HSA,_FSA,_&_COBRA_Administration_Services.pdf

City of Waxahachie

HSA, FSA, & COBRA Administration Services

RFP-2026-5-2

RESPONSES ARE DUE TO PURCHASING PRIOR TO:

May 29, 2026, 12:00 pm

NO LATE SUBMISSIONS WILL BE ACCEPTED

ELECTRONIC RESPONSES SUBMITTED THROUGH

https://procurement.opengov.com/portal/waxahachie-tx

FOR QUESTIONS CONCERNING THIS SOLICITATION PLEASE CONTACT:

Leila Cole , Purchasing Manager

Phone: (469) 309-4165 Email: lcole@waxahachie.com

Table of Contents

I. Introduction II. Respondent Instructions

III. Project Details IV. Evaluation Criteria V. General Conditions

VI. Vendor Questionnaire & Submissions

Attachments:

A - City of Waxahachie HSA, FSA and COBRA Fee Matrix

1. Introduction

1.1. Summary

The City of Waxahachie, Texas, is seeking proposals from qualified carriers to administer Health

Savings Accounts (HSA), Flexible Spending Accounts (FSA), and COBRA programs for approximately 475 employees.

The City aims to partner with a provider that offers efficient implementation, reliable administration, and strong customer service while minimizing disruption and enhancing the employee experience. Priority will be given to vendors that deliver user-friendly technology, flexible plan options, compliance expertise, and consistent, responsive support.

1.2. Contact Information

Leila Cole, Purchasing Manager

408 S Rogers

Waxahachie, TX 75165

(469) 309-4165 lcole@waxahachie.com

1.3. Timeline

Release Project Date: May 6, 2026

Question Submission Deadline: May 20, 2026, 10:00am

Response Submission Deadline: May 29, 2026, 12:00pm

There will be a public opening of the submittals at 12:05 PM Central Time on May 29th,2026 through an online TEAMS audio meeting. Only the names of the firms that submitted a response will be read out loud and published on the OpenGov portal.

All submittals will be kept confidential during the evaluation process and prior to the contract award.

TEAMS Audio Meeting:

Dial in number: 469-998-7643

Phone Conference ID: 696079157#

1.4. Plan History

Plan History The City of Waxahachie currently provides HSA, FSA, and COBRA administration services through Surency.

Employees regularly scheduled to work 30 or more hours per week are eligible to participate; certain employee classifications are excluded in accordance with the plan document.

For 2025, employee contribution limits are $3,300 for the Health FSA and $5,000 for the Dependent Care FSA. The

Health FSA allows rollovers of up to $660 to the next plan year and provides a 90-day run-out period after termination. HSA contributions follow the 2025 IRS limits ($4,300 for self-only, $8,550 for family, and $1,000 catch-up), and the City offers annual employer contributions of $750 for individual coverage and $1,250 for family coverage.

Surency currently provides administrative services for the Flex and COBRA programs. Proposals should align with or enhance the City’s current plan design and administrative capabilities.

Eligibility: Employees are eligible from their date of hire; regular full-time employees working 30 hours per week.

An RFP census is provided, which includes Actives.

Carrier History:

LINE OF

COVERAGE

CARRIER DATES FUNDING Coverage

HSA Surency 10/1/2022- present -

Surency

Fully Insured Active Employees

FSA Surency 10/1/2019-09/30/2021-

Discovery 10/1/2021- Present-

COBRA Surency 10/1/2019-09/30/2021-

BCBS

10/1/2021- Present-

2. Respondent Instructions

2.1. Important Instructions for Electronic Submittals

The City of Waxahachie requires electronic submittals for this Solicitation. Before the

Respondent can submit their electronic response to this solicitation, they must create a FREE account with OpenGov Procurement by registering online at https://procurement.opengov.com/signup. Once the Respondent has completed their account registration, they must return to this page to view the project details or use the following link https://procurement.opengov.com/portal/waxahachie-tx/projects/259750 . The Respondent should select "Draft Response" and follow the instructions provided to begin submitting their electronic response.

To view all City of Waxahachie project opportunities, use the following link: https://procurement.opengov.com/portal/waxahachie-tx. If you would like to be notified of any future City of Waxahachie project opportunities, select "Subscribe".

Please ensure the following items are included and completed before submitting your proposal:

1. Using the Vendor Submissions Section on OpenGov, answer all of the required questions provided.

2. Please complete the provided conflict of interest questionnaire and upload the completed document.

3. Please provide the company's most recent signed W-9.

4. Please use the final question on the Vendor Submissions Section to submit your proposal and required documents.

2.2. Instructions to Respondents

This Request for Proposal (RFP- Best Value Proposal is Awarded) will be available online through https://procurement.opengov.com/portal/waxahachie-tx from the date issued until the due date and time provided. Any subsequent addendums and/or attachments will be added to the website listed above.

All submittals must be received no later than 12:00 pm Central Time on Friday, May 29, 2026.

Late submissions will not be accepted.

https://procurement.opengov.com/signup https://procurement.opengov.com/portal/waxahachie-tx/projects/259750 https://procurement.opengov.com/portal/waxahachie-tx/projects/259750 https://procurement.opengov.com/portal/waxahachie-tx

Electronic submittals are required through our online electronic bidding system

Solicitation Questions

Questions regarding this solicitation shall be submitted online using the OpenGov electronic bidding system or shall be emailed to the City’s Purchasing Manager at Purchasing@waxahachie.com with the solicitation number in the subject line no later than

10:00 am Central Time, Wednesday, May 20, 2026.

