Method_of_Approach_Questionnaire_updated_07022024.xlsx
XLSX spreadsheet 36 KB Posted
- Attached to
- Group Life and Group Long Term Disability
- Solicitation number
- 240151
- Issued by
- Pima County, Tucson City, Arizona
About this file
This document is a Method of Approach Questionnaire for a Request for Proposal (RFP) issued by the City of Tucson for fully insured group life insurance and group long-term disability (LTD) insurance for city employees and retirees. The contract will be effective July 1, 2025, with a five-year term, and requires bidders to propose both life and LTD coverage together. Offerors must integrate with the City's Workday system for Evidence of Insurability (EOI) processing, bear integration programming costs, and provide coverage under group policies. The RFP mandates that proposals include comprehensive administrative services, claims processing, reporting capabilities, and meet specific technical requirements for life insurance, supplemental life, and long-term disability benefits.
The current incumbent is Hartford, and the City seeks a fully experience-rated, non-dividend eligible contract with no minimum enrollment requirements. The RFP emphasizes integrated disability management capabilities, detailed reporting requirements, and specific performance standards. Bidders must provide dedicated account management, customer service with specific operational hours, and comprehensive claims administration. The City requires real-time electronic reporting, ad-hoc reporting capabilities, and strict compliance with HIPAA, privacy, and security requirements. Pricing will be determined through a self-billing process with a 60-day payment grace period, and the City maintains control over billing format and enrollment processes.
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Vendor Instructions RFP Response Sheet
| Please read the directions below as our process has changed. |
| Please read, review and provide the information requested in this workbook. The cells will automatically expand as needed if your response is longer than the space shown in the cell, however, brevity is expected. Limitations do exist. |
| While the questionnaire may be available upon notice of RFP to the market, the financial exhibits will require a current NDA on file with Segal to obtain them for completion. No exceptions will be made for this process. |
| Beware that some questions request only a Yes or No response. Some questions contain limits on the length of your response. |
| The purpose for these limitations allows the Client to assess the responses as appropriate in a brief manner. |
| The worksheet is also locked so that you can only enter information in the Answers column or on the exhibits as requested. |
| Do NOT insert tabs or extra attachments unless instructed to do so. |
| Do NOT respond by "referring the Client to an attachment". |
| Do NOT delete sections of the questionnaire. If something does not apply to you leave it blank, or mark N/A. If you take something out, it will cause your responses to not line up correctly with the questions when we do the analysis. |
| 1) Questionnaire - Excel. Requires responses completed and returned in Excel format. DO NOT PDF |
| 2) Financial tabs - Excel. Requires responses completed and returned in Excel format. DO NOT PDF |
| We will not be able to include a response in any format other than Excel in the RFP analysis for the client. |
| Copyright © 2024 by Segal. All rights reserved. |
| This Request For Proposal form is the sole property of Segal and is not intended to be reproduced for any purpose other than review by the Plan Sponsor contracted with Segal to prepare a procurement analysis. This file cannot be copied or reproduced in any method without the written consent by Segal. |
| You must use the Price Exhibit provided in submitting your proposal. You may additionally include your normal underwriting pricing worksheets and caveats. However, we will use your responses on the required Price Exhibit and questionnaire as your proposal response when they differ from any supplemental underwriting materials you provide. |
Questions
| ID | Questions | Answers |
| Section 1 - MINIMUM REQUIREMENTS | ||
| 1.1 | Method of Contract Assembly: The final contract will be a layered document consisting of, but not limited to, the following documents: this RFP, the offeror's response to the RFP, written information provided as part of an interview, clarification, and/or negotiation. An Order of Precedence document shall be executed by both parties to indicate the order of precedence among the various documents that make up the contract. Indicate your agreement with this method of constructing the contract. | |
| 1.2 | Please confirm you will be proposing all coverages contained in this RFP process. | |
| 1.3 | Contractor must be able to integrate with the City's Workday system for the EOI process. Confirm you can comply. | |
| 1.4 | How many successful integration implementations with Workday's EOI process has your organization completed for clients who are of similar or greater size than City of Tucson? | |
| 1.5 | The Contractor must be willing to pay the cost for any City re-programming requirements needed for the Workday system to be able to interface with the Contractor's system. Please list if there is a limit up to which the Contractor is willing to pay. | |
| 1.6 | Describe the resources your organization employs to ensure successful integration with Workday's EOI process. | |
| 1.7 | Confirm you will accept all Evidence of Insurability applications via an online system that is provided and maintained by your company. | |
| 1.8 | Do you agree that the terms for the RFP/bid are guaranteed for at least 180 days from the proposal due date? | |
| 1.9 | Do you agree that the contract will not "auto" renew annually, and you will send a renewal confirmation each year, whether or not under a rate/fee guarantee, no later than 180 days prior to the effective date of coverage? | |
| 1.10 | Confirm that your proposal fees are guaranteed for a minimum of 36 months. Multi-year contracts are favored. | |
| 1.11 | Confirm the contract you are quoting is fully-experience-rated, non-dividend eligible group policies. | |
| 1.12 | Confirm you have integrated disability management capabilities. | |
| 1.13 | Do you agree that the terms of the RFP responses are valid until a final contract is executed? | |
| 1.14 | Confirm you understand that the Contract, if awarded, will expire at the end of the five year period. | |
| 1.15 | Do you agree that this bid response is NOT contingent on purchasing any services other than in the Scope of Work? | |
