Exhibit_A_-_Scope_of_Work.pdf

RFP PS 26-0317

Title: Fully Insured Vision Benefits

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, talent acquisition, compliance, and HR technology, to name a few. The City is a public employer that provides a comprehensive benefits package to 32,000 eligible full and part-time employees, retirees and eligible dependents (individually referred to as “Eligible Employees”, “Eligible Retirees” and “Eligible Dependents” “Eligible Survivor” collectively referred to herein as “Participants”).

1.3 The City offers a two-tier fully funded buy-up vision plan option for Active eligible Participants and a three-tier fully funded buy-up vision plan option for eligible Retiree Participants. The Buy-Up Voluntary Vision plan has been administered by Davis Vision by MetLife since January 1, 2021.

1.4 Eligible active Participants may voluntarily elect to enroll in either employee-only or family coverage, with premiums collected through monthly payroll deduction on a pre-tax basis.

1.5 Eligible retiree Participants have the option to voluntarily enroll in either retiree only, retiree plus one, or retiree plus family coverage with premiums collected through monthly pension payroll deduction on a post-tax basis.

Eligible City retirees may reside in the State of Arizona and/or throughout the United States. The City reserves the right, at its sole discretion, to modify the enrollment and premium payment process for Eligible retiree Participants at any time during the term of the Agreement. Should the City elect to implement such a change, the Contractor shall, upon the City’s request, implement a process that allows Eligible retiree Participants to enroll directly with the Contractor and remit premium payments directly to the Contractor. The Contractor shall provide payment options that include Automated Clearing House (ACH) payments and may offer other secure payment methods.

1.6 All Active eligible enrolled Participants pay 100% of the premium on a pre-tax basis. All eligible enrolled Retirees pay 100% of the premium on a post-tax basis and must have a sufficient monthly pension benefit amount to cover the monthly premium cost. Retirees without sufficient pension are not permitted to participate in the Buy-Up Vision plan through the City’s enrollment process.

1.7 Eligible Active City employees (Participants) complete all benefit elections through the City’s HRIS platform, PeopleSoft Self-Service (referred to “e- Chris). Eligible City retirees (Participants) enroll through a manual enrollment process administered by a designated benefits liaison.

1.8 This Request for Proposal (RFP) is Fully Insured Vision Benefits. The City invites proposals from qualified firms with in-depth knowledge and expertise in providing fully funded vision care benefit administration services, best-in-class provider network access, dedicated account management, competitive premiums and administrative fees that best meet the needs for City plan Participants.

1.9 The intent is to award a five-year contract term coupled with a favorable five

(5) year fixed guaranteed rate structure or longer should the City exercise the option to extend the Contract term by an additional one- or two-year term.

1.10 The current fully funded vision benefit plan coverage and eligibility rules are available in the City’s 2026 Employee and 2026 Retiree Benefit Guide which can be found at: City of Phoenix Benefits | City of Phoenix. The City is not interested in reducing the vision benefits currently offered.

1.11 The proposed plan designs should match, as closely as possible, the benefit provisions of the current plans, a large national vision network with access to qualified quality providers and negotiated discounts to provide optimum savings for City Participants. Proposers are invited to provide more robust benefits, pricing and discounts.

1.12 Proposals should demonstrate through their proposal that Contractor will provide the City and City Participants with unsurpassed quality customer service, premier industry standard technology and systems, efficient, effective and timely claims processing and timely and accurate reporting.

Proposed vision benefit plan offerings shall be listed in detail in Exhibit B, Fee Schedule.

2. DEFINITIONS

2.1 Automated Clearing House (ACH) – means an electronic funds transfer between accounts using the Automated Clearing House Network.

2.2 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.

2.3 Effective Date – means the day the Contract and Business Associate Agreement begins.

2.4 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.

2.5 Eligible Retiree – means retired from City due to credited service or approved medical retirement and with sufficient pension to cover monthly premium amounts.

2.6 Eligible Dependents are defined by the City as:

2.6.1 A legally married spouse, regardless of gender

2.6.2 A Qualified Domestic Partner (QDP), regardless of gender, approved through City of Phoenix QDP affidavit.

2.6.3 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

2.6.4 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.

2.7 Eligible Survivor – means a survivor of a deceased “Eligible Employee” who died in the line of duty or a pension eligible survivor of a deceased “Eligible Retiree” with sufficient pension to cover monthly premium amounts. In both situations the survivor must have been enrolled at the time of death of the Eligible Employee or Eligible Retiree.

2.8 Participants - means Eligible Employees, Eligible Retirees and Eligible Dependents

2.9 Plan Year - means the 12-month period of benefits coverage under a group health plan which begins January 1 and ends on December 31.

