Exhibit A - Specifications and Requirements for RFP AABA 2027-0021.pdf

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DPA Solicitation #:

RFP AABA 2027*0021

Dental Benefit Program

EXHIBIT A – SPECIFICATIONS AND REQUIREMENTS

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CONTENTS

SECTION 1.0 GENERAL INFORMATION

1.1. INTRODUCTION

1.2. BACKGROUND

1.3. ANTICIPATED CONTRACT TERM

1.4. TERMINOLOGY

SECTION 2.0 OFFEROR’S EXPERIENCE AND PERSONNEL

2.1. ACCESSIBILITY REQUIREMENTS

2.2. MANDATORY MINIMUM QUALIFICATIONS ........ ERROR! BOOKMARK NOT

DEFINED.

2.3. ORGANIZATIONAL EXPERIENCE ....... ERROR! BOOKMARK NOT DEFINED.

2.4. PERSONNEL REQUIREMENTS ............. ERROR! BOOKMARK NOT DEFINED.

SECTION 3.0 PROJECT SPECIFIC STATEMENT OF WORK

3.1. ........................................................................ ERROR! BOOKMARK NOT DEFINED.

SECTION 4.0 COMPENSATION AND INVOICINGERROR! BOOKMARK NOT DEFINED.

4.1. PRICING .................................................... ERROR! BOOKMARK NOT DEFINED.

4.2. DETAILED INVOICING AND PAYMENT PROCEDURESERROR! BOOKMARK

NOT DEFINED.

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SECTION 1.0 GENERAL INFORMATION

1.1. INTRODUCTION

1.1.1. The Division of Personnel & Administration Purchasing Unit on behalf of the Employee

Benefits Unit (EBU), Division of Human Resources, Department of Personnel &

Administration requests proposals to provide self-insured, experience-rated services for its

Dental Insurance plans to employees and their dependents effective July 1, 2027.

1.1.2. The purpose of this solicitation is to select Offeror(s) to provide all necessary and required services, notifications, insurance, self-insured administrative fees (ASO), claims adjudication, claims payment, customer service, underwriting, consulting, and reports for the State of

Colorado:

1.1.2.1. Basic Dental PPO Insurance services (self-insured), and

1.1.2.2. Basic Plus Dental PPO Insurance services (self-insured).

1.1.3. The State is looking for a partner to maintain high-quality and high-value plan options while achieving competitive financial terms without reducing member access and service.

1.2. BACKGROUND

1.2.1 The statutes governing the States’ employee benefits programs are found in Section 24-50-

601 through Section 24-50-617, C.R.S. Both employee and dependent are defined in these statutes (Section 24-50-603 C.R.S.) There are currently approximately 39,500 benefits-eligible employees working for the State.

1.2.1.1. Plan Year: The State’s budget is on a fiscal year basis (July 1 through June 30).

1.2.1.2. Open Enrollment:

1.2.1.2.1. Open enrollment for the State of Colorado employee benefit plans is determined by the

State and is generally mid-April through mid-May of each year. The Employee Benefits

Unit staff and/or other designated representatives from each State agency conduct a series of employee meetings throughout the state.

1.2.1.3. Payment of Administration Fees

1.2.1.3.1. For purposes of this RFP and subsequent Contract, the Offeror(s) will receive a monthly system-generated self-billed enrollment report for benefit in place.

1.2.1.3.2. The monthly administrative fee that will be due to the Offeror(s) will be paid by the

Department’s accounting unit.

1.2.1.3.3. The eligibility and insurance coverage information that will determine the monthly fee that will be due to the Offeror(s) will be provided by the Department’s outside online benefits administration vendor. This online benefits administration system is the

Department’s official benefit eligibility record keeping system. However, the University of Colorado (CU) does not use the Department’s benefit administration system, but they report their enrollment to the Department for billing and reconciliation purposes.

1.2.1.3.4. Although it currently does not do so, the Department reserves the right to add an internal administration fee to the billed fees to help fund the operation of the Employee Benefits

Unit.

1.2.1.4. Verification of Participants and Contribution Amounts

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1.2.1.4.1. For purposes of this RFP, the Offeror(s) will receive a system generated electronic eligibility and elected contribution data file on a monthly basis, which will be provided by the Department’s outside online benefits administration vendor. This online benefits administration system is the Department’s official benefit eligibility record keeping system.

1.2.1.5. Implementation

1.2.1.5.1. To assure a smooth transition, the Awarded Offeror(s) will adhere to an agreed upon implementation schedule including but not limited to system readiness, file layout confirmation and reliability tests, eligibility data file creation, eligibility data file receipt, data uploads, and training of Offeror(s) claims and customer service staff who will be working on the Department’s account.

1.2.1.6. Historical Documents

1.2.1.6.1. In order to obtain census, claims, and disruption data necessary to provide a proposal in response to this RFP, email the Sole Point of Contact listed in the Administrative

Information document to obtain a Non-Disclosure Agreement (NDA). Once the NDA is signed vendors will be provided access to a Google Drive with the information.

1.3. ANTICIPATED CONTRACT TERM

1.3.1. The initial term of the awarded Contract is expected to begin on April 1, 2027 and end on June

30, 2029.

