CTR059484_Contract_Documents.pdf

SCOPE OF WORK ARIZONA STATE

RETIREMENT SYSTEM

3300 N Central Ave

14th Floor Phoenix, AZ 85012

Contract No.: CTR059484 Description: Long-Term Disability Program Administration

Page of

TABLE OF CONTENTS

A. GENERAL REQUIREMENTS

B. SPECIFIC REQUIREMENTS

1. Implementation/Transition

2. Customer Service

3. Account Management

4. Claims Administration

5. Reporting

6. Financial Management

7. Audit and Accounting

8. Performance Guarantees

3300 N Central Ave

14th Floor Phoenix, AZ 85012

Contract No.: CTR059484 Description: Long-Term Disability Program Administration

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Contractor, unless otherwise or specifically indicated, shall be responsible to provide the Services listed below:

A. GENERAL REQUIREMENTS

1. Contractor shall provide LTD administration services for the ASRS in accordance with the provisions and requirements as stated in this document. In particular, services rendered under this Contract shall comply with A.R.S. § 38-797 and its subsections and related Administrative Rules. (see Exhibit 1).

2. Contractor shall make recommendations, as needed, for changes or amendments due to changes in federal law or industry practices.

3. Business Continuity Planning

Contractor will:

3.1. Maintain current and test a Business Continuity/Disaster Recovery Plan(s). Based on the plans, inform ASRS of the business priority categorization for Contractor applications that ASRS deems critical to ASRS operations.

3.2. Incorporate applicable recovery procedures to fully support ASRS continuity of business operations.

3.3. Notify ASRS and engage in escalation support on incidents affecting Contractor Services to ASRS.

3.4. Participate in joint business continuity test exercises with ASRS with 30 days advance notice.

4. Issue and Operation Error Escalation and Resolution

In the event of a Contractor operating error, event, or issue that has the potential to disrupt regular, ongoing operations, and have any impact to ASRS Contractor will:

4.1. Make every attempt to minimize any disruptive impact or exposure to ASRS.

4.2. Establish a methodology to address problems or issues that require escalation, which includes, at minimum, the following requirements. Contractor will:

4.2.1. Communicate to ASRS all discovered operating errors/events without undue delay

4.2.2. Escalate all discovered operating errors/events to the Account Executive and Contractor’s equivalent senior management.

4.2.3. Prior to the execution of any corrective action:

4.2.3.1. Convene with ASRS and provide detailed explanation of proposed resolution

4.2.3.2. Achieve joint agreement from Contractor’s senior management and ASRS on the resolution, corrective actions, and any operating loss payment(s).

4.3. Provide to ASRS annually a list of contact information detailing:

4.3.1. Contractor senior and risk management personnel

4.3.2. Contractor personnel who may be contacted during and outside of normal business hours.

4.4. If ASRS discovers an operating error/event by Contractor, ASRS agrees to communicate to Contractor without undue delay.

4.5. If ASRS causes an error/event that may impact Contractor, ASRS agrees to communicate to Contractor without undue delay.

5. Technology

Contractor will:

5.1. If applicable, ensure that Contractor-sourced interfaces and applications integrate successfully with the ASRS environment.

3300 N Central Ave

14th Floor Phoenix, AZ 85012

Contract No.: CTR059484 Description: Long-Term Disability Program Administration

Page

5.2. Maintain or have the ability to maintain the following computer resources:

5.2.1. Implement a disaster recovery plan to secure an off-site backup system for all ASRS transactions. Provide documentation to ASRS that such a system is in place and operating.

5.2.2. The ability to send/receive files (ANSI fixed length, ASCII comma delimited, XML, XLS, XLSM, etc.) in the ASRS-approved format, including all columns, number of records included on each file and number of files exchanged in current ASRS LTD procedures.

5.3. Limit use and access of participant SSN within the system accessed by ASRS staff by utilizing a unique identifier in its place.

5.4. Maintain detailed plans for the prevention of, and response and mitigation in the event of, data breaches.

B. SPECIFIC REQUIREMENTS

1. Implementation/Transition Upon award, Contractor shall:

1.1. Provide a team of individuals dedicated to implementing the provisions of this Contract. The implementation team shall include, but not be limited to, a project manager, an account manager, a network contracting manager, programmers, network contracting manager, enrollment specialists, claims specialists, and customer service staff.

1.1.1. The implementation/transition team shall expedite all Contract requirements, as outlined and prioritized by the ASRS, to ensure complete continuity, without exception, of all functions, deliverables, and objectives by dates established by ASRS.

1.1.2. The project manager must continue to provide support to ASRS for a minimum of forty-five (45) calendar days after completion of implementation at no additional cost to ASRS.

1.2. Develop a written plan that establishes key activities, milestones, and deliverables to ensure operational and financial readiness.

1.3. Collaborate and coordinate with ASRS in the development of communications, administration, and procedures.

1.4. Provide training and written procedures for Contractor’s portal at no additional cost to ASRS.

1.5. Contractor shall meet the following specific requirements for the implementation:

1.5.1. A customer call center and website are available no less than sixty (60) calendar days before the implementation date of July 1, 2022 (unless otherwise specified by ASRS) for transitioning current and potential new Participants to access information.

1.5.2. Comprehensive claim system testing and a quality assurance self-audit is completed ninety (90) calendar days prior to the implementation date. Contractor shall report detailed system testing and audit results to ASRS. These audits shall be provided at no additional cost to ASRS.

