DENTALRFP.pdf

RFQ No. DTSL55-15-Q-P0391 Page 1 of 7

WORK STATEMENT

1. BACKGROUND:

The Saint Lawrence Seaway Development Corporation (SLSDC) is a wholly owned instrumentality of the United States Government, created and existing by virtue of Public Law 358, 83rd Congress (33 U.S.C. 981, et.

seq.) as amended. It is the intent of SLSDC to provide a dental benefits program that will help promote and maintain healthy living for its program participants.

The SLSDC requires an entity to design, furnish, and implement/administer a dental insurance plan for approximately eighty (80) SLSDC employees located in Massena, New York, for a one-year period beginning January 1, 2015, with options to renew for four (4) additional calendar years. This is not a representation that this number will actually enroll in the plan nor will that conditions affecting requirements be stable or normal.

The number of eligible employees enrolled in the plan is estimated and used for the purpose of establishing a funding amount for each performance period (calendar year). The number of eligible employees is subject to change.

2. PLAN SPECIFICATIONS:

The Contractor will provide coverage, which meets or exceeds the following specifications:

a. No deductible, annual maximum of $1,250.00, for the following:

1. Diagnostic and Preventive Care: Paid at 100%.

2. Basic Services: Paid at 100%.

3. Major Services: Paid at 50%.

b. No deductible, separate lifetime maximum of $1,250.00, for:

1. Orthodontia: Paid at 50%.

c. Dental Plan Definitions:

1. Diagnostic and Preventive Care: Includes oral exams, X-rays, prophylaxis and fluoride treatment, simple extractions, space maintainers, and emergency treatment.

2. Basic Services: Includes anesthetics, amalgam fillings, endodontics, periodontics, and maintenance of prosthodontics, and other extractions.

3. Major Services: Includes major restorative care, i.e., gold foil, gold inlays, porcelain crowns, and installation of dentures and bridges.

d. Administrative Provisions:

1. Coverage is available only to active, permanent, non-supervisory, hourly employees, both full and part-time.

2. Conversion privileges and coverage continuation upon leaving or retiring from the Corporation shall be as follows:

a. Retirement: Coverage ends on the last day of the month of retirement.

b. Other terminations: Coverage ends on the last day of the month of separation from active employment.

RFQ No. DTSL55-15-Q-P0391 Page 2 of 7

COBRA coverage may apply.

3. Definition of Dependents:

a. Includes spouse of an employee and unmarried dependent children under age 22 (adopted child, stepchild, and foster children are covered if living in a normal parent-child relationship), students to age 25.

b. Children who are documented as being incapable of self-support are eligible for continued coverage after the age limitation.

4. There will be no pre-existing conditions limitations or waiting periods for current or future participants.

5. Premiums will be paid monthly with a standard 31-day grace period.

6. UCR determinations shall be based on the 90th percentile.

e. Special Considerations:

1. The contract will be awarded for a one (1) year period beginning January 1, 2015 through December 31, 2015, with options to renew for four (4) additional calendar years.

2. All yearly rate changes must be provided to the Corporation at least sixty (60) days prior to the beginning of a new contract period. Claims experience/information shall be used to determine each renewal rate.

These changes may be negotiated to determine fair and reasonable prices for the option period. A modification to the contract shall be issued for each option period.

3. Contractor must be able to provide national and international coverage.

4. Contractor must be able to show experience with group plans of the approximate size and coverage as the specifications shown in this request for proposal.

5. The Contractor shall be licensed to do business in New York State.

6. The Contractor shall provide plan brochures, detailing coverage and administrative provisions, within thirty (30) days after contract award.

3. INSURANCE POLICY IMPLEMENTATION:

The Contractor shall provide all necessary services, equipment, and supplies to implement the dental insurance coverage described including: preparing and printing an employee booklet describing the benefits of the plan, providing employee identification cards; enrollment and claim forms; and participating in meetings as requested by the Contracting Officer's Representative to discuss technical/contractual issues and to resolve problems.

