ESBD_455593_1758329684919_Attachment A - Cost Proposal.pdf
PDF 153 KB Posted
- Solicitation number
- RFP2025-P09
- Issued by
- Texas
About this file
This document is a Request for Proposal (RFP 2025-P09) for Workers Compensation Insurance & Administrative Services, specifically Attachment A: Cost Proposal. The form is designed for potential vendors to detail their pricing structure for various claims administration and workers compensation services. The cost proposal covers multiple service categories including claims administration for different claim types (workers compensation, incident, medical only, indemnity), field services, medical case management, utilization review, medical bill audits, healthcare networks, rehabilitation services, and other ancillary services like attending hearings, take-over costs, and legal representation.
The cost proposal requires vendors to specify pricing across three primary fee structures: fee per claim, flat fee, and fee per hour for each listed service. Additionally, the document includes a section for vendors to list any additional fees not already captured. The form concludes with a safety rebate section and a signature block where the bidding company's authorized representative must affirm that the bid was prepared independently and without collusion. Vendors must complete all sections of this attachment for their proposal to be considered responsive, with an explicit warning that failure to do so will result in proposal rejection.
View the file
Other files
Show all 16
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
RFP 2025-P09 Workers Compensa�on Insurance & Administra�ve Services Atachment A: Cost Proposal
(This form MUST be completed and returned for your proposal to be considered responsive. Failure to complete and return will result in the rejec�on of the proposal.)
Services Claims Administra�on Fee Per Allocated Expenses
Workers Compensa�on Incident
Medical Only Indemnity
Annual Fixed Fee Op�on – Life of Contract Pricing Fee Per
Claim Flat Fee Fee Per
Hour
Field Services/Inves�ga�on Medical Case Management U�liza�on Review/Pre-Authoriza�on Medical Bill Audits Healthcare Networks Rehabilita�on/Voca�onal Case Services
On-Line Computer Services Atending TDI Hearings Take Over Costs Workers Compensa�on
- Run-Off Costs
- Field Case
Management/Telephonic
Atorney /Hearing Fees Private Inves�gators DWC Aus�n Representa�ve
Other Fees/Cost – List any addi�onal fees not included above
Descrip�on of Services Fee Per Claim
Flat Fee Fee Per Hour
Safety Rebate Annual Safety Rebate $
The undersigned authority affirms that they are duly authorized to execute this contract, that this bid has not been prepared in collusion with any other bidder, and that the content of this bid has not been communicated to any other bidder prior to the official opening of this bid.
Company Name: _______________________________________________________________
Printed Name: ________________________________________________________________
Signature: ____________________________________________________________________
Email Address: ________________________________________________________________
Phone: _______________________________________________________________________
File details come from the government source that posted it. Updated .