2. Customer Service

2.1. Contractor shall provide the following services, including but not limited to:

2.1.1. An 800 number or other free telephone service that is staffed with live customer service representatives from at least 8 a.m. to 5 p.m. (Local Arizona time Zone), Monday to Friday, to assist participants and employers with questions and the claims filing process. Customer service representatives shall have the ability to view information regarding claims and be trained to explain claims status, calculations, and the Social Security Disability (SSD) process.

2.1.2. An online and telephonic access to self-service capabilities where the participant can obtain information about the claim through a secure system.

3300 N Central Ave

14th Floor Phoenix, AZ 85012

Contract No.: CTR059484 Description: Long-Term Disability Program Administration

Page

2.1.3. Notification to participants’ employers regarding claims requests and status.

2.1.4. A full time account representative with a work schedule that is acceptable to the ASRS.

2.1.4.1. The representative will serve as the single day-to-day contact for ASRS and should have the ability to make certain decisions on behalf of Contractor, including accepting applications, discussing with participants processes of the program, and resolving issues.

2.1.4.2. The representative will participate in educational meetings for participants and employers, as requested by ASRS.

2.1.4.3. The representative will correspond with the ASRS on participant issues by using the ASRS’s communication and workflow systems.

2.1.4.4. The representative will provide counsel to participants as well as act as a claims administrator and ombudsman.

2.1.4.5. Contractor will be responsible for software and connectivity service required to utilize Contractor’s and ASRS’ systems.

2.2. A single point of contact for overpayment questions from the ASRS and participants on open and closed claims.

2.3. Preparation, production, and distribution of participant communications materials and administrative forms, including but not limited to claim application/forms, participant informational handbooks, brochures, and other materials necessary for proper administration. The ASRS must review and approve all material prior to publication and distribution. Contractor will be responsible for any related costs, including but not limited to development, printing (if any), and postage.

3. Account Management

3.1. Contractor shall establish and maintain throughout the term of the Contract an account management team, and adjust staffing as required and if acceptable to the ASRS.

3.2. Contractor shall designate a qualified Account Manager to be assigned to the ASRS account who will perform the following services, including but not limited to:

3.2.1. Act as the principal contact for the ASRS with the primary responsibilities of managing all account activities, coordinating Contractor’s staff to resolve issues, and overseeing all aspects of any project management, including operational and information system requirements.

3.2.2. Participate in a minimum of two meetings (2) per fiscal year with ASRS personnel to review utilization and performance of the ASRS LTD Program.

3.2.3. Monitor industry and legislative information for potential application to the ASRS LTD Program.

4. Claims Administration

4.1. Contractor, with or without subcontractors, shall provide the following services, including but not limited to:

4.1.1. Claims Processing and Management

4.1.1.1. Intake – provide/receive participant, employer, medical and other required forms and information.

4.1.1.2. Evaluation – review/analyze participant eligibility using ASRS plan criteria and prevailing medical/disability standards; review/analysis to be conducted by qualified personnel, including nurse case managers.

4.1.1.3. Claim Approval/Denial – clearly document/communicate decisions to participants, employers and the ASRS.

3300 N Central Ave

14th Floor Phoenix, AZ 85012

Contract No.: CTR059484 Description: Long-Term Disability Program Administration

Page

4.1.1.4. Ongoing Case Management – review of open claims at appropriate intervals and upon change in disability (see Exhibit 1 for specific defined periods); conduct related assessment, planning, facilitation, and communication.

4.1.1.5. Independent Medical Examinations (IME) – conducted by credentialed medical providers, as recommended/necessary, and with the approval of the ASRS, to support the case management function.

4.1.1.6. Decision Reviews/Claim Appeals – provide first level Contractor reviews and assist ASRS with subsequent agency level appeals.

4.2. Benefits Disbursement

4.2.1. Calculate disability benefits due based on monthly compensation, as determined by the ASRS established disability date(s), required offset reductions, overpayment reductions, and minimum benefit requirements in accordance with applicable Statutes and Rules.

4.2.2. Issue payments directly to participants each month and, as necessary, off-cycle.

4.2.3. Withhold and remit applicable taxes (Federal and State of Arizona) from gross monthly benefit payments.

4.2.3.1. Prepare and provide required federal tax forms to participants annually.

4.2.4. Identify when participants have been overpaid benefits (e.g., due to miscalculations, retroactive offsets, or return to work) and pursue collection of all overpayments on open claims; identify and provide information to ASRS on closed claims.

4.2.5. When requested, provide overpayment estimate/amounts to ASRS within two (2) business days.

4.3. Offset Services

4.3.1. Identify and apply all required offsets (e.g., Social Security, workers’ compensation, veteran’s disability, employment wages and benefits) to monthly ASRS LTD program benefits.

4.3.2. Monitor Social Security and other offsets application/appeal processes.

4.3.3. At no out-of-pocket cost to the participant, Contractor shall provide or facilitate through a Subcontractor, Social Security legal appeals assistance.

4.4. Other Disability Management Services

4.4.1. At no cost to the participant, Contractor may provide rehabilitation assistance. When the ASRS approves a rehabilitation plan prior to services being provided to the participant, the ASRS will reimburse Contractor at cost. No additional Contractor fees will be allowed.

4.4.2. At no cost to the participant, Contractor may establish other transitional or return to work programs, with the prior approval of the ASRS. The program must have clearly defined parameters and/or requirements and must not put participants at risk of losing eligibility for LTD benefits.