2.10 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.

2.11 Services - means the work required of the Contractor by this Agreement and the Scope of Work incorporated therein.

2.12 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.

2A. ACRONYMS

2A.1 ACA – Affordable Care Act

2A.2 ADA – Americans with Disabilities Act of 1990

2A.3 COBRA – Consolidated Omnibus Budget Reconciliation Act

2A.4 FEMA – Federal Emergency Management Agency

2A.5 FMLA – Family Medical Leave Act

2A.6 PEPM – Per Employee per month

2A.7 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 a fully insured Buy-Up Voluntary Vision plan for eligible City Participants and that can provide, but not limited to the following services:

3.1 Provide top-tier customer service(s) to the City and its’ plan Participants.

3.2 Provide consistent, responsive, and professional administrative service supported by verifiable performance guarantee measurements.

3.3 Provide clear, effective and reliable communication(s) and assistance that aids Participants navigation and understanding of benefit offerings, Participant portal, network(s) access, and services.

3.4 Provide secure, multi-factor authentication, Participant self-service portal, web site, and mobile app that includes a search feature for up-to-date contracted providers by geographic area, service specialty and option to print ID card.

3.5 Provide for Monthly premium billing on a self-billed basis.

3.6 Monthly premium payment deadlines to be not less than 60 days after the last day of the month for which payment is due.

3.7 Accept the City’s six-digit employee ID number to enroll and identify plan Participants. Alternative ID numbers will not be accepted.

3.8 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.

3.8.1 Integrate using the City’s EDI file layout.

3.8.2 Post the electronic eligibility file feed within one (1) business day of receipt.

3.8.3 Provide weekly discrepancy report to the City within two business days.

3.8.4 Use Encrypted cloud storage to store all City sensitive data and back up media with implemented access controls.

3.8.5 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.

3.8.6 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.

3.9 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, member ID card, plan document outlining and defining all covered services, limitations, exclusions, schedule of benefits, procedures for receiving services and other plan requirements, and Participant portal registration instructions. The welcome packet shall be mailed within 10 business days of receiving the City’s eligibility file.

3.10 Flexibility over plan design, i.e., plan limits, exclusions, benefit coverage, network, etc., from year to year to enable the City to introduce new products, new buy-up plan, and/or enhanced features, as deemed necessary or appropriate by the City.

3.11 An experienced Implementation Coordinator to coordinate vendor resources toward a timely and successful January 1, 2028, implementation. The vendor implementation team must include an IT specialist able to answer file specification questions and identify options for success.

3.12 An Executive Sponsor who communicates regularly with Benefits Office management to assure that service expectations are met.

3.13 An Account Manager to handle day-to-day issues and questions from Benefits Staff.

3.14 Exceptional customer service to include access to customer service representatives by phone Monday through Friday from 7 a.m. to 6 p.m.

Arizona time.

3.15 A large, stable and high-quality network of vision care providers to serve Participants primarily in Maricopa County, but also throughout the State of Arizona and nationally.

3.16 Improve, or at minimum, maintain the size of the network for the duration of the contract.

3.17 Ensure network providers deliver Participants with access to high-quality vision care.

3.18 Improve patient care and the patient experience through best-in-class vision network management.

3.19 Keep the City’s designated Benefit Management liaison(s) up to date on new or upcoming staff information on the latest innovations in vision and care technology and plan design management.

3.20 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).

3.21 Meet with City’s Benefit Management liaison(s) on a monthly basis or as needed to review and evaluate vision plan administration.

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 for Active and Retiree multi-tiered plan options that include both in-network and out-of-network benefits.

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 plan document booklet 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). The redline draft or the first year of Contract is due no later than October 1, 2027, 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 and third-party assignees in relation to this Contract.

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 Contract.

4.8 Contractor shall have its customer call center, Participant portal, mobile app and website fully operational and in a state of readiness by/before the Open Enrollment Period for Eligible Employees by October 2027. 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 Vision clients similar in 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 Website, participant portal, mobile app access to account information benefits, and provider directory 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.

The toll-free line will include alternative language options (or access to language translation services).

4A.3 The Contractor shall at no cost to the City, ensure that City Participants who are deaf, hard of hearing, or have speech disabilities have equitable access to all telephone-based services through appropriate communication accommodations and accessible telecommunication technologies.

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 Plan Document Plan and against the Participant’s account. Procedures must include an appeals procedure for Participant’s whose claims have been denied.

