City_of_Edinburg_RFP#_2025-008_Ancillary_Products.docx

The City of Edinburg

Request for Proposal (RFP# XXXXX) Voluntary Employee (Insurance) Benefit Products: (Section 125 & Third-Party Administration for Consolidated Billing), 457 Administration, Accident, Cancer, Critical Illness, Vision, Dental, Short Term/Long Term Disability, Group Term Life/Voluntary Life and Accidental Death and Dismemberment, Employer Paid Life Insurance, Hospital Indemnity)

Effective Date: October 1, 2025 Deadline for Proposals: 03:00 P.M., Tuesday, July 15, 2025

Prepared by: Roger Garza, Insurance Consultant Valley Risk Consulting, Inc., 1200 Fresno, Suite C, McAllen, Texas 78501

The City of Edinburg is accepting proposals for:

RFP# XXXXXX Voluntary Employee (Insurance) Benefit Products: (Section 125 & Third-Party Administration for Consolidated Billing), 457 Administration, Accident, Cancer, Critical Illness, Vision, Dental, Short Term/Long Term Disability, Group Term Life/Voluntary Life and Accidental Death and Dismemberment, Employer Paid Life Insurance, Hospital Indemnity)

Proposals must be submitted electronically to: https://secure.procurenow.com/portal/cityofedinburg, no later than Tuesday, July 15, 2025 @ 03:00 p.m.”

Proposals will be accepted until 03:00 p.m. on Tuesday, July 15, 2025. Any proposals received late will not be accepted.

Any questions about this Request for Proposal should be submitted through the procurement portal by 05:00 p.m. Thursday, July 3, 2025.

The proposal will be awarded at a City Commission meeting in August. The city reserves the right to accept or reject any and/or all proposals, waive minor technicalities, or award the proposal to the most responsible offeror who best serves the City's interests.

Please fill out, sign, and submit with your proposal response the enclosed IRS Form, W-9, and Conflict of Interest Questionnaire.

We look forward to hearing from you. Sincerely, Erica Balli, Director of Human Resources

TABLE OF CONTENTS

SECTION 1:

STANDARD TERMS AND CONDITIONS

SECTION 2:

Benefit Exhibits:

Information provided on website

PROPOSAL PACKAGE CHECKLIST REMINDER

IN ORDER FOR YOUR PROPOSAL TO BE CONSIDERED IN THE PROPOSAL PROCESS, THE FOLLOWING ITEMS ARE REQUIRED TO BE INCLUDED IN THE PROPOSAL PACKAGE:

DESCRIPTION OF ITEM YES NO N/A

1. CONFIDENTIAL DISCLOSURE STATEMENT ______ _______ _______

SHEET

2. STANDARD TERMS & CONDITIONS, _______ _______ _______

GENERAL PROPOSAL & ASSUMPTIONS

BACKGROUND

3. FELONY CONVICTION NOTIFICATION _______ _______ _______

4. PROPOSAL SPECIFICATION REQUIREMENT _______ _______ _______

FORM

5. CRITERIA EVALUATION FORM _______ _______ _______

6. NON-COLLUSION STATEMENT & SIGNATURE _______ _______ _______

SHEET

7. CERTIFICATE OF INTERESTED PARTIES _______ _______ _______

(Form 1295)

8. PROPOSAL FORMS pertaining to this proposal _______ _______ _______ Should have all lines filled in as needed.

PLEASE SUBMIT THE WHOLE PACKAGE EVEN IF NOT SUBMITTING A PROPOSAL ON ALL ITEMS.

** (FAILURE TO MANUALLY SIGN THE PROPOSAL WILL DISQUALIFY IT) **

CONFIDENTIAL DISCLOSURE STATEMENT

For purposes of complying with the Texas Public Information Act (the “Act”), we are asking that VENDORS interested in submitting a response to a City’s request for bids, proposals or qualifications statements INCLUDE A STATEMENT (THIS FORM) STATING WHETHER NONE, ALL, OR SOME OF THE INFORMATION SUBMITTED WITH THEIR RESPONSES IS CONSIDERED BY THE COMPANY AS CONFIDENTIAL BECAUSE IT MEETS ONE OR MORE OF THE EXCEPTIONS LISTED IN THE ACT.

Failure by the company(s) to fill out and sign this form will release the City of Edinburg from any liabilities in the event the City of Edinburg releases information included in their bids, proposals, or qualifications statements responses as a result of complying with a request for public records under the Act.

