CSP015261_Rev_Contract.pdf

Index No.: BWC013

Eff. Date: 07/01/23

STATE OF OHIO

DEPARTMENT OF ADMINISTRATIVE SERVICES

GENERAL SERVICES DIVISION

OFFICE OF PROCUREMENT SERVICES

4200 SURFACE ROAD, COLUMBUS, OH 43228-1395

MANDATORY USE CONTRACT FOR: HEALTH AND WELLNESS PROGRAM

CONTRACT NUMBER: CSP015261 EFFECTIVE DATES: 07/01/23 TO 06/30/26

The Department of Administrative Services has accepted Proposals submitted in response to Request for Proposal (RFP) No.

SRC0000006138 that opened on 03/31/23. The evaluation of the Proposal responses has been completed. The Offeror listed herein has been determined to be the highest ranking Offeror and has been awarded a Contract for the services listed. The respective Proposal response including, Contract Terms & Conditions, any Proposal amendment, special Contract Terms & Conditions, specifications, pricing schedules and any attachments incorporated by reference and accepted by DAS become a part of this Services Contract.

This Requirements Contract is effective beginning and ending on the dates noted above unless, prior to the expiration date, the Contract is renewed, terminated, or cancelled in accordance with the Contract Terms and Conditions.

This Requirements Contract is available to the Bureau of Workers' Compensation as applicable.

The agency is eligible to make purchases of the contracted services in any amount and at any time as determined by the agency. The State makes no representation or guarantee that department will purchase the volume of services as advertised in the Request for Proposal.

This Requirements Contract and any Amendments thereto are available from the DAS Web site at the following address:

https://procure.ohio.gov/

Index No: BWC013

Page No. 2

Mutually Agreed to Clarifications/ Modifications to RFP

1. Supplement S – State Security Privacy and Data Handling_Rev_6.-21-23 – response dated 06/21/23

Page No. 3

ATTACHMENT NINE

COST SUMMARY FORM

Health and Wellness Program

UNSPSC CATEGORY CODE: 85101700

HEALTH AND WELLNESS PROGRAM (HWP) FEES

TOTAL

ANNUAL FEES

YEAR 1

TOTAL ANNUAL

FEES

YEAR 2

TOTAL ANNUAL

FEES

YEAR 3

All Administrative setup cost anticipated to get the Health & Wellness program underway as indicated in the Scope of Work with a breakdown of the following items:

1. Data Exchange

2. Identification, Engagement and Integration

3. Communication

4. Customer Service

5. Website and Web Portal

6. Marketing

$1,599,000 $1,599,000 $1,599,000

Optional Additional Unit Program Administration Fees - Custom Programming, Custom Reporting and Custom Data Feed Fees $150.00 /Hr.

YEAR ONE, TWO and THREE

PROGRAM AREA COST

Health Risk Assessment (HRA) $16.00 /Participant

Biometric Screenings as defined in Scope of Work $50.80 /Participant

Lifestyle Management as defined in the Scope of Work. $52.00 /Participant per Month

Disease Management as defined in the Scope of Work. $52.00 /Participant per Month

Health Decision Support (Nurse Line) $37.50 /Participant

Incentive Management $1.20 /Participant

ADDITIONAL PROGRAMS AVAILABLE

Physician Form Fasting Lipid/Glucose Panel: Total Chol, HDL, calc.LDL, Triglycerides, calc cholesterol/HDL ratio, blood glucose, Blood Pressure, calculated BMI - measured Height/Weight and/or waist circumference. Includes My Test (personal lab report) and Plan Sponsor Aggregate Report

$16.00 /Per Form

Activate Home Kit Lipid Panel (TC, HDL, TC/HDL ratio, LDL, Triglycerides) $18.00 /Per Kit Shipped

Activate Home Kit Lipid Panel (TC, HDL, TC/HDL ratio, LDL, Triglycerides) $58.50 /Total Cost Processed Kit

All costs must be in U.S. Dollars.

The State will not be responsible for any costs not identified.

There will be no additional reimbursement for travel or other related expenses.

Eff. Date: 08/01/24 *Page No. 4

ADDITIONAL PROGRAMS AVAILABLE CONT.

*Firefighter venipuncture add-on test option - Complete Blood Count (CBC) $6.00 /Participant

*Firefighter venipuncture add-on test option - Comprehensive Metabolic Panel (Chem 13)

$6.00 /Participant

*Firefighter venipuncture add-on test option - Prostate Specific Antigen (PSA) males only

$9.60 /Participant

*Firefighter venipuncture add-on test option - Thyroid Stimulating Hormone (TSH)

$4.80 /Participant

*Firefighter Insure Colorectal Cancer Screening Program

$14.40 /Per Kit Shipped

*Firefighter Insure Colorectal Cancer Screening Program

$48.00 /Total Cost Processed Kit

*Firefighter venipuncture add-on tests can be conducted at an on-site event or at a patient service center.

*There is a 20-participant minimum for events where venipuncture services are offered. If the participant minimum is not met, the Agency will be billed as if 20 participants were tested at the event.

*Indicates the expansion of Biometric Screening add-on test options available for the firefighter population, and repagination, per amendment 1.

*Page No. 5

CONTRACTOR INDEX

CONTRACTOR AND TERMS:

249746

ActiveHealth Management, Inc. DELIVERY: As Specified 233 Spring Street New York, NY 10013 TERMS: Net 30 Days

CONTRACTOR’S CONTACT:

Ms. Robin Kish PHONE: (330) 906-3030 EMAIL: rkish@activehealth.net

*Indicates repagination, per amendment 1.

mailto:rkish@activehealth.net

*Page No. 6

SUMMARY OF AMENDMENTS

Amendment Number

Effective Date Description

1 08/01/24

This amendment is issued to include a mutually agreed upon modification to the Cost Summary Form to expand the Biometric Screening add-on test options available for the firefighter population. This amendment is also issued to repaginate.

All other prices, terms and conditions remain unchanged.