Meetings may include an oral presentation to employees to discuss benefits, claims filing, etc., and to answer any questions.

4. CLAIMS ADMINISTRATION:

The Contractor shall provide complete claims administration including: (1) claims investigation and determination; (2) maintenance of current, complete, and confidential records and files for each covered person;

(3) preparation of claim worksheets, drafts, correspondence, and other claim forms needed; (4) performing reviews and follow-ups related to Corporation claims; (5) providing legal advice and/or legal defense on disputed Corporation claims by providers or other third parties; and (6) providing a customer service contact to answer enrollees' questions concerning plan coverage and claims processing.

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5. REPORTS:

The Contractor shall provide (at a minimum) periodic accounting and statistical reports, including:

reconciliation reports of supporting data for claims paid; an annual claims experience review and summary report; and quarterly claims detail reports providing a listing of claims by month paid, type of service, provider, amount claimed, and amount paid.

6. SECURITY REQUIREMENTS

The contractor’s proposed dental program may include an information system that will collect and store Personally Identifiable Information (PII) for SLSDC employees, i.e. names, phone numbers, email addresses, home addresses or other sensitive information related to the individual, this information shall be protected in accordance with the Federal Information Security Management Act of 2002 (Public Law 107-347) (FISMA).

The contractor’s proposed program/system shall, at a minimum, include the security controls identified in the National Institute of Standards and Technology (NIST) Special Publication 800-53 Revision 4 “Security and Privacy Controls for Federal Information Systems and Organizations” for a moderate impact system.

http://nvlpubs.nist.gov/nistpubs/SpecialPublications/NIST.SP.800-53r4.pdf

7. IT ACCESSIBILITY

All electronic documents shall comply with Section 508 of the Rehabilitation Act of 1973 as amended. The SLSDC has identified the following applicable standards:

36 CFR 1194.22 – Internet and Intranet Information and Applications 36 CFR 1194.41 – Information, Documentation, and Support

8. PERSONNEL REQUIREMENTS

The contractor shall provide a single point of contact that will serve as a liaison to the SLSDC to address day-to-day matters. This person is expected to ensure that all issues are addressed and responded to in a timely manner.

If an issue cannot be resolved by the next business day then the person must provide the SLSDC with a reasonable date that the issue will be resolved. This individual shall have a minimum of three years of account management experience in the insurance industry.

Designate below the person(s) whom the Government (SLSDC) may contact for prompt action on matters pertaining to administration of the dental plan.

NAME: ______________________________ TITLE: ______________________________

ADDRESS: _________________________________________

CITY: ___________________________ STATE: _____________ ZIP CODE: __________

TELEPHONE NUMBER: __________________________

FACSIMILE NUMBER: ___________________________ E-MAIL: ____________________

RFQ No. DTSL55-15-Q-P0391 Page 4 of 7

9. HISTORICAL INFORMATION

5-Year Premium Rate History Option 2014 2013 2012 2011 2010

Single

$11.37

$11.19

$10.39

Family

$38.28

$37.67

$34.97

Claims Paid 05/13–06/14 04/12–05/13 05/11-06/12 07/10-06/11

$11,335

$9,557

$12,223

$14,219

The current enrollment headcount is only captured as Single (self only) or Family (self and one or more dependents) for the covered groups below:

Covered Group Single Family SLSDC Active Employees 15 57 SLSDC Disabled Retirees

CONTRACT CLAUSES

OPTION TO EXTEND THE TERM OF THE CONTRACT: The Contractor shall provide the SLSDC with new annual rates at least sixty (60) days prior to each renewal period. Upon the SLSDC’s determination of fair and reasonable pricing, a modification will be issued to the contract for each option year. If the SLSDC exercises this option, the extended contract shall be considered to include this option clause. The total duration of this contract, including the exercise of any options under this clause, shall not exceed five (5) calendar years.

