Exhibit_A_-_Scope_of_Work.docx
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- Solicitation number
- RFP PS-26-0032
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This document is a Scope of Work for a Request for Proposal (RFP PS-26-0032) issued by the City of Phoenix for Group Term Life, AD&D, and Optional Life Insurance Plans. The City is seeking a contractor to provide fully insured life insurance services for its approximately 32,000 eligible full and part-time employees and dependents, with a five-year contract term beginning January 1, 2027, and potential two additional option years. The contract will cover multiple life insurance plan types including Basic Life and AD&D, Optional Life and AD&D, Line of Duty Exposure, Occupational AD&D, and Commuter AD&D insurance, with varying coverage levels based on employee classification and salary.
The current life insurance program is administered by Securian - Minnesota Life and is self-administered on a self-bill basis. The City currently pays 100% of Basic Life, AD&D, Line of Duty Exposure, Occupational AD&D, and Commuter AD&D premiums, while employees pay 100% of Optional Life and AD&D premiums through post-tax payroll deductions. The new contractor must match current benefit levels on a no-loss/no-gain basis and provide guaranteed issue coverage amounts for new employees. The RFP requires comprehensive service capabilities including implementation support, customer service, data integration, reporting, communication materials, account management, and robust technological infrastructure to support the city's complex benefits administration needs.
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Request For Proposal - Professional Services #RFP PS-26-0032 Title: Group Term Life, AD&D, and Optional Life Insurance Plans
EXHIBIT A – SCOPE OF WORK
1. INTRODUCTION AND BACKGROUND
| 1.1 | Phoenix is Arizona’s capital and the fifth largest city in the United States with a workforce of more than 15,000 full and part-time employees. |
| 1.2 | The City’s Human Resource Department is responsible for managing a full range of workforce services to include benefits and wellness, compliance, and HR technology, to name a few. The City is a public employer that provides a comprehensive benefits package to a combined total of 32,000 eligible full and part-time employees and eligible dependents (individually referred to as “Eligible Employees” and “Eligible Dependents” collectively referred to herein as “Participants”). |
| 1.3 | The City offers a fully funded Group Insurance program to employees and their dependents to provide financial protection through a variety of Life and Accidental Death & Dismemberment (AD&D) insurance plans. The intent is to ensure financial security should a catastrophic event occur. |
The Group Life Insurance is currently administered by Securian - Minnesota Life and includes Basic Life and AD&D, Optional Life and AD&D, Commuter AD&D, Line of Duty Exposure and Occupational AD&D plans. Securian - Minnesota Life has been the administrator of the Group Life Insurance since January 1, 2015.
The City pays 100% of the Basic Life and AD&D, Line of Duty Exposure, Occupational AD&D, and Commuter AD&D premium. Participants pay 100% of the Optional Life and AD&D premium(s) through monthly post-tax payroll deduction. The City operates on a self-administered, self-bill basis. This is defined as all enrollment processing and maintenance of data related to the coverage and beneficiaries, administration of the Continuation of Life Insurance (COL) benefit, determining eligibility for employer provided plans maintenance of coverage, premium determination, and reporting.
Participants make all benefit election choices through the City’s PeopleSoft eChris Self-Service platform.
1.4 The Contractor shall be responsible for the administration of the City’s fully funded Group Life and AD&D Insurance Services.
The Contractor shall match (no loss/no gain basis) the City’s current Basic Life and AD&D, Line of Duty Exposure AD&D, Occupational AD&D and Commuter Life Insurance Benefits. Rates shall be quoted based on the coverage to all eligible Participants as listed in the tables below. Employer paid rates must be self-supporting rates for each coverage type and must comply with the IRS Table I straddle test for employer sponsored life insurance.
The Contractor shall provide coverage at the current coverage levels (a no-loss basis) to all Participants enrolled and covered under the current group life insurance policies without evidence of insurability (EOI).
The City currently offers eligible Participants the following fully funded group life plan benefits (list of benefit coverage is not all inclusive) for additional information review the City’s 2025 Employee Guide which can be found at: City of Phoenix Benefits | City of Phoenix :
Basic Life and AD&D Insurance Benefit:
| Employee Group |
| Coverage |
| Unit 1 - Field Employees, Laborers, this group included eligible part-time employees |
| $15,000 |
| Unit 2 - Field Employees, Laborers, Semi-Skilled |
| The greater of one times base annual salary or $25,000 |
| Unit 3- Office and Clerical |
| The greater of one times base annual salary or $25,000 |
| Unit 4 - Police Officers |
| $15,000 |
| Unit 5 - Firefighters |
| 1 times base annual salary |
| Unit 6 - Police Supervisory and Professional |
| 1 times base annual salary |
| Unit 7 - Supervisory and Professional |
| The greater of one times base annual salary or $25,000 |
| Unit 8 - Confidential Office and Clerical |
| One and one-half times base annual salary |
| General City - Middle Managers |
| One and one-half times base annual salary to a maximum of $500,000 |
| General City - Executives |
| One and three-quarters times base annual salary to a maximum of $500,000 |
| Mayor and City Council |
| One and three-quarters times base annual salary to a maximum of $500,000 |
| Executive – City Manager |
| Two times base annual salary to a maximum of $500,000 |
| Middle Managers - Police |
| One and one-half times base annual salary to a maximum of $500,000 |
| Middle Managers - Fire |
| One and one-half times base annual salary to a maximum of $500,000 |
| Executives - Police |
| One and three-quarters times base annual salary to a maximum of $500,000 |
| Executives - Fire |
| One and three-quarters times base annual salary to a maximum of $500,000 |
| Police Reservists |
| None |
| Closed Disabled Group |
| None |
Note: Multiples of base annual salary is rounded to the next higher multiple of $1,000 if not already a multiple thereof.
