Exhibit A - Specifications and Requirements for RFP AABA 2027-0042.pdf

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DPA Solicitation #:

RFP AABA 2027*0042

Short-Term and Long-Term Disability

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 fully insured, experience-rated and non-participating premium rates and administration of its STD and LTD plans effective July 1, 2027.

1.1.2. The State anticipates proposed coverages and associated costs to be substantially similar to the coverages and costs currently in place. With that said, if an Offeror’s proposed plan is richer than the State’s current plan, there are opportunities to discuss how in Exhibit B - Offeror

Questionnaire.

1.1.3. The purpose of this solicitation is to select Offeror(s) to provide all necessary and required services, notifications, insurance, fully insured premiums, claims adjudication, claims payment, customer service, underwriting, consulting, and reports for the State of Colorado:

1.1.3.1. STD Plan (cost share information), and

1.1.3.2. LTD Plan (cost share information).

1.1.4. 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

1.2.1.1. Eligible Employees and Dependents

The current 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 approximately 39,500 State employees under the authority of the Department of

Personnel & Administration for employee benefits. Under this authority, benefits are provided for all full-time and permanent part-time (regardless of hours) State Personnel

System employees (commonly referred to as Classified), as well as judicial, legislative, some higher education, and other state employees. Temporary employees and retirees are not eligible. The major group of employees excluded from participation is the faculty and non-classified staff at the colleges/universities.

1.2.1.2. Funding of Disability Plan

1.2.1.3. The State’s contribution towards the cost of the STD and LTD plan is set each year by the

State’s General Assembly. The State currently pays 100% of the fully insured premium cost for the STD benefit and the LTD benefit is 100% employee paid. However, with notice to the Offeror(s), the State reserves the right to at any time change this payment amount and/or method to an employee paid premium cost. Although it currently does not do so, the State reserves the right to add an internal administration fee to the billed life insurance rates to help fund the operation of the Employee Benefits Unit.

1.3. GENERAL PROGRAM INFORMATION

1.3.1 Fully Insured Plans

The State’s disability plans are fully-insured plans.

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1.3.2. STD and LTD Plan Year

The State’s budget is on a fiscal year basis (July 1 through June 30), and the STD and LTD plans are also on the same fiscal year basis (July 1 through June 30).

1.3.3 Open Enrollment:

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.

1.3.4 Payment of Disability Premium

For purposes of this RFP and subsequent Contract, the Offeror(s) will receive a monthly system-generated self-billed premium report for STD and LTD plan.

The monthly STD and LTD premium that will be due to the Offeror(s) will be paid by the

Department of Personnel & Administration accounting unit.

The eligibility and insurance coverage information that will determine the monthly premium that will be due to the Offeror(s) will be provided by the State’s outside online benefits administration vendor. This online benefits administration system is the State’s official benefit eligibility record keeping system. However, the University of Colorado (CU) does not use the State’s benefit administration system, but they report their enrollment to the

Department of Personnel & Administration for billing and reconciliation purposes.

1.3.5 Payroll Systems

While the State has 14 different payroll systems with two payroll cycles (biweekly and monthly), the State will submit one consolidated self-billed premium report each month.

1.3.6 Implementation

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.

1.3.7 Historical Documents

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.

The current policy certificates is also provided as Exhibit G and H.

1.4 ANTICIPATED CONTRACT TERM

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

30, 2029.

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1.4.4 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.

1.4.5 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.

1.5 TERMINOLOGY

1.5.3 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:

1.5.3.1 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.

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

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

2 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.

3 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 April 1, 2027. The contract term will be for one year with up to four one-year renewals, for a total of five years starting April 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 eight sections:

General Professional Services

A. General company information.

B. Financial stability.

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

C. 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. Provide detailed claims files to the State's data warehouse if directed.

D. 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.

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

F. Capacity to produce specific services as evidenced by successful completion of prior large-scale contracts.

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.

I. If needed, ability to administer the short term program alongside the state family leave program.

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

Short Term Disability Component

A. Understanding and administrative capability to coordinate benefit offsets, entitlement tracking, and claim information with Colorado FAMLI, PERA Disability, and Workers' Compensation.

B. Ability to match or enhance current State Short Term Disability plan designs, including support for fully-insured leave supplementation up to 100% salary replacement and future Advice to Pay (ATP) structures.

C. Timeliness, accuracy, and efficiency of claim processing, eligible wage determination, and ongoing disability verification.

D. Effectiveness of disability duration assessment, clinical case management, return-to-work strategies, and ongoing physician communications.

E. Quality of assistance provided to claimants for initial applications and appeals for coordinated wage replacement benefits (e.g., Social Security, FAMLI, PERA, WC).

F. Ability to develop, design, and deliver compliant Summary Plan Descriptions (SPDs) and meet all Department of Labor claim procedure regulations.

Long Term Disability Component

A. Comprehensive coordination and calculation of offsets for PERA Disability, FAMLI, Workers' Compensation, and Social Security benefits, including procedures for overpayment reconciliation and refund collection.

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B. Capability to administer Voluntary LTD Evidence of Insurability (EOI) workflows, including member electronic portal features and direct automated file interfaces (EDI/API) with the State's benefits administrator (Businessolver).

C. Robustness and historical success of Return-to-Work, Vocational Rehabilitation, and clinical claim review programs (including specialized medical personnel and nurse case managers).

D. Operational rigor in managing definition-of-disability transitions ("Own" to "Any" occupation), ongoing disability validation, claim turn-around times, and fraud prevention protocols.

E. Administrative flexibility regarding initial Open Enrollment EOI waivers, custom premium update schedules (July 1 / January 1), cancellation rules, and regulatory tax reporting (IRC Section

6051(f)).

Cost Component

A. Separate monthly premium fees for the short term and long term disability plans

B. Confirmation of five (5) year rate guarantee for both the short term and long term plans.

C. Confirmation of requested product designs.

D. Confirmation of requested policy provisions.

E. Confirmation of requested performance guarantees (PGs)

Management Capability

A. Long-term viability in the marketplace.

B. Knowledge of regulatory requirements and the state’s FAMLI benefits.

C. Capacity and knowledge to support client inquiries timely

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.

Customer Service

A. Adequate business hours of operation.

B. Adequate online resources for members and claimants.

C. Quality of customer service representatives.

D. Responsiveness in handling phone calls and inquiries.

E. Timely issue resolution.

F. Communication materials

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.