5. Reporting

5.1. Contractor shall provide a complete and comprehensive administrative reporting package to the ASRS in a format acceptable to the ASRS, including but not limited to the following reports:

5.1.1. Monthly reporting due within five (5) business days of the last day of the month:

5.1.1.1. Claims activity – provide the status of all claims as of the final day of the month;

5.1.1.2. Funding – detail records of all benefits paid in the last month including the regular and off-cycle payments;

5.1.1.2.1. The report must be submitted as a CSV file unless otherwise directed by the ASRS. The required data for this report is available in Exhibit 9: LTD Funding

3300 N Central Ave

14th Floor Phoenix, AZ 85012

Contract No.: CTR059484 Description: Long-Term Disability Program Administration

Page

Report Sample. The required naming, data and file format are subject to change as required by the ASRS.

5.1.1.3. Bank reconciliations – detail of monthly bank account transactions;

5.1.1.4. Overpayments – a monthly record of overpayments due and collected on open claims and overpayments due on closed claims. The report should outline exceptions or changes over the previous month for reconciliation purposes;

5.1.1.5. Decision timeliness– documents the turnaround time for decisions on claims; due each month.

5.1.1.6. Claims termination – a record of the effective date of terminations for the previous month;

5.1.1.7. Plan highlights – a summary overview of plan elements requested by the ASRS, such as claims processed, number of open/closed claims, claim types, Social Security benefits approval rates; due each month.

5.1.1.8. Social Security and other offset processes – a record of the status of open applications, including appeals, and actions taken;

5.1.1.9. Appeal Status – provide the status of all appeals as of the final day of the month.

5.1.2. Quarterly reporting due within ten (10) days of the last day of the quarter:

5.1.2.1. Other Services - the status of any additional program efforts, including rehabilitation plans or return to work programs.

5.1.2.2. Quarterly Performance Guarantee Reporting

5.1.3. Annual reporting due within ten (10) days of the last day of the reporting period:

5.1.3.1. Open Claims Overpayments – Annually within in ten (10) days of the last day of June provide a report of non-collectable overpayments at or above $30,000.

5.2. Contractor shall include in any reports the key data fields identified as necessary for the ASRS to process/utilize/interface with its computer systems and processes, including but not limited to participant name, Social Security number or other unique identifier, date of disability, benefit amounts, offset amounts, taxes withheld, reductions and amounts paid, and termination dates.

5.3. Contractor shall submit reports in a secure manner, as appropriate for the content.

5.4. On an annual basis, Contractor shall provide a comprehensive analysis of the ASRS LTD program, providing an overview of key LTD program statistical outcomes, achievements, industry trends and practices, and recommend appropriate changes.

5.5. Upon request, Contractor must provide an audited financial report of the company and any other financial description that might be useful to the ASRS in determining the financial stability of Contractor. Contractor shall be responsible of any expenses related to such audits.

5.6. From time to time on an ad hoc basis, ASRS may request Contractor to prepare customized reports on a timely basis to assist ASRS in effective cost management of the program.

6. Financial Management

6.1. Contractor, with or without subcontractors, shall provide the following services, including but not limited to:

6.1.1. Establish a bank account for the purpose of paying ASRS LTD claims.

6.1.1.1. Establish appropriate procedures for accurate payment of benefits and monthly reconciliation reporting.

3300 N Central Ave

14th Floor Phoenix, AZ 85012

Contract No.: CTR059484 Description: Long-Term Disability Program Administration

Page

6.1.1.2. Transmit to the ASRS a report, in a file format acceptable to the ASRS, of all proposed benefits to be paid one (1) week prior to the scheduled payment date. ASRS will compare the report against its records and Contractor will explain any discrepancies.

6.1.1.3. Have the capability to accept the electronic transfer of funds. The ASRS will wire transfer sufficient dollars to fund the account as appropriate prior to the scheduled payment date.

6.1.1.4. Reconcile issued and cleared payments and stop payments.

6.1.1.5. Contractor shall absorb any costs for the printing of any checks.

6.1.2. Establish a clear billing process for established fees and approved expenses.

6.1.2.1. Costs/fees shall be billed to the ASRS on a monthly basis according to the format and content of the Pricing Schedule, as accepted by the ASRS. Invoices shall also reflect any reductions or discounts and include appropriate and acceptable documentation to validate the services performed as a basis for such costs.

6.1.2.2. Any additional costs/fees for any services that may be incurred by Contractor must be identified in writing and agreed to by the ASRS in advance.

6.1.2.3. Any savings gained by Contractor in utilizing subcontractors or by operational efficiencies must be reported to the ASRS.

6.1.3. Establish a clear process for collecting overpayments that includes the following:

6.1.3.1. All overpayment funds collected by or sent to Contractor will be netted against LTD benefit payment funding requests.

7. Audit and Accounting

Contractor shall:

7.1. Be responsible for all costs associated with any investigation and/or audit necessary to ensure that decisions are made properly.

7.2. Conduct internal audits at the request of ASRS should Participant service issues, regulatory changes, or failure to meet performance guarantees require ASRS to seek an intermittent audit of process or procedures.

7.3. Furnish a full annual accounting to the ASRS within sixty (60) calendar days of the end of the plan year showing all plan activity.

7.4. On an annual basis, provide a report of an operational audit (e.g. SSAE-18), conducted by an independent certified firm. Contractor shall be responsible for any expenses related to such audits.

8. Performance Guarantees

8.1. Contractor shall offer the following Performance Guarantees in which Contractor takes full financial risk for unsatisfied guarantees:

Service Performance

Standards Measurement Performance

Guarantee Frequency of Measurement Weight Frequency of

Assessment

Decision Timeliness

% new claims decision (approve or deny) is made within 60 calendar days after receiving complete packet.

