Montrose Community Schools RFP - 2019.docx

Request for Proposal Montrose Community Schools

Section 1: Timeline

Section 2: General Information and Requirements

· Expenses for developing or presenting a response to this RFP shall be the bidder’s responsibility.

· Should any portion of this RFP require clarification all known respondents will receive the clarifying question(s) and answer(s).

· Other than the contact identified below, do not contact any employee or board member regarding this RFP.

· Any or all RFP responses may become subject to the collective bargaining process between the employer and the employees’ representative. Final decisions on benefits and carriers are subject to collective bargaining.

· If your bid is adopted, in whole or in part, you, your company and agents are prohibited from holding or acquiring an interest that would result in a conflict of interest.

· IRAN Economic Sanctions Act: All bidders must provide certification that it is NOT an Iran linked business as defined by Michigan Public Act 517 of 2012 and attach the information to their bid. The district shall not accept a bid that does not include this certification.

· Submit one (1) electronic and one (1) hard copy of the proposal to the following:

Montrose Community Schools Health Insurance RFP Carrie Sekelsky 300 Nanita Drive PO Box 3129 Montrose, MI 48457 csekelsky@montroseschools.org

Section 3: Statement of Work and Objectives The outcome of this RFP is to select proposals that will be subject to collective bargaining between the employer and its respective employees’ representatives. It is expected that any benefits and carriers will become effective 1/1/2020.

The proposal should include quotes for any or all of the following products:

☒ Disability – Long Term ☒ Life Each bidder has the option to quote the above products bundled together or unbundled. For any bundled product quotes, indicate any special terms and discounts that apply.

Notice: Bidders should submit quotations based on the specifications set forth below. Alternate quotations, which are clearly identified and explained, providing broader or narrower coverages and services than requested in these specifications will receive considerations.

Objectives in selecting benefits and carriers are:

1. To provide for the benefit coverage, in accordance with the terms of the plans’ designs, for those eligible and, depending on the benefit, their eligible dependents;

2. To obtain competitive pricing for benefit coverage through a broad network of participating providers offering convenient access to those covered;

3. To have member claims paid in a timely manner;

4. To maintain a high level of member satisfaction with the program;

5. To obtain timely, accurate financial and utilization data reporting;

6. To provide programs in which members may participate in an effort to improve their health (with medical bid);

7. To provide superior service including a flexible customer service approach that is ingrained in the organization;

8. To provide a strong account management approach with the ability to respond quickly, directly, and accurately to the business office as well as members.

Section 4: Current Structure --- Foundation We are a school district in Genesee County. We employ 150 employees. Eligibility for insurance is based on full time status. See attached census as reported by the district.

The table below illustrates current enrollment in medical/pharmacy benefit options offered.

Enrollment Choices $500/1000

$10 OV

Saver Rx Choices $500/1000

$20 OV

$10/20 Rx Choices $500/1000

$20 OV

Saver Rx

ABC 1

ABC Rx

Single

2-Person

Full Family

The table below illustrates current enrollment in the dental plan offered.

80/80/80: $2000 80: $1500 80/80/80: $1300 80: $1800 80/80/80: $2000 80: $2000 80/80/80: $1300 0: $0

The table below illustrates current enrollment in vision insurance.

VSP 3

VSP 3 G

The table below illustrates current enrollment in long-term disability insurance.

66 2/3%

90 CDMF

$4,000 Max SS: Family 66 2/3%

90 CDMF

$4,000 Max SS: Primary

Employee

The table below illustrates current enrollment in life insurance.

Employee

Section 5: Medical Insurance Questions and Specifications to Quote See attached medical plan highlights. Quotes must combine both medical and prescription coverage. Each bidder must quote a plan that is identical to current benefits and cost shares (e.g. deductible, co-payments, etc). In addition to the current plan type(s), other types can be quoted. Indicate how each plan differs from our current benefit structure. Answers can be written on separate document—include the question when answering. (Current medical insurance plan(s) is/are attached).