If the Confidential Disclosure Statement is properly filed, and the City of Edinburg receives a request for public records under the Act related to such vendor’s response, the City of Edinburg will seek an opinion from the Texas Attorney General’s Office as required.

This Confidential Disclosure Statement is being made by:

__________________________________________________________ to the City of Edinburg for the (Vendor Name) The purpose of the non-disclosure of various materials included in this package.

The rights and obligations of the parties with respect to such information are as follows:

1. “Disclosing Party” means a party that discloses Confidential Information under this Request. “Receiving Party” means a party that receives Confidential Information under this Request.

2. “Confidential Information” means information of any kind that is obtained by the Receiving Party from the Disclosing Party relating to this Request and which, by appropriate marking, is identified as confidential and proprietary at the time of disclosure.

3. Notwithstanding the foregoing, Confidential Information shall not include any information that:

a) is publicly available before the Effective Date or becomes publicly available thereafter through no breach of this Request by the Receiving Party.

b) was known to the Receiving Party before the date of disclosure or became known to the Receiving Party thereafter, a third party that has no obligation to the Disclosing Party to keep such information confidential.

c) is independently developed by the Receiving Party without the benefit of Confidential Information of the Disclosing Party, as evidenced by written records; or

d) must be produced by the Receiving Party pursuant to an order of a court of competent jurisdiction or a valid subpoena, provided that the Receiving Party promptly notifies the Disclosing Party and cooperates reasonably with the Disclosing Party’s efforts to contest or limit the scope of such order.

4. The Receiving Party agrees that it will maintain the Confidential Information in confidence using a reasonable standard of care, and no less than the standard of care taken to protect its or his/her own confidential information and will use such Confidential Information solely to evaluate its or his/her interest in participating in a future Requests.

5. As stated above, in the event City of Edinburg receives a request for public records under the Act related to the vendor’s response, City of Edinburg will seek an opinion from the Texas Attorney General’s Office as required.

6. This Agreement shall not be construed as an obligation to enter into a Purchasing Agreement or any other subsequent relationship or agreement.

_________________________________________________ (vendor) wishes to have the following pages protected under this agreement and not be released to a third party. The following pages are not to be disclosed unless the City of Edinburg receives authorization via an opinion from the Texas Attorney General’s Office:

NONE of the Pages in this Request for Proposal is Confidential

ALL Pages in this Request for Proposal are Confidential

ONLY Pages _____________________ are labeled as Confidential

Name of Company or Firm:_______________________________________________________

By:________________________________________________ Title:_________________________________

Signature:__________________________________________ Date:___________________________

STANDARD TERMS AND CONDITIONS

NOTICE TO OFFERORS

ITEMS BELOW APPLY TO AND BECOME A PART OF TERMS

AND CONDITIONS OF PROPOSALS UNLESS SUPERSEDED BY ANY ATTACHED

TERMS AND SUPPLEMENTAL CONDITIONS OR SPECIFICATIONS

IN WHICH CASE ATTACHED CONDITIONS WILL PREVAIL

ANY EXCEPTIONS MUST BE IN WRITING

1. Proposals should be submitted on this form. Each proposal shall be placed in a separate envelope, sealed and properly identified with the proposal title, proposal number, date, and time to be opened.

2. The proposal shall follow the plan as specified. Answer all the yes and no questions and fill in the Blanks.

3. Proposals must be received at the hour and date specified. Late proposals will not be considered under any circumstances.

4. Proposals must have original signatures.

5. Proposal prices must be firm for acceptance ninety (90) days from the opening date. No proposals may be withdrawn without written approval after a contract has been signed or partial performance of the proposal agreement has begun.

6. Failure to manually sign the proposal will disqualify it. The person signing the proposal should show the title or authority to bind their firm to a contract.

7. The City reserves the right to accept or reject all or any part of any proposal, waive minor technicalities and award the proposal to best serve the interest of the City.

8. No Proposal: All proposal forms should be signed, as needed, and returned even if the Offeror is unable to submit a proposal at this time but wishes to remain on the Offeror’s list.

9. Term of Contract: The contract will be effective as per the Insurance Policy, or after city approval, whichever occurs later. The City would prefer a one-year contract with the option to renew for two (2) additional (separate) one (1) year terms, if there are no changes in terms and conditions, insurance agent or underwriting company, and the insurance rates do not increase more than 5% per year.

10 Venue: In the event of legal disputes related to this contract, the venue shall be Hidalgo County in the State of Texas.

STANDARD TERMS AND CONDITIONS

NOTICE TO OFFERORS

11. During the performance of this contract, the contractor agrees not to discriminate against any employee or applicant for employment because of race, color, national origin, age, religion, gender, marital or veteran status, or handicapping conditions.

