Exhibit_4_-_RFP_Offeror_Questionnaire_(revision_2).xlsx

XLSX spreadsheet 6 MB Posted Feb 22, 2024

Attached to: RFP for Claims Administration for the Self-Insured County of Orange Dental Plan
Solicitation number: 017-202401-MC
Issued by: Orange County, San Francisco City, California

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Written by GovTribe AI · Jul 1, 2025

The file "Exhibit_4_-RFP_Offeror_Questionnaire(revision_2).xlsx" is a request for proposal (RFP) document from the County of Orange Human Resource Services, Employee Benefits Department in California, seeking claims administration services for their self-insured dental plan. The RFP solicits proposals from qualified firms to provide comprehensive claims administration services for the County of Orange's dental plan, with the county explicitly noting they are not liable for any technical difficulties in the electronic bidding process.

While specific pricing details, set-asides, and contract term lengths are not fully detailed in the provided excerpt, the document represents a standard government procurement process for professional services in the healthcare benefits administration sector. The RFP appears to be focused on selecting a qualified vendor to manage dental claims processing for the county's self-insured plan, which suggests a need for specialized administrative expertise in healthcare claims management for a local government entity.

View the file

Other files

File	Type	Posted
Appendix_4_-Management_and_Attorney_Dental_Plan.pdf	PDF	Feb 22, 2024
Appendix_3_-_County_of_Orange_Dental_Plan_Census_by_Zip_Code.xlsx	XLSX spreadsheet	Feb 7, 2024
Appendix_1_-County_of_Orange_Dental_Plan.pdf	PDF	Feb 7, 2024
Attachment_L_-_County_of_Orange_Information_Technology_Security_Guidelines.docx	DOCX document	Feb 7, 2024
Dental_Claims_Administration_RFP_(Word_Version).docx	DOCX document	Feb 7, 2024
Dental_Claims_Administration_RFP.pdf	PDF	Feb 7, 2024

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A. Cover

EXHIBIT 4

RFP OFFEROR QUESTIONNAIRE
CLAIMS ADMINISTRATION FOR THE SELF-INSURED	17588
COUNTY OF ORANGE DENTAL PLAN

COUNTY OF ORANGE

February 2024

10400

80% AD
Same as deductible
	Same as deductible

$25 AD / $70 AD / $140 AD

* AD - After Deductible; N/A - Not Applicable; CY - Calendar Year; PA - Prior Authorization

B. Table of Contents

A	Cover
B	Table of Contents
C	Company Profile
D	General Info
E	Minimum Qualifications	17588
F	Plan Design
G	ASO Fees & Credits
H	Financial
I	Staffing and Communication Plans
J	Implementation, Ongoing Administration & Customer Service
K	Provider Network
L	Claims & Reporting
M	Disruption Analysis
N	Geo Access
O	Other
P	References		Same as deductible
P				Same as deductible
P			Yes
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P

Other
References
	30
	$25 AD / $70 AD / $140 AD

* AD - After Deductible; N/A - Not Applicable; CY - Calendar Year; PA - Prior Authorization

C. Company Profile

Question		Response	Comments
1	Company Legal Name
2	Company Legal Status (corporation, partnership, etc.)
3	Business Address
4	Website Address
5	Telephone Number
6	Facsimile Number
7	Email Address
8	Length of Time the firm has been in business
9	Length of time at current location
10	Years of Experience
11	In your firm a sole proprietorship? (Yes or No)
11.1	If yes, Sole Proprietor's social security number
12	Is your firm a sole proprietorship doing business under a different name? (Yes or No)
12.1	If yes, please indicate sole proprietor's name and the name you are doing business under
13	Is your firm incorporated (Yes or No)
13.1	If yes, State of Incorporation
14	Federal Taxpayer ID Number
15	D-U-N-S # (The County requires a valid D-U-N-S number prior to Contract Award. If needed, your company may obtain one at no cost at www.dnb.com. If you are unable to provide/obtain a D-U-N-S number, please indicate so in your proposal/bid submission response.)
16	Regular business hours
17	Regular holidays and hours when business is closed
18	Contact person in reference to this RFP
18.a	Telephone Number
18.b	Facsimile Number
18.c	Email Address
19	Contact Person For Accounts Payable
19.a	Telephone Number
19.b	Facsimile Number
19.c	Email Address
20	Name of service manager
20.a	Telephone Number
20.b	Facsimile Number
20.c	Email Address
21	NOTICES (Legal/Contract) attention to:
21.a	Telephone Number
21.b	Facsimile Number
21.c	Email Address
22	In the event of an emergency or declared disaster, the following information is required
22.a	Name of contact during non-business hours
22.b	Telephone Number
22.c	Facsimile Number
22.d	Email Address
22.e	Cell or Page Number

D. General Info

Instructions:

- Please provide answers in the blue box to the questions below. Select from the dropdown menu, if provided.