1.3.2. The total duration of the Contract, from the Start Date until termination, and including the

Department’s exercise of any options, is not anticipated to exceed five (5) years. The

Department may extend the Contract beyond the anticipated term in this subsection, in accordance with the Colorado Procurement Code and its implementing rules, in the event that the Department determines the extension is necessary to align the Contract with other

Department contracts, to address State programmatic or policy changes related to the Contract or to provide sufficient time to transition the Work.

1.3.3. The Department may, within its sole discretion, choose to not exercise any option or Extension

Term in the Contract for any reason. If the Department chooses to not exercise for any

Extension Term, it may re-procure the performance of the Work in its sole discretion.

1.4. TERMINOLOGY

1.4.1. In addition to the terms defined in §Error! Reference source not found. of the Contract, acronyms and abbreviations are defined at their first occurrence in this Exhibit A, Statement of Work. The following list of terms shall be construed and interpreted as follows:

1.4.1.1. Deliverable - any tangible or intangible object produced by Contractor as a result of the work that is intended to be delivered to the State, regardless of whether the object is specifically described or called out as a “Deliverable” or not.

1.4.1.2. Key Personnel - The position or positions that are specifically designated as such in this

Contract.

1.4.1.3. Other Personnel - Individuals and Subcontractors, in addition to Key Personnel, assigned to positions to complete tasks associated with the Work.

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SECTION 2.0 OFFEROR’S EXPERIENCE AND PERSONNEL

2.1. ACCESSIBILITY REQUIREMENTS

2.1.1. All work performed as a result of this solicitation must comply with all applicable provisions of §§24-85-101, et seq., C.R.S., and the Accessibility Standards for Individuals with a

Disability, as established by the Office Of Information Technology pursuant to Section §24-

85-103 (2.5), C.R.S. and 3) all State of Colorado technology standards related to technology accessibility and with Level AA of the most current version of the Web Content Accessibility

Guidelines (WCAG), incorporated in the State of Colorado technology standards.

SECTION 3.0 PROJECT SPECIFIC STATEMENT OF WORK

REQUIREMENTS OR SCOPE OF WORK:

The State of Colorado is seeking proposals for a vendor to provide best in class pricing, networks, and member services for basic and Basic Plus Dental Insurance covering employees and their dependents. This contract is expected to commence July 1, 2027. The contract term will be for one year with up to four one-year renewals, for a total of five years starting July 1, 2027 and potentially ending on June 30, 2032, including optional renewal periods.

The Statement of Work and Proposal Requirements (mandatory and preferred services) are divided into the following five sections:

General Professional Services

A. General company information.

B. Financial stability.

C. Ability to comply with local, state, and federal requirements

D. Knowledge of and compliance with regulatory requirements.

E. Overall quality of the proposal, ability to follow instructions, ability to communicate concisely

(this applies to all aspects of the proposal, but is scored in General Professional Services).

F. Ability to integrate with a new Benefits Administration System if necessary.

G. Prior experience with large clients. (Including references.)

H. Prior experience serving government sector.

Technical Component

A. Ability to accurately and timely administer the Dental services as requested.

B. An understanding and ability to solve the potential problems associated with self-funded plans.

C. Ability to perform administrative tasks and claims processing requirements as requested.

D. Provide services and reports with the purpose and specifications necessary to inform the State

(or their chosen consultant) of trends related to cost and services.

E. Quality eligibility system functionality, underwriting system functionality, claim payment system functionality, data tracking information, data transfer capabilities, IT environment, and claim monitoring functions for participants.

F. Ability to interface with the State’s systems at no additional cost.

G. Quality, expertise, and availability of resources to support the services to be provided.

H. Training programs for all staff working on the State’s account including claim processors and customer service representatives.

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I. Claims reporting portals, as well as agreement to provide detailed claims files to the State’s data warehouse if so directed.

J. Sufficient network access to members without significant disruption to the current enrollees including to those in rural areas.

K. Ability to transition from the State's existing vendor with minimal disruption to the membership and minimal administrative burden on the State.

Cost Component

A. Separate monthly administrative services fees for the basic and Basic Plus dental plans.

B. Claims repricing for in-network dental service

C. Confirmation of five (5) year rate guarantee for both the basic and basic plus Dental plans.

D. Confirmation of requested product designs.

E. Confirmation of requested policy provisions.

F. Confirmation of requested performance guarantees (PGs)

Management Capability

A. Responsiveness to client inquiries.

B. Capacity and knowledge to support client inquiries timely.

C. Experience of specific team members assigned to the State’s account and time dedicated to the

State.

D. Ability to preform regular audits and support the State with any additional audit requests

E. Timely banking and claims payment processes

F. Provide claims reporting portals, as well as agreement to provide detailed claims files to the

State’s data warehouse if so directed.

G. Communication

Customer Service

A. Adequate business hours of operation.

B. Quality of customer service representatives.

C. Responsiveness in handling phone calls and inquiries.

D. Timely issue resolution.

E. Adequate member access to resources

Minimum Qualifications included in this Scope of Work and the attached Questionnaire must be confirmed by all Offerors submitting a response. Offerors who do not meet the Minimum

Qualifications will not be considered.

You may provide attachments as requested in the questionnaire and one executive summary. Please be concise. When responding to the questionnaire please do not include marketing materials and unnecessary language. Most answers require fewer than 150 words to respond. The State values brevity.