Optional Life & AD&D Benefit:
The Contractor shall quote Life Insurance based on the coverage amount listed below and / or on an enhanced Guaranteed Issue and/or maximum benefit amount.
Guaranteed Issue – newly hired City employees can elect up to a maximum of $150,000 in coverage and up to $50,000 in coverage for spouse/QDP without evidence of insurability (EOI). The table below describes options for elections outside of newly eligible.
| Eligible Group |
| Amount of Optional Life Insurance |
| Units 1 – 8, Middle Managers (General City, Fire & Police) Executives (General City, Fire, & Police) |
| An amount elected by the employee in an increment of $10,000 to a maximum of $250,000 thereafter, $50,000 to a maximum of $500,000. |
| Police Reservists |
| None |
| Closed Disabled Groups |
| Amounts vary and are on file with the policyholder. |
Occupational AD&D Benefit:
Coverage is payable when death or covered accident occurs in the course of performing the employee’s job duties. Coverage may apply to inhalation of smoke or chemical substance. The benefit is paid in addition to the Basic Life and AD&D benefit.
| Employee Group |
| Coverage |
| Unit 1 - Field Employees, Laborers, this group included eligible part-time employees |
| $75,000 |
| Unit 2 - Field Employees, Laborers, Semi-Skilled |
| $75,000 |
| Unit 3 - Office and Clerical |
| $75,000 |
| Unit 4 - Police Officers |
| $100,000 |
| Unit 5 - Firefighters |
| $75,000 |
| Unit 6 - Police Supervisory and Professional |
| $100,000 |
| Unit 7 - Supervisory and Professional |
| $75,000 |
| Unit 8 - Confidential Office and Clerical |
| $75,000 |
| Middle Managers (General City and Fire), Executives (General City and Fire), Mayor and Council |
| $75,000 |
| Middle Managers and Executives (Police) |
| $75,000 |
| Police Reservists |
| $25,000 |
| Closed Disabled Group |
| None |
Line of Duty Exposure Benefit:
| Employee Group |
| Amount |
| Unit 4 - Police Officers |
| $100,000 |
| Unit 5 - Firefighters |
| $75,000 |
| Unit 6 - Police Supervisory and Professional |
| $100,000 |
| Middle Managers and Executives (Police) |
| $100,000 |
| Middle Managers and Executives (Fire) |
| $75,000 |
Line of Duty Exposure Benefit applies if an eligible insured’s loss of life is due to any disease, infirmity or impairment of health as set forth in A.R.S. §§ 23-901.01, 23-901.09.and meets the specific requirements set forth therein.
The Line of Duty Exposure benefit is only payable if a benefit is paid under the City’s Workers’ Compensation Plan or any replacement plan for the same disease, infirmity or impairment of health.
The Line of Duty Exposure benefit shall be paid in addition to the Basic Life & AD&D, and Optional Life & AD&D, if applicable.
Commuter AD&D Life Insurance Benefit:
The benefit pays $200,000 in the event of death resulting from an automobile accident within a two-hour timeframe while commuting to and from the employees established work location from/to home. This benefit applies to all part-time employees of the policyholder, including part-time employees who are not insured under the group policy with life insurance.
| Employee Group |
| Amount of Commuter AD&D Insurance |
| Units 1 – 8, Middle Managers, Executives (General City, Fire & Police, Mayor and Council) |
| $200,000 |
| Police Reservists and Closed Disabled Group |
| None |
Aggregate Limit: Total liability for all losses for any one accident under the commuter AD&D benefit will not exceed $3,000,000. If the total benefits otherwise payable would exceed this amount, the amount payable for each insured will be in the same proportion as the $3,000,000 bears to the total amount of insurance that would have otherwise been payable except for this provision.
Continuation of Life (COL):
Basic Life Insurance continuation of coverage for employees approved for the City’s self-administered Long-Term Disability program. This coverage terminates at age 65. The coverage amount is the amount in effect when initially disabled and cannot be increased. New claimants for employer provided coverage will be determined by the City of Phoenix Long-Term Disability Administration staff pursuant to the City’s coverage policy. Contractor shall assume and provide COL for Basic Life Insurance.
2. EMPLOYEE ELIGIBILITY FOR COVERAGE
2.1. Employee Type:
2.1.1. All full-time regular employees. Full-time is defined as 40 hours per week.
2.1.2. Benefits eligible part time employees, whether regular or temporary, may be covered for the plan year following an annual evaluation of eligibility pursuant to a collective bargaining contract or ACA analysis (October 1 of each year).
2.2. Eligibility Waiting Period
2.2.1. Basic, Basic AD&D, and Occupational AD&D is Employer Paid Coverage up to the Guarantee Issue maximum effective as of date of hire or the date employee becomes eligible for coverage following a change in status (i.e. from part-time to full-time). Coverage ends as of date of separation from City.
2.2.2. AD&D Commutation Life (Commuter Life) – all employees, whether regular, part time, temporary or police reserves are covered; effective on date of hire; coverage ends on date of separation from City.
2.2.3.Optional Life Insurance – effective the first of the month following date of hire, or first of the month following date coverage approved through EOI determination. Coverage ends as of the last day of the month of separation.
2.3 Continuation of Life
2.3.1. Basic life insurance for employees approved for the City’s self-administered Long Term Disability (LTD) program. This coverage terminates at age 65. The coverage amount is the amount in effect when approved for the City's LTD benefit and cannot be increased.
2.3.2. New claimants for COL employer provided coverage will be determined by City pursuant to the City’s coverage policy.