| 1.16 | Do you agree that any provisions for restating premium rates due to changes in enrollment that exceed a 20% need to be confirmed as acceptable with the client? | |
| 1.17 | Do you agree to maintain proper licensure as required by any state law where it relates to the services that you will be performing for the City of Tucson? | |
| 1.18 | Do you agree to provide no less than 90-day notice to the City of Tucson for any changes involving the sale, merger, data breaches, layoffs, participating provider terminations, consolidations, or outsourcing of services to foreign workers that will impact the City of Tucson? | |
| 1.19 | Do you agree to the Standard Terms and Condition, Paragraph 9.20, Indemnification? | |
| 1.20 | Do you agree to waive the "Actively-at-Work" clause upon the effective date of the policy, should you be awarded this RFP? | |
| 1.21 | Confirm you agree to the specified eligibility rules established by the City of Tucson and will communicate directly with the City regarding any uncertain claimant eligibility situations before notifying the claimant of ineligibility? | |
| 1.22 | Confirm you agree that the City of Tucson ultimately determines the eligibility of all enrollees. | |
| 1.23 | Confirm you agree to receive eligibility information via an eligibility interface with the City's online enrollment system, Workday. | |
| 1.24 | Confirm you have reviewed the Life Plan Design documents (Basic and Supplemental), including the Endorsements A and B, and are in agreement with each and every requirement in both sections A and B. If not, please explain. | |
| 1.25 | Do you agree to meeting all applicable HIPAA, EDI, Privacy, Security, and HITECH requirements and agree to hold the client harmless for breaches that are the result of your actions? | |
| 1.26 | Confirm you will not solicit Client's members for any other products or services that your firm might offer, and confirm you will not sell any mailing or other list that includes Client member information without express written consent from the Client. | |
| 1.27 | Do you agree to maintain all required records (all fields indicted on the billing) for seven years, pertaining to the administration of the City's plans in force? | |
| 1.28 | Rights to Claims Data: All member claim records are the sole property of the City of Tucson. Selling of the City of Tucson’s data to outside entities must be disclosed and approved in writing in advance by the City of Tucson. All claims data obtained during the contract period and for up to seven years after the contract termination is the property of the City of Tucson and must be available upon request. | |
| 1.29 | The City of Tucson treats any terminated employee who is rehired more than one year after the date of prior coverage termination as a new hire with guaranteed issue for all coverage levels. Rehires who are hired within one year after the date their life/LTD insurance ended under prior employment are limited to the same or lower level of life/long term disablity that was in force on the date of termination. Will you agree to this provision, or will you treat all rehires as new hires, regardless of the length of time they were not employed by the city? | |
| 1.30 | The City allows employees to continue insurance coverage for up to one year while on a qualifying leave of absence (medical, family medical, military), provided that employees continue paying their premiums to the City. The City in turn, transmits premium to the Contractor. Once one year of leave is exhausted, life and LTD coverage would end; portability for the life insurance would be offered, if the employee was hired prior to January 1, 2016 and is under the age of 70. Confirm that you agree to provide insurance in accordance with this policy. | |
| 1.31 | Do you agree to the Standard Terms and Conditions, Paragraph 9.35, Termination of Contract? | |
| 1.32 | Do you agree to the Standard Terms and Conditions, Paragraph 9.5, Assignment? | |
| 1.33 | Do you agree to the transition of all records as requested by the Client in the case of termination? This may include claim accumulators, plan experience, premiums (if applicable) and eligibility at no added fee to the Client? | |
| 1.34 | Do you agree to supply the necessary underwriting documentation for all renewals 180 days prior to the effective date? | |
| 1.35 | Excel Workbook: Please confirm you completed the RFP Exhibits in the separate Excel Workbook. | |
| 1.36 | Please confirm you will not require a minimum enrollment of eligible plan participants in order to underwrite and offer this program to City employees and retirees. | |
| 1.37 | List all potential fees to the City for additional services, such as initial start-up fees. If pricing is not provided, it will be assumed to be a free benefit to the City. | |
| 1.38 | Please confirm your rates include all communication and education materials. | |
| 1.39 | Confirm you will not automatically enroll the City of Tucson in any programs that involve any type of communication with members, without express written consent from the City of Tucson. | |
| 1.40 | Confirm you will only use employee addresses for purposes designated by The City and provide assurance that such information will remain confidential. | |
| 1.41 | Confirm that all enrollment/communication materials shall be sent to employees via First Class mail unless another class of mail or form of delivery is authorized by the City’s Benefits Office. | |
| 1.42 | Contractor agrees to acceptance of responsibility for financial losses incurred due to inaccurate data provided to the City of Tucson. Employees’ and retirees’ accounts will not be back billed for premiums lost due to inaccurate reporting. | |
| 1.43 | Does your firm have a City of Tucson Business License? If yes, confirm you have provided a copy of your City of Tucson Business license. | |
| Section 2 - ACCOUNT MANAGEMENT | ||
| 2.1 | What location/office would be responsible for providing account management to the City of Tucson? | |
| 2.2 | Confirm the City will have a dedicated account manager, who will ensure smooth operation of all aspects of the account and who will resolve any issues that arise, with initial actions taken no later than two business days after being notified of an issue. | |
| 2.3 | Confirm the Account Manager will respond to phone calls or emails within 24 hours of receipt. | |
| 2.4 | Confirm your team will make outgoing calls to participants in order to ensure resolution and communication of resolution to any employee/retiree who notifies the City of an issue with the plan. | |
| 2.5 | Confirm you will attend two days of Open Enrollment meetings, at various locations in the City, generally in the month of May to review benefits and respond to questions. | |
