CTR078198_Performance_Guarantees.xlsx
XLSX spreadsheet 307 KB Posted
- Attached to
- Master Agreement AZ|CTR078198
- Contract number
- CTR078198
- Issued by
- Arizona
About this file
This document is a Performance Guarantees Request for Proposal (RFP) from the Arizona Department of Administration (ADOA) State Procurement Office, specifically for an Employee Vision Plan contract. The primary contractor is Avesis Incorporated Inc., represented by Rusty Rice, Director of Commercial Sales. The document outlines detailed performance metrics, reporting requirements, and associated financial penalties for various operational aspects of the vision plan service.
The contract establishes comprehensive performance standards across six key areas: Account Management, Administration, Customer Service, Network Management, Reporting, and HIPAA Data Security. Avesis is required to meet specific targets, such as 90% satisfaction rates, timely response to inquiries, ID card issuance within 10 business days, and maintaining low phone abandonment rates. The performance guarantees include a total minimum of 15% of total annual premiums at risk, with additional 2% for implementation metrics. Reporting will be conducted monthly, quarterly, and annually, with Avesis required to provide detailed performance tracking logs and be subject to potential financial penalties for missed performance targets.
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Other files
| File | Type | Posted |
|---|---|---|
| CTR078198_COI_2025-10-01_GL__AL__WC.pdf | ||
| CTR078198_Pricing_Document.xlsx | XLSX spreadsheet | |
| CTR078198_COI_2025-10-01_Cyber.pdf |
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Text version
Performance Guarantees
| Request for Proposal | Arizona Department of Administration | |
| State Procurement Office | ||
| Solicitation No. BPM006879 | 100 N 15th Avenue | |
| Employee Vision Plan | Phoenix, AZ 85007 | |
| Attachment 14 – Performance Guarantees |
| Offeror Name | Avesis Incorporated Inc. |
| Contact Name | Rusty Rice, Director of Commercial Sales |
| Contact Phone Number | d 210-384-8103 | c 210-602-9386 | 866-884-4986 |
| Authorized Signature | //digitally signed Kirk Rothrock// |
| INSTRUCTIONS TO OFFERORS: |
| 1. Under each category, Offeror shall assign at least the minimum percent of total annual amount of premiums invoiced/paid by ADOA at risk shown below for each section, designating a percentage for each performance standard. |
| 2. Offeror may choose to increase the amount applied to each category but must meet the minimum. |
| 3. Offeror shall describe how the results will be reported to verify compliance. |
| Account Management | 3% |
| Administration | 2% |
| Customer Service | 3% |
| Network Management | 1% |
| Reporting | 1% |
| HIPAA Data Security and Protection | 5% |
| Total Minimum Percent at Risk | 15% |
Implementation – One time Measurement 2%
| Definitions: |
| Tracking and Reporting Method: the description of the report requested and the corresponding time frame that shows how the measure was met or missed. |
| Reporting Frequency: the frequency of reporting the Contractor’s results against the target. This is also the frequency with which penalties will be calculated (monthly guarantees are calculated as 1/12 of total annual amount of premiums invoiced/paid by ADOA at risk, quarterly measures are 1/4 of total annual amount of premiums invoiced/paid by ADOA at risk). At no time will quarterly or monthly measurements be re-averaged to alter results. All measurements missed during the reporting frequency period will be assessed at the end of the year for that frequency period. |
| # | Performance Measure | Tracking and Reporting Method | Reporting Frequency | Target | Percent at Risk | Detailed explanation of how the Offeror will meet and report outcomes for the measurement |
| 1 | Account Management | 9.00% | ||||
| 1.1 | Contractor shall obtain at least a ninety percent (90%) satisfaction rate on the annual account management survey. | ADOA Administered Survey shall measure ADOA’s overall satisfaction with the Account Management Team, including Contractor performance with providing sufficient staffing levels and expertise to appropriately support the State’s contract. | Annually | ≥90% | 3.00% | Measured by the ADOA Administered Survey annually. |
| 1.2 | Account service representative shall return ninety percent (90%) of calls within one (1) business day. | Provide detailed client account service log noting time of initial contact and response. | Monthly | ≥90% | 3.00% | Avesis will provide results monthly via Avesis Performance Grid / Project Tracking Log. |
| 1.4 | Account service representative shall respond to ninety percent (90%) of written inquiries within one (1) business day. | Provide detailed client account service log noting time of initial contact and response. | Monthly | ≥90% | 3.00% | Avesis will provide results monthly via Avesis Performance Grid / Project Tracking Log. |
| 2 | Administration | 4.00% | ||||
| 2.1 | ID Cards will be provided to members within ten (10) business days of receipt of eligibility data from the State. | Client specific reporting | Monthly | Pass/Fail | 2.00% | Avesis will provide results monthly via Avesis Performance Grid / Project Tracking Log. |