1. What were your projected trends and actual average rate increases for the following years:

Year

Dates Covered Projected Trend (Specify Med only or Med and Rx)

Actual Average Rate Change

2. What is the rating methodology used to determine the quoted rates?

3. Do you provide reports consistent with Public Employees Health Benefit Act, MCL 124.71 et seq (PA106), as amended, on a regular basis or only upon request? If you provide the reports regularly, explain the intervals at which you issue the reports. Include a sample of your PA 106 reporting.

4. The deductible year for the current plan(s) begins January 1 for medical. When does the deductible year for the proposed plan start? If different from current plan, how does the bidder propose to bring the deductible year into alignment?

5. Is there a 4th quarter carryover of the deductible? If yes, identify which plans.

6. Describe the provider network for the plans proposed, and provide a URL address to view provider networks online. Additionally, provide a disruption analysis.

7. Explain terms of coverage for non-minor children.

8. Do you confirm dependent eligibility? If so, explain the confirmation process in detail.

9. Describe wellness initiatives, if any, that are included in the plan?

10. Do you conduct open and special enrollments on behalf of your accounts? If so, are enrollments performed online, by paper application, or both?

11. If an employee’s and/or his/her dependents’ status changes, what is the process and how long does it typically take to have the status change recorded and operational in your system?

12. Do you have a case management program for high cost claimants? If so, what claims amount in a rolling 12-month period makes a member eligible for case management? Is participation mandatory or voluntary?

13. If included, describe the disease management programs.

14. Will we have an assigned/dedicated account representative? If so, is the representative’s office located in our county?

15. Do you have your own customer call center or does another entity provide customer services for you (if so, identify the entity)? Where is the call center located? Provide detailed call statistics for the past 2 year, including average speed of answer, average abandonment rate, average call volume, average talk time, first call resolution percentage and turnover rate.

16. Are commissions included in the quoted premium? If so, what percentage of the premium is commission? If not, are commissions billed separately? If no, how does the agent receive payment and in what form?

17. Are there any other fees or costs to be paid to you or a third-party if we adopt your proposal? Provide a detailed accounting.

18. Do you provide members’ materials on the plan designs? If so, how and how often?

19. How are cards issued? What is the time line for issuance for both new enrollees and replacement cards?

20. For each plan proposed, identify a coverages’ minimum and maximum annual cost share. Complete a chart for single coverage, 2-person coverage and full family coverage. In the chart header, make sure to identify the quoted plan being used.

The following is an example:

Plan quoted is XXXX. This is a PPO with an embedded deductible and out-of-pocket maximum.

Employee Only Coverage In-Network Employee Minimum Cost Share (No Services Except Preventive)

Employee Maximum Cost Share (Catastrophic Event)

Other Cost Share (Indicate)

2-Person Coverage In-Network Employee Minimum Cost Share (No Services Except Preventive)

Employee Maximum Cost Share (Catastrophic Event)

Other Cost Share (Indicate)

Full Family Coverage In-Network Employee Minimum Cost Share (No Services Except Preventive)

Employee Maximum Cost Share (Catastrophic Event)

Other Cost Share (Indicate)

21. Complete the premium decrement chart below for each quoted plan. Each quoted plan should be clearly labeled. The plan design of each, including the prescription plan, should be attached to the proposal. Here is a partially completed example:

Based on XX deductions

$20 generic $40 brand $100 specialty

$40 generic $80 brand

$40 generic $80 brand

$40 generic $80 brand

Based on XX deductions

22. Looking at the benefits offered under the current medical/prescription plan(s) (see attached medical plan highlights), indicate how each of your quoted plan(s) differ? For example, note dollar limits attached to specific services, visit limits, lifetime caps, etc.

23. What is the total annual projected cost, based on current enrollment, for medical/prescription coverage?

Section 6: Pharmacy Insurance Questions and Specifications to Quote In addition to providing plan details, and pricing information (if not already included in medical), all bidders must provide response to the questions below.

1. Describe the pharmacy network and provide a URL address to view provider networks online. Open, closed, etc. Additionally, provide a disruption analysis.

2. Will a formulary be used? If so, provide a copy with the RFP.

3. What utilization management programs, if any, will be included in each pharmacy plan quoted?

4. Describe each utilization management program in detail.

5. Do you provide reports consistent with Public Employees Health Benefit Act, MCL 124.71 et seq (PA106), as amended, on a regular basis or only upon request? If you provide the reports regularly, explain the intervals at which you issue the reports. Include a sample of your PA 106 reporting.