| 2.6 | How many clients does the Account Manager currently support? | |
| 2.7 | Confirm your Account Manager will meet with the client to define the group, subgroup, and other reporting criteria necessary to support the Client's decision making process. | |
| 2.8 | Confirm that Account Manager will be present for monthly/quarterly meetings established by the client or as requested. | |
| 2.9 | Confirm the Account Manager will present any legislative impacts to the employee/member benefits or any changes recommended for approval by the vendors. | |
| 2.10 | Do you agree that all sample forms and communication materials will be provided to the Client in advance of distribution for approval (i.e., claim forms, enrollment forms, booklets, brochures, flyers, mailers, etc.)? | |
| Section 3 - ADMINISTRATIVE SERVICES/CLAIM ADMINISTRATION | ||
| 3.1 | What is the minimum time for implementation needed to initiate the proposed benefits or scope of work? | |
| 3.2 | Confirm your customer service team is available to serve the Client's participants from 8:00AM - 6:00PM, MST. | |
| 3.3 | Are the calls received "after hours" of operation handled by a service or voicemail system allowing participants to leave a message? | |
| 3.4 | Will the customer service team offer a dedicated or designated team for the City of Tucson? | |
| 3.5 | During business hours, do the Client's participants reach a live representative or an interactive voice response unit? | |
| 3.6 | Do you offer access assistance for the Hearing Impaired, 24 hour toll-free automated benefits, eligibility, and customer service via internet? Specify which. | |
| 3.7 | Do you offer customer service representatives with multiple languages such as Spanish, French, etc.? | |
| 3.8 | Please provide the geographic location for the Customer Service unit that will be serving our Client. (City/State) | |
| 3.9 | Confirm all customer service representatives are located in the continental United States of America. | |
| 3.10 | Have you increased or decreased your staff counts by more than 5% in the last 24 months, specifically Customer Service or Claims Operations? | |
| 3.11 | Do you have the following capabilities? In your responses, please indicate if each of the following is available for the employer, the beneficiary, or both: | |
| 3.11.a | Claim initiation via the web? | |
| 3.11.b | Checking claim status via the web? | |
| 3.11.c | Claim initiation via IVR? | |
| 3.11.d | Checking claim status via IVR? | |
| 3.11.e | Dedicated claims customer service staff located stateside within the 50 United States for claims questions? | |
| 3.11.f | Dedicated claims processing staff located stateside within the 50 United States? | |
| 3.12 | What percent of your claims are auto adjudicated? | |
| 3.13 | Confirm you agree to provide the following life and LTD administrative services: | |
| 3.13.a | A toll free fax number for the submission of claims? | |
| 3.13.b | Conduct an orderly transition for an implementation date of July 1 of each contract year. | |
| 3.13.c | Create a claim file for each claim. The claim file must be maintained on computer media for at least (5) years or for such time as may be required by law, whichever is longer. | |
| 3.13.d | Evaluate claims to determine if they have been properly filed and notify claimants within 7 days of any additional information which is necessary to adjudicate a claim. | |
| 3.13.e | Compute benefits due in accordance with current benefits as detailed in the Hartford long term disability benefits booklet posted on the Disability page at www.tucsonaz.gov/insurance. | |
| 3.13.f | Apply claims control procedures necessary for the effective administration of the plan. | |
| 3.13.g | Investigate claims in which charges appear higher than usual. | |
| 3.13.h | Timely notify participants of delayed claim payments caused by duplicate coverage or an error or omission in claim payment documentation. | |
| 3.13.i | Respond within one working day to any inquiry from the City benefits supervisor, manager or designated staff regarding the disposition of pending claims. | |
| 3.14 | Describe the safeguards you have in place that prevent your system from overpaying participants and paying them in error? | |
| 3.15 | Describe the accuracy standards of your claims processing facility. What were your results for the last year? | |
| 3.16 | How often will you verify the disability status of a claimant? | |
| 3.17 | How do you verify if an individual qualifies for disability payments? | |
| 3.18 | How are the results of the re-evaluation reported back to the City? | |
| 3.19 | How do you handle a case where the participant no longer meets the clinical criteria for a condition? | |
| Section 4 - PRICING | ||
| 4.1 | The carrier must accept premium payments on a self-bill basis (City does the accounting) with no list bill and only summary payment information. Premiums are paid based on payroll deductions and employer fringe contributions during the first pay period of each month. | |
| 4.2 | Please confirm the City will control the format of the self-billing and will not reconcile to the Contractor's billing format. | |
| 4.3 | The carrier agrees to a payment grace period of not fewer than 60 days after the first day of any given month. (For example, July’s bill would be due no earlier than August 29.) | |
| Section 5 - UNDERWRITING | ||
| 5.1 | How does the initial renewal differ from succeeding renewals, if at all? | |
| 5.2 | What factor is used to convert the claim experience to an incurred claim estimate? (assuming you start with incurred and paid in 12 months) | |
| 5.3 | What credibility factor do you apply for a client with 4,300 employees? | |
| 5.4 | How many years of experience do you use for generating an incurred claim estimate for a client with 4,300 employees? | |
| 5.5 | Provide information about your online Evidence of Insurability reporting viewable by the Employer. Include how often the report is updated (daily, weekly, etc.). | |
| 5.6 | Provide information about your online Evidence of Insurability application process for those applying for coverage. | |
| 5.7 | By what date would your company need to be advised of being awarded the contract to be able to go live with open enrollment online evidence of insurability applications by May 1? Indicate what would be required from the City in order to do so. | |
| 5.8 | Provide statistics on average time to decide once life insurance Evidence of Insurability is submitted via your online EOI application system. What percent of applications are decided within one day? One week? One month? Other? | |
