DRAFT_RFP_31786-00193_Attachment_6.3_Cost_Proposal_Life_Insurance.xlsx

Instructions and Signature

COST PROPOSAL SCHEDULE— The Cost Proposal, detailed in this spreadsheet, shall indicate the proposed price for goods or services defined in the Scope of Services of the RFP Attachment 6.6., Pro Forma Contract and for the entire contract period. The Cost Proposal shall remain valid for at least one hundred twenty (120) days subsequent to the date of the Cost Proposal opening and thereafter in accordance with any contract resulting from this RFP. All monetary amounts shall be in U.S. currency or percentages and limited to three (3) places to the right of the decimal point.

Provide your proposed rates for each option in tables "A-Basic Life Conv Charge ", "B-Basic Admin Charge", "C-Basic Reserve", "D-Basic Prem", "E-Vol ADD Prem", "F-Active EmpVol Term Prem", "G-ActiveSpouseVolTermPrem", "H-Ported EmpVol Term Prem", "I-Ported SpouseVolTermPrm", and "J-Child Term Prem".

This pricing schedule must be completed in full. Do not skip any cells. If the Respondent fails to detail all cost information for the services proposed as required, the State may determine the proposal to be non-responsive and reject it. Enter numeric figures only. Anything else, including blank cells or any deviated text, will be considered as a zero (0) and will be a cost of zero (0) to the State and/or Member. The State cannot accept "N/A".

1. Each proposed rate must be below the rates for each age band in the table below.*, or

2. Each proposed rate must be equal to the rates for each age band in the table below.*, or

3. Each proposed rate must be above the rates for each age band in the table below.*, or

4. Each proposed rate must be below or equal to the rates for each age band in the table below.*, or

5. Each proposed rate must be above or equal to the rates for each age band in the table below.*

In no circumstances can the Respondent's proposed rates be below and above the rate chart shown below* (IRS straddle rule test) which is described in Internal Revenue Code section 79 and IRS Publication 15-B (see links below). If the Respondent fails to meet this criteria as required, the State may determine the proposal to be non-responsive and reject it.

*Voluntary Term Life Premium Rates Table for Comparison to Proposed Rates in "Table F - Active EmpVol Term Prem" Cost Per $1,000 of Protection for 1 Month

If the sum of the Evaluation Cost on a table equals zero, the Respondent will receive the maximum section score in the table. In this scenario, the State will use one cent (.001) in the formula listed in the table as the 'lowest evaluation cost amount from all proposals" to calculate all other proposals' point allocations, such that no proposal will receive more than the maximum number of points availlable for the applicable section.

This Cost Proposal must be signed, in the space below, by an individual empowered to bind the Respondent to the provisions of this RFP and any contract awarded pursuant to this RFP. If the individual signing this Cost Proposal is not the President or Chief Executive Officer, the Respondent must attach evidence to the Cost Proposal showing the individual’s authority to legally bind the Respondent.

RESPONDENT SIGNATURE:

PRINTED NAME & TITLE:

DATE:

RESPONDENT LEGAL ENTITY NAME:

https://www.irs.gov/government-entities/federal-state-local-governments/group-term-life-insurancehttps://www.irs.gov/pub/irs-pdf/p15b.pdf Table A-Basic Life Conv Charge

• The Proposer should not complete the shaded areas; the State will perform all calculations.

• In Table A below indicate your organization's conversion charges.

Table B-Basic Admin Charge

• The Proposer should not complete the shaded areas; the State will perform all calculations.

• In Table B below indicate your organization's administrative charges.

Table C-Basic Reserve

• The Proposer should not complete the shaded areas; the State will perform all calculations.

• In Table C below indicate your organization's reserving factor in the first year. Below that, indicate your organization’s guaranteed monthly reserve rate, by which Reserves are to be established, for each of the following lines of coverage, expressed as a percentage of annual premiums.

Table D-Basic Prem

• The Proposer should not complete the shaded areas; the State will perform all calculations.

• In Table D below, indicate your organization's guaranteed monthly premium rates for the Basic Term Life and Basic AD&D Plans.

(SUM x Evaluation Factor)

Table E-Vol ADD Prem

• Premium rates should be inclusive of all profits and expenses (i.e. administrative, claim, reserve, etc.)

• The Respondent should not complete the shaded areas; the State will perform all calculations.

(SUM x Evaluation Factor)

Table F-Active EmpVol Term Prem

VOLUNTARY TERM LIFE - ACTIVE EMPLOYEES

• In Table F below, propose the monthly premium for ACTIVE employees in the attained age brackets listed below for the Voluntary Term Life Insurance Plan as described in Pro Forma Contract Attachment E.

• Note: The payment of premium taxes will be the responsibility of the Contractor.

• The Proposer should not complete the shaded areas; the State will perform all calculations.

• Premium rates should be inclusive of all profits and expenses (i.e. administrative, claim, underwriting, reserve, etc.)

Table G-ActiveSpouseVolTermPrem

VOLUNTARY TERM LIFE - SPOUSES OF ACTIVE EMPLOYEES

• In Table G below, propose the monthly premium for SPOUSES of ACTIVE employees in the attained age brackets listed below for the Voluntary Term Life Insurance Plan as described in Pro Forma Contract Attachment E.

• Note: The payment of premium taxes will be the responsibility of the Contractor.

• The Proposer should not complete the shaded areas; the State will perform all calculations.

• Premium rates should be inclusive of all profits and expenses (i.e. administrative, claim, underwriting, reserve, etc.)

Table H-Ported EmpVol Term Prem

• The proposed ported premium rates must not exceed, in each age bracket, the proposed active premium rates by more than 20 percent (20%). If the Respondent fails to meet this criteria as required, the State may determine the proposal to be non-responsive and reject it.

• Note: The payment of premium taxes will be the responsibility of the Contractor.

• The Proposer should not complete the shaded areas; the State will perform all calculations.

• Premium rates should be inclusive of all profits and expenses (i.e. administrative, claim, reserve, etc.)

Table I-Ported SpouseVolTermPrm

• The proposed ported premium rates must not exceed, in each age bracket, the proposed active premium rates by more than 20 percent (20%).If the Respondent fails to meet this criteria as required, the State may determine the proposal to be non-responsive and reject it.

• Note: The payment of premium taxes will be the responsibility of the Contractor.

• The Proposer should not complete the shaded areas; the State will perform all calculations.

• Premium rates should be inclusive of all profits and expenses (i.e. administrative, claim, reserve, etc.)

Table J-Child Term Prem

• The Proposer should not complete the shaded areas; the State will perform all calculations.

• Premium rates should be inclusive of all profits and expenses (i.e. administrative, claim, reserve, etc.)

(SUM x Evaluation Factor) Child Term Rider $2,500 face amount

Total Cost Proposal Score