Medical 122435 O5- Addendum Two- Questions and Answers- Round Two V2.pdf

Addendum Two – Questions and Answers

SOLICITATION ADDENDUM TWO

QUESTIONS AND ANSWERS

SOLICITATION NUMBER: 122435 O5

Administrative Support Services for the State of Nebraska Employee Health Care Medical Benefit Plans

Opening Date: July 17, 2025 Addendum Effective Date: July 9, 2026

Questions and Answers

Following are the questions submitted and answers provided for the above-mentioned solicitation.

The questions and answers are to be considered as part of the solicitation. It is the responsibility of bidders to check the State Purchasing Bureau website for all addenda or amendments.

Question Number

RFP

Section

Reference

RFP

Page Number

Question State Response

1.

NEBRASKA

NETWORK

ACCESS FILE

Entire File

Can the State please provide instructions on how bidders are to utilize the separately called out members in the Pediatric (< age 18) and OBGYN (Females > age 12) columns? These two member groups are included within the overall total membership (which includes waived employees), and GeoAccess reporting is normally run on one set of zip codes, either on total subscribers or total members.

The number of members meeting criteria “OB/GYN (female members, age 12 and older)” will be measured against group of members in “Members (Female, Age >=12)”, and members meeting criteria “Pediatrician (members, birth through age 18)” will be measured against group of members in “Members (Age <= 18)”.

2.

RFP Document

ATTACHMENT C -

QUESTIONNAIRE

Multiple

Items I.1, I.13, and Section J

(Wellness)

There are several references to “wellness” throughout the RFP, Attachment C Questionnaire, and the Cost Sheet. Is the State asking for an actual wellness program proposal, or are these references intended for any resources, health coaching, etc., that are included within the clinical management programs? We have seen separate Wellness RFPs from the State, so just looking for clarification.

Thank you

The State is not looking for a separate wellness proposal. Bidders may include/suggest wellness programs that are part of the medical benefit. “Buy up” wellness programs may be included in the Cost Sheet.

Note: these programs will not be scored.

3.

COST SHEET

HSA Fee Section

The State’s Cost Sheet has requested HSA administrative fees. Our company does not perform in-house HSA administration, but we do utilize a preferred vendor. This differs from the incumbent who appears to offer both medical administration and HSA administration.

All services in the proposal must be part of the contract between the bidder and the State, no separate contracts with preferred vendors will be made.

When employers purchase our vendor’s HSA administration, the contractual agreement is between the vendor and the employer. Our company is not included in the HSA administration contract arrangement between an employer and our preferred vendor.

Can the State please confirm if you would consider quotes from external vendors, and if so, is it acceptable that we do not include a copy of the vendor’s contract since it will not be part of our medical administration agreement with the State?

Outsourcing or utilizing a preferred vendor as a bidder’s subcontractor is acceptable.

The RFP allows for subcontractors on services for the awarded bidder.

The State of Nebraska will not consider quotes from external vendors for HSA services.

These services must be included and if needed, be subcontracted through the awarded bidder.

4.

ATTACHMENT C –

QUESTIONNAIRE

Section K Health

Savings Account

Is the State using an enrollment system, and if so, which system?

Is the State using a payroll system, and if so, which system?

Does the State have any HSA administration customization or marketing needs?

Does the State have any HSA reporting needs?

What are the State’s Open Enrollment needs in regard to HSA?

Will the State be selecting finalists for HSA administration, and if so, would the potential HSA finalist presentations be incorporated with the MEDICAL finalist presentations?

The State administers their own enrollment via Workday system and payroll via JD Edwards system.

The State requires a standard HSA reporting package. Bidders are to provide their standard HSA reporting package details in Attachment C1 – Questionnaire (section K).

Open Enrollment needs include: Updated information annually as well provide us with any information needed to share with public servants.

If the State decides to hold vendor demonstrations, the Medical presentation includes HSA.

5. MEDICAL DATA

FILE FOR

REPRICING

N/A Please confirm the number of rows included on the claim file submitted to us on June 18, 2025. We are counting 1,101,590 rows of data, but due to the size of the file and with the file being in TXT format, the rows exceed the number allowed in Excel so we would just like confirmation of the grand total rows of data. Thank you

The Medical Data Layout & Control Totals file in the secure workspace confirms 1,101,590 records are in the claims repricing file.