| 5.9 | Are waiver of premium or pending life claims for accidental death and dismemberment claims included in your estimated incurred claims? | |
| 5.10 | How will you establish what are to be considered paid claims on the policy anniversary date (i.e., paid and incurred within the policy year less any pooled amounts)? | |
| 5.11 | Will you consider paid claims as any claims incurred prior to the anniversary date, but paid subsequent thereto, if payment is made before the preparation of the annual experience accounting? | |
| 5.12 | What is the estimated amount you would set up for incurred but unpaid claims at the end of the first policy year for each of the benefits that you are quoting? | |
| 5.13 | Describe any claims charges (i.e., accumulated deficit) that would be made against the policy, other than paid claims and the reserves. | |
| 5.14 | Will you pool the claims experience of any coverage or portion thereof under this policy with any other policyholder or group of policyholders? | |
| 5.15 | Describe your pooling formula by coverage, indicating what portion of each coverage will be pooled and whether the pooling charge will be shown as an adjustment of incurred claims or as an item of retention. | |
| 5.16 | Please describe the capabilities and process entailed with use of the online Evidence of Insurability (EOI) system. | |
| 5.17 | Open enrollment is usually conducted for two weeks in May of each contract year in advance of the July 1 effective. Confirm you agree the City will determine each year whether a positive or passive open enrollment will be conducted. | |
| 5.18 | Vendor will receive an EOI integration file from the City in early June, after the close of open enrollment. Describe, in detail, how your EOI integration with Workday works. | |
| 5.19 | The City requires that employees start their EOI process no later than June 30 each year. Confirm that you are able to close EOI acceptance on June 30 each year and that you will not allow employees to initiate EOI after June 30. | |
| 5.20 | Confirm you agree that employees who complete the initial EOI request must show good faith effort to complete the entire EOI process within 60 days after their initial EOI request is received, or their request will be declined. | |
| 5.21 | Confirm that your organization has the capability to provide, at no additional cost to the City or employee, a single sign on integration with Workday to allow employees to complete EOI when EOI is required. | |
| 5.22 | What percentage of EOI requests receive a yes/no decision within 48 hours after being submitted? | |
| 5.23 | Do you have any experience working with Workday, the City’s enrollment system? | |
| 5.24 | If the claims experience of this group will be used to develop rates, explain how future rates will be determined at the first renewal. Include expected claims credibility factor assuming no change in current enrollment. | |
| 5.25 | What retention charge (as a percent of premium) was used to develop your proposed premium rates? | |
| 5.26 | How are your IBNR reserves determined for a client the size of the City? | |
| Section 6 - REPORTING | ||
| 6.1 | Pended Claims: Make available, upon request, reports regarding the number and nature of claims pended, if your organization is processing the claims. | |
| 6.2 | Confirm that your company will send City of Tucson EOI decisions via an integration with Workday, and describe the time lag between date of approval and date when the decision will be sent to the City via Workday. | |
| 6.3 | The carrier must provide real time electronic reports to the City’s Benefits Office of all EOI decisions. If the carrier notifies the City of an approval after the City’s current pay period payroll cutoff, premium payment will be made starting with the pay period during which the City receives notification of the approval. (In other words, no retroactive premium payments will be made.) | |
| 6.4 | Provide a list and detailed description (including frequency) of reports provided on a standard basis (no additional cost) that the City of Tucson Benefits Staff can access from your Employer Portal. | |
| 6.5 | Describe ad-hoc life insurance claim reporting offered via your employer portal. | |
| 6.6 | Please explain your ability to accommodate requests for ad hoc or customized reports, including normal turnaround time and costs. | |
| 6.7 | Confirm you will provide the following LTD reports: | |
| 6.7.a | Claims Analysis: Including premium paid, volume, number of covered participants, number of claims filed, number of claims filed year-to-date, claims patterns, cause of total disability, amount of claim dollars paid, amount of claim dollars paid year-to-date. |
Claims data to include total number of bills submitted per level of coverage, total paid per plan.
| 6.7.b | Pending Claims: Name of insured, date pended, disability type, monthly benefit. |
| 6.7.c | Open Claims List: Name of insured, DOB, disability type, gross and net monthly benefit, reserve amount. |
| 6.7.d | Performance Tracking: Detail report on each performance measure by appropriate time period including the status narrative for each of the requirements detailed in Attachment F Performance Standards. |
| 6.7.e | Claims: Data to include total number of bills submitted per level of coverage, and total paid per plan, claim turnaround report (time from receipt of completed claim form was received by claim office to response or claim check is mailed to employee), Claims Acknowledgement, Disability Decision, Financial Accuracy, Decisional Accuracy, Procedural Accuracy, Statistical Coding Accuracy. |
| 6.7.f | Claims Investigation/Appeals: Data to include identified members requesting appeal, current status of appeal; identified members under investigation or requesting investigation. |
| 6.7.g | The City reserves the right to request any additional reports as needed at no additional charge. Confirm that you agree. |
| Section 7 - BASIC LIFE | |
| 7.1 | The City is seeking to match the current Basic Life plan design as detailed in the current Hartford Supplemental Life booklet posted on our Life page at https://tucsonaz.gov/benefits. Any deviations must be detailed in the Vendor’s response on Attachment H “Deviations/Exceptions” stating the current language and the proposed deviation on the form. If nothing is indicated on Attachment H “Deviations/Exceptions” it will be assumed your proposal matches the benefits, specifications, and terms and conditions exactly even if you include material that states differently. |
Please confirm you have completed Attachment H, Deviations/Exceptions listing any exceptions to the current design or any provisions of the current contract.