12. Awarding of Proposal: The City will be awarding this proposal to only one vendor. Vendor’s proposals will be evaluated for approval based on the evaluation criteria listed on page 12.

13. Payment Terms: Payment for items acquired under this proposal will be paid “net, 30 days” after satisfactory receipt of goods ordered, or receipt of invoice, whichever occurs last.

14. Governmental Immunity: The City of Edinburg does not transfer or convey its governmental immunity to any vendor.

15. Vendors must submit an electronic response at https://secure.procurenow.com/portal/cityofedinburg.

_______________ _____________________ ________________ Date Company Name Initials

GENERAL PROPOSAL REQUIREMENTS & ASSUMPTION BACKGROUND

Proposals will be accepted until 03:00 p.m. on Tuesday, July 15, 2025, at which time they will be opened. City of Edinburg is not responsible for proposals submitted incorrectly.

1. Proposed effective date as per insurance policy inception date, or after approval by the city commission, whichever occurs later.

2. City of Edinburg would like to enter into a one-year contract with the option to renew for two (2) additional (separate) one (1) year terms, if there are no changes in terms and conditions, insurance agent, or underwriting company. The city would like a three-year rate guarantee on all products.

3. A minimum of 90 days' advance notice must be provided to the City concerning any subsequent adjustment to premium rates or fees.

4. Please return the original proposal forms in the same order received, with yes or no questions answered, and the blanks filled in. This will make it a lot easier to analyze the proposal. This is to the Benefit of both parties.

5. Carriers must include standard commission rates and disclose any tech credits.

6. The City retains the services of Roger Garza, with Valley Risk Consulting Inc., McAllen, Texas. VRC will evaluate all proposals and make a recommendation to the City of Edinburg Administration and the City Commission.

FELONY CONVICTION NOTIFICATION

State of Texas Legislative Senate Bill No. 1, Section 44.034, Notification of Criminal History, Subsection (a), states “a person or business entity that enters into a contract with a school City must give advance notice to the City if the person, owner or operator of the business entity has been convicted of a felony. The notice must include a general description of the conduct resulting in the conviction of a felony.”

Subsection (b) states “a school City may terminate a contract with a person or business entity if the City determines that the person or business entity failed to give notice as required by Subsection (a) or misrepresented the conduct resulting in the conviction. The City must compensate the person or business entity for services performed before the termination of the contract.”

THIS NOTICE IS NOT REQUIRED OF A PUBLICLY HELD CORPORATION, BUT THE COMPANY REPRESENTATIVE MUST CHECK OFF A SELECTION BELOW (A, B, OR C)

I, the undersigned agent for the firm named below, certify that the information concerning notification of felony convictions has been reviewed by me and the following information furnished is true to the best of my knowledge.

VENDOR NAME: _________________________________________________________________

AUTHORIZED COMPANY OFFICIAL’S NAME (PRINTED) AND SIGNATURE:

DATE: _____________________________

***** PLEASE CHECK OFF A SELECTION BELOW*****

( ) A. My firm is a publicly held corporation; therefore, this reporting requirement is not applicable.

( ) B. My firm is not owned and/or operated by anyone who has been convicted of a felony.

( ) C. My firm is owned or operated by the following individual(s) who has/have been convicted of a felony:

Name of Felon: ______________________________________________________________

Details of Convictions(s): ______________________________________________________

PROPOSAL SPECIFICATION REQUIREMENTS

(TO BE FILLED IN BY OFFEROR AND SUBMITTED WITH PROPOSAL)

Is this proposal in conformance with the enclosed specifications?

Yes __________ No __________

If the answer is no, the offeror must identify and explain each exception taken, with reference to each page and paragraph to which the exception will apply.

It should be understood that if no exception is taken, the vendor should supply all items as specified at the time of sale. Failure to indicate any difference in products offered proposed in this proposal may be deemed sufficient grounds for a vendor’s proposal.

Comments: ______________________________________________________________________

CRITERIA EVALUATION

In determining to whom to award a contract, the City shall consider the following:

(1) the purchase prices.

(2) the reputation of the vendor and of the vendor’s goods or services.

(3) the quality of the vendor’s goods or services.

(4) the extent to which the goods or services meet the City's needs.

(5) the vendor’s past relationship with the City.

(6) the impact on the ability of the City to comply with laws and rules relating to historically underutilized business.

(7) the total long-term cost to the City of acquiring the vendor’s goods or services.