The City’s response to the questions shall be provided to all respondents through an addendum and will be bound with and made a part of the contract documents. No other explanation or interpretation will be considered official or binding. Respondents shall not contact any City staff except those designated in this solicitation or subsequent addendums. Noncompliance with this provision may result in the rejection of the submittal.

A copy of all questions in the addendum format shall be posted online through https://procurement.opengov.com/portal/waxahachie-tx. The City of Waxahachie shall

NOT be held liable for any costs incurred by any respondent for work performed in preparation of and production of the submittal or for any work performed prior to the execution of an awarded contract.

Any submittal may be withdrawn or a revised submittal provided prior to the submittal deadline.

Solicitation Opening

There will be a public opening of the submittals at 12:05 PM Central Time on May 29th,2026 through an online TEAMS audio meeting. Only the names of the firms that submitted a response will be read out loud and published on the OpenGov portal. All submittals will be kept confidential during the evaluation process and prior to the contract award.

TEAMS Audio Meeting:

Dial in number: 469-998-7643

Phone Conference ID: 696079157#

2.3. Contract Award and Contract Terms

Contract Award

All submissions received from qualified, responsible, and responsive respondents will be evaluated fully to ascertain which respondent provided a response most advantageous to the

City. The City reserves the right to enter into an agreement with a single award, split awards, non-award, or use any combination that best serves the interest and at sole discretion of the

City.

https://procurement.opengov.com/portal/waxahachie-tx https://procurement.opengov.com/portal/waxahachie-tx mailto:Purchasing@waxahachie.com

Any contract awarded in pursuant to this solicitation is not assignable. The awarded

Contractor(s) shall not sell, assign, transfer, sub-contract, or convey this contract, in whole or in part, without the prior written consent of the City of Waxahachie.

The City reserves the right to accept and/or reject any and all submitted responses or any part thereof, waive immaterial errors, waive any irregularities or informalities in the submittal received, and award the contract in the best interest of the City.

Respondents shall promptly notify the City of any omissions, ambiguity, inconsistency, or error that they may discover upon examination of this solicitation. The City shall not be responsible or liable for any errors and/or misrepresentation that result from the solicitations which are inadvertently incomplete, ambiguous, inconsistent or obviously erroneous.

Any submitted responses may be withdrawn or a revised submission may be substituted prior to the submittal deadline. The solicitation documents submitted to the City cannot be altered, amended, or withdrawn by the Respondent after the submittal deadline, unless such alteration, amendment or withdrawal notice is approved in writing by the Purchasing Manager.

An opened response may not be changed for the purpose of correcting any error by the

Respondent or Respondent’s agent. Any ambiguity in the submittal as a result of omission, error, lack of clarity or noncompliance by the Respondent with specifications, instructions, and all conditions shall be construed in the favor of the City. If the unit prices and their extensions do not coincide, the City may accept the price most beneficial to the City, and the Respondent will be bound thereby.

Contract Term

The City intends to enter into a contract starting October 1st 2026 with the awarded Contractor for a period of one (1) year with four (4) additional one (1) year term renewal options. The contract will automatically renew unless either party provides a written cancellation notice at least ninety (90) days before the active term end date. The contract pricing must be valid for at least the first full year of the contract.

Any price increases, when renewing the agreement, must be submitted to the City at least one hundred and twenty (120) days prior to a potential renewal. The price increase agreement must be signed by both parties and agreed upon before the price adjustment will be considered for any future invoices as well as the effective date of the increase. If there is a failure between the

City and Contractor to agree to the price adjustment request, this may result in a termination of the Contract.

Contract Termination

If at any time, the successful Contractor fails to fulfill or abide by the terms, conditions, specifications, or performance requirements of this solicitation, or any contract awarded and entered pursuant thereto, the City reserves the right to deduct charges from successful

Contractor’s invoice at the time it is due; or Cancel the contract at the City’s convenience, without penalty, by furnishing written notice of termination to Contractor, and select another

Contractor and award a contract to its Contractor pursuant to the terms thereof.

At the City’s sole discretion, any awarded contract may be canceled or terminated for convenience without penalty at any time by giving the Contractor thirty (30) days written notice. The Contractor may be entitled to payment for services actually performed; to the extent said services are satisfactory.

Availability of Funds

This solicitation is conditioned upon the availability of federal, state, or local funds, which are appropriated or allocated for payment of the requested services. If, during any stage of this contract, funds are not allocated and available for the requested services, the contract will be canceled. The City will notify the Contractor at the earliest possible time if this occurs.

3. Project Details

3.1. Scope of Work

The selected vendor will administer the City’s HSA, FSA, and COBRA programs, ensuring accuracy, compliance, and efficient service delivery.

Responsibilities include HSA custodial services, contribution processing, investment options, debit card management, and reporting. FSA services will include claims processing, expense substantiation, and management of run-out and carryover provisions, along with a clearly defined funding methodology (including fund handling, reimbursement timing, and any prefunding requirements).

COBRA administration will include timely distribution of notices, management of qualifying events, premium billing and collection, remittance processing, and record retention.

The City seeks a vendor that delivers streamlined administration, clear processes, and reliable support.

Vendors are requested to submit a quote for the following lines of coverage for the City of

Waxahachie for an October 1, 2026, effective date:

• Health Savings Accounts (HSA)

• Flexible Spending Accounts (FSA)- Healthcare, Dependent Care

• COBRA Continuation of Coverage

Primary Industry SIC Code: 9111

Employee Population Approximately 475

Project Producer Lance Pendley, McGriff Insurance Services

Corporate Location 408 S. Rogers St.