| 7.2 | Confirm you will not require an employee to be actively at work and dependents to be non-hospital confined on the effective date of the policy. |
| 7.3 | If you are unable to waive actively at work, explain how you will ensure no employee loses coverage under a change of vendor event. |
| 7.4 | Are there any takeover limitations or restrictions? |
| 7.5 | Do you agree to grandfather existing life insurance amounts for all currently covered employees and dependents so that evidence of insurability is not required? |
| 7.6 | Does your policy include a conversion option? |
| 7.7 | Is the conversion charge included in your fees/premiums? |
| 7.8 | What provisions apply to the conversion option if the master contract is terminated? |
| 7.9 | Do you require evidence of insurability at conversion to continue the same benefits as when active status was offered? |
| 7.10 | Are there any provisions or limitations in your policy regarding age, pre-existing conditions, etc.? If so, what are they? |
| 7.11 | Is the converted policy non-cancelable to age 65? |
| 7.12 | Indicate whether your accelerated death benefit applies to the following coverage types: |
| 7.12.a | Basic Life |
| 7.12.b | Additional Employee Life (Voluntary) |
| 7.12.c | Additional Spousal Life (Voluntary) |
| 7.12.d | Additional Child Life (Voluntary) |
| 7.13 | What benefit improvements are you willing to include for accelerated death benefit at no additional change to those rates quoted? |
| 7.14 | Are you prepared to support an employee/member who is filing a claim? |
| 7.15 | Indicate services you provide, including online service tools that would simplify administration for the Client's benefit staff or administrators of the plan. |
| 7.16 | What is the best way to contact your organization with questions regarding the life policies? |
| 7.17 | Confirm that you will provide a copy of the Basic Life Evidence of Coverage booklets. |
| 7.18 | What type of information will the member receive confirming the level of insurance coverage Basic Life benefits? |
| 7.19 | The carrier agrees to accept from the City of Tucson only an annual open enrollment file of all coverages elected (if requested by the carrier) with no subsequent mid-year change files. |
| 7.20 | Will you require a periodic census report? If so, with what frequency? |
| 7.21 | The carrier agrees to continue Basic and Supplemental coverage for 6 months following termination of employment for Executive City Attorneys, Executive City Managers and Executive City Clerks. |
| 7.22 | Are you willing to increase the maximum benefit for unique classes such as Board Members, Executive Council, Superintendents, Chairman of the Boards, etc. |
| 7.23 | Basic dependent life must be guaranteed issue with no underwriting requirement each year, even if a dependent was not previously enrolled. |
| 7.24 | Do you agree to duplicate current port coverage policy provisions? Portability is offered only to separating employees, as well as those who are retiring from employment, who were hired prior to January 1, 2016. |
| 7.25 | Do you agree to maintain all records and collect all premiums for ported and converted policies including but not limited to names, amounts, beneficiary designations, billing, and collection of premium, and to provide Customer Service for policyholder questions and claims about portability and conversion policies? |
| 7.26 | Portability policies currently are split into two pools: |
1. Starting July 1, 2017, employees under age 70 who were hired before January 1, 2016 elect portability through the incumbent's normal portability protocols. The City has no obligation for this group in the event of termination of the contract. The successful offeror for the contract starting July 1, 2025 must offer portability to employees under age 70 who were hired before January 1, 2016. Employees who elect portability under this pool will be the obligation of the successful offeror in the event of contract termination.
2. City of Tucson has a small, captive group of legacy portability policyholders whose policies were in place before July 1, 2017. This group is offered portability under a separate pricing structure, and must be tracked separately by the successful offeror. For this group, the successful offeror will be responsible for premium billing and collection, claims processing and payment, beneficiary designations, customer service to policyholders and beneficiaries, and periodic census reporting to the City. As of April 1, 2024, this group consisted of 84 policies (spouse or employee) with total coverage of $6,000,000 ("Direct Billing (Legacy Portability) Census" Exhibit).