(8) any other relevant factor specifically listed in the request for bids or proposals; and

(9) the vendor or the vendor’s ultimate parent company or majority owner has its principal place of business in this state.

NON-COLLUSION STATEMENT & SIGNATURE SHEET

The undersigned affirms that he/she is duly authorized to execute this contract, that this company, corporation, firm, partnership or individual has not prepared this proposal in collusion with any other Offeror, and that the contents of this proposal as to prices, terms or conditions of said proposal have not been communicated by the undersigned nor by any employee or agent to any other person engaged in this type of business prior to the official opening of this proposal.

Further, I affirm that prior to or after the opening of this proposal, I (or any representative of my company) will not discuss the contents of this proposal with any person affiliated with the City of Edinburg, other than the Purchasing Department or City of Edinburg Designee prior to the awarding of this proposal. I understand that failure to observe this procedure may cause my proposal to be rejected.

I also affirm that no officer or stockholder of the offeror (bidder) is a member of the staff or related to any employee of the City of Edinburg except as noted herein ______________________________________________________________________________.

By signing this proposal, the vendor makes the assurance that the vendor has not been debarred or suspended from conducting business with the U. S. Government according to Executive Order 12549 entitled “Debarment and Suspension.”

I have represented the truth concerning the felony conviction notification. I have checked off one of the three statements and have signed the form.

I have read the criteria for evaluation that the City shall consider awarding this contract.

I fully understand the proposal’s insurance information forms and cost sheets.

COMPANY ________________________________________________________

ADDRESS _________________________________________________________

CITY, STATE, ZIP CODE _____________________________________________

TELEPHONE/FAX __________________________________________________

Implementation of House Bill 1295 Certificate of Interested Parties (Form 1295):

In 2015, the Texas Legislature adopted House Bill 1295, which added section 2252.908 of the Government Code. The law states that a governmental entity or state agency may not enter into certain contracts with a business entity unless the business entity submits a disclosure of interested parties to the governmental entity or state agency at the time the business entity submits the signed contract to the governmental entity or state agency. The law applies only to a contract of a governmental entity or state agency that either (1) requires an action or vote by the governing body of the entity or agency before the contract may be signed or (2) has a value of at least $1 million. The disclosure requirement applies to a contract entered into on or after January 1, 2016.

The Texas Ethics Commission was required to adopt rules necessary to implement that law, prescribe the disclosure of interested parties form, and post a copy of the form on the commission’s website. The commission adopted the Certificate of Interested Parties form (Form 1295) on October 5, 2015. The commission also adopted new rules (Chapter 46) on November 30, 2015, to implement the law. The commission does not have any additional authority to enforce or interpret House Bill 1295.

Filing Process:

By January 1, 2016, the commission will make available on its website a new filing application that must be used to file Form 1295. A business entity must use the application to enter the required information on Form 1295 and print a copy of the completed form, which will include a certification of filing that will contain a unique certification number. An authorized agent of the business entity must sign the printed copy of the form and have the form notarized. The completed Form 1295 with the certification of filing must be filed with the governmental body or state agency with which the business entity is entering into the contract.

The governmental entity or state agency must notify the commission, using the commission’s filing application, of the receipt of the filed Form 1295 with the certification of filing not later than the 30th day after the date the contract binds all parties to the contract. The commission will post the completed Form 1295 to its website within seven business days after receiving notice from the governmental entity or state agency. Information regarding how to use the filing application will be available on this site by January 1, 2016. A sample Form 1295 is included in this procurement document to make prospective vendors aware of this requirement. Vendors are NOT required to complete the enclosed form and include it in their response. Complete instructions and important information can be located from the following link:

https://www.ethics.state.tx.us/whatsnew/elf_info_form1295.htm

CERTIFICATE OF INTERESTED PARTIES FORM 1295

Complete Nos. 1 - 4 and 6 if there are interested parties.

Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties.

OFFICE USE ONLY

1 Name of business entity filing form, and the city, state, and country of the business entity's place of business.

2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed.

3. Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the goods or services to be provided under the contract.

Name of Interested Party

City, State, Country (place of business) Nature of Interest (check applicable)

5 Check only if there is NO Interested Party.

6 AFFIDAVIT I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct.

Signature of authorized agent of contracting business entity

AFFIX NOTARY STAMP / SEAL ABOVE

Sworn to and subscribed before me, by the said , this day of , 20 , to certify which, witness my hand and seal of office.

Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath

ADD ADDITIONAL PAGES AS NECESSARY

Description of Plan must be in the labeled format below and include the following:

Company Name

Authorized Signature

Address

Type Signatory’s Name and Title

Telephone Number

Contact Name

Fax Number

Contact Address

Date

Contact Email Address

Section

Assumptions

Voluntary Employee (Insurance) Benefit Products: (Section 125 and Consolidated Billing – TPA, 457 Administration, Accident, Cancer, Critical Illness, Vision, Dental, Short Term/Long Term Disability, Critical Illness, Group Term Life/Voluntary Life and Accidental Death and Dismemberment, Employer Paid Life, Hospital Indemnity)

1. At completion of enrollment, the City is to be provided with a master payroll deduction list that includes age, benefit amount and premium for both employees and dependent, if applicable. Two lists are to be provided: one for biweekly employees and one for monthly employees.

2. Each proposed product submitted will have its rates illustrated in monthly premiums. Life Insurance & AD&D in bands of $1000. Short/Long Term Disability products will be in units of 100. Interest Sensitive life insurance or any Life insurance product that offers cash accumulation will not be considered.

3. Proposals should be submitted electronically at https://secure.procurenow.com/portal/cityofedinburg.

Only products that are outlined in this Request for Proposals (RFP) will be considered. The City will only consider one company for each insurance plan advertised.

4. Carriers offering products that combine any of the requested products together will NOT be considered. (i.e. Cancer with Critical Illness)

5. Proposals are desired for Cancer Supplements, Critical Illness, Voluntary Group Accident Insurance, Vision, Dental, Group Term Life/Voluntary Life & AD&D, Short/Long Term Disability, IRC 125 & Flex Plan Admin, 457 Administration, Employer Paid Life Insurance. These plans should meet the requirements of the IRC Section 125 for all benefit provisions.

6. The city desires three (3) rate guarantees on all lines of coverage.

7. The City desires to receive proposals for a one (1) year term with the option to renew for two (2) additional one (1) year terms.

8. The insurance company must have an A.M. Best rating of an A- or better.

9. Multiple proposals from the same carrier/insurance company will not be accepted. Carriers/insurance companies may submit an attached list of agent/agencies requesting consideration.

10. Services are to include monthly education/enrollment meetings with new employees and annual group education/enrollment will all employees.

11. The effective date is to be October 1, 2025. All participants enrolled in the voluntary group disability insurance plan as of May 31, 2025, are to be allowed to continue current coverage on a “no loss/no gain” basis. Employees not currently enrolled are to be allowed to enroll during an open enrollment period.

12. RFP will NOT be available as a Word document. If necessary, submit answers on a separate sheet of paper numbered and answered as outlined in this RFP.

13. The City of Edinburg shall retain the right to select the agent(s) or agencies of its choice pertaining to this RFP. A statement of agent or agency’s qualifications shall include contact information (address, phone numbers, facsimile numbers, and email contact), services to be provided, and years in business, and a copy of the proper Texas Department of Insurance license to perform the service.

Section

Proposer Questionnaire

Please indicate which insurance products you are submitting:

☐Cancer ☐Critical Illness (Stand Alone)

☐Dental ☐Vision

☐Voluntary Accident ☐Term Life & AD&D/Employer Paid Term Life

☐Short/Long Term Disability ☐Section 125 & TPA Consolidated Billing

☐Hospital Indemnity ☐457 Plan Administration

Group Dental Questionnaire

1. Business entity submitting proposal:

Name of business entity: ____________________________________________________________________________________

Address:

Contact Person:

Telephone & Fax Number:

Email Address:

Year Founded:

2. Current A.M. Best rating & financial size category: _____________

3. Provide three (3) Texas client references of comparable size:

City respects the privacy of all submitters’ client lists, but we require the information for proper evaluation. References will only be contacted if necessary and upon selection of the finalist(s). Failure to provide references will be reflected in the evaluation process.

4. Claim Payment Services:

Address for payment of claims:

What is the average claim processing time?

List documentation needed for payment of claim: _______________________________________________________________________________________________

5. Will your plan cover adult orthodontics? □ Yes □ No Explain:

6. Can you mirror the current plan design? □ Yes □ No

Explain:

7. Are claims from Mexico eligible? □ Yes □ No

Explain:

8. Are customer service agents bilingual? □ Yes □ No

9. Provide a list of in-network providers in Hidalgo County along with their specialties (attach list to proposal):

10. Please describe in detail your plans for waiting periods for employees with existing coverage through the City and the waiting period for new employees new to the City:

11. Please describe your lifetime maximums for each tier:

12. Is the policy portable? □ Yes □ No. If yes, at the same rate? □ Yes □ No

If not, explain:

13. Is COBRA administration for this product included and at no additional cost to the City? □ Yes □ No

Explain: ________________________________________________________________________________________________________________________________________________________________________________________________________

14. Are rates guaranteed fixed for a three (3) year period? □ Yes □ No

15. Agent Information – Provide the following information for each agent. The City reserves the right to award benefits as a package to one firm/agency. Only those benefits and value-added services specifically listed will be considered.