| 2.2 | Contractor shall provide to ADOA open enrollment communications material to develop, review, and distribute to members at least forty-five (45) calendar days prior to open enrollment. | Project tracking log | Annually | Pass/Fail | 2.00% | Avesis will provide results monthly via Avesis Performance Grid / Project Tracking Log. |
| 3 | Customer Service | 18.00% | ||||
| 3.1 | All member written inquiries shall be responded to within ten (10) business days. | Client specific reporting | Monthly | Pass/Fail | 3.00% | Avesis will provide results monthly via Avesis Performance Grid / Project Tracking Log. |
| 3.2 | All member telephone inquiries shall be responded to within two (2) business days. | Client specific reporting | Monthly | Pass/Fail | 3.00% | Avesis will provide results monthly via Avesis Performance Grid / Project Tracking Log. |
| 3.3 | Contractor shall maintain phone abandonment rate of five percent (5%) or less. | Based on internal automated phone system report measured and reported monthly. Report shall be client- specific. | Monthly | Pass/Fail | 3.00% | Avesis will provide results monthly via Avesis Performance Grid / Project Tracking Log. |
| 3.4 | At least 90% of phone calls requesting a member services representative will be answered in 30 seconds or less. | Based on internal automated phone system report measured and reported monthly. Report shall be client- specific. | Monthly | Pass/Fail | 3.00% | Avesis will provide results monthly via Avesis Performance Grid / Project Tracking Log. |
| 3.5 | Accurate and timely response to member request for review; urgent appeals resolved within seventy-two (72) hours of request, pre-service resolved within fifteen (15) calendar days of request, and post-service resolved within thirty (30) calendar days of request. | Client-specific turnaround time reporting including % of appeals upheld and overturned reported monthly. | Monthly | Pass/Fail | 3.00% | Avesis will provide results monthly via Avesis Performance Grid / Project Tracking Log. |
| 3.6 | Contractor shall receive at least ninety percent (90%) on the annual member satisfaction survey. | ADOA Administered Survey shall measure overall member satisfaction of the vision plan | Annually | ≥90% | 3.00% | Measured by the ADOA Administered Survey annually. |
| 4 | Network Management | 1.00% | ||||
| 4.1 | Network must be maintained with less than 5% of provider turnover monthly. Contractor will accept referrals. | Vendor report showing provider counts by specialty by county. Contractor will report the number of providers added monthly by specialty and by count. | Monthly | ≤5% | 1.00% | Avesis will provide results monthly to measure that less than 5% of the provider network turned over from the previous month via Avesis detailed provider reports and Performance Grid / Project Tracking Log. |
| 5 | Reporting | 3.00% | ||||
| 5.1 | Monthly reports shall be due to ADOA within thirty (30) calendar days after the close of month. | ADOA audit review | Monthly | Pass/Fail | 1.00% | ADOA Annual Review of report timeliness. |
| 5.2 | Quarterly reports shall be due to ADOA within forty-five (45) calendar days after the close of quarter. | ADOA audit review | Quarterly | Pass/Fail | 1.00% | ADOA Annual Review of report timeliness. |
| 5.3 | Annual reports shall be due to ADOA within sixty (60) calendar days after the close of the year | ADOA audit review | Annually | Pass/Fail | 1.00% | ADOA Annual Review of report timeliness. |
| 6 | HIPAA Data Security and Protection | 5.00% | ||||
| 4.7 | Data Breach - Vendor agrees to abide by all obligations set forth in the Business Associate Agreement (BAA), including government reporting and notification requirements associated with a data breach, credit monitoring, etc. If there is an incident governed by the BAA the Vendor will be penalized | Contractor shall provide notice to ADOA of any breach. | Ongoing | Pass/Fail | 5.00% | Avesis will provide results monthly via Avesis Performance Grid / Project Tracking Log. |
| 6 | Implementation – One time measurement | 8.00% | ||||
| 6.1 | ID Cards will be provided to members within ten (10) business days of receipt of eligibility data from the State. | Client specific reporting | 90 days after implementation | Pass/Fail | 2.00% | Avesis will provide results monthly via Avesis Performance Grid / Project Tracking Log. |
| 6.2 | Claim system set-up, including testing, shall be completed ninety (90) calendar days prior to implementation. | Client specific reporting | 90 days after implementation | Pass/Fail | 2.00% | Avesis will provide results monthly via Avesis Performance Grid / Project Tracking Log. |
| 6.3 | Customer call center system shall be set up, including testing, forty-five (45) calendar days prior to open enrollment. | Client specific reporting | 90 days after implementation | Pass/Fail | 2.00% | Avesis will provide results monthly via Avesis Performance Grid / Project Tracking Log. |
| 6.4 | The Contractor website shall be set up and tested forty-five (45) calendar days prior to open enrollment. | Client specific reporting | 90 days after implementation | Pass/Fail | 2.00% | Avesis will provide results monthly via Avesis Performance Grid / Project Tracking Log. |
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