Waxahachie, TX 75165

3.2. Minimum Standards for Responsible Prospective Participants

A prospective Proposer must affirmatively demonstrate the Proposer’s responsibility. A prospective Proposer must meet the following requirements in order to proceed in the process:

• Demonstrate adequate financial resources, or the ability to obtain such resources by providing the most recent fiscal year financial statement.

• Demonstrate an ability to comply with the required or proposed delivery schedule.

• Demonstrate a satisfactory record of performance by providing at least 5 references where like products and/or services have been supplied by their firm; preferably municipalities of the same size and demographics. Please include name of the firm, address, telephone number and name of representative.

• Be otherwise qualified and eligible to receive an award by providing appropriate company licenses, certifications, key staff assigned to work with the City and other pertinent resources.

Proposers must submit documentation supporting minimum standards as indicated above. Those failing to meet and/or provide documentation as requested will be considered non responsible. The information contained herein is believed to be accurate and up to date but is not intended to be an express or implied warranty.

3.3. Assumptions & Expectations

• The proposal is to be based on the requested plan of benefits.

• There are to be no commissions included in the proposal submission. All rates should be

NET of commissions.

• The City intends to establish an initial one-year contract with up to four (4) additional one-year renewal options, for a total potential term of five (5) years, subject to acceptable renewal rates.

• The City is requesting multi-year rate guarantees where applicable.

o HSA administration fees: requested multi-year rate guarantees o FSA administration (HC, FSA, DCFSA): multi-year rate guarantees o COBRA administration event/PEPM fees: multi-year guarantees and caps

• The City is Tax-Exempt, and all quoted rates should be exclusive of Texas Sales and Use

Tax.

• It is expected that the vendor will provide timely responses to inquiries from plan participants and providers of service regarding eligibility, status of claim, correspondence, payment, and any other information requested by such parties that will limit the City’s involvement in day-to-day inquiries.

3.4. Plan History

The City of Waxahachie currently provides HSA, FSA, and COBRA administration services through Surency. Employees regularly scheduled to work 30 or more hours per week are eligible to participate; certain employee classifications are excluded in accordance with the plan document.

For 2025, employee contribution limits are $3,300 for the Health FSA and $5,000 for the

Dependent Care FSA. The Health FSA allows rollovers of up to $660 to the next plan year and provides a 90-day run-out period after termination. HSA contributions follow the 2025 IRS limits

($4,300 for self-only, $8,550 for family, and $1,000 catch-up), and the City offers annual employer contributions of $750 for individual coverage and $1,250 for family coverage.

Surency currently provides administrative services for the Flex and COBRA programs. Proposals should align with or enhance the City’s current plan design and administrative capabilities.

Eligibility: Employees are eligible from their date of hire; regular full-time employees working 30 hours per week. An RFP census is provided, which includes Actives.

Carrier History:

LINE OF COVERAGE CARRIER DATES FUNDING Coverage

HSA Surency 10/1/2022- present - Surency

Fully Insured

Active Employees

FSA Surency 10/1/2019-09/30/2021- Discovery

10/1/2021- Present- Surency

COBRA Surency 10/1/2019-09/30/2021- BCBS

10/1/2021- Present- Surency

4. Evaluation Criteria

All submissions received from qualified, responsible, and responsive respondents will be evaluated fully to ascertain which respondent provided a proposal most advantageous to the

City. The respondent’s submittal should provide a straightforward, concise description of the respondent’s capabilities to satisfy the requirements listed in this solicitation.

An evaluation committee (“Committee”) will review the submitted proposals. The Committee will evaluate all submissions and ultimately determine a final list of the most competent and qualified respondents.

During the evaluation process, the Committee and the City reserve the right, where it may serve the City’s best interest, to request additional information or clarifications from the respondents. In fairness to all firms, requests for interviews, visits, or presentations prior to the closing time and date will not be permitted. Interviews with selected firms may or may not be requested at the sole discretion of the City after the closing date. Selection may be made strictly from the information provided in the proposal, however, the City of Waxahachie reserves the right to conduct interviews as well as request presentations from any respondents as part of the final selection process.

The proposals will be evaluated on the following criteria and scored on a 100-point basis:

No. Evaluation Criteria Scoring Method Weight (Points)

1. Cost, Pricing, and Multi-Year Guarantees

- Competitive and transparent pricing

- Multi-year rate guarantees or renewal caps

- Flexibility for enrollment or plan changes

Points Based 35 (35% of Total)

2. Technical Capability (HSA/FSA/COBRA)

- User-friendly platforms for participants and administrators

- Automated COBRA compliance

- Integration with payroll and HRIS

- Mobile access and system reliability

Points Based 25 (25% of Total)

3. Implementation & Account Management

Team

- Clear implementation plan and timeline

- Experienced project and account management

- Training and ongoing support

Points Based 15 (15% of Total)

4. Data Security & Compliance

- Compliance with HIPAA, IRS, COBRA regulations

- Data encryption and access controls

- Security certifications and breach protocols

Points Based 15 (15% of Total)

5. Reporting & Integrations

- Customizable, timely reporting

- Integration with City systems

- Real-time data access

Points Based 5 (5% of Total)

6. References

- Experience with similar clients

Points Based 5 (5% of Total)

5. General Conditions

5.1. Standard Terms and Conditions

The obligations of the parties under a contract awarded through this solicitation will be performed in Ellis County, Texas. Exclusive venue shall be Ellis County, Texas, and any contract awarded under this solicitation shall be governed by the laws of the State of Texas. All work must be in compliance with and conform to any and all applicable state or local laws, ordinances, regulations, codes, rules, policies, and interpretations thereof.