2.3.3. Contractor shall assume and provide Continuation of Life (COL) for Basic life insurance.
2.4 Eligible Dependents
2.4.1. Legally Married Spouse – the employee’s legally married spouse is eligible for the Voluntary Spouse Life coverage.
2.4.2. Qualified Domestic Partner (QDP) may be the same or opposite gender. A domestic partner status must be approved through the City’s HR Benefits & Wellness Division QDP application process.
2.4.3. Child(ren) – the employee’s child up to age 26. Dependent child(ren) include employee’s biological child(ren), stepchildren/qualified domestic partner’s children(for the duration that the QDP is approved and intact), legally adopted children (from the time of placement) and children up to 18 who live with the employee and for whom the employee has legal custody or court-ordered guardianship (until guardianship or court order expires). The employees disabled child age 26 or over with confirmed disabled dependent certification and recertification by health insurance carrier prior to child attaining 26 years of age.
Note: there is no full-time student requirement for child coverage to age 26.
2A. DEFINITIONS
2A.1 Automated Clearing House (ACH) – means an electronic funds transfer between accounts using the Automated Clearing House Network.
| 2A.2 | Designated Teams – means persons trained on the City’s benefits and assigned by the Contractor to service the City account. Persons assigned to perform Implementation and/or Account Management Services. |
| 2A.3 | Effective Date – means the day the Contract and Business Associate Agreement begins. |
| 2A.4 | Eligible Employee – means active full-time, job-share, and benefits eligible part-time City employees or any other person the City determines to be eligible including without limitation employees on approved leave of absence due to FMLA (paid or unpaid), LTD, ADA, USERRA, FEMA or any person eligible for continuation of coverage. |
| 2A.5 | Eligible Dependents are defined by the City as: |
| 2A.5.1 | A legally married spouse, regardless of gender |
| 2A.5.2 | A Qualified Domestic Partner (QDP), regardless of gender, approved through City of Phoenix QDP affidavit. |
2A.5.3 Children to age 26, including biological child; an adopted child or child placed for adoption; a stepchild who the employee is married to or has an active Qualified Domestic Partnership with the child’s parent; and children for whom the employee has legal guardianship or legal custody; and 2A.5.4 Children aged 26 and older provided the child had existing coverage as an eligible dependent and the child has a long-term or permanent disability that makes the child incapable of self-sustaining employment.
| 2A.6 | Participants - means Eligible Employees and Eligible Dependents |
| 2A.7 | Plan Year - means the 12-month period of benefits coverage under a group health plan which begins January 1 and ends on December 31. |
| 2A.8 | Qualified Life Event – or (QLEs) describe events deemed acceptable by the IRS that may allow Participants to change their participation election for health coverage outside of Open Enrollment. QLEs include but are not limited to: Marriage, Divorce, Annulment, Death of a Spouse, Birth, Adoption, Placement for Adoption, Legal Guardianship, Change in Legal Custody, Becoming Covered in Other Group Insurance. |
| 2A.9 | Services - means the work required of the Contractor by this Agreement and the Scope of Work incorporated therein. |
| 2A.10 | Subcontractor or Assignee – means any vendor or group of individuals who are not employed by the Contractor but perform Services on behalf of the Contractor for the City. |
| 2B. | ACRONYMS |
| 2B.1 | ACA – Affordable Care Act |
| 2B.2 | ADA – Americans with Disabilities Act of 1990 |
2B.3 AD&D – Accidental Death and Dismemberment
| 2B.4 | CAA – Consolidated Appropriations Act |
| 2B.5 | COBRA – Consolidated Omnibus Budget Reconciliation Act |
| 2B.6 | EOI – Evidence of Insurability |
| 2B.7 | FEMA – Federal Emergency Management Agency |
| 2B.8 | FMLA – Family Medical Leave Act |
| 2B.9 | PEPM – Per Employee Per Month |
| 2B.10 | SSAE – Statements on Standards for Attestation Engagement |
2B.11 USERRA – Uniformed Services Employment and Reemployment Rights Act
3. GOALS AND OBJECTIVES
The City of Phoenix seeks to contract with a qualified firm that can best support and provide fully insured Basic Life and AD&D, Optional Life and AD&D, Line of Duty Exposure, Occupational AD&D, and Commuter AD&D Insurance for eligible City Participants and that can provide the following services, but not limited to the following:
| 3.1 | Provide high quality service(s) to plan Participants. | |
| 3.2 | Provide consistent, responsive, and professional administrative service supported by verifiable performance measurements. | |
| 3.3 | Provide clear, effective and reliable communication(s) and assistance that aids Participants through navigation and understanding of benefit offerings, secure Participant website, Participant microsite, evidence of insurability process, financial resources, and services. | |
| 3.4 | Provide for Monthly premium billing on a self-billed basis. | |
| 3.5 | Monthly premium payment deadlines to be not less than 60 days after the | last day of the month for which payment is due. |
| 3.6 | Accept the City’s six-digit employee ID numbers, that begin with zero, to enroll and identify plan Participants. Alternative ID numbers will not be accepted. | |
| 3.7 | Acceptance of a weekly eligibility file feed from the City at no cost to the City and in adherence to the City’s Security and EDI Protocols. The City uses Oracle’s PeopleSoft for payroll processing. | |
| 3.7.1 | Integrate using the City’s EDI file layout. | |
| 3.7.2 | Post the electronic eligibility file feed within one (1) business day of | |
| receipt. | ||
| 3.7.3 | Provide weekly discrepancy report to the City within two business days. | |
| 3.7.4 | Use Encrypted cloud storage to store all City sensitive data and back up media with implemented access controls. | |
| 3.7.5 | Establish/Use secure and encrypted PGP, FTP, SFTP, HTTPS, and VPN methods of data transmission as a means of sending and receiving files to and from the City. | |
| 3.7.6 | Use a secure method such as encrypted email, password-protected email, and/or password-protected attachments to send and receive emails to and from designated City administrative staff. | |
| 3.8 | At no cost to the City, prepare and mail a welcome packet to |
newly enrolled Plan Participants. The welcome packet shall include an enrollment confirmation and welcome letter, certificate of insurance outlining and defining all covered services, limitations, exclusions, schedule of benefits, procedures for receiving services and other plan requirements, and information on financial resources. The welcome packet shall be mailed within 10 business days of receiving the City’s eligibility file.