Annual percentage rate for commission:

Provide a copy of the agent’s Errors & Omissions Insurance Certificate ($1,000,000) & the Agent’s current license.

Name, Mailing Address, Contact Number for agent:

Group Vision Questionnaire

Name of business entity: ______________________________________________________________

Address: ___________________________________________________________________________

Contact Person: ___________________________________________________________________

Telephone & Fax Number: _____________________________________________________________

Email Address: ______________________________________________________________________

Year Founded: ___________________________________

2. Current A.M. Best rating & financial size category: _____________________________

3. Provide three (3) Texas client references of comparable size:

The city respects the privacy of all submitters’ client lists, but we require the information of the finalist(s). Failure to provide references will be reflected in the evaluation process.

4. Claim Payment Services:

Address for payment of claims:

5. Fill in the following table with the number of in-network providers in Hidalgo County and provide an electronic directory.

Ophthalmologists

Optometrists

6. Can the provider select where lenses are produced? □ Yes □ No

Explain:

7. Is there an out-of-network for all services? □ Yes □ No

Explain:

8. Are customer service agents bilingual? □ Yes □ No

9. Concerning the contact lens benefit. Are the benefits in addition to or instead of glasses? □ Yes □ No

10. What is the frame frequency and allowance for each plan?

11. What is the contact lens frequency and allowance for each plan?

12. Is the policy portable? □ Yes □ No. If yes, at the same rate? □ Yes □ No

If not, explain:

13. Is COBRA administration for this product included and at no additional cost to the City? □ Yes □ No Explain:

14. Are rates guaranteed fixed for a three (3) year period? □ Yes □ No

15. Agent Information – Provide the following information for each agent. The City reserves the right to award benefits as a package to one firm/agency. Only those benefits and value-added services specifically listed will be considered.

Annual percentage rate for commission:

Provide a copy of the agent’s Errors & Omissions Insurance Certificate ($1,000,000) & the Agent’s current license.

Name, Mailing Address, Contact Number for agent:

Group Cancer Questionnaire

Name of business entity: ______________________________________________________________

Address: ________________________________________________________________________

Contact Person: ___________________________________________________________________

Telephone & Fax Number: ____________________________________________________________

Email Address: _____________________________________________________________________

Year Founded: _____________________

2. Current A.M. Best rating & financial size category: _________________________

3. Provide three (3) Texas client references of comparable size:

The city respects the privacy of all submitters’ client lists, but we require the information for proper evaluation. References will only be contacted if necessary and upon selection of the finalist(s). Failure to provide references will be reflected in the evaluation process.

4. Will existing applications be accepted with no re-enrollment required? □ Yes □ No

Explain:

5. Claim Payment Services:

Address for payment of claims:

What is the average claim processing time?

List documentation needed for payment of claim: ___________________________________________________________

6. Do benefits include any type of return of premium provision, or other form of deferred compensation, that would prevent all insurance premiums from being eligible under IRC Section 125 Cafeteria Plan? □ Yes □ No Explain:

7. Are illnesses directly caused or aggravated by cancer covered? □ Yes □ No

Explain:

8. Is skin cancer covered? □ Yes □ No Explain:

9. Describe “guarantee issue” underwriting guidelines:

10. List pre-existing condition limitations:

11. List underwriting procedures for applicants subject to medical review:

If no, explain:

13. Is the policy convertible to an individual policy? □ Yes □ No If yes, at the same rate? □ Yes □ No If no, explain:

14. Does the policy include a “Waiver of Premium” provision? □ Yes □ No

15. Will “take over” be on a “No Loss/No Gain” basis for members currently enrolled? □ Yes □ No

16. Is COBRA administration for this product included and at no additional cost to the City? □ Yes □ No

17. What is the first occurrence benefit amount?

18. Are rates guaranteed fixed for a three (3) year period? □ Yes □ No

19. Agent Information – Provide the following information for each agent. The City reserves the right to award benefits as a package to one firm/agency. Only those benefits and value-added services specifically listed will be considered.