All submittals shall be subject to the Texas Public Information Act Texas Government Code

552 unless the respondent clearly and prominently identifies a particular section in the submittal as proprietary and said item unequivocally qualifies for this exception under the Act as determined by the Texas Attorney General.

Texas Government Code Chapter 176 mandates the public disclosure of certain information concerning persons doing business or seeking to do business with the City of Waxahachie, including affiliations and business and financial relationships such persons may have with City of Waxahachie officers. An explanation of the requirements of Chapter 176, applicable forms, and a complete text of the new law is available at: https://www.ethics.state.tx.us/filinginfo/conflict_forms.htm. By doing business or seeking to do business with the City of Waxahachie, you acknowledge that you have been notified of the requirements of Chapter 176 of the Texas Local Government Code and that you are solely responsible for complying with the information provided.

Once a selection is made and the City has the intent to award, the successful respondent will be required to submit Form 1295 to the State of Texas electronically prior to executing the agreement. https://www.ethics.state.tx.us/filinginfo/1295/ https://statutes.capitol.texas.gov/Docs/GV/htm/GV.552.htm https://statutes.capitol.texas.gov/Docs/GV/htm/GV.552.htm https://statutes.capitol.texas.gov/Docs/LG/htm/LG.176.htm https://www.ethics.state.tx.us/filinginfo/conflict_forms.htm https://www.ethics.state.tx.us/filinginfo/1295/

Lobbying of selection committee members, City staff, or City Council members will not be permitted nor tolerated during the solicitation process.

Prohibition of Boycott Israel: By submission of this solicitation response, the Contractor verifies that they will not Boycott Israel and agrees that during the term of this Contract, they will not

Boycott Israel as that term is defined in Texas Government Code 2271. Effective September 1, 2019, this section does not apply if the Vendor is a sole proprietor, a non-profit entity, or a governmental entity; and only applies if: (i) the Vendor has ten (10) or more full-time employees and (ii) this Contract has a value of $100,000.00 or more to be paid under the terms of this Contract.

Prohibition of Boycott of Energy Companies: By submission of this solicitation response, the

Contractor verifies that is does not Boycott Energy Companies and agrees that during the term of this Agreement will not Boycott Energy Companies as that term is defined in Texas

Government Code 2276, as amended. This section does not apply if the Contractor is a sole proprietor, a non-profit entity, or a governmental entity; and only applies if: (i) Contractor has ten (10) or more full-time employees and (ii) this Agreement has a value of $100,000.00 or more to be paid under the terms of this Agreement.

Prohibition of Discrimination Against Firearm Entities and Firearm Trade Associations: By submission of this solicitation response, the Contractor verifies that it does not have a practice, policy, guidance, or directive that discriminates against a firearm entity or firearm trade association; and (ii) will not discriminate during the term of the contract against a firearm entity or firearm trade association as that term is defined in Texas Government Code 2274. This section only applies if: (i) Contractor has ten (10) or more full-time employees and (ii) this

Agreement has a value of $100,000.00 or more to be paid under the terms of this Agreement;

and does not apply: (i) if the Contractor is a sole proprietor, a non-profit entity, or a governmental entity; (ii) to a contract with a sole-source provider; or (iii) to a contract for which none of the submittals from a company were able to provide the required certification.

The Contractor shall be and remain an independent contractor throughout the term of any contract awarded pursuant to this soliciation for all purposes, including but not limited to, the application of the Fair Labors Standards Act minimum wage and overtime payments, Federal

Insurance Contribution Act, the provisions of the Internal Review Code, and all State of Texas revenue, workers compensation, and unemployment insurance laws. The Contractor will retain sole and absolute discretion over the manner and means of carrying out the activities and all responsibilities listed herein. The Contractor agrees that it is a separate and independent enterprise from the City and that it has full opportunity to find other business, that it has made its own investment in its business, and that it will utilize a high level of skill necessary to perform the work. This agreement shall not be construed as creating any joint employment relationships between the Contractor and City, and the City will not be liable for any obligation incurred by the Contractor.

https://statutes.capitol.texas.gov/Docs/GV/htm/GV.2271.htm https://statutes.capitol.texas.gov/Docs/GV/htm/GV.2276.htm https://statutes.capitol.texas.gov/Docs/GV/htm/GV.2276.htm https://statutes.capitol.texas.gov/Docs/GV/htm/GV.2274.htm

5.2. Contractor Insurance Requirements

Contractors for City of Waxahachie shall provide the City a certificate of insurance evidencing the coverage and coverage provisions identified herein.

The Contractor hereby covenants and agrees to indemnify, hold harmless, and defend the City, its officers, agents, servants, and employees, from and against any and all claims or lawsuits of any kind or character, whether real or asserted, for either property damage or loss (including alleged damage or loss to contractor’s business, and any resulting lost profits) personal injury, including death, to any and all persons, and damages for claims of intellectual property infringement, arising out of or in connection with this agreement, to the extent caused by the acts or omissions of contractor, its officers, agents, subcontractors, servants or employees.

All insurance and certificate(s) of insurance shall contain the following provisions: (1) name the

City, its officers, agents, and employees as additional insureds as to all applicable coverage with the exception of Workers' Compensation Insurance; (2) provide for at least thirty (30) days prior written notice to the City for cancellation, non-renewal, or material change of the insurance; (3) provide for a waiver of subrogation against the City for injuries, including death, property damage, or any other loss to the extent the same is covered by the proceeds of insurance.

All insurance companies providing the required insurance shall be authorized to transact business in Texas and rated at least “A” by AM Best or other equivalent rating service.

The Contractor shall during the term hereof maintain in full force and affect the following insurance: The City reserves the right to amend or require addition all types depending on the nature of the work.

