Exhibit_20_-_OID_SBE_Tech_Solution_-_Demo_Scenarios.docx

EXHIBIT 20

Demo Scenarios for Oral Presentations The purpose of the Demonstration Scenarios is to enable the State to evaluate the Bidder’s proposed solution, operational model, administrative tooling, and overall readiness to support Oklahoma’s future-state Enhanced Direct Enrollment (EDE)-based State Exchange model.

The State is not requesting a fully configured Oklahoma-specific implementation. Bidders may demonstrate existing production implementations, representative workflows, sandbox environments, prototype configurations, or comparable operational models that reflect the capabilities of the proposed solution.

To support a fair and consistent evaluation, all Bidders shall follow a standardized demonstration structure, including defined scenarios and time allocations.

Overall Structure Recommendation

· Total Demo Duration: 140 minutes

· Approach:

· Demonstrations are structured using fixed time allocations per scenario to support consistency and comparability across Bidders.

· Strict time enforcement is applied throughout the session to prevent overruns. It is recommended that the State designate a dedicated timekeeper responsible for actively monitoring progress and enforcing time limits, including implementing hard cutoffs when necessary.

· To reinforce adherence, the State may incorporate time management as an evaluation consideration, including applying scoring impacts for material deviations from the established time structure.

Scenarios

Scenario 1 — New Enrollment Journey

Recommended Time: 30 minutes

A consumer applies for coverage through an Oklahoma Enrollment Partner (OKEP). The application is submitted for real-time eligibility determination and enrollment processing.

Bidder to demonstrate:

· Real-time eligibility determination workflow and supporting API orchestration

· APTC/CSR calculation accuracy and response latency

· Enrollment confirmation workflow

· 834 transaction generation and transmission workflow

· Agent attribution and NPN association

· Duplicate consumer or account detection and handling

· Workflow and operational handling when a CMS Hub timeout or transaction failure occurs

· Retry processing, alerting, and operational escalation handling

· Consumer, OKEP, and State visibility into enrollment status throughout the transaction lifecycle

Scenario 2 — SEP / Life Event

Recommended Time: 15 minutes

An existing enrollee reports a qualifying life event through an OKEP resulting in a Special Enrollment Period request and plan change.

Bidder to demonstrate:

· SEP eligibility verification API call and response

· Real-time and manual verification processing

· Documentation flag and exception workflow when verification is pending

· Consumer notification and communication controls

· Workflow coordination when supporting documentation is collected through an EDE

· State administrative visibility into pending SEP requests and verification status

· Fraud prevention or validation controls associated with SEP requests

Scenario 3 — Renewal & Redetermination with Pre-Verification

Recommended Time: 15 minutes

The Exchange executes annual renewal and redetermination activities for existing enrollees, including passive renewals and pre-verification activities.

Bidders to demonstrate:

· Batch renewal and redetermination processing workflows

· Pre-renewal trigger - how the platform identifies which enrollees require it and routes accordingly

· Re-calculation of eligibility – to include APTC determinations and calculations

· Plan crosswalk flow and handling – to include scenario when current Qualified Health Plan is discontinued

· State alerting when renewal is processed without affirmative consumer action

Scenario 4 — Agent Oversight, Fraud, Waste, and Abuse (FWA)

Recommended Time: 20 minutes

The Exchange must oversee agent certification, enrollment attribution, monitoring activities, and consumer protection workflows.

Bidders to demonstrate:

· Agent certification and approval workflows

· NPN validation against external data sources

· State administrative review and approval capabilities

· Controls preventing uncertified or suspended agents from submitting or being associated with enrollments

· Fraud, waste, and abuse monitoring capabilities

· Operational reporting and alerting for suspicious enrollment behavior

· Identification of unusual enrollment patterns, rapid plan switching activity, or geographic anomalies

· Enrollment lock, plan change reversal, and consumer protection workflows

· Consumer disaffiliation workflows to remove agent association from an account

· Agent suspension, termination, and decertification workflows

· Audit trail and historical reporting capabilities associated with agent activity

· Ability for State users to query and review enrollments associated with a specific NPN

Scenario 5 — EDE Partner Escalation & Vendor Support Tooling

Recommended Time: 15 minutes

An OKEP escalates a disputed or stuck enrollment requiring vendor investigation and operational support.

The Bidder shall demonstrate:

· Escalation intake and case management workflow

· Ticket routing, prioritization, and severity management

· Operational tooling used to investigate and resolve escalated cases

· Coordination workflows between the vendor, the State, and the OKEP

· State visibility into open escalations, status, and resolution tracking

· Reporting and trend analysis related to escalation activity

· SLA monitoring and operational reporting provided to the State

· Identification and management of repeat issues or recurring partner trends

Scenario 6 — Operational Resilience

Recommended Time: 15 minutes

The Exchange experiences elevated transaction volume during Open Enrollment while a downstream dependency outage impacts eligibility processing.

The Bidder shall demonstrate:

· Platform scalability and throughput monitoring during peak operational periods

· Operational dashboards and monitoring available to the State during high-volume events

· State visibility into outage conditions and operational impacts

· Protection of enrollments or transactions in-flight during outages or disruptions

· Security incident response visibility and operational coordination capabilities

Scenario 7 — Consumer-Facing Portal

Recommended Time: 30 minutes

A consumer applies for coverage through a consumer-facing portal. The consumer receives their eligibility, shops for a plan, and confirms enrollment.

Bidder to demonstrate:

· Application data collection and submission

· Real-time eligibility determination

· Display of eligibility details

· Shopping flow to enroll in coverage which may involve selection of special enrollment events