| 3.9 | Flexibility over plan design, i.e., plan limits, exclusions, benefit coverage, etc., from year to year to enable the City to introduce new products, and/or enhanced features, as deemed necessary or appropriate by the City. | ||||||
| 3.10 | An experienced Implementation Coordinator to coordinate vendor | ||||||
| resources toward a timely and successful January 1, 2027, | |||||||
| implementation. The vendor implementation team must include an IT | |||||||
| specialist able to answer file specification questions and identify options | |||||||
| for success. | |||||||
| 3.11 An Executive Sponsor who communicates regularly with Benefits | Managment team to assure that service expectations are met. | ||||||
| 3.12 | An Account Manager to handle day-to-day issues and questions from | ||||||
| Benefits Staff. | |||||||
| 3.13 | Exceptional customer service to include access to live customer service | ||||||
| representatives by phone Monday through Friday from 7 a.m. to 6 p.m. | |||||||
| Arizona time. | |||||||
| 3.14 | Allow for the continuation of the City’s self-administration of the plans, | billing, and continuation of life benefits. | |||||
| 3.15 | Accept beneficiary designations maintained by the City in the electronic | enrollment system in the event of a claim. | |||||
| 3.16 | Coverage amounts of Basic Life and AD&D, Line of Duty Exposure, | Occupational AD&D, and Commuter AD&D | amounts will be continued | at current levels. Optional Life and AD&D Guaranteed Issue | coverage amount(s) (when initially eligible) and any purchase coverage | amount(s) after originally eligible shall continue at a minimum at the | current coverage amount. |
| 3.17 | Keep the City’s designated Benefit Management liaison(s) up to date on new or upcoming staff information on the latest innovations in customer service, claims processing, financial resources, and plan design management. | ||||||
| 3.18 | Provide statistical plan reports including utilization data, enrollment status and other relevant analysis reports on a monthly, quarterly, and annual cadence, or as needed or requested by the City’s designated Benefit Management liaison(s). | ||||||
| 3.19 | Meet with City’s Benefit Management liaison(s) on a monthly basis or as needed to review and evaluate Group Life and AD&D plan administration. | ||||||
| 3.20 | Provide Participants electronic EOI submission process with clear instructions describing the medical underwriting process and required supporting documentation. |
4. SCOPE OF SERVICES / GENERAL REQUIREMENTS
| 4.1 | Contractor shall provide the benefits and Services that are: (1) required under Exhibit A, Scope of Work; (2) proposed by Contractor and accepted by the City; and (3) otherwise required under the Contract between the Contractor and the City. |
| 4.2 | Contractor shall provide the Services as specified within Exhibit A, Scope of Work effective January 1, 2027. |
| 4.3 | The Plan Year begins annually on January 1, with the Open Enrollment period scheduled during the previous October. The City reserves the right to change these dates with a sixty (60) calendar days’ notice to the Contractor. |
| 4.4 | Contractor shall provide the City a certificate in redline draft by October 1 of every Contract year. All proposed modifications defining all covered services, limitations, exclusions, schedule of benefits, procedures for receiving services, and other plan information requirements, shall be in the form of redline(s). To ensure a seamless go live effective date of January 1, 2027, the redline draft or the first year of Contract is due no later than October 1, 2026, and thereafter by October 1st for every subsequent year of the term of the Contract. The City shall review and approve prior to any distribution to Plan Participants. |
| 4.5 | The Contractor shall disclose to the City all Subcontractors and third-party assignees used to provide Services in relation to this Contract through the term of the Contract. Contractor shall not perform any of the Contract services from outside of the United States, including not utilizing offshore subcontractors or third-party assignees provided for under this Agreement. |
| 4.6 | The Contractor shall allow the City to participate in any quality assurance processes for any and all Subcontractors as it relates to this Agreement. |
| 4.7 | The Contractor shall immediately, upon any oral or written notification to the Contractor, report to the City any potential litigation relating to issues involving Contractor, the City, third-party assignee and/or any Subcontractor as it pertains to any Services provided under this Agreement. |
| 4.8 | Contractor shall have its customer call center and Participant microsite fully operational and in a state of readiness by/before the Open Enrollment Period for Eligible Employees by October 2026. Customer service representatives must be fully trained on the City’s specific benefits prior to the initial and thereafter all subsequent annual Open Enrollment start date(s). |
| 4.9 | Contractor shall designate an Account Manager who has authority to act on behalf of the contractor who has at least three (3) years of experience as an account manager for Group Life Insurance clients similar in scope and size to the City and the authority to make same-day decisions regarding company policy. |
| 4.9.1 | The Contractor shall make available designated representatives to coordinate with City staff during the initial and future Open Enrollment periods and participation in multiple virtual and in-person group information and planning meetings upon request by the City’s designated Benefit staff at no cost to the City. |
| 4.9.2 | The Contractor shall provide an employer portal that provides authorized designated benefit staff liaison access to enrollment reports. |
| 4.9.3 | The Contractor shall provide training on the Participant and employer portal to all identified benefits liaisons, upon request by the City at no cost to the City. |
| 4.9.4 | Contractor agrees that the use of any written or visual communication materials or changes to materials being used must be approved by the City in writing in advance of any distribution. |
| 4.10 | The annual Open Enrollment period shall be determined by the City. During Open Enrollment, eligible individuals shall be allowed to join a plan, change coverage, or to add/delete Eligible Dependents. Open Enrollment election changes are effective on the first day of each Plan Year. |
4A. PARTICIPANT SERVICES
| 4A.1 | Contractor shall provide: | |
| 4A.1.1 | Excellent customer service to plan Participants who elect coverage or are continuing coverage with member service representatives available to assist members between the hours of 7:00 a.m. and 6:00 p.m. Arizona time, each business day. Calls shall be recorded to the extent allowed by and in accordance with applicable law. | |
| 4A.1.2 | A toll-free phone number with 24/7 interactive voice response | |
| (IVR). | ||
| 4A.1.3 | Participant microsite access to account information benefits for the Participants. | |
| 4A.1.4 | Employer portal with limited access to account and membership information. Access limited to authorized designated Benefit liaison(s) as approved by the City’s Benefit Management Liaison(s). | |
| 4A.2 | The Contractor shall provide at no cost to the City, a fully operational, toll-free line that is answered by a live member service representative Monday through Friday (7:00 am to 6:00 pm) Arizona Time (Arizona does not participate in Daylight Saving Time), excluding City observed holidays (https://www.phoenix.gov/calendar/holidays). |
Calls outside of these hours shall be handled by voice mailbox or equivalent system, available twenty-four (24) hours a day, seven (7) days a week, and three hundred sixty-five (365) days a year.