| 7.26.a | Confirm that you agree that starting July 1, 2025, you will offer portability to employees under age 70 who were hired before January 1, 2016 through your organization's normal portability protocols. The City will have no obligation for this group in the event of termination of the contract. Individuals who elect portability under this pool will be the obligation of your organizataion in the event of contract termination. |
| 7.26.b | Confirm that you agree to take over the existing group of 84 captive portability policies described in 7.26, above. Describe any limitations or considerations of which the City should be aware. |
| 7.27 | If you agree to take over the City's captive portability group participants, would they become part of your normal portability pool, or would they remain part of the City's experience group? |
| 7.28 | Do you agree to waive any active-at-work provisions for employees on leave of absence as of June 30, 2025? |
| 7.29 | The current policy allows employees who are on approved leave of absence to continue coverage for up to one year of approved, continuous leave. Confirm you will allow employees who are on approved leave to continue Basic Life coverage in accordance with the policy. |
| 7.30 | May an employee who has waived supplemental employee life elect the maximum spouse life benefit ($22,500), or are there limitations that would prevent them from doing so? |
| 7.31 | Eligibility for waiver of premium is available should an employee become totally disabled. In some cases, this notice may be slightly longer than one full year as employees may have benefits which extend authorized leave time with the City in excess of one year. The disabled employee has 31 days from the date of termination of employment to make an application with the insurance vendor. Employees who are retiring due to disability are eligible for waiver of premium, provided that disability qualification requirements are met. Do you agree to this provision? |
| 7.32 | Confirm you have provided a sample claim form and explain the claims submission process. |
| 7.33 | Confirm you have provided sample copies of your standard certificate and summary of coverage. |
| 7.34 | Will you offer portability and conversion to eligible employees who are retiring, as well as to employees who are simply separating from employment? |
| 7.35 | If so, how would this impact a retiree life insurance ($7,500) claim? |
| 7.36 | Are portability and conversion offered on a guaranteed issue basis, provided that application and premiums are received by the prescribed deadline? |
| 7.37 | If the group contract terminates, what options do you provide to the individuals who are losing coverage? Provide sample rates. |
| 7.38 | Do you agree to maintain the current Basic Life age reduction schedule? |
| 7.39 | Is there a reserve set up for known and/or approved waiver of premium claims? |
| 7.40 | What is the amount of the reserves? |
| 7.41 | What interest credit is applied to the reserve amount and how is it calculated? |
| 7.42 | Will you return the reserve in the event of cancellation? |
| 7.43 | Indicate any enhanced services (financial planning, EAP, funeral services, etc.) that are included in your proposal at no cost to the City. Include marketing materials that further explain these services. |
| Section 8 - SUPPLEMENTAL LIFE | |
| 8.1 | The City is seeking to match the current supplemental life plan design as detailed in the current Hartford Supplemental Life booklet posted on our Life page at https://tucsonaz.gov/benefits. Any deviations must be detailed in the Vendor’s response on Attachment H “Deviations/Exceptions” stating the current language and the proposed deviation on the form. If nothing is indicated on Attachment H “Deviations/Exceptions” it will be assumed your proposal matches the benefits, specifications, and terms and conditions exactly even if you include material that states differently. |
Please confirm you have completed Attachment H, Deviations/Exceptions listing any exceptions to the current design or any provisions of the current contract.
| 8.2 | Confirm that you will provide a copy of the Supplemental Life Evidence of Coverage booklets. |
| 8.3 | What type of information will the member receive confirming the level of insurance coverage Supplemental Life benefits? |
| 8.4 | Minimum Participation: |
| 8.4.a | Do you have a minimum participation requirement? |
| 8.4.b | What happens if the minimum participation requirements are not achieved? |
| 8.4.c | Is the City's current supplemental life enrollment sufficient to met your minimum participation requirements? |
| 8.5 | Will you require a periodic census report? If so, with what frequency? |
| 8.6 | Does the Supplemental Life Insurance product include a Waiver of Premium provision? |
| 8.7 | If a member qualifies for the Waiver of Premium under the Supplemental Life contract, will the premium for covered dependents also be waived? |
| 8.8 | Is an elimination period required for your Waiver of Premium Provision? If so, please describe |
| 8.9 | If approved for Waiver, are premiums waived back to the date of the disability or only after the elimination period is satisfied? |
| 8.10 | How is the Client notified of the Waiver of Premium? |
| 8.11 | What benefit improvements are you willing to include for the supplemental life at no additional charge to the proposed rates? |
| 8.12 | Do you agree to grandfather existing supplemental life insurance amounts for all currently covered members (employees and dependents) so that evidence of insurability is not required? |
| 8.13 | Does your policy provide terminal liability for waiver of premium claims upon termination of the Client's agreement? |
| 8.14 | Will you agree to permit annual open enrollment periods that will not require evidence of insurability? |
| 8.15 | Confirm that your rates do not straddle IRS Table 1. |
| 8.16 | Do you require the employee/subscriber to be actively at work on the effective date of your contract? |
| 8.17 | The current policy allows employees who are on approved leave of absence to continue coverage for up to one year of approved, continuous leave. Confirm you will allow employees who are on approved leave to continue Supplemental Life coverage in accordance with the policy. |
| 8.18 | Is the policy portable (i.e., can the member retain the same coverage level after leaving employment)? |
| 8.19 | Confirm that newly eligible employees are guaranteed issue for all levels of supplemental employee and spouse life during their initial enrollment period. |
| 8.20 | Confirm that employees not enrolled in supplemental life as of June 30, 2025 and newly eligible employees who decline the supplemental life during their initial eligibility period may request to increase coverage during the annual open enrollment period (to be determined by the City), subject to your Evidence of Insurability requirements. |
| 8.21 | Confirm you agree that employees may not request to increase supplemental life mid-plan year due to qualifying life events. |
| 8.22 | Confirm you agree that during the life of this contract, the City, at its discretion, may choose to allow employees to request to increase supplemental life mid-plan year due to qualifying life events. If so, what would be the impact to the rates? |
| 8.23 | Confirm that employees may elect to reduce or waive supplemental life coverage from the first of any given month following the date the Benefits Office receives their reduction request. |
| 8.24 | May an employee who has waived supplemental employee life elect the maximum spouse life benefit ($22,500), or are there limitations that would prevent them from doing so? |
| 8.25 | Can coverage for the dependent children be elected if the employee/subscriber does not elect supplemental employee coverage? |
| 8.26 | Can an eligible employee port spouse life even if he/she is not porting employee supplemental life? |
| 8.27 | Does Supplemental Life offer a conversion option? |
| 8.28 | Do you agree to maintain the current Supplemental Employee Life coverage caps and age reduction schedule? |
| 8.29 | Can Spousal and Dependent coverage be converted? |
| Section 9 - LTD | |
| 9.1 | The City is seeking to match the current long-term disability plan design as detailed in the current Hartford Long Term Disability Coverage booklet posted on our Disability page at www.tucsonaz.gov/insurance. Any deviations to either the LTD Basic or Buy-up benefit must be detailed in the Vendor’s response on Attachment H “Deviations/Exceptions” stating the current language and the proposed deviation on the form. If nothing is indicated on Attachment H “Deviations/Exceptions” it will be assumed your proposal matches the benefits, specifications, and terms and conditions exactly even if you include material that states differently. |
Please confirm you have completed Attachment H, Deviations/Exceptions listing any exceptions to the current design or any provisions of the current contract.