90% Quarterly 2.0% Annually

Timely Delivery of Defined Scheduled Reports

% defined reports delivered by established due dates. 99% Quarterly 1.0% Annually

3300 N Central Ave

14th Floor Phoenix, AZ 85012

Contract No.: CTR059484 Description: Long-Term Disability Program Administration

Page

Service Performance

Standards Measurement Performance

Guarantee Frequency of Measurement Weight Frequency of

Assessment

Financial Accuracy

% audited claims with correct payment (random sample audit of 2% of new approved claims for the period).

99% Quarterly 1.0% Annually

LTD Approval Process

Average overall satisfaction on participant-satisfaction surveys.

90% Quarterly 1.0% Annually

LTD Ongoing Claims Maintenance

Average overall satisfaction on participant-satisfaction surveys.

90% Quarterly 1.0% Annually

Issue Resolution Timeliness

% member payment issues resolved by Contractor before next regular billing cycle (or thirty (30) days, as appropriate).

95% Quarterly 1.0% Annually

Call Answer Speed % speed to answer less than or equal to thirty (30) seconds. 60% Quarterly 0.5% Annually

Call Abandonment Rate

Maintain a call abandonment rate of 10% or less. 100% Quarterly 0.5% Annually

Call Satisfaction Survey Results

% of participant callers satisfied with call. 90% Quarterly 2.0% Annually

Total Maximum Assessment 10%

8.2. Performance standards shall be measured by Contractor on an account-specific basis for the ASRS.

8.3. On the frequency of measurement basis outlined for each guarantee, Contractor shall document and provide reports to ASRS to show actual results for the current period, results from prior periods, and the guaranteed standard.

8.4. Contractor shall place a maximum of ten percent (10%) of total annual administrative costs at risk for all performance guarantees in aggregate. The relative weight of the assessment for each performance guarantee is as indicated in the table in 8.1 above.

8.5. Penalty assessments associated with performance guarantees shall be reviewed within 90 days of the quarter’s end and collected annually, as required, at the end of each Contract year.

8.6. ASRS may request the inclusion of additional performance measurements. Any additional performance measurements shall be mutually agreed upon through written Contract Amendment.

8.7. ASRS reserves the right to audit Contractor’s performance, records, and standards. Contractor shall cooperate with auditors and provide records, as requested, at no cost to the ASRS.

All terms not defined herein shall have the meaning given to them in the Uniform Terms and Conditions.

Best and Final

PRICING SCHEDULE ARIZONA STATE

RETIREMENT SYSTEM

3300 N Central Ave

14th Floor Phoenix, AZ 85012

Contract No.: CTR059484 Description: Long-Term Disability Program Administration

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Fees, charges, or costs that are not stated on this Pricing Schedule will not be authorized. All pricing (fixed, project basis, etc.) must be inclusive of travel.

Offeror must complete the Items tab in APP by entering $1 in the Unit Price field.

1. ADMINISTRATIVE FEES

In the Excel file included below, provide pricing for the administrative services described in the Scope of Work. Offeror must identify any and all qualifications, conditions, and limitations/maximums (e.g., on the number of claims, appeals, etc.).

Double click on the icon labeled Administrative Fee Detail.xlsx below. Complete the spreadsheet, and save and close the Excel file to retain it in this document. Do NOT save as a separate document to attach to Offer.

Pricing attached for 5 year rate guarantee.

Worksheet in C Broadspire BestandF

2. OPTIONAL/ALTERNATIVE PRICING

The Offeror may propose alternative pricing structures, including multi-year pricing, provided it has submitted pricing information under item 1 above. The Offeror has full discretion in what it may propose, however, the ASRS is under no obligation to accept such proposals.

Alternate pricing provided – 3 year rate guarantee.

Worksheet in C Broadspire BestandF

3. PAYMENT DISCOUNT OPTIONS

For the services specified herein, the following apply:

If payment is made within calendar days after acceptance of services, the above quoted price, shall be discounted by .

We do not offer early payment discounts.

SERVICES DESCRIPTION

FEE TYPE

(Fixed/Actual Fee Reimbursement)

FEE OR UNIT COST

(If Cost, provide estimated averages)

UNIT OF

MEASUREMENT

FREQUENCY OR

QUANTITY

Example:

New Claim

One-time charge in month claim is approved for benefit

Fixed $200.00 Per Claim One time

Example:

Open Claim

Charge for an open claim approved in a previous month; action may/may not be taken on the claim in a given month

Fixed $25.00 Per Claim Per Month

Example:

Medical Record Expenses

Charges from physician office and other medical facilities to provide records received by the participant and requested by Contractor to make a claim determination.

Actual Fee Reimbursement Variable; historical experience indicates average

(avg) of $25

Per Participant Avg of 3 facilities upon initial claim; avg of 2 facilities upon review in claim year 3

Account Management Fee A recurring charge to be billed monthly Fixed $14,500 Per Month Per month

New Claims One-time charge in month claim is approved for benefit

Fixed $521. 00 Per Claim One Time

Open Claims Charge for an open claim approved in a previous month; action may/may not be taken on the claim in a given month

Fixed $36 .00 Per claim Per Month

Late Claims No additional charge, any late filed claims would be considered part of the new claim

No Charge

Pre-Existing Review No additional charge, Pre-X claims would be considered as part of a new claim No Charge

Contractor Level Appeals Appeals reviewed and processed by

Broadpsire Fixed

$395 .00 Per Claim One Time

Medical Records Expenses Charges from physician office and other medical facilities to provide records received by the participant and requested by Contractor to make a claim determination.