Responses to messages shall be returned by a knowledgeable staff member by the end of the following business day, excludes observed holiday(s).
The toll-free line will include alternative language options (or access to language translation services). The toll-free line will include oral language services that include answering questions in at least the following non-English language(s): Spanish.
| 4A.3 | The Contractor shall at no cost to the City, ensure that the City and its Participants who are deaf or hearing impaired have access to communication services that enable them to use the phone lines. |
| 4A.4 | The Contractor shall provide an escalation process to respond to Participant service issues within one (1) business day for issues that cannot be resolved at the customer service level. |
4B. CLAIMS ADMINISTRATION
| 4B.1 | Contractor shall agree to accept and accurately process claims timely for all Participants. |
| 4B.2 | Contractor shall ensure that procedures are in place for reviewing claims and their appropriateness against the benefits covered as stipulated in the Certificate against the Participant’s account. Procedures must include a detailed appeals procedure with an updated FAQ for Participant’s whose claims have been denied. |
4B.3 Contractor shall provide the City with a minimum of twelve (12) months advanced notice of any claim system conversion or change that may disrupt the current processes.
4B.4 Contractor shall make any decisions on claims in compliance with any federal and state laws, internal claims and appeals and external review processes.
| 4B.5 All Services provided under this Contract shall be quality services, | ||
| meeting or exceeding the City-approved industry standards. When | ||
| Services do not meet industry standards, or when standards are | ||
| inappropriate, undesirable, and/or poor quality (as identified by the City) | ||
| the Contractor shall take immediate, corrective action and provide to the | ||
| City a written action plan that clearly outlines the corrective steps to be | ||
| taken and the time frames for their completion. The resources needed to | ||
| correct Services that do not meet industry and the City quality standards | ||
| shall be provided at no cost to the City. | ||
| 4B.6 | Contractor shall take immediate corrective action and provide a |
written corrective action plan within fourteen (14) calendar days, as requested by the City, should the City identify any deficiencies in the performance of the Contract, including missed performance guarantees or audit findings. No fees shall be charged in the recovery or reimbursement of any funds identified in the audit findings. The corrective action plan shall include, at a minimum:
| 4B.6.1 Reference to the specific error or finding and a summary of the | ||
| overall impact of the error, whether financial or to Participant(s) | ||
| 4B.6.2 Causal factor(s) | ||
| 4B.6.3 Name and title of the person accountable for implementing and | ||
| overseeing the corrective action plan. | ||
| 4B.6.4 Corrective action items including: | ||
| 4B.6.4.1 Specific deliverables including, but not limited to, claim | ||
| impact reports, reprocessed claim report, and training | ||
| documents | ||
| 4B.6.4.2 The anticipated completion date(s) | ||
| 4B.6.4.3 The reason the corrective action is not necessary, if | ||
| applicable | ||
| 4B.6.4.4 Disclosure of metrics used to measure the success of | ||
| each deliverable. | ||
| 4B.6.4.5 Participant notification process, if applicable | ||
| 4B.6.4.6 Notification and supporting documentation of | ||
| completion of issue resolution. |
4B.10 The Contractor shall provide resources to respond within fourteen (14) business days to all the City inquiries related to quality assurance, corrective actions, deficiencies, and/or inefficiencies in operations at no cost to the City.
| 4B.11 Contractor shall provide to the City annual quality management initiatives | |
| including but not limited to, process improvements, customer service, and | |
| operational standards. Annual quality management initiatives shall be | |
| provided during implementation and each plan year with | |
| results from the prior year’s initiatives. |
4C. ELIGIBILITY & DATA INTEGRATION
| 4C.1 | The City shall determine eligibility of Participants for enrollment in and coverage by City Health Plans including the Group Life and AD&D plans. |
| 4C.2 | The City’s determination of eligibility for City Health Plans shall be guided by federal, state and local rules, regulations and laws, including, but not limited to 26 U.S. Code 125, the Internal Revenue Code of 1986, the Patient Protection and Affordable Care Act (PPACA), Public Health Service Act (PHSA); the Consolidated Omnibus Budget Reconciliation Act (COBRA), the Family Medical Leave Act (FMLA), Medicare, Medicaid, and the Uniformed Services Employment and Reemployment Rights Act (USERRA), Federal Emergency Management Agency Act (FEMA), as well as City policies and collective bargaining agreements to the extent such policies and agreements meet or exceed other legal requirements. |
4C.3 Contractor shall accept enrollment eligibility, qualified life event changes, and cancellation dates as stated in the City’s transmissions, reports, or files. Discrepancies should be addressed promptly to ensure the accuracy of the record. Discrepancies remaining at the end of each plan year shall not exceed 1% between amounts owed based on Contractor’s eligibility system and fees/premiums remitted by the City will be written off at the end of each contract year.