| 9.2 | Is your definition of disability consistent with the current Hartford definition? Explain any differences. |
| 9.3 | Does your company’s contract include integration with any other income source? |
| 9.4 | If yes, outline those contract provisions. |
| 9.5 | Describe all sources of income offset including if full family direct is applicable. |
| 9.6 | Does your LTD contract contain any exclusions or limitations for alcoholism, psychiatric treatment, drug abuse, musculoskeletal and connective tissue disorders, chronic fatigue syndrome and fibromyalgia? |
| 9.7 | If yes, outline the specific exclusions and limitations that apply. |
| 9.8 | Does your policy have any restrictions for pre-existing conditions? |
| 9.9 | Confirm that you will waive the pre-existing condition provision for current insureds that should be covered on the effective date but are not at work (i.e., vacations, etc.). |
| 9.10 | Do you have a minimum participation requirement for the LTD Buy-Up? |
| 9.11 | What happens if minimum participation requirements are not achieved? |
| 9.12 | Is the City’s current LTD enrollment sufficient to meet your minimum participation requirements? |
| 9.13 | Confirm you agree that employees enrolled in the LTD Buy-Up option as of June 30, 2025 do not need to provide evidence of insurability to continue the LTD Buy-Up option. |
| 9.14 | Confirm that newly eligible employees are guaranteed issue in the LTD Buy-Up option during their initial enrollment period. |
| 9.15 | Confirm that employees not enrolled in the LTD Buy-Up option as of June 30, 2025 and newly eligible employees who decline the LTD Buy-Up during their initial eligibility period may request to buy-up during the annual open enrollment period (to be determined by the City), subject to your Evidence of Insurability requirements. |
| 9.16 | Confirm you agree that employees may not request to buy-up mid-plan year due to qualifying life events. |
| 9.17 | Confirm you agree that during the life of this contract, the City, at its discretion, may choose to allow employees to request to buy-up mid-plan year due to qualifying life events. If so, what would be the impact to the rates? |
| 9.18 | Confirm that employees may reduce coverage from Buy-Up to Basic the first of any given month following the date the Benefits Office receives their reduction request. |
| 9.19 | Outline your vocational and general rehabilitation services that are available to LTD claimants. |
| 9.20 | Describe any partial disability benefit you offer. |
| 9.21 | Confirm you agree to provide coverage to all eligible employees, as determined by the City. |
| 9.22 | Confirm you will to provide coverage for employees who are currently on approved leave of absence (with or without pay), provided the employee and City continue to pay premiums according to the City rules for the period of approved leave of absence. |
| 9.23 | Please confirm that neither the City nor the employee is responsible to pay premiums after the elimination period and for as long as benefits are payable under the plan. |
| 9.24 | The current policy allows employees who are on approved leave of absence to continue coverage for up to one year of approved, continuous leave. Confirm you will allow employees who are on approved leave to continue LTD coverage in accordance with the policy. |
| 9.25 | Confirm that in the event of a future change in carriers you will assume responsibility for any claims incurred with a date of occurrence within the term of the contract; whereby, all disability payments will be made to the disabled employee for the entire period of disability or the balance of the period of the disability, whichever occurs later. |
| 9.26 | Do your “actively at work” requirements deviate from the current definition as written in the current Hartford Long Term Disability Coverage Booklet posted on the Disability page at www.tucsonaz.gov/insurance? |
| 9.27 | Confirm you will be responsible for all new disability claims, regardless of reported or unreported, for those eligible employees not at work on the effective date of coverage. |
| 9.28 | Confirm you agree that Employees must exhaust all sick, vacation and other accrued leave before benefits become payable. |
| 9.29 | Do you have a procedure for responding to and resolving enrollee complaints, disputes, and appeals regarding the appropriateness of treatment, utilization review decisions, problems with provider access, requests for change of providers, requests to obtain second opinions on disability determinations, and other matters concerning quality of care? |
| 9.30 | Will you inform enrollees about the availability of the dispute resolution process and provide them with forms with which to report problems needing resolution? |
| 9.31 | Confirm you will respond to all complaints, disputes, and appeals promptly, according to time standards established by the City. |
| 9.32 | Confirm you will endeavor to include enrollee representatives in the design and execution of the dispute resolution process as requested by the City. |
| 9.33 | On average, what percentage or number of disability claims or cases are referred to a physician for consultation and review? |
| 9.34 | Will you track claim investigations and record those investigations? |
| 9.35 | Will you provide the City a report of these activities on a quarterly basis to show number of investigations conducted and the outcome? |
| 9.36 | Please answer the following in regard your Return To Work, and Rehabilitation programs: |