Actual Fee Reimbursement Variable Per Participant

Avg of 3 facilities upon initial claim; avg of 3 facilities upon review in claim year 3

Peer Review Services $405 .00

Per hour, one hour minimum, $94.00 for each additional 15 minute increments over an hour

As Needed

Vocational Rehabilitation

When an individual cannot return to work with their employer, we can assist in the development and implementation of a retraining program to help enable the individual to return to gainful employment within a new occupation

$3,800.00 -$4,200.00 Per Participant As Needed

Transferable Skills Analysis

Compares the individuals’ current skills or competencies based on their prior work experience. These competencies are then compared to the current job market to determine if there are transferrable employment opportunities that align with limitations/restrictions to identify suitable or realistic alternative occupations.

$730 .00 Per Participant As Needed

Independent Medical Exam

This cost is variable based on the type of exam and location of the employee.

The average cost is approximately $1,500.00 -

$2,000.00

Per Participant As Needed

Ad Hoc Reports $150 .00 Per Hour As Needed

Labor Market Survey

Provides assessment of the existence of positions, wages, and availability within the individual’s geographical region. Analyzes the feasibility of that position and verify the qualifications and employment potential of the individual within that occupation. We are assessing, job requirements, wages, physical demands, and availability. Max of 8 contacts included. Additional contacts billed at T&E

$950.00, $112.00 Plus Expenses

Per Participant As Needed

Vocational Rehabilitation Plan Monitoring

We monitor the retraining plan, handling issues that may arise from the school or the individual from their first day to their last day of the training program.

$112 .00 Per Participant, Per Hour As Needed

Broadspire System Access These are the licenses granted to no more than 22 ASRS employees to perform system work

No Charge

BEST AND FINAL OFFER

ATTACHEMENT C: ADMINISTRATIVE FEE DETAIL

The below fees are gauranteed for:

FEE GUARANTEE

ASRS COSTS

PARTICIPANT COSTS (fees or costs that may be collected from a participant, if applicable)

Account Management: (Including but not limited to)

Reimburseable Expenses: (Including but not limited to)

Other: (include additional fees as necessary)

SOLICITATION CODE: BPM003900

ASRS Long-Term Disability Program Administration

Complete the table below in the format provided. All fees or charges to the ASRS or fees that may be charged or collected from an ASRS LTD Participant and that are associated with this Contract shall be listed.

Offeror shall provide pricing in each of the Service category (in Bold type) offered. Offeror should further break-out pricing in the administrative fee detail areas (non-bold type).

Additional rows may be inserted, as necessary.

Use the Description field to clearly explain all qualifications or conditions.

If optional services that may be offered as part of the Scope of Work are not part of Offer, indicate N/A.

Any fee not stated herein is deemed to be included in the Total Account Management Fee.

Any additional fees not included in the provided list should be added in the "other" section.

ADMINISTRATIVE FEE DETAIL SUMMARY

Other Services:

1 year 5 years

(Fixed/Actual Fee Reimbursement)

FEE OR UNIT COST

(If Cost, provide estimated averages)

UNIT OF

MEASUREMENT

FREQUENCY OR

QUANTITY

Example:

New Claim

One-time charge in month claim is approved for benefit

Fixed $200.00 Per Claim One time

Example:

Open Claim

Charge for an open claim approved in a previous month; action may/may not be taken on the claim in a given month

Fixed $25.00 Per Claim Per Month

Example:

Medical Record Expenses

Charges from physician office and other medical facilities to provide records received by the participant and requested by Contractor to make a claim determination.

Actual Fee Reimbursement Variable; historical experience indicates average

(avg) of $25

Per Participant Avg of 3 facilities upon initial claim; avg of 2 facilities upon review in claim year 3

Account Management Fee A recurring charge to be billed monthly Fixed $14,500 Per Month Per month

New Claims One-time charge in month claim is approved for benefit

Fixed $505. 00 Per Claim One Time

Open Claims Charge for an open claim approved in a previous month; action may/may not be taken on the claim in a given month

Fixed $35 .00 Per claim Per Month

Late Claims No additional charge, any late filed claims would be considered part of the new claim

No Charge

Pre-Existing Review No additional charge, Pre-X claims would be considered as part of a new claim No Charge

Contractor Level Appeals Appeals reviewed and processed by

Broadpsire Fixed

$382 .00 Per Claim One Time

Medical Records Expenses Charges from physician office and other medical facilities to provide records received by the participant and requested by Contractor to make a claim determination.

Actual Fee Reimbursement Variable Per Participant

Avg of 3 facilities upon initial claim; avg of 3 facilities upon review in claim year 3

Peer Review Services $405 .00

Per hour, one hour minimum, $94.00 for each additional 15 minute increments over an hour

As Needed

Vocational Rehabilitation

When an individual cannot return to work with their employer, we can assist in the development and implementation of a retraining program to help enable the individual to return to gainful employment within a new occupation

$3,800.00 -$4,200.00 Per Participant As Needed

Transferable Skills Analysis

Compares the individuals’ current skills or competencies based on their prior work experience. These competencies are then compared to the current job market to determine if there are transferrable employment opportunities that align with limitations/restrictions to identify suitable or realistic alternative occupations.

$730 .00 Per Participant As Needed

Independent Medical Exam

This cost is variable based on the type of exam and location of the employee.

The average cost is approximately $1,500.00 -

$2,000.00

Per Participant As Needed

Ad Hoc Reports $150 .00 Per Hour As Needed

Labor Market Survey

Provides assessment of the existence of positions, wages, and availability within the individual’s geographical region. Analyzes the feasibility of that position and verify the qualifications and employment potential of the individual within that occupation. We are assessing, job requirements, wages, physical demands, and availability. Max of 8 contacts included. Additional contacts billed at T&E

$950.00, $112.00 Plus Expenses

Per Participant As Needed

Vocational Rehabilitation Plan Monitoring

We monitor the retraining plan, handling issues that may arise from the school or the individual from their first day to their last day of the training program.