4C.4 Contractor shall check the eligibility of claimants against the eligibility files that will be sent electronically by the City and includes new enrollments, cancellations, terminations, and other changes applicable to City plans before authorizing benefits. Contractor shall process such enrollments, cancellations, terminations and changes in a timely manner, but no later than 48-hours from receipt of weekly eligibility file.
4C.5 The City shall provide Contractor with a weekly eligibility file in a secure electronic format. The City may determine it is beneficial to change the file format in the future and reserves the right to do so at no charge to the City by the Contractor.
| 4C.6 | The Contractor shall accept the City’s HIPAA compliant, weekly electronic data transmissions as the official Participant eligibility/enrollment records, subject to adjustments as authorized by the City. |
| 4C.7 | Contractor understands that after the employee’s initial enrollment period, employee benefit elections may only be changed annually during the designated Open Enrollment period or within the applicable election period associated with a Qualified Life Event (QLE). |
4C.8 Contractor shall securely and timely process the weekly electronic transaction file noting Participant enrollment changes (additions, deletions, and changes of address, employment status, etc.) and the full file showing all Participants that are eligible for benefits.
4C.9 The City may request, and the Contractor shall perform manual enrollments or other manual enrollment changes in between weekly electronic data transmissions to expedite such a change. Contractor shall accept such requests and perform the requested enrollment or other changes no later than 48 hours after receipt of the City’s request. Contractor shall only accept City request from designated and authorized Benefit Management liaisons.
4C.10 Contractor agrees to incur all expenses of any modifications that are necessary to its systems to process the information provided by the City. The City will not make any modifications to its current system or file content or structure to accommodate the Contractor.
| 4C.11 | Contractor shall have and maintain HIPAA compliant hardware, software, and systems that are capable of retrieving or receiving electronic data transmission form the City regarding enrollments, changes to enrollments, premiums and other matter related to the contract. Contractor shall at the highest level protect and maintain the confidentiality and security of all City Confidential information, implement and maintain adequate and necessary security systems, policies and appropriate protocols in adherence to this Agreement. |
| 4C.12 | Dependent eligibility beyond age 26 - Dependent children are eligible from live birth to the attainment of age 26. The Contractor shall provide written notice of the conversion right to the dependent if an insured dependent’s coverage terminates because he/she is no longer eligible, death of the policy holder, or termination or amendment of coverage for eligible dependents. |
4D. CREDITS AND ALLOWANCES
| 4D.1 | Contractor shall provide credits and allowances (“CA Funds”). The City retains full discretion over the use of such funds. Unused CA Funds roll over year over year through the term of the Contract. At City’s discretion, CA Funds may be maintained as a single fund to encompass the initiatives which include but are not limited to the following: |
| 4D.2 | Initial and Ongoing Implementation Allowance. |
| 4D.3 | Implementation Audit Allowance. |
| 4D.4 | Compliance Review Allowance. |
| 4D.5 | Training/Client Summit/ Allowance. |
| 4D.6 | Communication Allowance. |
4F. TECHNOLOGY
| 4F.1 Employer support | |
| 4F.1.1 | The Contractor shall provide authorized City staff access to the City’s data via any and all Contractor’s tools and relevant databases. Authorized staff shall be determined by the City Human Resources designated Benefits Management liaison. Contractor agrees to grant/rescind user access within one (1) day of receipt of notice. Contractor shall confirm in writing all City authorized staff at the beginning of each plan year. |
| 4F.1.2 | The Contractor shall image and retain Life and AD&D documentation in an electronic transferable and standard readable format to the City or other Contractors should the City change vendors. |
| 4F.1.3 | The Contractor shall maintain disaster recovery procedures for eligibility, billing and accounts receivable, which includes but is not limited to: daily data backups maintained at an off-site/onshore (offshoring outside of the United States, not permitted) facility; and documentation to support regulatory compliance. |
| 4F.1.4 | The Contractor shall accept the City of Phoenix defined data elements when building the vendor account structure; |
| 4F.2 Participant support | |
| 4F.2.1 | Secure Participant Portal – the Contractor shall at no cost to the City enable Participants, through a reasonably thorough, functional, and secure Participant portal access to online resources for Life and AD&D activity and financial information. The secure Participant portal capability shall allow the Participant to perform standard functions such as submit evidence of insurability, file a claim, submit a change of address, review of covered Participants and read/review plan provisions. This site shall be subject to requirements as stated in Section 10 (Additional Data and Security) of Exhibit A, Scope of Work. |
| 4F.2.2 | The Contractor agrees to support a mobile application that is secure, with two-factor authentication and provides access to relevant Participant history, allows Participant to file a claim and verify coverage. |
| 4F.2.3 | The Contractor shall ensure that Participant Portal is compliant with all language, formatting, accessibility standards or guidelines that provide accessibility to Participants with disabilities. |
| 5. | PERFORMANCE GUARANTEES |
| 5.1 | The Contractor shall offer competitive implementation performance guarantees as well as aggregate performance guarantees consistent with Financial Worksheet, Tab 12 PG (Performance Guarantees). |
| 5.2 | The Contractor shall place annual fees at risk for failing to maintain the performance guarantees in accordance with the Financial Worksheet, Tab 12 PG (Performance Guarantees). Performance fees at risk will be calculated at the same frequency with which performance guarantees are reported. At no time will quarterly or monthly measurements be re-averaged to alter results. |
| 5.3 | The City reserves the right to allocate the percent of the fees at risk for each performance guarantee. Additionally, the City requires the ability to re-allocate the amount at risk for each performance standard on an annual basis. |
| 5.4 | The City may request the inclusion of additional performance measurements annually. Any additional performance measurements shall be mutually agreed upon through a written Contract amendment. |
| 5.5 | The Contractor shall measure all performance standards and provide to the City any supporting reports as City-specific. Reports shall show actual results for the current period versus: (1) prior period(s); and (2) the guaranteed standard. Such reports shall be submitted on a schedule consistent with Section 9.3 or as otherwise agreed by the Parties. |
| 6. | IMPLEMENTATION |
| 6.1 | The Contractor shall submit an implementation plan and begin the implementation process within ten (10) business days of Contract award. Implementation process shall begin within (5) business days of City's review and approval of implementation and transition plan. The City may request changes to the implementation plan at its discretion. The Implementation Plan commencement date shall commence no later than May 2026, or date requested by the City (if different). |
