Dickenson County Public Schools RFP.pdf

Dickenson County Public Schools

Request for Proposal

RFP-260526 – 001

Dickenson County Public Schools (DCPS) is seeking written proposals for its healthcare and Prescription Drug programs with an effective date of July 1, 2026. DCPS is accepting proposals from TPAs, reinsurers and fully insured carriers. Technical questions or requests for clarification shall be directed by e-mail directly to the Advisor. DCPS responses to the proposer’s question shall be directed to the e-mail address provided and only to the proposer asking the question and not shared with other respondents.

Information:

Advisor: Bayse Benefit Advisors e-mail Address: alanbayse@baysebenefitadvisors.com

Direct Line: 540 521 7711

Proposals are to be sent directly to:

Bayse Benefit Advisors / DCPS

522 Grandview Drive

Troutville, Virginia 24175

1.0 GENERAL INFORMATION

1.1 KEY DATES

May 27 – Release date

May 27 – June 9 Question and answer period

June 19 June deadline for receipt of proposals (Noon)

June 23 Oral Interviews with selected respondents

June 25 Selection completed / Final Negotiations / Decision

Enrollment to begin upon selection.

mailto:alanbayse@baysebenefitadvisors.com

DCPS reserves the right to extend the submission deadline or any other deadline or date indicated in the RFP in the event that an extension would be in the best interest of DCPS.

1.2 Background of DCPS

Location: Clintwood, Virginia

Current Number of Employees: 237

Plan Funding Type: Partially Self-Funded

Pertinent Information – see email attachments Email Attachment 1: Request for Proposals Email Attachment 2: Summary Plan Description Email Attachment 3-7: Monthly Claims Summaries & High Dollar Claims Email Attachments 8: Census

1.3 Preparation Costs

DCPS shall not be responsible for proposal preparation costs, nor the cost including attorney’s fees associated with any administrative, judicial or other type of challenge to the determination of the selected proposer and/or award of the contract and/or rejection of such proposal. The effective date for medical and Rx should be 07/01/26. By submitting a proposal, each respondent agrees to be bound in the respect and waives all claims to such costs and fees.

2. RULES GOVERNING PROPOSALS

2.1 Confidentiality

The content of all proposals will be kept confidential throughout the selection process and afterward except as required by state law for the school system. Copies of any proposal will not be shared with other respondents.

2.2 Disposition of Proposals

All materials submitted in response to the RFP shall become the property of DCPS.

2.3 Modification of Proposals

Modifications to proposals will not be accepted by DCPS.

2.4 Late Submissions

Proposals not received prior to the date and time specified will not be considered and will be returned to the proposer unopened.

2.5 Acceptance/Rejection of Submittal

DCPS reserves the right to reject any or all responses to the RFP, to waive minor irregularities in any proposal or in the RFP Procedures, and to accept any proposal presented which meets or exceeds these specifications and which is deemed to be in the best interests of DCPS. However, the requirements for time lines shall not be waived.

2.6 Proposal Evaluation

A committee of individuals representing DCPS will perform the evaluation of all proposals.

Following this written evaluation process, the committee will elect as many as four respondents to complete an oral interview before the committee. The purpose of the interview is to allow those further selected firms expansion and discussion of their written responses. Should there be less than four respondents all qualified respondents will compete in the oral presentation.

2.7 Oral Interviews

Oral interviews are required by DCPS and are for the purposes of allowing DCPS to broaden their understanding of certain selected respondents.

2.8 Final Selection

The final selection of the successful respondent(s) is scheduled to be completed by June 23, 2026. The successful respondent will assume their responsibilities on July 1, 2026.

3.0 MINIMUM QUALIFICATIONS

All healthcare providers and any TPAs submitting a proposal must:

a.) Be licensed to do business in all states as appropriate.

b.) Have the expertise, licenses and resources to provide employee benefit services for

DCPS current and future operations.

c.) Consistently maintain and allocate sufficient staffing resources to provide timely service.

d.) Maintain a staff that is qualified and available to provide specialized technical expertise in various disciplines as necessary.

e.) Execute Bid Proposal Form (included at end of RFP)

4.0 PROPOSAL GUIDELINES – Responses will be received from fully insured providers, Third Party Administrators and Reinsurance Companies. Please respond to questions that are pertinent to your proposal.

Observe the following guidelines:

a.) Respond to questions as directly as possible along with any supporting information you feel will be pertinent to these questions.

b.) Proposals must be received by email or at the offices of Bayse Benefit Advisors (see cover page) no later than noon on June 19, 2026.

c.) Our final employee benefits provider selection will be made based on our evaluation of the criteria outlined in this request. They may be made up of reinsurance carriers, TPAs or Fully Insured Providers or a mix of these.

Submission of a proposal will be construed to imply agreement in advance to the services outlined in the enclosed materials. The proposal package should be kept as brief as possible.

Brochures, photos, annual reports or any other appropriate printed material may be included in your proposal. The proposal package should be kept as brief as possible, however, subject areas should be clearly defined.