$112 .00 Per Participant, Per Hour As Needed

Broadspire System Access These are the licenses granted to no more than 22 ASRS employees to perform system work

No Charge

BEST AND FINAL OFFER

ATTACHEMENT C: ADMINISTRATIVE FEE DETAIL

FEE GUARANTEE

ASRS COSTS

PARTICIPANT COSTS (fees or costs that may be collected from a participant, if applicable)

Account Management: (Including but not limited to)

Reimburseable Expenses: (Including but not limited to)

Other: (include additional fees as necessary)

SOLICITATION CODE: BPM003900

ASRS Long-Term Disability Program Administration

Complete the table below in the format provided. All fees or charges to the ASRS or fees that may be charged or collected from an ASRS LTD Participant and that are associated with this Contract shall be listed.

Offeror shall provide pricing in each of the Service category (in Bold type) offered. Offeror should further break-out pricing in the administrative fee detail areas (non-bold type).

Additional rows may be inserted, as necessary.

Use the Description field to clearly explain all qualifications or conditions.

If optional services that may be offered as part of the Scope of Work are not part of Offer, indicate N/A.

Any fee not stated herein is deemed to be included in the Total Account Management Fee.

Any additional fees not included in the provided list should be added in the "other" section.

ADMINISTRATIVE FEE DETAIL SUMMARY

Other Services:

3 years

SPECIAL TERMS & CONDITIONS ARIZONA STATE

3300 N Central Ave

14th Floor Phoenix, AZ 85012

Contract No.: CTR059484 Description: Long-Term Disability Program Administration

Page

TABLE OF CONTENTS

1. Definition of Terms

2. Contract Interpretation

3. Contract Administration and Operation

4. Pricing and Payments

5. Contract Changes

6. Contract Termination

7. Risk and Liability

8. Information Security and Data Privacy

Best and Final

PRICING SCHEDULE ARIZONA STATE

RETIREMENT SYSTEM

3300 N Central Ave

14th Floor Phoenix, AZ 85012

Contract No.: CTR059484 Description: Long-Term Disability Program Administration

Page of

Fees, charges, or costs that are not stated on this Pricing Schedule will not be authorized. All pricing (fixed, project basis, etc.) must be inclusive of travel.

Offeror must complete the Items tab in APP by entering $1 in the Unit Price field.

1. ADMINISTRATIVE FEES

In the Excel file included below, provide pricing for the administrative services described in the Scope of Work. Offeror must identify any and all qualifications, conditions, and limitations/maximums (e.g., on the number of claims, appeals, etc.).

Double click on the icon labeled Administrative Fee Detail.xlsx below. Complete the spreadsheet, and save and close the Excel file to retain it in this document. Do NOT save as a separate document to attach to Offer.

Pricing attached for 5 year rate guarantee.

Worksheet in C Broadspire BestandF

2. OPTIONAL/ALTERNATIVE PRICING

The Offeror may propose alternative pricing structures, including multi-year pricing, provided it has submitted pricing information under item 1 above. The Offeror has full discretion in what it may propose, however, the ASRS is under no obligation to accept such proposals.

Alternate pricing provided – 3 year rate guarantee.

Worksheet in C Broadspire BestandF

3. PAYMENT DISCOUNT OPTIONS

For the services specified herein, the following apply:

If payment is made within calendar days after acceptance of services, the above quoted price, shall be discounted by .

We do not offer early payment discounts.

(Fixed/Actual Fee Reimbursement)

FEE OR UNIT COST

(If Cost, provide estimated averages)

UNIT OF

MEASUREMENT

FREQUENCY OR

QUANTITY

Example:

New Claim

One-time charge in month claim is approved for benefit

Fixed $200.00 Per Claim One time

Example:

Open Claim

Charge for an open claim approved in a previous month; action may/may not be taken on the claim in a given month

Fixed $25.00 Per Claim Per Month

Example:

Medical Record Expenses

Charges from physician office and other medical facilities to provide records received by the participant and requested by Contractor to make a claim determination.

Actual Fee Reimbursement Variable; historical experience indicates average

(avg) of $25

Per Participant Avg of 3 facilities upon initial claim; avg of 2 facilities upon review in claim year 3

Account Management Fee A recurring charge to be billed monthly Fixed $14,500 Per Month Per month

New Claims One-time charge in month claim is approved for benefit

Fixed $521. 00 Per Claim One Time

Open Claims Charge for an open claim approved in a previous month; action may/may not be taken on the claim in a given month

Fixed $36 .00 Per claim Per Month

Late Claims No additional charge, any late filed claims would be considered part of the new claim

No Charge

Pre-Existing Review No additional charge, Pre-X claims would be considered as part of a new claim No Charge

Contractor Level Appeals Appeals reviewed and processed by

Broadpsire Fixed

$395 .00 Per Claim One Time

Medical Records Expenses Charges from physician office and other medical facilities to provide records received by the participant and requested by Contractor to make a claim determination.

Actual Fee Reimbursement Variable Per Participant

Avg of 3 facilities upon initial claim; avg of 3 facilities upon review in claim year 3

Peer Review Services $405 .00

Per hour, one hour minimum, $94.00 for each additional 15 minute increments over an hour

As Needed

Vocational Rehabilitation

When an individual cannot return to work with their employer, we can assist in the development and implementation of a retraining program to help enable the individual to return to gainful employment within a new occupation

$3,800.00 -$4,200.00 Per Participant As Needed

Transferable Skills Analysis

Compares the individuals’ current skills or competencies based on their prior work experience. These competencies are then compared to the current job market to determine if there are transferrable employment opportunities that align with limitations/restrictions to identify suitable or realistic alternative occupations.