CONTRACTING OFFICER’S REPRESENTATIVE (COR): The Contracting Officer will appoint in writing a COR, a copy of which appointment will be provided to the contractor. The COR will ensure that the SLSDC's project objectives are met. To this end, the COR will provide necessary information, direction, coordination, etc., within the contractual work description. The COR is not authorized to change any of the terms or conditions of this contract. The Contracting Officer will make changes in the scope of work only by proper written modifications to the contract. When, in the opinion of the contractor, the COR requests effort outside the existing scope of the contract, the contractor shall promptly notify the Contracting Officer in writing. The contractor under such a direction by the COR shall take no action until the Contracting Officer has issued a contractual change or otherwise resolved the issue.

INTERPRETATION OR MODIFICATION: No oral statement of any person and no written statement of anyone other than the Contracting Officer shall modify or otherwise affect any provision of the contract. Only Contracting Officers acting within the scope of their authority are empowered to execute contract modifications on behalf of the SLSDC. No claim by the Contractor for any increase in the contract price or adjustment in the delivery date shall be valid except as such claim may be covered by an executed contract modification.

The Contractor shall not in any way represent that he/she is part of the United States Government or that he/she has the authority to contract or procure supplies on the credit of the United States of America.

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DEPARTMENT OF TRANSPORTATION ACQUISITION REGULATION CLAUSES (48 CFR

CHAPTER 12)

1252.242-72 DISSEMINATION OF CONTRACT INFORMATION (OCT 1994)

1252.242-73 CONTRACTING OFFICER’S TECHNICAL REPRESENTATIVE (OCT 1994)

INSTRUCTIONS TO OFFERORS

• The offeror is required to complete the following:

(1) Technical/Management Proposal, and

(2) Price Proposal.

• Each proposal shall be structured as follows:

(1) The cover for each proposal shall contain the name, title of the project, Request for Quotation number, and identification of the volume, e.g., technical/management and price. The date of the proposal and the period for which it is valid shall be included on the first page of each volume. The offeror shall also provide a transmittal letter containing the following information:

a. Assertion of the offeror’s acceptance of the terms and conditions contained in the RFQ.

b. The offeror’s Tax Identification Number (TIN), Dun & Bradstreet Number (DUNS), and CAGE code.

c. A statement identifying, by business name, any proposed subcontracts or consulting agreements.

d. Contact name, email address, and telephone number.

e. Complete business mailing address.

f. A statement that the offeror’s proposal shall be valid for at least sixty days.

(2) Table of Contents: The table of contents shall serve to quickly access important points of discussion in the proposal. All sections and enclosures shall be identified and all pages numbered.

(3) Contents - Technical/Management Proposal:

(a) The content of the technical/management proposal shall be formatted to that shown in PLAN SPECIFICATIONS, to aid in its evaluation and comparison to SLSDC requirements. Brochures used to supplement this format shall be simple, complete, legible, and cross-referenced so that information can be easily located and understood. Elaborate artwork, expensive paper/binding, visual or other presentation aids are neither necessary nor desired. The technical/management proposal shall state how the offeror intends to comply with the requirements of the request for proposal, not merely that they intend to do so.

The proposal submitted may contain trade secrets and commercial information, which the offeror or its proposed subcontractor(s) does not want disclosed for any purpose other than the proposal evaluation. All such restricted information contained in the proposal shall be clearly identified.

(b) Provide resumes describing the relevant background of key project personnel, including home office, marketing, service, and claims personnel, not to exceed one (1) page per individual.

(c) Identify subcontractors, outside associates, and consultants to be used, their location, status as a small, small disadvantaged, women-owned, or large business, and the subcontract award amount.

(d) Provide a work plan consisting of concise descriptions of the main tasks to be performed, the key project personnel assigned to each task, and the amount of man-hours each will devote to that task.