Annual percentage rate for commission:

Provide copy of agent’s Errors & Omissions Insurance Certificate ($1,000,000) & Agent’s current license.

Name, Mailing Address, Contact Number for agent:

Group Term Life and AD&D Questionnaire

Name of business entity: ______________________________________________________________

Address: ___________________________________________________________________________

Contact Person: ___________________________________________________________________

Telephone & Fax Number: ___________________________________________

Email Address: ____________________________________________________

Year Founded: ________________________________

2. Current A.M. Best rating & financial size category: ________________________

3. Provide three (3) Texas client references of comparable size:

of the finalist(s). Failure to provide references will be reflected in the evaluation process.

Explain:

Address for payment of claims:

What is the average claim processing time?

List documentation needed for payment of claim:

6. Will current elections exceed guarantee issue and/or policy maximum amounts, if any, “grandfathered”? □ Yes □ No

7. Describe underwriting procedures for applicants subject to medical review:

8. Is guaranteed issue at inception and subsequent annual enrollment periods available for employees not enrolled? □ Yes □ No

10. Does the policy include an accelerated death benefit for terminal illness? □ Yes □ No

If not, explain:

13. Is the policy convertible to an individual policy? □ Yes □ No If yes, at the same rate? □ Yes □ No If not, explain:

Explain:

15. Are age-branded increases and spouse rates based on the employee's date of birth? □ Yes □ No Explain:

16. Is COBRA administration for this product included and at no additional cost to the City? □ Yes □ No Explain:

17. Will the “actively at work” provision be waived for the effective date of the contract? □ Yes □ No Explain:

18. Is AD&D coverage 24 hours and on a guaranteed issue basis with no underwriting? □ Yes □ No Explain:

19. Does the quote include coverage for spouse/Children? □ Yes □ No Explain:

20. Are rates guaranteed fixed for a three (3) year period? □ Yes □ No Explain:

21. Agent Information – Provide the following information for each agent. The City reserves the right to award benefits as a package to one firm/agency. Only those benefits and value-added services specifically listed will be considered.

Annual percentage rate for commission:

Provide a copy of the agent’s Errors & Omissions Insurance Certificate ($1,000,000) & the Agent’s current license.

Name, Mailing Address, Contact Number for agent:

Life and AD&D - EZ Quotation Form

* ALL RATES SHALL BE QUOTED PER $1,000 OF BENEFIT AMOUNT AND BASED ON A MONTHLY PREMIUM

Submitter: Rate Guarantee:

Note: RATES FOR TERM LIFE ONLY. Do not include Whole Life or other interest sensitive life insurance

Non-Tobacco Employee Male Female < 25

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75+

Non-Tobacco Spouse Male Female

Tobacco Employee Male Female

Tobacco Spouse Male Female

Benefit Reduction Schedule:

@ Age Percentage

Dependent Benefit

Life per $1,000 AD&D per $1,000

Child

Employee

Spouse

Voluntary Group Disability Insurance Questionnaire

Name of business entity: _____________________________________________________________________________ Address: _____________________________________________________________________________________________ Contact Person: _______________________________________________________________________________________ Telephone & Fax Number: _______________________________________________ Email Address: __________________________________________________________ Year Founded: ______________________________

2. Current A.M. Best rating & financial size category: ______________________________

3. Provide three (3) Texas client references of comparable size:

of the finalist(s). Failure to provide references will be reflected in the evaluation process.

Explain:

Address for payment of claims:

Is a toll-free telephone number available for checking the status of claims? □ Yes □ No

6. Do benefits include any type of return of premium provision, or other form of deferred compensation, that would prevent all insurance premiums from being eligible under IRC Section 125 Cafeteria Plan? □ Yes □ No

7. Describe “guarantee issue” underwriting guidelines:

8. List pre-existing condition limitations:

9. List underwriting procedures for applicants subject to medical review:

10. Is the policy portable? □ Yes □ No. If yes, at the same rate? □ Yes □ No If not, explain:

11. Is the policy convertible to an individual policy? □ Yes □ No. If yes, at the same rate? □ Yes □ No If not, explain:

12. Does the policy include a “Waiver of Premium” provision? □ Yes □ No Explain:

13. Will “take over” be on a “No Loss/No Gain” basis for members currently enrolled? □ Yes □ No Explain:

14. Is COBRA administration for this product included and at no additional cost to the City? □ Yes □ No Explain:

15. Are rates guaranteed fixed for a three (3) year period? □ Yes □ No Explain:

16. Agent Information – Provide the following information for each agent. The City reserves the right to award benefits as a package to one firm/agency. Only those benefits and value-added services specifically listed will be considered.