$730 .00 Per Participant As Needed

Independent Medical Exam

This cost is variable based on the type of exam and location of the employee.

The average cost is approximately $1,500.00 -

$2,000.00

Per Participant As Needed

Ad Hoc Reports $150 .00 Per Hour As Needed

Labor Market Survey

Provides assessment of the existence of positions, wages, and availability within the individual’s geographical region. Analyzes the feasibility of that position and verify the qualifications and employment potential of the individual within that occupation. We are assessing, job requirements, wages, physical demands, and availability. Max of 8 contacts included. Additional contacts billed at T&E

$950.00, $112.00 Plus Expenses

Per Participant As Needed

Vocational Rehabilitation Plan Monitoring

We monitor the retraining plan, handling issues that may arise from the school or the individual from their first day to their last day of the training program.

$112 .00 Per Participant, Per Hour As Needed

Broadspire System Access These are the licenses granted to no more than 22 ASRS employees to perform system work

No Charge

BEST AND FINAL OFFER

ATTACHEMENT C: ADMINISTRATIVE FEE DETAIL

The below fees are gauranteed for:

FEE GUARANTEE

ASRS COSTS

PARTICIPANT COSTS (fees or costs that may be collected from a participant, if applicable)

Account Management: (Including but not limited to)

Reimburseable Expenses: (Including but not limited to)

Other: (include additional fees as necessary)

SOLICITATION CODE: BPM003900

ASRS Long-Term Disability Program Administration

Complete the table below in the format provided. All fees or charges to the ASRS or fees that may be charged or collected from an ASRS LTD Participant and that are associated with this Contract shall be listed.

Offeror shall provide pricing in each of the Service category (in Bold type) offered. Offeror should further break-out pricing in the administrative fee detail areas (non-bold type).

Additional rows may be inserted, as necessary.

Use the Description field to clearly explain all qualifications or conditions.

If optional services that may be offered as part of the Scope of Work are not part of Offer, indicate N/A.

Any fee not stated herein is deemed to be included in the Total Account Management Fee.

Any additional fees not included in the provided list should be added in the "other" section.

ADMINISTRATIVE FEE DETAIL SUMMARY

Other Services:

1 year 5 years

(Fixed/Actual Fee Reimbursement)

FEE OR UNIT COST

(If Cost, provide estimated averages)

UNIT OF

MEASUREMENT

FREQUENCY OR

QUANTITY

Example:

New Claim

One-time charge in month claim is approved for benefit

Fixed $200.00 Per Claim One time

Example:

Open Claim

Charge for an open claim approved in a previous month; action may/may not be taken on the claim in a given month

Fixed $25.00 Per Claim Per Month

Example:

Medical Record Expenses

Charges from physician office and other medical facilities to provide records received by the participant and requested by Contractor to make a claim determination.

Actual Fee Reimbursement Variable; historical experience indicates average

(avg) of $25

Per Participant Avg of 3 facilities upon initial claim; avg of 2 facilities upon review in claim year 3

Account Management Fee A recurring charge to be billed monthly Fixed $14,500 Per Month Per month

New Claims One-time charge in month claim is approved for benefit

Fixed $505. 00 Per Claim One Time

Open Claims Charge for an open claim approved in a previous month; action may/may not be taken on the claim in a given month

Fixed $35 .00 Per claim Per Month

Late Claims No additional charge, any late filed claims would be considered part of the new claim

No Charge

Pre-Existing Review No additional charge, Pre-X claims would be considered as part of a new claim No Charge

Contractor Level Appeals Appeals reviewed and processed by

Broadpsire Fixed

$382 .00 Per Claim One Time

Medical Records Expenses Charges from physician office and other medical facilities to provide records received by the participant and requested by Contractor to make a claim determination.

Actual Fee Reimbursement Variable Per Participant

Avg of 3 facilities upon initial claim; avg of 3 facilities upon review in claim year 3

Peer Review Services $405 .00

Per hour, one hour minimum, $94.00 for each additional 15 minute increments over an hour

As Needed

Vocational Rehabilitation

When an individual cannot return to work with their employer, we can assist in the development and implementation of a retraining program to help enable the individual to return to gainful employment within a new occupation

$3,800.00 -$4,200.00 Per Participant As Needed

Transferable Skills Analysis

Compares the individuals’ current skills or competencies based on their prior work experience. These competencies are then compared to the current job market to determine if there are transferrable employment opportunities that align with limitations/restrictions to identify suitable or realistic alternative occupations.

$730 .00 Per Participant As Needed

Independent Medical Exam

This cost is variable based on the type of exam and location of the employee.

The average cost is approximately $1,500.00 -

$2,000.00

Per Participant As Needed

Ad Hoc Reports $150 .00 Per Hour As Needed

Labor Market Survey

Provides assessment of the existence of positions, wages, and availability within the individual’s geographical region. Analyzes the feasibility of that position and verify the qualifications and employment potential of the individual within that occupation. We are assessing, job requirements, wages, physical demands, and availability. Max of 8 contacts included. Additional contacts billed at T&E

$950.00, $112.00 Plus Expenses

Per Participant As Needed

Vocational Rehabilitation Plan Monitoring

We monitor the retraining plan, handling issues that may arise from the school or the individual from their first day to their last day of the training program.