4B.3 Contractor shall provide the City with a minimum of twelve (12) months advanced written notice of any planned claim system conversion, platform migration, major software upgrade, or other material change that may affect or claims administration, eligibility processing, customer service, reporting, provider payments, or data exchange functions. The notice shall include but not limited to complete details to include reason for the change, description of conversion/enhancement, expected outcome/benefits, detailed implementation timeline, scope of impact, communication plan, and member disruption, 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.7 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.8 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 through Contract term along with the performance measurement 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 fully funded vision plan.

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 of less than 5% 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 supplied electronically by the City that shows 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.

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 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 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 Disabled dependent eligibility beyond age 26 - Contractor shall verify qualifying permanent disabilities for a dependent or dependent child in accordance with Social Security Administration guidelines. The Contractor shall verify disability status based upon SSA guidelines and at the frequency stipulated by the City during implementation and through the full term(s) of this Contract.

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.1.1 Initial and Ongoing Implementation Allowance.

4D.1.2 Implementation Audit Allowance.

4D.1.3 Compliance Review Allowance.

4D.1.4 Training/Client Summit/ Allowance.

4D.1.5 Communication Allowance.

4E. TECHNOLOGY

4E.1 Employer support

4E.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.

4E.1.2 The Contractor shall image and retain Vision documentation in an electronic transferable and standard readable format to the City or other Contractors should the City change vendors.

4E.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.

4E.1.4 The Contractor shall accept the City of Phoenix defined data elements when building t he vendor account structure;

4E.2 Participant support

4E.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 Vision activity and financial information. The secure Participant portal capability shall allow the Participant to perform standard functions such as accessing Explanation of Benefits (EOB), verify coverage and cost, request or print a new ID card, submit a change of address, review of covered Participants and read/review plan provisions, conduct a network provider search, and review claims information. This site shall be subject to requirements as stated in Section 10 (Additional Data and Security) of Exhibit A, Scope of Work.

4E.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 look up network providers, verify coverage and cost, and access a digital ID card.

4E.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.

4E.3 Provider support

4E.3.1 Contractor shall enable qualified providers, through a reasonably thorough, functional, and secure website, to perform standard operating procedures including without limitation administrative communication, review of eligibility, review and download of patient vision history, as well as claim submission. The site shall be subject to requirements as stated in Section 10 (Additional Data and

Security)

4E.3.2 Contractor shall provide an up to date and complete list of network providers in a link or format that can be posted to the City’s Benefit website.

4F. NETWORK AND PROVIDER MANAGEMENT

4F.1 The Contractor shall require contracted vision providers meet quality of care guidelines by following national evidence-based vision standards and practices.

4F.2 The Contractor shall maintain an adequate number of credentialed providers in locations where plan Participants reside.

4F.3 The Contractor shall make available access to providers nationwide through their own network, leased networks, letters or agreement or other means.

4F.4 Contractor shall conduct an annual provider satisfaction survey at its own expense during the plan year. Such survey shall be for the purpose of assessing provider satisfaction with the Contractor. The provider survey tool and questionnaire shall be pre-approved by the City and meet the City’s requirements.

4F.5 Contractor shall update the online provider directory every seventy-two (72) hours or three (3) calendar days for any changes reported from the provider.

4F.6 Contractor agrees to maintain an adequate provider network to provide Participants with access to quality patient care through participating vision care professionals. If a location experiences a significant reduction in providers to the extent it may no longer be able to perform the requirements of this Contract and meet the performance guarantees, the Contractor shall notify the City in writing at least ninety (90) calendar days in advance and:

4F.6.1 The City shall determine from the facts and circumstances what would constitute a significant change. At the City’s option, Participants in the Vision Plan may be offered an opportunity to dis-enroll.

4F.7 Contractor shall include in its provider contracts guidelines for appointment wait times and emergency appointment availability, where appropriate.

4F.8 Contractor shall adopt and disseminate practice guidelines that consider the needs of enrolled Participants and are:

4F.8.1 Based on reasonable vision evidence or a consensus of vision care professionals.

4F.8.2 Developed and/or adopted in consultation with contracting vision care professionals.

4F.8.3 Reviewed and updated periodically within time frames determined appropriate by the Contractor and approved by the City.

4F.8.4 Applied consistently to all Participants covered under the Vision Plan.

4F.9 Contractor shall provide monitoring and evaluation of all types of provider performance.

4F.10 Contractor shall provide a network that includes a provider profiling program.

4F.11 Contractor shall provide a National Provider Identifier and provider tax identification numbers as requested by the City and as allowed under federal and the City privacy rules.

4F.12 Contractor shall offer to the network of providers both toll-free telephone support and field service support. The Contractor shall resolve provider issues that relate to the Participants in a timely fashion.