Annual percentage rate for commission:

Provide a copy of the agent’s Errors & Omissions Insurance Certificate ($1,000,000) & the Agent’s current license.

Name, Mailing Address, Contact Number for agent:

Name, Mailing Address, Contact Number for agent:

Section 125 Administration

If yes, identify each lawsuit by party, case number, court, subject matter, and disposition

If yes, please provide a full description of the matter:

If yes, provide the name of the court and the case number(s):

If yes, provide the name of the court and the case number(s)

Is a longer rate guarantee available?

If yes, please describe:

21. Agent Information – Provide the following information for each agent. The City reserves the right to award benefits as a package to one firm/agency. Only those benefits and value-added services specifically listed will be considered.

Annual percentage rate for commission:

Provide a copy of the agent’s Errors & Omissions Insurance Certificate ($1,000,000) & the Agent’s current license.

Name, Mailing Address, Contact Number for agent:

Name, Mailing Address, Contact Number for agent:

457 Plan Administration

1. Describe the business entity submitting the proposal:

a. Name of Business Entity: _______

b. Current Business Address:

c. Mailing Address:

2. Financial Information:

a. Has the business entity filed a voluntary or involuntary petition in bankruptcy, obtained an order for relief, or received a discharge on any debt under the U.S. Bankruptcy laws during the preceding seven (7) years? |_| Yes |_| No If yes, provide the name of the court and the case number(s):

b. Has any owner, member, or partner of the business entity filed a petition in bankruptcy, obtained an order for relief, or received a discharge on any debt under the U.S. Bankruptcy laws during the preceding seven (7) years? |_| Yes |_| No If yes, provide the name of the court and the case number(s):

4. How long has your organization been providing services to City's 457 plans?

5. Provide three (3) Texas client references:

6. Provide a brief description of any unique qualifications of the firm. Including the firm’s consulting specialties, strengths, and limitations. What advisory role have you performed with your clients with respect to the Pension Protection Act? What negotiating experience and strengths does your firm have? Has your firm resolved quality and service delivery issues between Plan Sponsors and Service Providers? If yes, please describe. Provide examples of “value-added” advice and problem-solving capability for clients.

7. Describe your participant communication and education services. Include sample materials.

8. Describe your proposed communication process for the City of Edinburg.

9. Describe the communications you would provide to City of Edinburg Administration. Include the frequency of Fund Performance Results.

10. Do you currently have staff located in Hidalgo County? |_| Yes |_| No

11. Do you have an office located in Hidalgo County? |_| Yes |_| No If no, where is the closest physical office? ________________________________________

12. Do participant statements aggregate all account information if the employee were to have multiple plans/accounts with you?

|_| Yes |_| No

15. How many days after quarter end until statements are mailed to participants? ___________________________________________________________________________________

16. Are quarterly statements available to participants online? |_| Yes |_| No If yes, how many business days after quarter end until they are available? _______________________________________________________________________________

17. Are you willing to indemnify and hold the City harmless from any legal claims and actions arising out of the education activities related to investments of the plan in compliance with the related deferred compensation and qualified plan fiduciary compliance requirements under state and federal law? |_| Yes |_| No If not, please explain.

20. Quantify your proposed, ongoing, on-site annual enrollment/education commitment. How many group meetings will you commit to perform annually? How many individual consultations?

21. Describe the process whereby you select an appropriate and diversified portfolio of offering within the plan.

22. Agent Information – Provide the following information for each agent. The City reserves the right to award benefits as a package to one firm/agency. Only those benefits and value-added services specifically listed will be considered.

Annual percentage rate for commission:

Provide copy of agent’s Errors & Omissions Insurance Certificate ($1,000,000) & Agent’s current license.

Name, Mailing Address, Contact Number for agent:

Name, Mailing Address, Contact Number for agent:

Group Accident Questionnaire

Name of business entity: ________________________________________________________________________________ Address: _____________________________________________________________________________________________ Contact Person: ________________________________________________________________________________________ Telephone & Fax Number: ____________________________ Email Address: _____________________________________ Year Founded: ____________________________

2. Current A.M. Best rating & financial size category: __________________________________

3. Provide three (3) Texas client references of comparable size:

of the finalist(s). Failure to provide references will be reflected in the evaluation process.

Explain:

Address for payment of claims:

What is the average claim processing time?

List documentation needed for payment of claim: ___________________________________________________________

6. Do benefits…