CSP027240_Contract.pdf

Part 8 – Contract

A CONTRACT BETWEEN

THE OHIO DEPARTMENT OF ADMINISTRATIVE SERVICES

ON BEHALF OF THE

DEPARTMENT OF ADMINISTRATIVE SERVICES

AND

VISION SERVICE PLAN INSURANCE COMPANY

This Contract (#CSP027240), which results from Request for Proposals #SRC0000021373 titled Vision Program for Exempt State of Ohio Employees (RFP), is between the State of Ohio, through the Department of Administrative Services, on behalf of the Department of Administrative Services, and Vision Service Plan Insurance Company (Contractor).

This Contract is the result of agreed upon changes to the RFP including all exhibits and written amendments to this RFP and the Contractor's negotiated and accepted Proposal. It will also include any materials incorporated by reference in the above documents. The terms and conditions for this Contract are contained in Parts 2-4 of the RFP. If there are conflicting provisions between the documents that make up the Contract, the order of precedence for the documents is as follows:

1. This one-page Contract;

2. Contract Part 6;

3. This RFP, including all sections, parts, and exhibits, as amended; and

4. The Proposal dated January 22, 2025.

Once awarded, the term of the Contract will be from July 1, 2025 through June 30, 2028. The State may solely renew this Contract at its discretion for a period of one month. Any further renewals will be by mutual agreement between the Contractor and the State. The parties may renew this Contract for up to four additional one-year term(s). Any such renewal of all or part of the Contract is also subject to the satisfactory performance of the Contractor and the needs of the State of Ohio.

To show their agreement, the parties have executed this Contract as of the dates below.

VISION SERVICE PLAN INSURANCE COMPANY STATE OF OHIO,

DEPARTMENT OF ADMINISTRATIVE SERVICES

By: _________________________________ By: ____________________________________

Name: ______________________________ Name: __________________________________

Title:________________________________ Title: Director

Date: ________________________________ Date: ___________________________________

Part 6 – Mutually Agreed Upon Changes

A. The Contractor has agreed to use the Office of Procurement Service’s standard contract format and retracts Exhibit C – Sample OH Risk IR Contract-Advantage from its Proposal.

B. The Contractor retracts its proposed VSP Data Security Addendum from its Proposal.

C. The Contractor confirms that the administrative fee will be calculated in accordance with Scope of

Work (SOW) requirement O.1.d. The Agency makes no guarantee of enrollment numbers.

Enrollment numbers may fluctuate over time.

D. The Contractor confirms that the monthly administrative fees payment terms are net 30 (after the receipt of a properly prepared invoice) in accordance with SOW requirement O.1.e.

E. SOW requirement O.2.c is rewritten as follows: The payment terms for claim reimbursement payments to the Contractor is net 30 upon receipt of a properly prepared and detailed claims reimbursement invoice (see invoice requirements below under Section O(3), Invoice Requirements).

F. The Contractor imposes no restrictions or limitations on the implementation credit offered. The credit is intended to help offset implementation costs related to the administration and/or communication of the Contractor plan. The intention is to allow flexibility and avoid unnecessarily stringent restrictions or limitations on how the credit is used. The Contractor asks for the Agency to provide it with documentation of the expenses for which the credit was used for internal reporting and audit purposes. The implementation credit can be released upon Contract award.

G. If the Contractor fails to meet timeframes and promised deliverables agreed upon in the customized Implementation Action Plan (customized and agreed upon after Contract award), the implementation satisfaction fees at risk proposed by the Contractor will be paid out according to the fees at risk for the section(s) of the plan in which the Agency expresses dissatisfaction.

H. Regarding fees at risk offered for positive migration to the Contractors network, the Contractor will track migration by leveraging member-specific claims information, or as an alternative, can measure overall usage instead. However, the Contractor is not able to set percentage targets until it has reviewed the data. The Contractor is offering a total of $30,000 at risk. The Contractor would determine aggregate usage at the 3 named retail locations. If State employees are still using those locations in excess of 15% in Year 1, the payout would be $15,000; If employees are still using these locations in excess of 12% in Year 2, an additional payout of $15,000 will be paid to the Agency.

I. The Contractor confirms it can accept both 8-digit unique identifiers as well as SSN’s, in accordance with SOW requirement B.6.

J. SOW requirement F.1 is rewritten as follows: The Contractor must acknowledge Member complaints in writing within 24 hours of receipt. 90% of Member complaints must be resolved within 15 Business Days and 99% of the complaints must be resolved within 30 calendar days of receipt.

K. SOW requirement J.3 is rewritten as follows: The Contractor must pay approved claims to vision providers at least twice a month for claims. For out-of-network claims, reimbursement checks are mailed daily to Members.

L. SOW requirement R.3 is rewritten as follows: The Contractor agrees to be audited for up to two years post-termination or expiration of this Contract on any matters related to this Contract (including appeals, customer service, claims, operational, etc.) by the Agency or by an entity chosen by the Agency with a completed and signed Contractor Non-Disclosure Agreement (NDA), without additional cost to the Agency and within 60 days of notification by the Agency.

M. SOW requirement R.7 is rewritten as follows: The Contractor must sign a reasonable confidentiality agreement with the auditing entity for each audit. If the Agency chooses to have a third party conduct the desktop audit, the Contractor’s NDA is required to be completed and signed with the third party.

N. As a result of the Best and Final Offer (dated 3/5/25), the Contractor’s Implementation Guarantee is $50,000. This includes collaborating with the Agency to create a customized Implementation Action Plan that includes detailed roles, responsibilities, timeframes, and deliverables to ensure a successful implementation and Open Enrollment.