| 6.2 | The Contractor agrees the City may conduct a pre- or post- implementation audit to verify readiness to administer the City’s program. The pre-implementation audit must be completed before the program effective date and the post-implementation audit will be conducted at a mutually agreed upon time frame post effective date. If the City opts to initiate an audit, the review will be conducted by an audit firm selected by the City and will include test claims developed independently by the audit firm to represent the City’s requirements. |
| 6.3 | The Contractor agrees to provide a designated implementation manager and support team (not part of the regular account management team) that will be assigned to lead and coordinate the implementation activities with the City. Contractor agrees the implementation manager shall not be managing more than three (3) implementations in total while leading the implementation for the City. |
| 6.4 | The Contractor shall provide a team of individuals dedicated to implementing the provisions of this Contract upon award. The implementation team shall include, but not be limited to programmers, data analysts, a project manager, an account manager, an audit/quality assurance lead, enrollment specialists, and member services lead staff. |
| 6.5 | The Contractor shall perform comprehensive systems testing and quality assurance audits with results reported to the City by a mutually agreed to date but prior to the effective date of the 2027 Plan Year as part of the premium rates with no charge to the City. Systems testing should include, but not be limited to, the following elements: |
| 6.5.1 Benefit limitations | |
| 6.5.2 Benefit exclusions | |
| 6.5.3 Eligibility file maintenance including disabled dependent verification | |
| 6.5.4 Appeal processes, administrative and clinical | |
| 6.5.5 Reporting | |
| 6.5.6 Website | |
| 6.5.7 Call Center | |
| 6.5.8 Banking and billing | |
| 6.5.9 Call Center | |
| 6.5.10 Other items as identified during the implementation process | |
| 6.6 | The Contractor shall provide an administrative manual for the program that provides the information necessary for the City team members to operate the program. The manual shall be provided at the time of implementation and shall be updated on an ongoing basis by the account management team and/or by the City. This manual shall be provided as part of the premiums and with no cost to the City. |
| 6.7 | The manual shall be in a mutually agreed upon format and include, but not be limited to, the following information: |
| 6.7.1 | Account management structure and contact information. |
| 6.7.2 | A process for handling questions and the escalation process. |
| 6.7.3 | Eligibility file layout and exchanges. |
| 6.7.4 | System testing and documentation. |
| 6.7.5 | A catalog for all Participant communication. |
| 6.7.6 | Eligibility processes and time frames. |
| 6.8 | The designated implementation manager shall continue to support the City through completion of the implementation process and for a minimum of forty-five (45) calendar days after the Contract effective date of January 1, 2027. Such support includes but is not limited to weekly calls with the City and the designated account management team, maintenance of issue tracking logs, and issue resolution. This support must be provided as part of the premiums with no cost to the City. |
| 6.9 | The Contractor shall be required to begin Services prior to the plan year effective date to prepare for the program (e.g., implementation, open enrollment). |
| 7. | PLAN PARTICIPANT COMMUNICATION MATERIALS |
| 7.1 | All communication materials to Participants shall be sent using First Class mail at no cost to the City unless another class is required or authorized by the City. All Participant communication material must be approved by the City prior to any distribution. |
| 7.2 | The Contractor shall co-brand any communication material with the City logo or other logo determined by the City as part of the premiums and at no cost to the City. |
| 7.3 | The Contractor shall include a toll-free telephone number on the website and on all communication material. |
| 7.4 | The Contractor shall provide a web portal for Participants that provides the information necessary to comport with federal and state law and meets the confidentiality and data security specifications required by this Agreement, City policy and HIPAA privacy regulations. |
| 7.5 | The Contractor shall prepare, design, produce, and mail all announcements, letters, notices, brochures forms, and other supplies and Services at no cost to the City. All communication is subject to review and approval by the City prior to any distribution. |
| 7.6 | The Contractor shall submit copies of all Plan Participant communication materials to the City. The City reserves the right to review the content of any communication and to make revisions. All such materials shall be approved in writing by the City prior to use in promoting the applicable program to Participants. Materials include but are not limited to customized Participant communication materials during the transition and implementation activities, notification letters, error/correction letters, appeal letters, newsletters, and/or any material distributed to the City Life and AD&D Plans Participants. |
7.6.1 Policies, riders, and amendments
7.6.2 All communication materials, advertisements, and marketing materials
| 7.7 | The Contractor shall facilitate links between the City websites and Contractor’s website as part of the premiums and at no cost to the City. |
| 7.8 | The Contractor shall have available the following secure online tools and Services, to be updated at least quarterly, at no cost to the City: |
| 7.8.1 | Benefit information, including but not limited to: policies, riders, and amendments |
7.8.2 Electronic EOI Submission
7.8.3 Claims submission
7.8.4 Decision support tools
7.8.5 Financial wellness resources
7.8.6. Microsite which provides benefit information, decision support tools, and financial wellness resources
| 8. | ACCOUNT MANAGEMENT TEAM |
| 8.1 | The Contractor shall provide a team of designated professionals who are responsible for ensuring that all Contractual requirements and service deliverables are met by the Contractor. The City reserves the right to approve the staffing of the City service team. The Designated Teams may also serve other clients if such assignment does hinder timely performance of Services for the City. |
| 8.2 | The Contractor shall provide an account management team that is experienced in providing Services for similar entities, trained on the applicable City Life and AD&D plans, accessible to the City geographically, and with sufficient capacity and authority to respond to the City issues in a timely manner. The account management team shall include: |
8.2.1 Account Manager – shall be the single, day-to-day contact for the City with the primary responsibilities of responding to all issues, coordinating the efforts of the Contractor’s staff to resolve issues, and overseeing all aspects of project management including, but not limited to the initial implementation and ongoing new program facilitation. The Account Manager shall have a minimum of three (3) years of experience with the Contractor’s organization or a similar industry. If possible, Account Manager shall also be a local resident of Arizona.