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(e) Provide experience in servicing group plans of similar size and coverage to the SLSDC's requirements, beginning 2010 to date, addressing the following:

• Contractor, Contract/Project Number, whether government or commercial, Project Officer, telephone number, dollar amount, and current status;

• Number of claims paid annually, time required to process various-type claims, and percentage of claim rejects and payment errors per specific claim categories;

• Financial, management, and analytical information that can be provided and typical report formats; and

• Identify and explain any terminations for default or convenience.

(4) Contents - Price Proposal:

(a) The Price Proposal shall be submitted in the following format:

Employee Only Employee & Family

Monthly Premium: $_______________ $________________ (U.S. Funds) (U.S. Funds)

(b) Completed Provision 52.212-3, Offeror Representations and Certifications – Commercial Items, if not completed on the System for Award Management website at www.sam.gov .

• The offeror shall submit his/her proposal via email to Patricia White, Contracting Officer, at patricia.white@dot.gov . Offerors are responsible for submitting proposals, and any modifications or revisions, so as to reach the Contracting Office by the closing date and time, no later than 4:30 pm, EST, Monday, December 29, 2014.

• Questions/Clarifications: Offerors are expected to reach a reasonable understanding of the request for proposal's requirements by careful study and application of qualified knowledge and experience. If such a review establishes the need for correction or clarification, such information shall be directed to Patricia White, Contracting Officer, at the following telephone and facsimile numbers and e-mail address:

Telephone: 315-764-3236; Facsimile: 315-764-3268 E-mail: Patricia.White@dot.gov

In this manner, the information can be reviewed, resolved, and if necessary, provided to all potential offerors prior to submission of proposals. Questions/clarifications must be submitted no later than two (2) weeks prior to proposal due date.

• By submission of an offer, the offeror acknowledges the requirement that a prospective awardee shall be registered in the System for Award Management (SAM) database at www.sam.gov during performance and through final payment of any contract resulting from this solicitation.

• The Contracting Officer is the only individual who can legally bind the SLSDC to an expenditure of public funds should a contract result from this request for proposal. This request does not commit the SLSDC to pay for costs incurred prior to the execution of a formal contract unless such costs are specifically authorized in writing by the Contracting Officer.

http://www.sam.gov/ mailto:patricia.white@dot.gov http://www.sam.gov/

RFQ No. DTSL55-15-Q-P0391 Page 7 of 7

SOLICITATION PROVISIONS

52.217-3 EVALUATION EXCLUSIVE OF OPTIONS (APR 1984)

52.212-2 EVALUATION-COMMERCIAL ITEMS (OCT 2014)

(a) The Government will award a contract resulting from this solicitation to the responsible offeror whose offer conforming to the solicitation will be most advantageous to the Government, price, and other factors considered.

The following factors shall be used to evaluate offers:

1. Technical Proposal – 50%

The technical/management evaluation will be based on the capabilities indicated by each offeror to understand and satisfy the requirements of this solicitation. The criteria below will be used to rate each technical proposal.

(a) General Quality and Responsiveness of Proposal 10%

Includes the thoroughness and lucidity of the proposal and evidence the offeror fully comprehends the requirements.

(b) Organization Capabilities and Facilities 25%

Includes the ability to install and administer the plan effectively based on offeror’s relevant experience in handling similar type and size plans; quality of home office, marketing, service and claims personnel; locations and facilities.

(c) Administrative Systems 15%

Includes the quality of the systems employed to bill and collect premiums, to effectively and efficiently pay claims, and to provide periodic reporting and accounting of financial results of the plan.

2. Price Proposal - 50%

The offeror is urged to be as specific as possible in stating how the dental benefits will be provided to SLSDC employees, including the necessary organization, administration, management, and control required. The proposals will be evaluated in accordance with the material and documentation actually presented in each proposal and not on the basis of what is inferred.

Technical evaluation factors are equal to cost or price.