Form_2_Worksheet.docx

FORM 2, RFP # Y23-183-KK

Proposal Services and Benefits Worksheet

Orange County Government GROUP TERM LIFE, ACCIDENTAL DEATH, LONG AND SHORT TERM DISABILITY AND DISMEMBERMENT Effective January 1, 2024

I. General Information

Proposer / Contractor Name:

Address:

Contractor Contact:

Telephone:

Contact email:

Fax:

Account Manager

Indicate the number of clients and total EE population that the Account Manager currently services.

Does your company have any pending legal actions, disciplinary actions, restrictions or pending reviews by any client, former client, Federal, or State authorities that will impact your company’s ability to provide the services proposed herein? If yes, please explain.

II. Scope of Services – General

1. Provide separate billing formats for each agency.

2. Provide a secure on-line administration portal, to each participating agency, with limited access to information relating only to that agency.

3. Provide administration for varying payroll schedules.

4. Match and administer the County’s current class descriptions, eligibility and waiting period definitions.

5. Provide integrated Life waiver of premium and Long Term Disability claims.

6. Match the employers share of FICA taxes, at your company’s expense, and prepare W-2’s.

7. Provide claim forms in web-based, paper, and PDF formats.

8. Provide customer services and staffing through an experienced and dedicated team.

9. Provide a dedicated Account Manager with the authority, capability and availability.

10. Provide full time onsite employee to be an advocate to employees accessing the Life and Disability claims process.

11. Assist the County in developing enrollment, general marketing and informational materials.

12. Incur all cost of producing, printing and mailing / distributing marketing and administrative supplies, including Certificates of Coverage.

13. Provide representatives at annual enrollment benefit fairs and enrollment meetings.

14. Provide medical underwriting services with decisions on evidence of insurability made prior to effective date of initial payroll deductions.

15. Provide reports as outlined on the RFP. Provide sample reports under Tab 2.

16. Provide performance standards and guarantees.

17. Provide a plan implementation team.

18. Provide premium billing and collection from disabled members up to the waiver of premium acceptance.

19. Confirm your company will allow all employees and their dependents to enroll in Supplement Life / AD&D and Short Term disability coverage up to the guarantee issue maximus with out EOI requirements regardless of any prior denials for plan year 2024.

III. Administrative Questions

1. Indicate location of local service and administration office, and hours of operation.

2. Indicate location of claims office, including hours of operation and toll free phone number.

3. Provide your company’s claim office administrative performance standards utilized in 2021 for the following:

a. Average speed of answer

b. Call abandonment rate

c. Claim turnaround time a.

6. Indicate your company’s current AM Best financial strength rating and Financial Size Category

7. Has your AM Best rating changed within the last three (3) years? If so, provide the previous rating and outline reasons for the change.

8. Indicate your company’s current Standard & Poor’s Insurer financial strength rating.

9. Has your S&P rating changed within the last three (3) years? If so, provide the previous rating and outline reasons for the change.

10. Indicate your company’s current Moody’s insurance financial strength rating.

11. Has your Moody’s changed within the last three (3) years? If so, provide the previous rating and outline reasons for the change.

12. How long has your company been administering Life and Disability insurance in Florida?

13. Will Orange County have on-line access to view claim status, eligibility status, and run reports?

14. Do you subcontract any life or disability management services to other vendors? If so, specify the roles and responsibilities of all parties included in your proposal.

15. In addition to Family Medical Leave (FML), the County may allow paid leave of absence of up to 4-6 weeks for personal reasons. Also Head Start employees can continue benefits during summer breaks by paying their portion of premium. Indicate whether your leave of absence language will include coverage for these circumstances.

16. Does your company offer Family Medical Leave Administrative Services? If so, please include the cost of the service.

IV. References

Please provide the following information regarding the public sector clients your currently serve:

A. Provide a list of your top five (5) clients references for which you currently provide insurance products similar to those requested by the County (Florida public sector over 5,000 employees preferred):

Name of Organization/ Number of Employees

You Provide Contact Person /Title

B. Provide the names of two (2) clients, if any, who have terminated your services in the last three years and the reason why services were terminated (Florida public sector over 5,000 employees preferred):

Name of Organization/Number of Employees

V. Group Term Life / AD&D Questions

1. Briefly describe the process and timeline for reviewing and approving waivers of premium.

2. Will the elimination periods for the Life and LTD waivers of premium be the same?

3. Will the ported rates be the same as the proposed rates? If not, how are they calculated?

4. Indicate how your ported charges will impact the active employee plan experience.

5. If an employee is called to active duty, will you allow spouse and child life to be continued?

6. What are the life insurance options for payment to a beneficiary? Payment options must guarantee that funds are held in trust separate from the Contractor’s operational assets and not subject to Contractor creditors.

7. List the exclusions and limitations to your Life Insurance plan that differ from the current plan.

8. List the exclusions and limitations to your AD&D plan that differ from the current plan.

9. What is your turnaround time in making a final determination on Evidence of Insurability applications and what do employees being denied coverage receive?

10. Describe your appeal process for denial of benefits.

11. Is your program a participating or non-participating contract?

12. Provide the rate calculation formula that will be utilized in determining renewal rates beyond the guarantee period and indicate your tolerable loss ratio to be used in future renewal calculations.