4F.13 Contractor shall assist Participants in disputes between provider contract and claims administration.

4F.14 All provider fee schedules shall be prospective on the effective date.

4F.15 Contractor shall provide notice to the City of any network provider (any individual entity, person, or other provider of vision services) change or potential change affecting at a minimum five percent (5%) or one hundred

(100) enrolled Participants (whichever is less) in Arizona or other coverage areas within five (5) business days of initial notice by the provider.

4F.16 Contractor shall link processes for all providers outside of Arizona with Arizona infrastructure for common delivery of Plan requirements for those Participants living outside of Arizona and/or receiving care outside of Arizona as directed by the Plan provisions.

4F.17 Contractor shall have written quality standards for provider credentialing that follows NCQA, URAC, or other federally or industry qualified standards (includes access, wait times, etc.) as applicable.

4F.18 Contractor shall have a vision performance profiling program.

4F.19 Contractor shall monitor and evaluate optometrist/ophthalmologist performance for:

4F.19.1 Cost

4F.19.2 Clinical outcome

4F.19.3 Functional outcome

4F.19.4 Patient satisfaction

4F.20 Contractor shall take responsibility for all subcontracted credentialing

(i.e., by optometry groups, etc.)

4F.21 Contractor shall provide a Participant website to review provider information including but not limited to review of contracting status, licensing, specialty designation, education and background, acceptance of new patients, address, phone number, fax number, and the ability to obtain general plan information as necessary and as may be directed by the City. The Contractor shall provide appropriate levels of access to the City, as allowed under the City and federal privacy regulations.

5. PERFORMANCE GUARANTEES

5.1 The Contractor shall offer competitive implementation performance guarantees as well as aggregate performance guarantees consistent with

‘Exhibit B and Attachment 3 – Financial Worksheet, Tab 11 PG’.

5.2 The Contractor shall place annual fees at risk for failing to maintain the performance guarantees in accordance with ‘Exhibit B and Attachment 3 – Financial Worksheet, Tab 11 PG’. 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 2027, 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, a network contracting 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 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 Co-payment/allowance application

6.5.2 Plan Accumulators

6.5.3 Benefit limitations

6.5.4 Benefit exclusions

6.5.5 Out of Network claim identification and processing

6.5.6 Eligibility file maintenance including disabled dependent verification

6.5.7 Appeal processes, administrative and clinical

6.5.8 Reporting

6.5.9 Billing process

6.5.10 Other items as identified during the implementation process

6.5.11 Website

6.5.12 Call Center

6.5.13 Banking and billing

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.

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 Vision plan Participants.

7.6.1 Plan document booklet

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 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: plan document booklets that include:

7.8.2 Access to claim history

7.8.3 Provider search tool

7.8.4 Vision wellness tools

7.8.5 Summary of benefits

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 Vision plan, 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 Vision/Provider Network Leader – shall be responsible for collaborating with the City on issues related to the network, Vision Plan management, provider relations, and provider contract.

8.2.5 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.

8.2.6 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.

8.2.7 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 Vision plan 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.

8.2.8 Data Analytics Manager – shall be responsible for providing analysis, assessment, and recommendations to the City based on the City’s vision trend and utilization to improve the Vision Plan performance.

The Data Analytics Manager shall participate in the City data analytics manager meetings and shall provide recommendations to support quality improvement programs, wellness initiatives, 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 develop and provide the designated Benefit Management liaison(s) with an updated weekly electronic tracking and resolution log of all open and closed the City issues in the required format.

The Contractor will provide the log via email, prior to each weekly or agreed to meeting cadence.

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. The documentation should include how issues are resolved timely and communication at onset of identified issue, during resolution period and when resolved.

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, provider network leader, 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 vision 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 and provider 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 Vision Plan Participants, the legislature, and/or the media if requested.

8.12 The Contractor shall ensure that staff is appropriately trained on the City Vision Plan 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.

8.16 The Contractor agrees that designated account representatives shall be available to answer questions from the City’s designated Benefits Staff, designated City Consultants, , as approved by the City’s designated Benefit Management liaison.

8.17 Contractor agrees to provide the City with comprehensive open enrollment readiness support each contract year. Such support shall include, at a minimum:

8.17.1 Training designated customer service and support staff on all new plan year changes and benefit modifications;

8.17.2 Implementing approved plan design changes within all applicable systems;

8.17.3 Accurately configuring claims adjudication systems to reflect plan provisions and benefit changes;

8.17.4 Accurately configuring and maintaining the open enrollment website, including rates, plan design information, network information, and participant facing communication content;

8.17.5 Developing and distributing accurate participant communication(s).

All participant communication must be…