$112 .00 Per Participant, Per Hour As Needed

Broadspire System Access These are the licenses granted to no more than 22 ASRS employees to perform system work

No Charge

BEST AND FINAL OFFER

ATTACHEMENT C: ADMINISTRATIVE FEE DETAIL

FEE GUARANTEE

ASRS COSTS

PARTICIPANT COSTS (fees or costs that may be collected from a participant, if applicable)

Account Management: (Including but not limited to)

Reimburseable Expenses: (Including but not limited to)

Other: (include additional fees as necessary)

SOLICITATION CODE: BPM003900

ASRS Long-Term Disability Program Administration

Complete the table below in the format provided. All fees or charges to the ASRS or fees that may be charged or collected from an ASRS LTD Participant and that are associated with this Contract shall be listed.

Offeror shall provide pricing in each of the Service category (in Bold type) offered. Offeror should further break-out pricing in the administrative fee detail areas (non-bold type).

Additional rows may be inserted, as necessary.

Use the Description field to clearly explain all qualifications or conditions.

If optional services that may be offered as part of the Scope of Work are not part of Offer, indicate N/A.

Any fee not stated herein is deemed to be included in the Total Account Management Fee.

Any additional fees not included in the provided list should be added in the "other" section.

ADMINISTRATIVE FEE DETAIL SUMMARY

Other Services:

3 years

3300 N Central Ave

14th Floor Phoenix, AZ 85012

Contract No.: CTR059484 Description: Long-Term Disability Program Administration

Page

The Special Terms and Conditions modify the Uniform Terms and Conditions. It can modify them by replacing, deleting, appending to, or revising the text of an existing provision or by inserting a new paragraph into an existing article. No other document modifies or adds to the Uniform Terms and Conditions, except as may subsequently be otherwise and expressly agreed and incorporated by Contract Amendment.

1. DEFINITION OF TERMS

All other terms not defined herein shall have the meaning given to them in the Uniform Terms and Conditions.

1.1. “Acceptance of Offer” means the Attachment labeled “Offer and Acceptance” bearing the State contract number once the Procurement Officer has signed it to signify the (1) formal acceptance of the Offer and (2) the formation of the Contract. For clarity of intent, the foregoing is not to be confused with the term ‘acceptance’ used throughout the Contract in the context of delivery, inspection, etc., with respect to Materials or Services.

1.2. “Order” means the instrument by which ASRS authorizes Contractor to perform some or all of the Work. Whether the Contract will have one Order or many Orders depends on the scope of the Contract and how the ASRS will use it. Any of the following is to be construed as being an “Order”:

1.2.1. A purchase order;

1.2.2. A task order or service order;

1.2.3. Written correspondence or instruction.

1.3. “Subcontractor” has the meaning given in A.R.S. § 41-2503(38), which, for convenience of reference only, is “… a person who contracts to perform work or render service to … [C]ontractor or to another [S]ubcontractor as a part of a contract with a state governmental unit. . . .” The Contract is to be construed as “a contract with a state governmental unit” for purposes of the definition. For clarity of intent, a person carrying out any element of the Work is a Subcontractor from the moment they first carry out that element of the Work regardless of whether or not a Subcontract exists then or subsequently.

1.4. “Work” means the totality of the materials and the Services and all the acts of administration, creation, production, and performance necessary to fulfill and incidental to fulfilling all of Contractor's obligations and duties under the Contract in conformance with the Contract and applicable laws.

2. CONTRACT INTERPRETATION

2.1. Usage

Where the Contract:

2.1.1. assigns obligations to Contractor, any reference to “Contractor” is to be construed to be a reference to Contractor and all Subcontractors, whether they are first-tier subcontractors, sub-subcontractors, suppliers, sub-suppliers, consultants, or sub-consultants, as well as all of Contractor’s and the Subcontractors’ respective agents, representatives, and employees in every instance unless the context plainly requires that it is be a reference only to Contractor as apart from Subcontractors;

2.1.2. uses the permissive “may” with respect to a party’s actions, determinations, etc., the term is to be interpreted as in A.A.C. R2-7-101(31) [Definitions]. For clarity of intent, any right given to ASRS using “ASRS may” or a like construction denotes discretion and freedom to act so far as any regulatory or operative constraints permit in the relevant circumstances, provided that: (a) where written “may, at its discretion,” the discretion extends to whatever is most advantageous to ASRS; and (b) where written only as “may,” the discretion is constrained by what is fair, reasonable, and as accommodating of the respective best interests of both parties as practicable under the circumstances;

3300 N Central Ave

14th Floor Phoenix, AZ 85012

Contract No.: CTR059484 Description: Long-Term Disability Program Administration

Page

2.1.3. uses the imperative “shall” with respect to a party’s actions, duties, etc., the term is to be interpreted as in A.A.C. R2-7-101(43) [Definitions]. Conversely, the phrase “shall not” is to be interpreted as an imperative prohibition.

2.1.4. uses the term “must” with respect to a requirement, criterion, etc., the term is to be interpreted as conveying compulsion or strict necessity, and is to be read as though written “must, if [the subject] is to be entitled to have [the object] considered or credited as being compliant with, conforming to, or satisfying [the requirement, criterion, constraint, etc.], otherwise, [the object] will be considered or debited as being non-compliant, non-conforming, or unsatisfactory for its Contract-related purposes” in every instance;

2.1.5. uses the term “might” with respect to an event, outcome, action, etc., the term is to be interpreted as conveying contingency or non-discretionary conditionality; and

2.1.6. uses the term “will” or the phrases “is to be” or “are to be” with respect to an event, outcome, action, etc., the term or phrase is to be interpreted as conveying such certainty or imperativeness that “shall” is…