The successful Contractor shall procure and maintain in force during the terms of any contract awarded pursuant to this solicitation, at its own cost, the following minimum insurance coverage:

Type of Insurance Amount of Insurance Provisions

A. Commercial General

(Public) Liability to include coverage for:

A. Premises/Operations

B. Products/Completed

Operations

C. Independent Contractors

D. Personal Liability

E. Contractual Liability

$1,000,000 each occurrence

$2,000,000 general aggregate

$2,000,000 Umbrella/ Excess

Liability

City to be listed as additional insured and provided 30-day notice of cancellation or material change in coverage.

City requires that insurer be rated A or higher by A.M. Best or equivalent.

Waiver of subrogation

2. Business Auto Liability • $1,000,000 per occurrence

• $1,000,000 aggregate or;

• $1,000,000 combined single limits

City to be named as a additional insured

3. Workers’ Comp &

Employers’ Liability

Statutory Limits

$1,000,000 each accident

Waiver of subrogation

Prior to the execution of any awarded contract by the City, the successful Contractor shall forward Certificates of Insurance to the department contact that will be managing the contract.

The required insurance policies shall be procured and maintained in full force and effect for the duration of the awarded contract. The Certificate Holder shall be the City of Waxahachie at 408

S Rogers St., Waxahachie, TX 75165.

6. Vendor Questionnaire & Submissions

6.1. Authorized Respondent’s Information

6.1.1. Authorized Official's Contact Information*

Please provide the contact Information of the authorized official submitting this response.

-Legal Name

-Title

-Email Address

-Phone Number

*Response required

6.1.2. Response Confirmation*

By clicking "Please confirm" below, hereon affixed, the respondent declares they have read this solicitation entirely and with full knowledge of the requirements, does hereby agree to furnish the services in full accordance with the requirements of this solicitation if selected.

Confirming also indicates the following:

• Person or person’s interest in this solicitation as principals are those named herein.

• I (we) have carefully examined the contents of this solicitation, and its requirements, and agree to the terms stated herein.

• The respondent acknowledges the Conflict of Interest Clause and agrees to follow the necessary requirements.

The undersigned represents that they are authorized to bind the Respondent to fully comply with the terms and conditions of this solicitation's requirements.

☐ Please confirm

*Response required

6.1.3. Conflict of Interest Questionnaire*

Please download the document below and upload the completed questionnaire.

• Form_CIQ_(Conflict_of_Inter...

*Response required

6.2. Company Information

6.2.1. Please provide your company's most recent signed W-9*

Please download the below documents, complete, and upload.

