AFPS RFP Attachment 11 Health Insurance Questionnaire.pdf

DJJE-10-RFP-0662

Attachment (11)

Health Insurance Questionnaire:

Overall

1. Confirm that all employees, who were covered as of the last day of the current contract, will be eligible for coverage, with no waiting periods or pre-existing conditions, on the first day of the new contract.

2. Provide details of your initial and subsequent open enrollment period(s) and process, including draft materials. Materials used in prior years, if for similarly situated populations, may be submitted. Is enrollment conducted on-line? Describe your process for processing life change events that may occur post open enrollment? Provide details of your process and expected timeline to provide proof-of-coverage insurance cards to employees following completed applications for benefits.

3. Provide details of how you would coordinate deductibles, out-of-pocket maximum and other accumulators for a mid-year plan change.

4. How will you and your carrier ensure continued coverage for any patient receiving ongoing care as of the contract change date?

5. Describe what, if any, changes are needed to comply with the Patient Protection & Affordable Care Act (PPACA) and the Health Care & Educations Reconciliation Act

(HCERA)?

Medical Benefits

1. Provide the following information for each of the medical plan offerings:

a. Benefit schedules, identifying any items that can be modified over the length of the contract.

b. Monthly expected employer and employee costs for each benefit offering. Identify any items that can be modified over the length of the contract. Provide rates for all tiers and benefits for all benefit offerings.

c. Provide a list of all vendors used, including insurance companies, claims administrators, provider networks, care management companies and specialty networks. Which vendors can be replaced during this contract period?

d. Will employees in different geographic areas be offered the same coverage using the same insurance companies, provider networks, etc.? If not, provide details of the differences in benefit levels and vendors by area.

2. For any benefit with a preferred provider (or other network) benefit, provide a summary of the GeoAccess studies identifying network access coverage and issues for all employees.

Attachment (12) provides the 3-digit zip codes for each currently covered employee. Your summary report should identify the percentage of total employees who have access to one network hospital within 15 miles, and 2 physicians within 10 miles.

3. If an employee does not have reasonable access to a network provider (e.g. nearest network provider is more than 50 miles away), what coverage is provided and how are benefits paid?

4. List any precertification, utilization management, chronic care management, and disease management programs that are in-place or are planned to be implemented during this contract.

Pharmacy Benefits

1. Provide the following for each of the pharmacy benefit offerings:

a. Benefit schedules, identifying any items that can be modified over the length of the contract.

b. Monthly expected employer and employee costs for each benefit offering. Identify any items that can be modified over the length of the contract. Provide rates for all tiers and benefits for all benefit offerings.

c. Provide a list of all vendors used, including insurance companies, and pharmacy benefit managers. Which vendors can be replaced during this contract period?

d. Will employees in different geographic areas be offered the same coverage using the same pharmacy benefit managers? If not, provide details of the differences in benefit levels and vendors by area.

e. Is the pharmacy benefit program integrated with the medical plan or a stand-alone program?

2. List any step therapy, prior authorization, dosage management and other utilization management programs.

Dental Benefits

1. Provide the following for each of the dental benefit offerings:

a. Benefit schedules, identifying any items that can be modified over the length of the contract.

b. Monthly expected employer and employee costs for each benefit offering. Identify any items that can be modified over the length of the contract. Provide rates for all tiers and benefits for all benefit offerings.

c. Provide a list of all vendors used, including insurance companies, claims administrators and provider networks. Which vendors can be replaced over this contract period?

d. Will employees in different geographic areas be offered the same coverage using the same insurance companies, administrators and provider networks? If not, provide details of the differences in benefit levels and vendors by area.

2. For any benefit with a preferred provider (or other network) benefit, provide a summary of the GeoAccess studies identifying network access coverage and issues.

3. If an employee does not have reasonable access to a network provider (e.g. nearest network providers is more than 50 miles away), what coverage is provided and how are benefits paid?

Vision Benefits

1. Provide the following for each of the vision offerings:

a. Benefit schedules, identifying any items that can be modified over the length of the contract.

b. Monthly expected employer and employee costs for each benefit offering. Identify any items that can be modified over the length of the contract. Provide rates for all tiers and benefits for all benefit offerings.

c. Provide a list of all vendors used, including insurance carriers, claims administrators and provider networks. Which vendors can be replaced during this contract period?

d. Will employees in different geographic areas be offered the same coverage using the same insurance companies, administrators and provider networks? If not, provide details of the differences in benefit levels and vendors by area.

2. For any benefit with a preferred provider (or other network) benefit, provide a summary of the GeoAccess studies identifying network access coverage and issues.

3. If an employee does not have reasonable access to a network provider (e.g. nearest network provider is more than 50 miles away), what coverage is provided and how are benefits paid?

Group Life Insurance and Accidental Death and Dismemberment

1. Provide the name of the insurance carrier(s) to be used for the group life insurance and AD&D program.

2. Provide the following for each of the Group Life Insurance and AD&D offerings:

a. Benefit schedules, identifying any items that can be modified over the length of the contract.

b. Monthly expected employer and employee costs for each benefit offering. Identify any items that can be modified over the length of the contract.

Short Term Disability

1. Provide the name of the insurance carrier(s) to be used for the short term disability program.

2. Provide the following for each of the short term disability offerings:

a. Benefit schedules, identifying any items that can be modified over the length of the contract.

b. Monthly expected employer and employee costs for each benefit offering. Identify any items that can be modified over the length of the contract.

c. Explain the interaction, if any, between short term disability and paid time off for other illnesses.

Long Term Disability

1. Provide the name of the insurance carrier(s) to be used for the long term disability program.

2. Provide the following for each of the long term disability offerings:

a. Benefit schedules, identifying any items that can be modified over the length of the contract.

b. Monthly expected employer and employee costs for each benefit offering. Identify any items that can be modified over the length of the contract.

3. Summarize the application process for long-term disability benefits.

4. List any programs utilized to encourage employees to return to work.

Voluntary Benefits

1. Provide details, including benefit descriptions and rates, regarding any voluntary benefit programs that will be offered?

2. Provide the name of the carriers, the length of time that carrier has insured the benefit, and details of extended rate guarantees, minimum participation levels and length of contract.