Inquiries and Answers for RFP AABA 2027-0021.pdf

DPA Solicitation #:

RFP AABA 2027*0021

Dental Benefit Program

INQUIRIES AND ANSWERS

Question 1: Can the State provide the evaluation weighting or point allocation assigned to each evaluation criterion? If weighting is not being disclosed, are all evaluation criteria considered equally important?

Answer 1: Yes, all evaluation criteria are considered important. at this time we are not disclosing the weighting of the criteria.

Question 2: The Technical Component within the Offer Questionnaire indicates that out-of-network claims are reimbursed at the 80th percentile of UCR; however, the corresponding "Out-of-Network Percentile of UCR" field in the Cost Exhibit is blank. Furthermore, the plan summaries located online state that payment is based on the PPO allowable fee at PPO dentists, the Premier Maximum Plan Allowance at Premier dentists, and the PPO allowable fee at non-participating dentists. Please confirm the current out-of-network reimbursement methodology and advise whether the Cost Exhibit will be updated.

Answer 2:

Offerors should submit pricing that offers the best value to the State.

The financial exhibits are designed to allow each Offeror to propose their solution for OON claims. The State anticipates that not every Offeror will have the same network or the same split of In vs Out of Network claims. Offerors are asked to provide their approach to OON claims repricing as well as an explanation of how such an arrangement provides the best value to the

State and its members.

Under the State's current dental plans, out-of-network benefits are reimbursed based on Delta

Dental's PPO allowable fee schedule rather than a percentile-of-charges methodology. Payment is based on the PPO allowable fee or the provider's submitted charge, whichever is less. PPO allowable fees are developed using market-based reimbursement considerations and network access objectives designed to support a strong provider network.

Question 3: If the out-of-network reimbursement is based on a percentile of Reasonable and

Customary, please provide additional detail regarding the methodology used to determine out-of-network reimbursement, including the source used to establish UCR, the geographic basis utilized, and whether reimbursement is based on submitted provider charges or allowed amounts.

Answer 3:

Question 4: Please provide utilization and claims paid distribution separately for each plan option:

• Delta PPO providers

• Delta Premier providers

• Out-of-network providers

Answer 4:

Based on amount paid:

● 57% Delta PPO providers

● 39% Delta Premier providers

● 4% Out-of-network providers

Based on claims volume:

● 63% Delta PPO providers

● 33% Delta Premier providers

● 4% Out-of-network providers

Question 5: Beyond pricing, what factors are most important to the State when evaluating competing dental administrators?

Answer 5: All of the Evaluation Criteria listed in the Administrative Information for RFP

AABA 2027-0021 - Accessibility Requirements, General Professional Services, Technical

Component, Cost Component, Management Capability, Customer Service

Question 6: Please explain the reason(s) that this RFP is out to the market.

Answer 6: The State is required to publicly solicit work on an every five year basis.

Question 7: Can you please provide a copy of the current dental certificate for our review?

Answer 7: The plan documents are available at https://dhr.colorado.gov/state-employees/state-employee-benefits/plan-documents-legal-notices-cobra

Question 8: How long has the coverage been with the current carrier? What was the original effective date of the plan?

Answer 8: The State has offered Delta Dental for over 10 years.

Question 9: Is there a specific amount of credits (implementations and/or ongoing) that is desired?

Answer 9: Offerors may offer credits as a part of their response. Each offeror should propose credits that align with their most competitive offer.

Question 10: Is the incumbent’s Out-of-Network R&C level based on submitted or allowed charges? Submitted and allowed charges are defined as:

• Submitted (billed) charges are based on the actual, non-discounted charges as billed by providers

• Allowed (covered) charges reflect the negotiated or “in-network” allowed amounts.

Answer 10: Out of network claims are processed with an allowed amount.

https://dhr.colorado.gov/state-employees/state-employee-benefits/plan-documents-legal-notices-cobra https://dhr.colorado.gov/state-employees/state-employee-benefits/plan-documents-legal-notices-cobra

Question 11: Please provide the last 36 months of paid premium and paid claim experience on a monthly basis with the following items split by plan (and by population if applicable):

• Premium (or premium equivalents if ASO arrangement)

• Paid claim dollars split by In-Network and Out-of-Network

• Claim counts or EOBs

• Employee Lives (eligible and enrolled)

• Dependent Lives

Answer 11: Offerors who have completed the NDA will be provided data files that include the necessary data elements to assess the state’s population and utilization. This information is available by emailing phil.rollins@state.co.us and completing an NDA.

Question 12: Confirm the percentage of claims paid In-Network (if customer is unable to split actual paid claim amounts by In-Network and Out-of-Network).

