit the Association's website at www.utlifega.org or contact:

Utah Life and Health Insurance Guaranty Assoc. Utah Insurance Department 60 East South Temple, Suite 500 3110 State Office Building Salt Lake City UT 84111 Salt Lake City UT 84114-6901

(801) 320-9955 (801) 538-3800

A written complaint about misuse of this Notice or the improper use of the existence of the Association may be filed with the Utah Insurance Department at the above address.

notice/va 20

NOTICE FOR RESIDENTS OF VIRGINIA

IMPORTANT INFORMATION REGARDING YOUR INSURANCE

In the event You need to contact someone about this insurance for any reason please contact Your agent. If no agent was involved in the sale of this insurance, or if You have additional questions You may contact the insurance company issuing this insurance at the following address and telephone number:

200 Park Avenue

New York, New York 10166 Attn: Corporate Consumer Relations Department

To phone in a claim related question, You may call Claims Customer Service at:

1-800-275-4638

If You have been unable to contact or obtain satisfaction from the company or the agent, You may contact the Virginia State Corporation Commission’s Bureau of Insurance at:

The Office of the Managed Care Ombudsman Bureau of Insurance

P.O. Box 1157 Richmond, VA 23218

1-877-310-6560 - toll-free…