8.2.2 Implementation Manager – Responsible for development and execution of implementation plan. Coordinates with the City, internal and other external resources. The Implementation Manager shall represent the sole, consistent point of contact to the City during the implementation process. Three (3) years of experience as an Implementation Manager and experience with groups of 20,000 Participants and larger are also required.
8.2.3 Executive Sponsor – shall be responsible for collaborating with the City on issues related to legislation and policy and shall provide recommendations to the City. The Executive Sponsor shall work with the entire senior management team in other roles as well, including high-level operational issues resolution.
8.2.4 IT System Manager – shall be a day-to-day contact who will have the primary responsibility of responding to and resolving all IT-related issues that arise for the duration of the Contract.
8.2.5 Enrollment/Eligibility Lead – shall be a day-to-day contact with the primary responsibility of responding to all issues related to billing, enrollment, termination, and eligibility. The Enrollment/Eligibility Lead will be responsible for resolving all such issues that surface during implementation, open enrollment, and all ongoing service.
8.2.6 Member Services Manager –The Contractor shall provide a minimum of one Member Services Manager who is responsible for all customer service functions and reporting. The Member Services Manager shall be intimately familiar with the City’s Life and AD&D plans to serve the Participants. Three (3) years of experience as a Member Services Manager and experience with groups of 20,000 members and larger are also required.
8.2.7 Data Analytics Manager – shall be responsible for providing analysis, assessment, and recommendations to the City based on the City’s life and AD&D trend and utilization to improve the Life and AD&D Plans performance. The Data Analytics Manager shall participate in the City data analytics manager meetings and shall provide recommendations to support quality improvement programs and plan design changes.
| 8.3 | The Contractor shall provide to the City’s designated Benefits Management liaison(s) at least thirty (30) calendar days advanced notice of any planned change to the primary account manager. |
| 8.4 | The Contractor shall provide to the City an escalation process to assist in matters which are unable to be resolved at the account team level. |
| 8.5 | The Contractor shall provide the City with access to an electronic tracking and resolution log of all open and closed the City issues in the required format. |
| 8.6 | The Contractor shall provide to the City documentation of a process for prompt issue resolution in the event of a failure to perform a required service. |
| 8.7 | The Contractor shall attend weekly virtual account management meetings with appropriate personnel to address potential questions as requested by the City. Contractor account management shall be available to meet in person at the City designated location, should the need arise at any point for the duration of the Contract. |
| 8.8 | The core members of the account management team: account manager, member services manager, IT system manager, and data analytics manager, and executive sponsor shall meet with the City’s designated Benefits Management team and designated Benefits Consultant representatives quarterly within fifty-five (55) calendar days after the close of each quarter. Meetings are to be held by virtual platform unless the City requests in person meeting. |
8.9 The Contractor shall conduct a Participant satisfaction survey as it relates to life and AD&D services under this Contract. The survey shall be conducted annually during the plan year. The Contractor shall provide the City with a copy of the survey instrument for its review. Such surveys shall be for the purpose of assessing Participant satisfaction with Services performed by Contractor.
| 8.10 | The Contractor shall conduct an annual account management satisfaction survey/score card. The survey and scoring methodology shall be mutually agreed upon by the City and the Contractor during implementation. |
| 8.11 | The City may make public the results of such surveys for distribution among Life and AD&D Plans Participants, the legislature, and/or the media if requested. |
| 8.12 | The Contractor shall ensure that staff is appropriately trained on the City Life and AD&D Plans, and that quality assurance and financial accuracy procedures are in place so that procedures are applied consistently, fairly, and accurately. |
| 8.13 | The Contractor agrees to participate in vendor summit discussions to identify opportunities to enhance the Participant experience. |
| 8.14 | The Contractor agrees that the City of Phoenix has the right to review, meet with and approve changes to the account team assigned to service City of Phoenix, and agrees not to change the assigned account team without prior consent from the City. |
| 8.15 | The Contractor agrees to participate in regular Account Team meetings with City of Phoenix management as frequently as on a weekly basis immediately following implementation and on a weekly, semi-monthly, or monthly basis after implementation is fully achieved. |
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