• Blank_W-9_2024.pdf

*Response required

6.2.2. Full Legal Company Name*

*Response required

6.2.3. Principal Place of Business Address*

*Response required

6.2.4. Principal Place of Business Phone Number*

*Response required

6.2.5. Company Website URL*

https://procure-now.s3.us-west-2.amazonaws.com/shared-sections/production/1798/07a52eb7-fa3b-431c-bff2-4635ee633b79_Form_CIQ_%28Conflict_of_Interest_Questionnaire%29_-_CIQ.pdf?X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Content-Sha256=UNSIGNED-PAYLOAD&X-Amz-Credential=ASIA47RIURE4KCP6TIL3%2F20260506%2Fus-west-2%2Fs3%2Faws4_request&X-Amz-Date=20260506T130002Z&X-Amz-Expires=72000&X-Amz-Security-Token=IQoJb3JpZ2luX2VjENT%2F%2F%2F%2F%2F%2F%2F%2F%2F%2FwEaCXVzLXdlc3QtMiJHMEUCIHuan3VTGzXRCJ5KmBeryAPffUFctMQUvrKJeQYB%2BOzOAiEAmU6ZTrWZ78WykAs2Ml08Bhtx0xPxo4%2BYvpOp70MYAwIqlQUInf%2F%2F%2F%2F%2F%2F%2F%2F%2F%2FARACGgw4OTIzNjQ2ODc2NzIiDAYslDW2qH9s083nsCrpBFDAYxmeZpkg82JA839rPxFQEysVodU7skD6%2F5FIoeHZhRSFJLdvrLv9yx3PmQ7qDxC%2B3cpmdy7ki4M5lJ%2FVZr30AGS2BZE4RO376CIxYnf4GTKBBN7x01OApbnrQjyo01qDA4mj3A0LnEW9VLdr9gI06LFu5eaeM5ZrsQEjSZXOD%2BgqvMltLgbiWuFJVm7he4x0V1ZBN723UmKA0oAKmduULyHuRiplcGcd0%2BU2OIzH53kN3iUgYPtBCsmMDm7yWd0mpo%2BK43Qr6bCmEcZnurfhht4DaI0uK0gUZsPX5ACzKtZwvhPELlKtlSzdpKN2n7sTHCR%2FpVM9pV%2BKCL9MX%2FKnlZCxNqSW6%2BRAZOMYyZGHndcIUplR2r7C14HnsyUItYDVSIaHqRxwvzb2IMi%2B1wHzATJvOZPJDYP9xELD%2BQFhC4sImENv4gdy1iqQ9u9lclsXLwesmAARdRMK7nUDOrZX5vriPJCJcF85RbW4JgooH2%2B2X62QMx%2Fidq1DosdmLcBqvVZcwtJreUEfQ1QBgWRHop2YbGRtiTApQXsq1w0Aw9jAOU%2B4rvwf7McAiePSNsVepDCTtNaLIxTuOIWJkrxiSnQtBDyvhu9ZV3YPDAGh24sYWMBFDl3WgKiqQtQuhfNczEkyYd6JsuEwj7KA02yR3YdzwtPSk6GmCTivQHzc9c2qYsWujPjdxJsGfWqEfKlNAdFRKURDkidt5Vdal2AiJRNEgxxrnPd817yB1fWCDbvrev2IUwjam%2BtjJwrnRt27%2FQzT9pWmNv9Rhzs41KgmKYyop%2FYpSAhE4MzRyMSbD8Y6Wn4oVmgeMPzT7M8GOpkBVVcQ2OCgHkYTIK7fQI%2BR1JMNMuj818E2tDe16XFLgzRKXADOEQKhTJxXm0E0z6EZDBfwStXW%2BPXxyDwbmqTRv0rT5xmtuF9o79BdwP1QXo%2BcR9cnxQKCMU5f27aF5qut91RY1P6gcUP%2B8fqqXPQk16Tm76ro0R8v4bqBBRM7YYq5iemEHOOsvcqKQfYQntmdH7wTROolN2Fn&X-Amz-Signature=d6e22a4806008fc13b7f173bc55194a50aae4facf90289ab89d04ae38bdc65ae&X-Amz-SignedHeaders=host&response-content-disposition=attachment%3B%20filename%3D%22Form_CIQ_%28Conflict_of_Interest_Questionnaire%29_-_CIQ.pdf%22&x-id=GetObject https://procure-now.s3.us-west-2.amazonaws.com/shared-sections/production/1798/e5cb081b-5538-4635-8db5-e27f194dc508_Blank_W-9_2024.pdf?X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Content-Sha256=UNSIGNED-PAYLOAD&X-Amz-Credential=ASIA47RIURE4KCP6TIL3%2F20260506%2Fus-west-2%2Fs3%2Faws4_request&X-Amz-Date=20260506T130002Z&X-Amz-Expires=72000&X-Amz-Security-Token=IQoJb3JpZ2luX2VjENT%2F%2F%2F%2F%2F%2F%2F%2F%2F%2FwEaCXVzLXdlc3QtMiJHMEUCIHuan3VTGzXRCJ5KmBeryAPffUFctMQUvrKJeQYB%2BOzOAiEAmU6ZTrWZ78WykAs2Ml08Bhtx0xPxo4%2BYvpOp70MYAwIqlQUInf%2F%2F%2F%2F%2F%2F%2F%2F%2F%2FARACGgw4OTIzNjQ2ODc2NzIiDAYslDW2qH9s083nsCrpBFDAYxmeZpkg82JA839rPxFQEysVodU7skD6%2F5FIoeHZhRSFJLdvrLv9yx3PmQ7qDxC%2B3cpmdy7ki4M5lJ%2FVZr30AGS2BZE4RO376CIxYnf4GTKBBN7x01OApbnrQjyo01qDA4mj3A0LnEW9VLdr9gI06LFu5eaeM5ZrsQEjSZXOD%2BgqvMltLgbiWuFJVm7he4x0V1ZBN723UmKA0oAKmduULyHuRiplcGcd0%2BU2OIzH53kN3iUgYPtBCsmMDm7yWd0mpo%2BK43Qr6bCmEcZnurfhht4DaI0uK0gUZsPX5ACzKtZwvhPELlKtlSzdpKN2n7sTHCR%2FpVM9pV%2BKCL9MX%2FKnlZCxNqSW6%2BRAZOMYyZGHndcIUplR2r7C14HnsyUItYDVSIaHqRxwvzb2IMi%2B1wHzATJvOZPJDYP9xELD%2BQFhC4sImENv4gdy1iqQ9u9lclsXLwesmAARdRMK7nUDOrZX5vriPJCJcF85RbW4JgooH2%2B2X62QMx%2Fidq1DosdmLcBqvVZcwtJreUEfQ1QBgWRHop2YbGRtiTApQXsq1w0Aw9jAOU%2B4rvwf7McAiePSNsVepDCTtNaLIxTuOIWJkrxiSnQtBDyvhu9ZV3YPDAGh24sYWMBFDl3WgKiqQtQuhfNczEkyYd6JsuEwj7KA02yR3YdzwtPSk6GmCTivQHzc9c2qYsWujPjdxJsGfWqEfKlNAdFRKURDkidt5Vdal2AiJRNEgxxrnPd817yB1fWCDbvrev2IUwjam%2BtjJwrnRt27%2FQzT9pWmNv9Rhzs41KgmKYyop%2FYpSAhE4MzRyMSbD8Y6Wn4oVmgeMPzT7M8GOpkBVVcQ2OCgHkYTIK7fQI%2BR1JMNMuj818E2tDe16XFLgzRKXADOEQKhTJxXm0E0z6EZDBfwStXW%2BPXxyDwbmqTRv0rT5xmtuF9o79BdwP1QXo%2BcR9cnxQKCMU5f27aF5qut91RY1P6gcUP%2B8fqqXPQk16Tm76ro0R8v4bqBBRM7YYq5iemEHOOsvcqKQfYQntmdH7wTROolN2Fn&X-Amz-Signature=a665e704c57e1a7e2b33e3f39feeac51c8c0c565ce98c80b03a612af7f63b58f&X-Amz-SignedHeaders=host&response-content-disposition=attachment%3B%20filename%3D%22Blank_W-9_2024.pdf%22&x-id=GetObject

6.2.6. Person Authorized to negotiate and sign contracts with the city (if different than the Authorized Contact Provided)*

*Response required

6.2.7. Number of years in business working on similar types of project?* *Response required

6.2.8. State and Date of Incorporation, Partnership, or Ownership Established?* *Response required

6.2.9. Are you a certified Small Business (SBE), Disadvantaged Business Enterprise (DBE), or Historically Under-utilized Business (HUB)?*

☐ Yes

☐ No

*Response required

6.3. Cooperative Purchasing

6.3.1. The City of Waxahachie has established several government entity interlocal agreements. Should any of these Government Entities desire to utilize this contract, would you offer the same terms, conditions,specifications, and pricing to that entity? **

☐ Yes

☐ No

*Response required

6.4. References

Please provide five (5) references who can verify the quality of service your company provides.