As a reminder, per the email on the release of the secure data, the claims repricing file MUST be returned to the secure workspace in the same order and format as it was received.

6. 1.PROCUREMENT

PROCEDURE,

O.9.

SOLICITATION

REQUIREMENTS

V.PROJECT

DESCRIPTION &

SCOPE OF

WORK, F.31 PLAN

REQUIREMENTS

COST SHEET

SF Medical Repricing Tab

The RFP lists the items that are “to be addressed” in the bid response, which includes #9 “Completed Attachment E – Claims Repricing File”.

Instructions in #31 are for bidders to “complete all RFP attachments:

Attachment E – Claim Repricing File”.

Can the State please confirm what is to be “completed” on the repricing file and returned with the bid? We do not release claim line repricing allowed amount detail and instead provide Medical Reprice Summaries when performing repricings. The COST SHEET also includes a tab titled “SF Medical Repricing”, which asks bidders to complete the eligible and repriced dollar amounts.

Will the State agree to accept medical reprice summaries and the completed SF Medical Repricing tab on the COST SHEET as the completed response to the medical repricing request without claim file line item allowed pricing?

Details on completing the Claims Repricing file can be found in the Medical Data Layout & Control Totals file. Bidders are to provide network status, contracted amount, and contract type fields as noted in the file. Claim line repricing contracted amount is required and is imperative for evaluation in determining the differential between current plan costs and expected plan costs associated with possibly moving to a new vendor.

The State does not agree to accept medical reprice summaries and the completed SF Medical Repricing tab on the COST SHEET as the completed response to the medical repricing request.

7. ATTACHMENT C –

QUESIONNAIRE

Section K Health

Savings Account

Can the State please provide the total HSA AUM (Assets Under Management) for the following?

• Cash account balance

• Investment balance

Is there an employer contribution to the

HSA?

• Cash Balance - $2,635,276

• Investment Balance - $1,499,084

• Total - $4,134,360

• Accounts – 1,165

There is no Employer contribution to the HSA.

8. Medical Benefits RFP - 1. b. ii. The “Contractual Agreement Form” must be signed manually in ink or by DocuSign…

Pg. 7 Will a digital signature fulfill this request?

DocuSign and an ink signature are both approved ways to complete the signature requirement process.

9. Medical Benefits

RFP - O.

Solicitation Requirements

Pg. 9

Please send documents labeled 9.

Attachment E – Claims Repricing File and 10. Attachment F – Count Network Access Analysis

The Claims Repricing File and the By County Network Access File were provided via secure workspace to all bidders who submitted the required Intent to Propose form and provided a fully executed NDA with Segal by the RFP due dates.

This addendum will be incorporated into the solicitation.

10. Medical Benefits RFP – Vendor Duties G. Prices

Pg. 29 How does section G. relate to the Medical contracts? What does the 3.5% apply to? Is this in relation to Medical fees?

State of NE/Procurement The 3.5% refers to the maximum ASO increase in fees following the initial contract period, for the remainder renewal years.

11. Medical Benefits RFP - Project Description and Scope of Work F.

Plan Requirements Q.9

Pg. 44 Is this referring to an audit or do you want to confirm we’re adjudicating claims properly?

This plan requirement refers to bidder’s claims adjudication processes.

12. Attachment C - Questionnaire:

Network Access Management

Questionnaire Tab - Row 385; Column B

Please confirm if some or all listed categories below should be included as "Family Nurse Practitioner" Specialists Codes (Physicians/Allied Health Prof)

Prov Type Category Prov Type Name ALLIED HLT PROF Nurse, Registered

ALLIED HLT PROF Nurse, Licensed Practical

ALLIED HLT PROF Nurse Practitioner

ALLIED HLT PROF

Clin Nurse Specialist (non- Behavioral)

ALLIED HLT PROF

Home Health / Private Duty Nurse

ALLIED HLT PROF Family Nurse Practitioner

ALLIED HLT PROF

Advanced Registered Nurse Practitioner

ALLIED HLT PROF Licensed Vocational Nurse

ALLIED HLT PROF

Nurse, Registered, First Assistant (RNFA)

ALLIED HLT PROF Pediatric Nurse Practitioner

ALLIED HLT PROF Visiting Nurse

Bidders will have to determine whether to include categories listed (in vendor question) as a "Family Nurse Practitioner" based on their understanding of the type of services provided in each of those categories.