13. Indicate the percentage of the original life face amount that will be charged to experience for waiver claims.

14. Indicate your conversion charges to the plan’s experience.

15. Indicate your formula for calculating Incurred but not Reported (IBNR).

16. Describe how active claim reserves are set, including interest assumptions and expense assumptions.

17. What are the advantages of your Life / AD&D plan compared to other carriers?

18. Describe your underwriting process and your process for appeal.

19. Confirm your ability to accept electronic beneficiary information and electronic signature?

20. The County is considering adding a $10,000 life insurance policy for benefit eligible employees retiring 1/1/2023 or later. The coverage will be employee paid and available for a term of 10 years after the date of retirement and guarantee issue . Please provide the following:

a) Estimated flat rate

b) Plan provisions that would apply to this coverage.

VI. Group Term Life / AD&D Benefits & Provisions

Group Term Life Benefits

Basic Life Insurance

Accelerated Death Benefit

a. Benefit

b. Define Qualifying Event

a. 75% to $500,000

b. 12 months

Waiver of Premium

a. Qualifying age

b. Elimination period

c. Age waiver terminates

a. Qualifying age 60

b. 180 Day Elimination Period

c. Terminates at age 65

Additional Life Insurance

Annual Enrollment Offer to Increase Coverage $10,000 if not previously declined.

Spouse Insurance

Option 2: Increments of $10,000

Annual Enrollment Offer to

$10,000 if not previously declined.

Dependent Child(ren) Life Insurance

Option 2: $5,000 or $10,000 (Not to exceed Employee combined Basic + Additional Life)

Group Term Life Benefit Provisions

Waiver of Premium

Accelerated Death Benefit

Suicide Exclusion

Conversion

Portability

Survivor Financial Counseling

World Wide Travel Assistance

Repatriation Benefits

Other

Group AD&D Benefits

Basic AD&D

Additional Employee AD&D

Spouse AD&D

Group AD&D Benefit Provisions

Suicide Exclusion

Conversion

Portability

Seat Belt Benefits

Air Bag Benefits

Child Care Benefits

Higher Education Benefits

Spouse Career Adjustment Benefits

Common Carrier Benefits

Paraplegic Benefits

Quadriplegic Benefits

Exposure and Disappearance Benefits

Repatriation Benefits

Other

VII. Disability Questions

1. Are the following methods of claims reporting available to covered employees: electronic claim, paper claim, facsimile, telephonic, and online reporting?

2. What information do you require from the claimant to approve a disability claim?

3. What information do you require from the County to process a disability claim?

4. How does your company obtain a release of medical information from claimants and how do you follow up getting the medical information?

5. What additional information do you require to approve a long term disability claim for a participant who was approved and exhausted the short term disability benefit?

6. Indicate your benefit check payment run cycle (i.e., when benefit checks are run and mailed.)

7. Describe your case management process and provide outcome data, including ROI.

8. Provide your Social Security approval percentage when assisting participants who apply.

9. How do you handle reimbursement of overpayments following Social Security approval?

10. What procedures do you use to detect fraudulent claims?

11. What is your average turnaround time for making a disability claim determination?

12. Indicate how disability claim denials are communicated to the employee.

13. Indicate how disability claim denials are communicated to the County.

14. Describe the actions your company takes to focus the disabled employee on eventually returning to work.

15. Describe your process for identifying and managing rehabilitation cases.

16. Is participation in your rehabilitation program mandatory or voluntary?

17. Do you have an in-house rehabilitation staff dedicated solely to disability claimants?

18. Describe your appeal process for denial of benefits.

19. Are your company’s clinical and length of absence protocols available on-line?

20. Describe your underwriting process and your process for appeal.

21. Describe your process for settling LTD claims.

22. Does your proposal include zero days residual?

23. Indicate your residual/partial benefit calculation formula and if your plan offers a return to work incentive provision, please describe and provide the benefit calculation formula.

24. Please describe programs, if any, you have in place to assistant an employee in returning to work.

25. Please describe programs, if any, you have in place to prevent an employee from going out on a leave.

26. Indicate the duration of benefits, i.e., ADEA, Social Security Normal Retirement Age (SSNRA), other.

27. What is the minimum guaranteed benefit and under what circumstances would an employee who is eligible for benefits, receive no check?

28. Indicate how trial work days are calculated.

29. Does your program include self-reported contract language? If so, please define.

30. List all exclusions and limitations to your STD plan that are deviations from the current plan.

31. List all exclusions and limitations to your LTD plan that are deviations from the current plan.

32. What additional provisions will your company include in your proposal to assist the County in managing disability claims?

33. Is your proposed program a participating or non-participating contract?

34. Provide the rate calculation formula that will be utilized in determining renewal rates beyond the guarantee period and indicate your tolerable loss ratio to be used in future renewal calculations.

35. Indicate how your disability reserves are established.

36. Describe how open claim reserves are set, including interest assumptions, recovery/death assumption, and expense assumptions.

37. What are the advantages of your disability plan compared to other carriers?

VIII. Long Term Disability Benefits & Provisions

Other Provisions

IX. Short Term Disability Benefits & Provisions

Plan 2: 90 days / 90 days Plan 3: 60 days / 60 days Plan 4: 30 days / 30 days Plan 5: 15 days / 15 days

Plan 2: 13 weeks Plan 3: 18 weeks Plan 4: 22 weeks Plan 5: 24 weeks

Partial Benefit (Zero Day Residual) Included 80% of pre-disability earnings

Annual Enrollment Offer to

One step down in is allowed in a decrease in your benefit waiting period and increase in maximum benefit period, if not previously declined.

I authorize that the responses herein are accurate.

Name of Firm (Proposer)

Signature

Printed Name/Title

Date