Exhibit_7-_Language_Standards_(1).docx
DOCX document 40 KB Posted
- Solicitation number
- EVT0010856
- Issued by
- Sedgwick County, Kansas
About this file
This is a language standards exhibit from the State of Kansas Employee Health Plan (SEHP) related to Bid Event #0010856 for Audit Services covering plan years 2027, 2028, and 2029. The document establishes standardized terminology and definitions to ensure consistency across all health plan documents and communications. The standards specify that covered individuals be referred to as "members" rather than participants, subscribers, or insureds; providers with contractual relationships be called "network providers" instead of contracting or preferred providers; and non-contracted providers be termed "non-network providers" rather than out-of-network or non-preferred providers.
The exhibit defines key health plan terms with consistent meanings across all SEHP plan documents, including deductible, coinsurance, coinsurance maximum, copay/copayment, self-insured/self-funded plans, benefit description, and preferred drug list (PDL). These definitions establish that deductibles are flat dollar amounts paid before plan coverage begins; coinsurance represents percentage-based cost-sharing between members and the plan up to a preset maximum; copayments are fixed amounts per service with no accumulation toward coinsurance maximums; self-insured plans place the employer risk for claims; benefit descriptions are annual documents detailing coverage; and the preferred drug list identifies drugs preferred for dispensing to members. The standards were developed based on employee feedback requesting clarity and consistency in health plan terminology and documentation.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Exhibit_1-_Audit_Services_Technical_Proposal.docx | DOCX document | |
| Exhibit_3_-_Confidential_Section_(1).docx | DOCX document | |
| Exhibit_4-_Medical_Claims_Report_2024-2025.xlsx | XLSX spreadsheet | |
| Agency_response_to_questions.xlsx | XLSX spreadsheet | |
| RFP_-_Question_Format.xlsx | XLSX spreadsheet | |
| State_Employee_Health_Benefit_Plan_Audit_Services.pdf | ||
| Exhibit_2-_Audit_Services_Cost_Proposal.xlsx | XLSX spreadsheet | |
| Amendment_1_-_Response_to_Questions_.doc | DOC document | |
| Exhibit_6-_Performance_Guarantee_Standard.xlsx | XLSX spreadsheet | |
| Exhibit_5-_April_2026_Enrollment_with_Plan_Data.xlsx | XLSX spreadsheet | |
| SOKID_RFX0002907_0.00.pdf |
Show all 11
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
Exhibit 7- Language Standards Bid Event # 0010856 Audit Services RFP-Plan Years 2027, 2028, 2029
Exhibit 7 Language Standards for the State of Kansas Employee Health Plan
Based on employee feedback requesting consistency in terminology, we have adopted simple language standards for all health documents.
1. Employees and their dependents covered under the plan = members.
a. We do not use the terms participants, subscribers, or insureds.
2. Providers that do contract with the health plan = network providers.
a. We do not use the terms contracting, preferred, or participating providers
3. Providers that do not contract with the health plan = non-network providers.
a. We do not use the terms out of network, non-preferred, non-participating, or non-contracting.
4. The SEHP will spell and use the following terms consistently in our plan documents. While the exact wording of the definition may vary between plans, the words themselves will mean:
a. Deductible – a flat dollar amount paid by the members for covered services before the health plan begins to cover eligible expenses.
b. Coinsurance – a cost-sharing provision usually expressed as a percentage whereby the member and health plan will share in expenses, usually to some preset maximum.
c. Coinsurance Maximum – a preset maximum on the amount of member out-of-pocket cost for coinsurance in a given plan year. Once the coinsurance maximum is met, eligible claims are paid at 100% for the remainder of the plan year.
d. Copay or Copayment – a flat dollar amount that is paid by the member each and every time a service is provided. The copay or copayment does not accumulate toward the coinsurance maximum. There is no limit on the number of copays a member may incur during a plan year.
e. Self Insured or Self Funded – plans set by an employer to pay the health claims of its employees. The employer assumes the risk of providing the benefits and is obligated to pay claims for covered services in accordance with the benefit description.
f. Benefit Description - the plan document provided to members on an annual basis that outlines the coverage available under self funded programs. Benefit descriptions are mailed to the member’s home and are available on the SEHP website.
g. Preferred Drug List –a list that identifies those Prescription Drug Products that are preferred by the Plan for dispensing to members when appropriate. This list is subject to periodic review and modification. We use PDL instead of formulary.
File details come from the government source that posted it. Updated .