Answer 12:

Based on amount paid:

● 57% Delta PPO providers

● 39% Delta Premier providers

● 4% Out-of-network providers

Based on claims volume:

● 63% Delta PPO providers

● 33% Delta Premier providers

● 4% Out-of-network providers

Question 13: Please provide a Network Savings report or similar that shows, split into in-network/out-of-network, over a recent 12-month time period: Submitted Charges, Allowed amounts after dentist discounts/R&C rollbacks are applied, and ultimately, paid claims.

Answer 13: Offerors who have completed the NDA will be provided data files that include the

Question 14: Please provide a census file that includes the run date as well as the following key information:

• Gender

• Zip code

• State of Residence

• Plan election (if multiple plans are offered)

• Tier enrollment (such as Employee Only, Employee +1, Family, etc.)

• Active/Retired status

• Date of birth

Answer 14: This information is available by emailing phil.rollins@state.co.us and completing an

NDA.

mailto:phil.rollins@state.co.us

Question 15: What are the current rates (or fees) for each plan?

Answer 15: Current rates are available here: https://dhr.colorado.gov/benefit-premium-rates

Question 16: Is a recent billing invoice available including the lives and current rates?

Answer 16: An invoice is not available, however, see Answer 15 for rates. Offerors who have completed the NDA will be provided data files that include the necessary data elements to assess the state’s population and utilization. This information is available by emailing phil.rollins@state.co.us and completing an NDA.

Question 17: Is the Out-of-Network reimbursement based on Delta’s standard Out-of-Network allowance, a specific R&C percentile, PPO fee schedule, or Premier fee schedule?

Answer 17: The State does not have a specific OON (Out-of-Network) arrangement at this time.

Reimbursement is based on Delta’s standard OON allowance.

Question 18: Are Premier claims paid based on the Premier fee schedule or based on the PPO fee schedule with balance billing?

Answer 18: Claims are paid based on the contract associated with the specific provider and could be PPO, Premier, or OON.

Question 19: Are discounts in the Delta Dental PPO and the Delta Dental Premier networks extended to non-covered services?

Answer 19: No. Delta Dental of Colorado does not apply contracted network discounts to non-covered services. Colorado law prohibits carriers from requiring participating dentists to accept carrier-established fees for services that are not covered under a member's dental plan. As a result, fees for non-covered services are determined between the dentist and the patient in accordance with applicable law. (Colorado Revised Statutes §10-16-121.5)

Question 20: Please provide the paid claim amounts split by PPO, Premier and Out-of-Network or provide the percentage of claims paid under the PPO network and the percentage of claims paid under the Premier network if the claim dollar splits are not available.

Answer 20: Offerors who have completed the NDA will be provided data files that include the

Question 21: Within the Management Capabilities of the Offeror questionnaire it states that year-end financial accounting reports are due within 60 days of the contract anniversary date.

Can you please specify which reports are included within this request?

https://dhr.colorado.gov/benefit-premium-rates

Answer 21: This is your year-end report / annual business review. At a minimum, it should include utilization, trends, spend, plan performance, vendor performance against goals and performance guarantees, recommendations to improve the plan, etc.

Question 22: House Bill 26-1070 requires affirmative provider consent for third-party network leasing arrangements. How will the State evaluate and verify a bidder's ability to maintain its proposed provider network after implementation, particularly if network participation is dependent upon future provider opt-in decisions? Will bidders be required to disclose the percentage of their network that is owned directly versus accessed through leased or third-party network arrangements?

Answer 22: Offerors are asked to present whether their networks are owned or leased, and if leased, what percentage of the network is leased. The State will evaluate an Offeror's network solution as part of the overall scoring of this procurement. The State’s contract requires compliance with all applicable state and federal laws, if a vendor violates the law then the State will work through the remedies available, up to and including termination.

Question 23: To ensure an accurate comparison of provider access, will the State require bidders to disclose their methodology for counting participating dentists, including whether individual providers are counted more than once across multiple practice locations or network arrangements? Additionally, will network adequacy evaluations consider unique participating providers rather than total reported provider counts?

Answer 23: Network adequacy will be measured on true disruption that will be calculated by the

Offeror’s response to the claims repricing request. GeoAccess has been requested based on unique providers as well as by location.

Question 24: Will the State require bidders to identify any assumptions regarding provider fee concessions, network repricing, or future contracting activities that are necessary to achieve proposed savings or maintain network competitiveness during the contract term?

Answer 24: Bidders will need to propose network solutions based on signed network agreements that will be in place at the go-live. Offerors are not to include in-network pricing arrangements for providers who are “anticipated” to be on contract. GeoAccess and Disruption should also be prepared using the same approach. The State understands network expansion also relies on having the membership to leverage such an expansion. Offerors are allowed to propose contractual guarantees around network recruitment, or address how they will fill “holes” in their network solution before 7/1/2027.