5.0 SCOPE OF SERVICES (TPAs, Fully Insured Providers and Reinsurers as Applicable)

The scope of claims/administrative services for the DCPS medical plan would include, but not be limited to, the automated processing and payment of medical and prescription drug claims in accordance with plan documents and contracted network reimbursement fee schedule, utilization review, case management, stop loss reporting, third party recovery and coordinating medical coverage.

5.1 Plan Documents

Maintain a master file of plan documents, summary plan descriptions, plan booklets (if needed), benefit provisions, claims administration policies and guidelines, changes in plan benefits and any other material needed to properly administer claims in accordance with provisions of the plan as well as applicable state and federal law.

5.2 Eligibility

Maintain information to verify eligibility for benefits of plan participants and dependents.

Eligibility to be transmitted electronically and/or manually by DCPS.

5.3 Forms

Design, print deliver and periodically update all forms and form letters used in connection with claims processing at administrator’s expense. DCPS reserves the right to approve and disapprove all forms and form letters. The forms required include, but are not limited to:

1.) Explanation of Benefits 2.) Third-party liability 3.) Coordination of Benefits 4.) Identification Cards

5.4 Claims Processing

1. Input historical data from previous TPA, including, but not limited to, deductibles and lifetime maximums. Maintain accurate claims records, which contain all pertinent claims, bills, correspondence, deductibles, benefits accumulators, coordination of benefits information, etc.

Provide adequate security of patient information.

2. Review and examine claims (bills, invoices, and statements) submitted by plan participants or received from physicians, hospitals, pharmacies, labs and any other eligible providers who have rendered care to eligible employees and their dependents. Procure any missing information immediately, by personal contact, telephone, or correspondence.

3. Determine reasonableness of charges and monitor the quality, quantity, and utilization of professional, medical and hospital care rendered, referring claims for “medical review” when necessary.

4. Process all appropriate claims as determined by the provisions of the plan documents and plan administrative policies/guidelines, utilizing the fee/reimbursement schedules established and provided by DCPS’ contracted PPO network. For claims incurred outside of the network area, determine and pay reasonable and customary charges for that geographical area. Obtain timely updates of fee schedules and conversion factors. Provide accurate claims processing in a timely manner according to performance standards.

5. Prepare/issue checks or electronic payments and itemized Explanation of Benefits forms to plan participants and providers.

6. Pend or deny claims not eligible for payment and issue related correspondence. Advise plan participants, dependents, or beneficiaries whose claims have been denied of the specific reasons for denial and procedure for review of the denial. Advise plan participants regarding pending of a claim, the reasons for such action and the actions necessary to release the claim.

7. Follow the records retention policy established/approved by DCPS.

5.5 Customer Service

1. Provide professional, courteous and timely responses to telephone, written and in-person inquiries and complaints from all sources. Such inquiries may include eligibility information, claims payment, benefit provisions, and related questions, from parties with authorized access to information such as plan participants, providers, legal counsel, DCPS, ETC.

2. Establish a DCPS telephone number and mailing address for filing claims.

3. Furnish a toll-free telephone number for incoming customer service calls.

4. Provide assistance with respect to special inquiries when requested from DCPS (e.g., claims processing for payment of claims).

5. Survey plan participants annually on their satisfaction with service and provide results to

DCPS.

5.6 Prescription Drug Program

State your ability to work with our selected transparent pass-through PBM and, if agreeable, coordinate processing and payment of prescription drug claims.

5.7 Utilization Review Services

Provide hospital pre-admission certification, hospital concurrent utilization review, hospital length of stay monitoring, discharge planning services, and preauthorization when requested by providers or plan participants.

5.8 Medical Review

Coordinate with DCPS contracted network to utilize their peer medical review services/committee or provide a medical review system, utilizing medical professionals acceptable to DCPS.

5.9 Coordination of Benefits

Provide coordination of benefits in accordance with plan documents and federal/state law.

Apply standard, non-duplication of benefits. Follow the requirements of federal law concerning coordination of benefits with Medicare.

5.10 Stop Loss

Work with DCPS stop loss provider, reporting large claims in a timely manner, in accordance with policy requirements and ensure reimbursement to DCPS for claims exceeding the stop loss deductible.

5.11 Subrogation

Pursue liens in favor of DCPS for sums of money recovered by the plan participant in connection with any illness, injury, disease, or other condition for which a third party may be liable to the extent of the benefit payments made by the plans.

5.12 Overpayments

Collect all overpayments or other incorrect payments. Any outstanding overpayments/incorrect payments should be reported to DCPS on a prudent basis.

5.13 Management Reports

Provide reports/information pertaining to the program which may be required by DCPS, auditors, actuary, legal counsel, or consultant and assist with the preparation and filling of any reports required by law.

5.14 Internal Controls

Apply industry standard internal claim control systems/procedures necessary for the effective implementation of the plan.

Audit all hospital claims that exceed $25,000.

Administrator must agree to maintain the security and confidentiality of all medical, financial, and patient information, guaranteeing HIPAA requirements are met in all areas of operation.

5.15 Financial Services

Follow the banking requirements of DCPS, such as establishing, maintaining and reconciling a specified checking account with appropriate deposit and transfer procedures for the payment of claims, or make other claims payment arrangements acceptable to DCPS. The claims administrator will maintain check registers and will provide a monthly or more frequent check register to DCPS.