The City prefers references from customers/governmental entities with a scope of work similar to the project mentioned in this solicitation in which the respondent has worked in the past three years.

• Company Name Work Was Completed For:

• Company Location:

• Time Period Service was Provided:

• Contact Person and Title:

• Phone:

• Email:

• Description of Contracted Services:

6.4.1. Reference 1*

6.4.2. Reference 2*

*Response required

6.4.3. Reference 3*

*Response required

6.4.4. Reference 4*

*Response required

6.4.5. Reference 5*

*Response required

6.5. Claims and Suits

6.5.1. Has your organization ever failed to complete any work awarded to your company?* ☐ Yes

☐ No

*Response required

6.5.2. Are there any judgments, claims, arbitration proceedings, or suits pending or outstanding against your organization or its officers?*

☐ Yes

☐ No

*Response required

6.5.3. Has your organization filed any lawsuits or requested arbitration regarding awarded contracts within the last five years?*

☐ Yes

☐ No

*Response required

6.5.4. If you have answered "Yes" to any of the claim and suit questions, please provide supplemental information/documents here.*

*Response required

6.6. Deviations From Specifications

6.6.1. Does your organization agree to the Assumptions & Expectations as well as minimum qualifications as outlined in the RFP?* ☐ Yes

☐ No

6.6.2. Would you be willing to agree to a performance‐based contract using these criteria?

If so, please outline your proposed performance guarantees. *

☐ Yes

☐ No

*Response required

6.6.3. Will your organization administer and/or underwrite the benefits as they currently stand in the attached summaries/certificates?*

☐ Yes

☐ No

*Response required

6.7. HSA Administration Questionnaire

General Administration

6.7.1. Identify the HSA custodian(s) or banking partner(s) used.* *Response required

6.7.2. Describe your KYC (Know Your Customer) process and timeline for opening new HSA accounts.*

*Response required

6.7.3. Explain how employer and employee contributions are processed (including timing, payroll files, corrections, and error handling).*

*Response required

6.7.4. Describe your capabilities for employer portal administration (batch funding, reporting, reconciliation, etc.).*

*Response required

6.7.5. Provide a sample employee-facing HSA account statement.* *Response required

6.7.6. Describe the debit card program, including: *

• Debit care setup, including whether accounts are combined into one card (stacked wallets) or if separate cards can be provided for HSA and FSA; please include options for separate cards, if available

• MCC restrictions

• Real time substantiation

• Mobile wallet compatibility (Apple/Google/Samsung Pay)

6.7.7. Explain your process for replacement card issuance and average fulfillment timelines.*

*Response required

6.7.8. Describe your investment lineup (tier structure, brokerage window availability, expense ratios).*

*Response required

6.7.9. What is the minimum balance required before participants can invest?* *Response required

6.7.10. Describe your approach to fund lineup changes and participant communications.* *Response required

6.7.11. Are investment advisors or robo tools available? If yes, describe.* *Response required

6.7.12. Describe the process for incoming HSA rollovers and trustee to trustee transfers.* *Response required

6.7.13. Are there fees for outgoing transfers or rollovers? If yes, provide details.* *Response required

6.7.14. Provide screenshots of the participant portal and mobile app.* *Response required

6.7.15. Describe available educational tools (calculators, emails, webinars, live support).* *Response required

6.7.16. What is your average call center hold time, first call resolution rate, and hours of operation?*

*Response required

6.7.17. Confirm your procedures for issuing IRS Forms 1099 SA and 5498 SA.* *Response required

6.7.18. Describe your reporting package for the employer (frequency, content, delivery method).*

*Response required

6.7.19. Provide an overview of your fraud monitoring and account protection practices.* *Response required

6.7.20. Provide your full HSA fee schedule and indicate which fees are employer paid vs.

participant paid.*

*Response required

6.7.21. Describe any account closure, transfer, or investment related fees.*

6.8. FSA Administration Questionnaire

6.8.1. Describe your claim substantiation process and confirm you support 100% IRS compliant substantiation.* *Response required

6.8.2. What percentage of claims are auto adjudicated?*

*Response required

6.8.3. Describe how receipts and documentation can be submitted (mobile app, upload, email, fax, mail).*

*Response required

6.8.4. Describe your process for denied claims, notification timelines, and appeal procedures.*

*Response required

6.8.5. Describe your debit card capabilities (stacked wallets, auto sub, real time adjudication, outage controls), including whether accounts are combined into one card or if separate cards can be provided for FSA when paired with an HSA.*

*Response required

6.8.6. How do you monitor card misuse and send substantiation reminders?* *Response required

6.8.7. Provide your timing and SLA for card fulfillment.*

*Response required

6.8.8. Describe your administration of: *

• Grace period

• Carryover

• Run-out period

*Response required

6.8.9. Describe blackout period requirements, if any.*

*Response required

6.8.10. Please describe whether FSA elections are front-loaded (impressed), and any requirements, limitations, or funding considerations associated with this approach. *

*Response required

6.8.11. Please outline when FSA funds become available for use, including any timing considerations at the start of the plan year*