- If applicable, please follow additional instructions in the Comments section

Company Information
Question		Response	Comments
1	Name and address of person to receive notices and who is authorized to make decisions, represent and legally bind the Offeror. Also provide the name, title, address, e-mail address and telephone and fax numbers of the person(s) who the County should contact with questions regarding your response.
2	Are you the Offeror, a subsidiary or affiliate of another company?
2.1	Give full disclosure of all direct or indirect ownership and type of relationship with affiliate companies. If Offeror is a foreign corporation, submit a copy of Certificate of Good Standing for State of California.
3	Indicate whether any services will be subcontracted to another company, in accordance with Article 11, “Assignment or Sub-Contracting,” and list the company name and services for anticipated sub-contractors.		<Include under separate cover in Part 5, and indicate the document names here>
4	Describe any pending discussions, negotiations or agreements to merge, spin off, or sell Offeror.
5	Has Offeror been cited or threatened with citation within the last five (5) years by any federal or state regulators for violations of any state or federal law or regulations? If yes, describe in the Comments section.
6	In the last five (5) years, has Offeror had a contract terminated by a client for cause? If so, describe by whom and under what circumstances? Provide the name and telephone number of each client that has terminated Offeror's services for cause.
7	In the last five (5) years has Offeror failed or refused to complete a contract? If so, provide a detailed explanation in the Comments section.
8	Provide complete information and proof of existing and/or proposed legal organization structure within the County of Orange and where applicable, outside the County of Orange. Specifically, that Offeror is licensed to conduct business in the State of California. If not, attach an opinion of counsel giving his or her opinion as to whether he or she anticipates any difficulties in obtaining all necessary licenses prior to the effective date of the Contract.
9	In the past five (5) years, has Offeror been denied a license to do business? If so, state the date of the denial, the license denied, the state in which the license was denied, the reason given for denial of the license, whether Offeror has had a bona fide change of ownership or management since Offeror license was denied and whether Offeror has eliminated the cause for which the license was denied.
10	If current Insurance coverage is less than required in the Proposed Contract, are you willing and able to increase coverage to minimum required limits?
11	Do you have appropriate physical and electronic safeguards in place to prevent inappropriate use or disclosure of Protected Health Information?
12	Do you have the capability to comply with all HIPAA Electronic Transactions and Security Standards?
13	How many DPPO members are in your current book-of-business commercial plan membership in California for calendar year 2023?
14	Please list any previous or current contracts with the County of Orange within the last 5 years. Include agency or department name, address, and contact person.

Organizational and Financial Stability
Question		Response	Comments
1	Provide your most recent financial ratings from the following rating bureaus:
	Standard & Poor’s
	Moody’s
	Fitch
2	During the last five (5) years has your firm had any lawsuits brought against it covering the administration or claims processing of any plan? If so, explain in the Comments section.
3	Confirm that upon termination of the Offerors business relationship with the County, the Offeror agrees to provide reasonable assistance to enable smooth transition at no additional expense to the County, assuming responsibility for the services that Offeror had provided.
4	Confirm the Offeror will indemnify the County and its plan for all damages, fines, penalties, costs and fees related to any act or omission of Offeror or any of its employees or agents as to the services described in the Contract between the parties.
5	Provide history of acquisition, buyouts or mergers with other entities for the past ten years.

Statement of Qualifications and Vendor Experience
Question		Response	Comments
1.	Provide your Annual Report for the last two (2) years. Offeror must also include independently audited financial statements for the last two (2) fiscal years. Audited financial statements are required; un-audited financial statements will not be accepted.		<Include under separate cover in Part 5, and indicate the document names here>
2.	Provide your audited SOC (Service Organization Controls) 1 Report - Type 2 or SOC 2 Report - Type 2 for the last two (2) years.		<Include under separate cover in Part 5, and indicate the document names here>

Eligibility Connections Standards
Question		Response	Comments
1	Confirm you will perform at least monthly, full eligibility reconciliations with the County of Orange Benefits Administrator.
2	Confirm the County of Orange Benefits Administrator can request urgent eligibility updates and that the updates will be made within 24 hours.
2.1	Please confirm that eligibility reports can be accessed in an electronic format or via the Internet.
3	Indicate whether you can accept eligibility information by electronic media (i.e., internet), tape or hard copy. Confirm you can accept HIPAA-compliant ANSI 834 format, currently used by the County’s Benefits Administrator to provide files to vendors.

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File details come from the government source that posted it. Updated Jul 1, 2025.