| 9.36.a | Do your programs target specific conditions, ages, etc.? |
| 9.36.b | If so, please explain briefly. |
| 9.36.c | Do you contract with independent medical and vocational rehabilitation vendors? |
| 9.36.d | If so, name any such vendor located in Tucson, AZ. |
| 9.36.e | What is your success rate of rehabilitation, as a percent of all claimants in rehab programs? |
| 9.37 | Briefly describe the process as a claimant moves from “Own” to “Any” occupation requirement of total disability. |
| 9.38 | Briefly describe benefit payment options, as well as any other financial services that are available to the claimant. |
| 9.39 | What is the average length of time from initial filing of an LTD claim to actual processing of the claim and commencement of benefit payments? |
| 9.40 | How will your organization verify eligibility at the time of claim? |
| 9.41 | Does your quoted contract contain language to support and administer a plan with provisions outlined in IRS ruling 2004-55? |
| 9.42 | Once approved for disability benefits, how frequently is validation of continued disability required? |
| 9.43 | Briefly describe the process used to validate continued disability once approved. |
| 9.44 | Briefly describe your claim management process, and the types of personnel involved (e.g. nurse case managers, others). |
| 9.45 | Describe the qualifications and experience of such personnel. |
| 9.46 | Are all such personnel registered nurses? |
| 9.47 | With whom do these personnel have contact (employee, employer, physician, etc.)? |
| 9.48 | What determines whether your (carrier’s) physician will review the attending physician's statement? |
| 9.49 | Briefly describe quality controls, auditing, and peer review mechanisms utilized in claim-processing. |
| 9.50 | Do you use internal or independent/outside auditors? |
| 9.51 | Will you require a periodic census report? If so, with what frequency? |
| 9.52 | Indicate how you communicate new LTD claim approvals, and end of existing LTD claims, to the client. |
| 9.53 | Cost |
| 9.53.a | How is the LTD plan rated? |
| 9.53.b | Briefly explain how you establish the reserve for claimants during the elimination period. |
| 9.53.c | Does your company review ongoing claims and vary reserves from the tabular calculation, based on known claim circumstances? If yes, how often? |
| 9.53.d | Upon your renewal development, do you anticipate or require any form of claims stabilization reserve? |
| 9.53.e | If yes, please explain rationale, and provide basis for determining the amount of reserve necessary. |
| 9.54 | What percentage of interest is paid or credited to the policyholder for the following reserves: |
| 9.54.a | Incurred but not reported? |
| 9.54.b | Disabled life reserve for open claims? |
| 9.54.c | Claim stabilization reserve, if applicable? |
| 9.55 | Do you have a fraud detection unit or program in place? |
| 9.56 | What part does your company play in assisting LTD claimants to obtain Social Security disability benefit awards? |
| 9.57 | Do you pay out the unreduced benefit and then collect retroactively if Social Security disability is approved? |
| 9.58 | Do you pay the net benefit and then pay an additional amount if Social Security is ultimately denied? |
| 9.59 | Briefly describe your process and success rate in obtaining refunds of overpayments due to subsequent Social Security awards, when full LTD benefits have previously been paid without Social Security offsets ( e.g. applicable to claimants who previously worked for an employer participating in Social Security.) |
| 9.60 | Briefly describe what steps you take to ensure that the claimant applies for all other income sources. |
| 9.61 | Will an employee's City of Tucson pension offset the LTD benefit? |
| 9.62 | If an employee's City of Tucson pension will offset the LTD benefit, will it differ if it's a normal retirement pension vs a disability pension? |
| 9.63 | When would you prepare and present a final experience accounting? |
| 9.64 | Are costs associated with the Return To Work and Rehabilitation programs included in your quoted rates? |
| 9.65 | If not, the cost to add these programs must be clearly indicated on RFP Cost Exhibit (bidders may add lines to the bottom of Cost Exhibits if necessary). |
| 9.66 | Are you able to match the current LTD definition of disability exactly for all plans? |
| 9.67 | If not, list all deviations. References to attached plan designs may be provided in addition to listing deviations, but all deviations must be summarized below. |
| 9.68 | Are you able to match the current LTD definition of predisability earnings exactly for all plans? |
| 9.69 | If not, list all deviations. References to attached plan designs may be provided in addition to listing deviations, but all deviations must be summarized on the Deviations page. |
| 9.70 | Are you able to match the current LTD definition of deductible income exactly for all plans? |
| 9.71 | If not, list all deviations. References to attached plan designs may be provided in addition to listing deviations, but all deviations must be summarized on the Deviations page. |
| 9.72 | Are you able to match the current LTD limitations and exclusions provisions for all plans? |
| 9.73 | If not, list all deviations. References to attached plan designs may be provided in addition to listing deviations, but all deviations must be summarized on the Deviations page. |
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