Accumulate data, prepare, and mail 1099 forms for all providers of service who are paid during the calendar, as required by the IRS.

Provide any required federal or state financial or tax reports.

Provide appropriate information and documentation to DCPS auditor when requested.

5.16 Administrative Expenses

The selected administrator will be expected to bear the cost of:

1. Installing any necessary administrative systems.

2. Installing historical data, including lifetime maximums and deductibles from the previous administrator.

3. Transferring records and systems to the succeeding Administrator at the termination of the contract.

4. Administrative fees should cover the cost of administrator’s staff, all office space, supplies, forms, medical plan identification cards, standard management reports, telephone expenses, postage, computer hardware/software and other equipment/supplies necessary for claims handling.

5.17 Client Communication

Notify DCPS of all claim back logs on a regular and timely basis.

Provide prompt updates on legal and regulatory changes that could affect the plan.

Promptly notify DCPS of any pending egregious claims and/or claims action and litigation.

Provide assistance, such as cost calculations for benefit changes, benefit adequacy studies etc., when requested for proposed plan design changes.

Matters of significance must be called to DCPS attention at the earlies appropriate time (i.e., claims processing back logs, system problems, large overpayments, etc.).

6.0 INFORMATION TO BE PROVIDED BY ALL RESPONDERS

6.1 Firm History

1. Provide a brief history of your organization.

2. Briefly describe the ownership of your organization.

6.2 Background/Experience

1. Describe your background and experience as a TPA/Carrier.

2. Provide the attributes that make your organization valuable to DCPS.

3. Please share any industry awards, recognitions received by your organization.

6.3 Clients

1.How many total clients do you currently have?

2. How man of those clients are public schools?

3. How many of those clients have Transparent Pass-Through PBMs?

4. Please provide three of your clients as references that are relative to a school system.

List Contact, Phone and e-mail address.

6.4 Team

Provide an overview of a typical team that would be assigned to a client like DCPS. If you have a pre-determined team, provide highlights outlining qualifications and experience. Provide a summary of roles and distribution of responsibilities.

6.5 Specialties (all proposers must answer)

1. Does your team have experience in dealing with Orphan Drug Programs?

2. How much knowledge do you have in infusion support? 340B Drugs?

3. Do you have a rare-disease case management team?

4. Do you have an employee benefits counsel?

5. Does your organization have an organized program when dealing with pregnancy?

6. Do you have a system that rates physicians?

7. Do you have a program designed to cut costs for diabetics using injectables?

8. Are your administrative costs guaranteed for more than one year?

9. Describe your most competitive network?

Please state what network you will be using. Will that network cover surrounding areas to include Kentucky (the Pikeville area), the tri-cities in Tennessee, Johnston Memorial in Abingdon and the areas surrounding Dickenson County?

a.) What is your average discount for this area?

b.) What are your approximate discounts for the Pikeville area?

c.) What is the cost of your network?

d.) Outside of the immediate areas, how are covered individuals handled?

e.) Can you work in conjunction with a Rx Specialty company?

f.) What was your average trend increase in your overall business this past year?

7.0 Reports/Statements to be Provided:

1. Sample of actual monthly claims reports, high dollar claimant reports, Rx usage

2. Sample of quarterly and annual reports.

3. Financial Statement: Please provide a full and detailed presentation of the true condition of the proposer’s assets, liabilities and net worth. The report should include a balance sheet and income statement.

8. Reinsurance Response Needed – NO COMMISSIONS for the Advisor

The group is requesting a quote for the following:

Specific Cap (Medical & Rx): $100,000 & $125,000

Contract Basis – Paid or a 24/12/12

Premium (Composite or Otherwise)

Lifetime Reimbursement

Maximum Policy Reimbursement

Aggregate Cap (Medical & Rx): 125%

Contract Basis: Paid or a 24/12/12

Loss Limit per Individual: $100,000, $125,000

Maximum Policy Period Reimbursement: $1,000,000

Premium (Composite or Otherwise)

Aggregate Deductible

Please provide Total Costs

Dickenson County Public Schools

Proponent’s Agreement/Bid Proposal Form

RFP – 26052026 - 001

In submitting this proposal, as here in described, the proponent agrees that:

1. They have carefully examined the Scope of Services and all other provisions of this document and understand the meaning, intent and requirements of same.

2. They will enter into contract negotiations and furnish the services specified.

3. They have signed the compensation agreement and will adhere to such.

4. Confidentiality: Successful Proponent hereby acknowledges that information provided by Dickenson County Public Schools is personal and confidential and shall not be used for any purpose other than the original intent outlined in the Request for Proposal. Breach of confidentiality shall be just cause for immediate termination of the agreement.

Your signature certifies that all statements and information provided by your organization are complete and true.

I hereby certify that I am authorized to sign, personally or as a representative of the firm.

Name of the Firm or individual____________________________________

Address:_____________________________________________________

Signature____________________________________________________

Name (type or print)____________________________________________

Title________________________________________________________

Telephone____________________Email___________________________

Date________________________________________________________