*Response required

6.8.12. Provide screenshots of participant tools (account view, transactions, claims filing).*

6.8.13. Describe member communications during:*

• Open enrollment

• New hires

• Mid-year events

*Response required

6.8.14. List languages supported in your call center and mobile app.* *Response required

6.8.15. Describe your support for nondiscrimination testing.* *Response required

6.8.16. How do you notify the employer of potential testing failures?* *Response required

6.8.17. Describe your eligibility file requirements.*

*Response required

6.8.18. Describe payroll integration for FSA deductions.*

*Response required

6.8.19. Provide samples of standard monthly reporting.*

*Response required

6.8.20. Provide your full FSA fee schedule (PEPM, transaction fees, card fees).* *Response required

6.8.21. Describe any additional or optional services and associated costs.* *Response required

6.9. COBRA Administration Questionnaire

6.9.1. Describe your full COBRA administration process from the qualifying event to the termination of COBRA coverage.* *Response required

6.9.2. Are all notices prepared, mailed, and tracked internally or through a partner?* *Response required

6.9.3. Describe how you ensure compliance with timing requirements for: *

• General Notices

• Election Notices

• QE Notices

• Premium payment grace periods

6.9.4. Provide sample versions of all required COBRA notices.* *Response required

6.9.5. How do you verify address accuracy for all mailings?*

*Response required

6.9.6. Do you offer electronic notice delivery? If yes, describe the consent and tracking process.*

*Response required

6.9.7. Describe how premium billing is handled (frequency, methods, late notices).* *Response required

6.9.8. How do participants remit payment (online portal, check, ACH, auto draft)?* *Response required

6.9.9. Explain your procedures for NSF payments, reinstatements, and cancellations.* *Response required

6.9.10. Describe your process for updating insurers with COBRA enrollments/terminations.* *Response required

6.9.11. What carriers or systems do you currently integrate with?* *Response required

6.9.12. Describe file feed formats and timing.*

*Response required

6.9.13. Provide your call center metrics (ASA, abandonment rate, first call resolution).* *Response required

6.9.14. Describe your escalation process for urgent participant issues.* *Response required

6.9.15. Provide standard hours of operation and after hours support details.* *Response required

6.9.16. Describe your record retention and archiving practices.* *Response required

6.9.17. Do you maintain audit trails of all participant interactions?* *Response required

6.9.18. Provide examples of employer reporting for COBRA activity.* *Response required

6.9.19. Provide your COBRA fee structure (PEPM, per event fees, optional services).*

6.9.20. Describe any pass through postage or print costs.*

6.10. Security, Privacy & Compliance Questionnaire

6.10.1. Provide your most recent SOC 2 Type II report and list the systems in scope.* *Response required

6.10.2. Are you HITRUST certified? If not, when is certification planned?* *Response required

6.10.3. Describe your IAM program (RBAC, SSO, MFA, password policy).* *Response required

6.10.4. Describe your privileged access monitoring controls.* *Response required

6.10.5. Confirm encryption at rest and in transit (provide standards: AES 256, TLS 1.2+).* *Response required

6.10.6. Describe your vulnerability management program (patch cadence, scanning schedule).*

*Response required

6.10.7. What is your incident response SLA for notifying the City of Waxahachie?* *Response required

6.10.8. Provide your breach notification process.*

*Response required

6.10.9. Provide your standard Business Associate Agreement (BAA).* *Response required

6.10.10. Describe how you manage downstream/subcontractor BAAs.* *Response required

6.10.11. Describe your data retention and destruction policy.* *Response required

6.10.12. Confirm the cost and process for returning all City data upon contract termination.* *Response required

6.11. Implementation Questionnaire

6.11.1. Describe your implementation methodology and provide a sample project plan. * *Response required

6.11.2. Provide a proposed implementation timeline for a group of approximately 475 eligible employees. *

6.11.3. Identify roles and responsibilities (City vs. vendor). *

6.11.4. Describe required data elements for eligibility files. * *Response required

6.11.5. Describe your testing process for: *

• Eligibility files

• Payroll contributions

• COBRA QE files

*Response required

6.11.6. Describe your blackout period (if applicable). *

*Response required

6.11.7. Provide your escalation matrix and client communication cadence.* *Response required

6.12. Reporting & Analytics Questionnaire

6.12.1. Provide a list of all standard reports available to the City. * *Response required

6.12.2. Describe your ad hoc reporting capabilities. *

*Response required

6.12.3. Provide samples of monthly and quarterly reporting. * *Response required

6.12.4. How long does the report data remain available to the employer? * *Response required

6.12.5. Describe your billing/invoicing reports for HSA, FSA, and COBRA.* *Response required

6.13. Fees & Guarantees Questionnaire

Please Complete the attached Fee Matrix (Attachment C).

6.13.1. Provide:*

• Implementation fees

• PEPM fees

• Per-account fees

• Event-based COBRA fees

• Banking/custodial fees

6.13.2. Identify employer vs. participant paid fees.*

*Response required

6.13.3. Provide proposed rate guarantees for up to 5 years.*

*Response required

6.13.4. Describe any: *

• Implementation credits

• File feed credits

• Communication materials credits

*Response required

6.13.5. Provide any at risk guarantees (performance credits).* *Response required

6.13.6. Please outline any fees related to debit cards, including initial issuance and replacement/reprint fees. *

*Response required

6.13.7. Outline any fees associated with transferring HSA accounts during implementation. * *Response required

6.14. Proposal Submission

Upload your proposal documents.

Required Submission Documents:

• Completed Admin Services Proposal

• Pricing Sheet & Fee Matrix

• Sample COBRA notices

• Sample account management structure

• Sample reporting package

• SOC 2 Type II/HITRUST summary

• BAA Template

6.14.1. Please upload your proposal submission here.*