1. The comprehensive Implementation Action Plan includes the following sections:

a. Communications

b. System accuracy

c. Plan accuracy

d. Membership management

e. VSP network doctor access

Each of the above sections is assigned a maximum penalty amount of $10,000. Those amounts are payable in the event the State is not satisfied with our performance in that section.

2. Additionally, the Contractor will provide the following Open Enrollment member communication materials for the State to review within 10-business days of notification of Contract award:

a. Member Benefit Summary

b. Member Benefits PowerPoint Presentation

c. Enrollment Email Communications templates

d. Relevant Member Communication flyers

O. Part 2, Section I (Performance Guarantees) is replaced with the mutually agreed upon performance guarantees:

This Contract includes minimum Performance Guarantees (PGs) that will be used to monitor and manage the Contractor’s performance of the Work. The Contractor may supplement the minimum PGs with additional PGs that are generally applicable to its other customers only if the additional parameters are not addressed in, or are more stringent than, the minimum PGs set forth in this Contract. Modifications to the PGs may only be made by written agreement of the State and the Contractor.

The Contractor must maintain, at a minimum, the following PGs throughout the term of the Contract.

PGs will be measured quarterly. The amount due for an unmet PG is based on the administrative fees paid for the quarter(s) where a PG is not met. The Agency requires a minimum risk of 45% of the total annual administrative fees. PGs may be modified on an annual basis, as mutually agreed upon by the Agency and the Contractor. Performance Standard Measurements are based on the Contractor’s performance on this Contract not the Contractor’s book of business.

PG # PG

Performance Standard Measurement

Percentage of fees at risk

Plan sponsor satisfaction with implementation (implementation - applies to first year only)- Plan sponsor will score based on its satisfaction of the implementation results.

Minimum score of 4.0 (on a 5.0 point scale). 5.0%

Claims Incidence Accuracy: Financial errors are totaled and taken as a percentage of the total dollars paid for all claims audited during the given month (with a 0.5% margin of error).

Claims Incidence Accuracy minimum of 99%.

5.0%

Claims financial accuracy- Calculated on a monthly basis based upon daily audit results. The term “financial error” encompasses all errors found in the audit process, regardless of whether the error caused/resulted in an overpayment or an underpayment. Any error found that results in a financial impact is recorded as a financial error. At the end of the month, financial errors are totaled and taken as a percentage of the total dollars paid for all claims audited during the given month (with a 0.5% margin of error).

Claims financial accuracy minimum of 99%

3.0%

Claims processing accuracy - Calculated monthly, based on daily audit results. The term “processing error” encompasses all errors found in the audit, regardless of whether the error caused a financial impact.

At month’s end, all processing errors for the month are totaled and taken as a percentage of the total number of claims audited for the month.

Claims processing accuracy minimum of 99%

2.0%

Overall accuracy - calculation methodology

- 99% claims financial and processing accuracy.

Overall accuracy of claims financial and processing accuracy minimum of 99%

1.0%

6 Claim turnaround time

95% of all preferred provider claims processed within five business days

95% of all member claims processed within five business days

99% of all claims processed within 15 business days

2.5%

Average speed of answer- The average speed of answer (the amount of time a caller is waiting while on hold) is

80% of all calls answered within 30 seconds by a live

1.5% calculated by dividing the total time all calls are on hold (in seconds) by the total number of calls received. Results are reported to the tenth decimal (versus rounding to a whole number).

customer service representative.

Call Center telephone abandonment rate- Calculated monthly by taking the total number of abandoned calls, divided by the number of calls accepted by the Call Center, which includes calls answered via the Interactive Voice Response and Automated Call Distribution systems.

Abandonment rate less than or equal to 3%.

The calculation is:

Abandoned Calls / Total Calls = Abandoned Call Rate.

1.0%

Call resolution (same day response)

Minimum of 98% Calculated as follows:

1.00 - Number of Research Inquiries/ Total Number of Calls (IVR and Customer Service Representative) = % Call resolution (same day response)

3.0%

10 Claim adjustment turnaround time

95% of all preferred provider claims adjusted within five business days.

95% of all member claims adjusted within five business days.

99% of all claims adjusted within 15 business days.

2.0%

Agency satisfaction with Account Manager performance via Account Management Survey. The Contractor must score at a minimum 4 out of 5. Contractor and Agency will mutually agree upon contents of survey upon implementation.

Agency subjective measure related to the satisfaction of the Account Manager’s performance. This PG will be an annual PG evaluation.

6.0%

Annual account management survey-the Plan sponsor will score based on its satisfaction of the account management team’s performance. Survey to be developed after Contract award and must be agreed upon by both the Agency and the Contractor.

Minimum score of 4.0 (on a 5.0- point scale).

5.0%

13 Overpayment recovery-total number of dollars overpaid to providers

A minimum of 90.00% 0.5% that are collected in the stated time divided by total number of dollars overpaid.

recovered within 180 days

Network turnover-level of voluntary and involuntary vision provider turnover in the State’s network in the State of Ohio.

Optometrist:

<3% Ophthalmologist:

<4%.

1.5%

15 Network turnover notification

Agency must be notified of the termination of a provider group with more than 50 claims for client’s covered population during the last twelve months within 15 business days of termination and agrees to provide a monthly report of all terminations.

3.0%

Data enrollment files- The Contractor will process and confirm weekly enrollment information provided by the Agency within the timeframe set forth by the Agency following receipt of clean enrollment file (an enrollment file that is free from errors).

A minimum of 100.00% of files loaded within two business days or less upon receipt from the State.

2.0%

Web portal availability- The Contractor must ensure the web portal is available to Members 99.9% of the time (excluding scheduled down time).

The web portal is available to Members 99.9% of the time (excluding scheduled down time).

1.0%