DAS003_CSP900020_Contract_Rev.pdf

Index No.: DAS003

Eff. Date: 09/18/20

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: MEDICAL THIRD-PARTY ADMINISTRATOR (TPA)

CONTRACT NUMBER: CSP900020 EFFECTIVE DATES: 07/01/19 TO 06/30/22

* Renewal through 06/30/26

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

CSP900020 that opened on 08/29/18. 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 Department of Administrative Services (DAS), Human Resources Division (HRD), Office of Benefits Administration 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:

www.ohio.gov/procure

*Indicates renewal through 06/30/26 with Medical Mutual of Ohio and Anthem Blue Cross and Blue Shield per Amendments 1 and 2.

Eff. Date: 09/01/23

MUTUALLY AGREED TO CLARIFICATIONS / MODIFICATIONS TO THE RFP

ANTHEM

Clarifications - response dated 10/10/18, 11/09/18

Finalist Interview, & acceptance to final terms - response dated 10/26/18 and 11/15/18

Performance Guarantees – response dated 11/05/18

Best and Final Offer - response dated 10/26/18

*State of Ohio Network PG_ASO_Dayton region FY2023 FINAL – 06/23/2023

*State of Ohio Network PG_Cincinnati FY2023 FINAL – 06/23/2023

*State of Ohio Network PG_Southern FY2023 FINAL – 06/23/2023

*State of Ohio Network PG_Youngstown FY2023 FINAL – 06/23/2023

*Anthem Discount Language 042523 FY24 – 06/22/2023

*Final State of Ohio Network Guarantees FY24 – 06/22/2023

MEDICAL MUTUAL

Clarifications - response dated 10/08/18

Finalist Interview, & acceptance to final terms - response dated 10/26/18

Best and Final Offer - response dated 10/26/18

State of Ohio Discount Guarantee MMO FY23 FY26 Proposal 04282023 – response dated 06/08/23

*Indicates the mutual agreement for the Discount Guarantees that will apply for Anthem for the periods of FY23 through FY24.

Eff. Date: 09/18/20

CONTRACT AWARD SCHEDULE AND PRICING

TITLE: MEDICAL THIRD-PARTY ADMINISTRATOR (TPA)

RFP NUMBER: CSP900020

UNSPSC CATEGORY CODES: 85101706

REGION CONTRACTOR

Columbus Medical Mutual Toledo Medical Mutual Youngstown Anthem Cleveland - Akron Medical Mutual Cincinnati Anthem Dayton - Springfield Anthem Southern Anthem Out of State Employees (182) Anthem

Not to Exceed Administrative Service Fee (ASO) Per Employee Per Month Fee (PEPM) PPO Fees by Carrier

CONTRACTOR FY 2020

PEPM

FY 2021

PEPM

FY 2022

PEPM

FY 2023

PEPM

FY 2024

PEPM

FY 2025

PEPM

FY 2026

*Anthem $32.78 $32.78 $32.78 $33.76 $33.76 $33.76 $33.76

Medical Mutual $26.50 $0.00 $27.96 $27.96 $27.96 $27.96 $27.96

Not to Exceed Administrative Service Fee (ASO) Per Employee Per Month Fee (PEPM) CDHP Fees by Carrier

CONTRACTOR FY 2020

FY 2021

PEPM

FY 2022

PEPM

FY 2023

PEPM

FY 2024

PEPM

FY 2025

PEPM

FY 2026

*Anthem $33.19 $33.19 $33.19 $33.76 $33.76 $33.76 $33.76

Medical Mutual $26.50 $0.00 $27.96 $27.96 $27.96 $27.96 $27.96

*Indicates addition of Anthem’s administrative fees for FY23-FY26 per amendment 2.

Eff. Date: 07/01/19

CONTRACTOR INDEX

CONTRACTOR: CONTRACT NO.: CSP900020-1

OAKS Vendor ID: HR00001368

Community Insurance Co.

dba Anthem Blue Cross and Blue Shield 6740 North High Street Worthington, Ohio 43085

CONTRACTOR'S CONTACT: Cindy McCarty Telephone: (614) 433-8627 Fax: (614) 438-3688 Email: cindy.mccarty@anthem.com

CONTRACTOR: CONTRACT NO.: CSP900020-2

OAKS Vendor ID: HR00000484

Medical Mutual of Ohio dba Medical Mutual Services LLC 10 W. Broad St. Suite 1400 Columbus, OH 43215

CONTRACTOR'S CONTACT: Veronica Hawkins Telephone: (614) 621-4581 Fax: (614) 621-4578 Email: Veronica.Hawkins@MedMutual.com

Eff. Date: 09/01/23

SUMMARY OF AMENDMENTS

Amendment Number

Effective Date Description

5 09/01/23

This amendment is issued to incorporate the revised Anthem Blue Cross Blue Shield’s Discount Guarantees into the contract by mutual agreement between Anthem Blue Cross Blue Shield and the State of Ohio, effective for the contract year beginning 07/01/22.

4 07/07/23 This amendment is issued to incorporate the revised Medical Mutual Services’ Discount Guarantee into the contract by mutual agreement between Medical Mutual Services’ and the State of Ohio, effective for the contract year beginning 07/01/22.

3 02/26/21

This amendment is issued to incorporate Anthem Blue Cross Blue Shield’s Discount Audit Guarantee into the contract and revise Medical Mutual Services’ Discount Audit Guarantee, effective 07/01/19. Both Anthem Blue Cross Blue Shield’s and Medical Mutual Services’ Discount Audit Guarantee are firm 07/01/19 through 06/30/22, with an opportunity to negotiate for the contract year beginning 07/01/22.

2 09/18/20

This amendment is issued to notify that as a result of mutual agreement between the state of Ohio and the Contractor, Anthem Blue Cross and Blue Shield, this contract is renewed for an additional 48 months, effective 07/01/22 through 06/30/26. Anthem’s administrative fee for the renewal period has been added, effective with all orders issued on or after 07/01/22.

1 08/07/20

This amendment is issued to adjust Medical Mutual of Ohio’s administrative fee, effective with all orders issued on or after 07/01/2020.

Additionally, this amendment is issued to notify that as a result of mutual agreement between the state of Ohio and the Contractor, Medical Mutual of Ohio, this contract is renewed for an additional 48 months, effective 07/01/22 through 06/30/26.