6. Are there any pharmacy outreach programs included? If so, describe in detail.

7. Are there any prescription “site of care” programs used? If so, describe in detail.

8. Are there any excluded drugs? If so, explain. Include an up to date attachment of all excluded drugs.

9. Do you have a home delivery provider of maintenance prescriptions? If so, give details regarding the pharmacy benefit manager and the home delivery program, including whether it is mandatory.

10. Would employees have a separate prescription card? If so, describe in detail.

11. Is there a separate account representative for pharmacy or is this included in the medical representative’s duties?

12. Are there free drugs which require no deductible, copay, or coinsurance? If so, provide the list of free drugs. If not, can this be added for an additional fee? If yes, what is that fee?

13. How does each plan handle and charge “Dispense as Written” prescriptions? Provide an example, including costs, when DAW is indicated.

14. Do you provide materials on the plan designs to members? If so, how and how often?

15. How are cards issued? What is the time line for issuance for both new enrollees and replacement cards?

Section 7: Dental Questions and Specifications to Quote See attached dental plan highlights. The deductible year for the current plan(s) begins July 1 for dental. In addition to providing plan details, and pricing information, all bidders must provide response to the questions below.

1. Are you proposing insured dental coverage, self-funded, or both?

2. What dental network will be used, if any?

a. On average, what is the dental discount?

b. Are non-network dentists reimbursable? How?

c. Provide a listing or URL of the dental providers? Additionally, provide a disruption analysis.

d. Are there different levels of coverage based on what network the dentist is in (a network within a network)? Explain.

3. Describe how coordination of benefits work.

4. Do you conduct open and special enrollments on behalf of your accounts? If so, are enrollments performed online, by paper application, or both?

5. If insured, what were your projected trends and actual average rate increases for the following years, for each proposed plan:

Year

Dates Covered

Projected Trend Actual Average Rate Change

6. Looking at our current dental plan offered, how does your proposed plan differ? Identify coverage shortfalls, enhancement, and value-added services.

7. Do you provide reports consistent with Public Employees Health Benefit Act, MCL 124.71 et seq (PA106), as amended, on a regular basis or only upon request? If you provide the reports regularly, explain the intervals at which you issue the reports. Include a sample of your PA 106 reporting.

8. Do you offer orthodontics under your plan? Is it included in the proposed plan? If not, can this be added as a rider? Provide the cost for this benefit.

9. In the quote attachment, include all that applies:

a. Proposed benefit detail

b. Monthly premium by coverage or illustrative rate by coverage

c. Administrative fees

d. Commissions

e. Taxes

f. Etc.

10. How was the premium, or illustrative rate, calculated (include methodology and utilization percentages)?

11. Do you provide materials on the plan designs to members? If so, how and how often?

12. Do members receive a separate dental card? If so, how are cards issued? What is the time line for issuance for both new enrollees and replacement cards?

Section 8: Vision Questions and Specifications to Quote See attached vision plan highlights. The deductible year for the current plan(s) begins July 1 for vision. In addition to providing plan details, and pricing information, all bidders must provide response to the questions below.

1. Are you proposing insured vision coverage, self-funded, or both?

2. What vision network will be used, if any?

a. Are there vision discounts? Explain.

b. Are non-network providers reimbursable? How?

c. Provide a current listing or URL of the vision providers.

d. Provide a disruption analysis.

e. Are there different levels of coverage based on what network the provider is in (a network within a network)? Explain.

3. Describe how coordination of benefits work.

4. Do you conduct open and special enrollments on behalf of your accounts? If so, are enrollments performed online, by paper application, or both?

5. If insured, what were your projected trends and actual average rate increases for the following years, for each proposed plan:

Year

Dates Covered

Projected Trend Actual Average Rate Change

6. Looking at our current vision plan offered, how does your proposed plan differ? Identify coverage shortfalls, enhancement, and value-added services?

7. Are there special riders available for purchase that are not included in your quote? Explain.

8. In the quote attachment, include all that applies:

a. Proposed benefit detail

b. Monthly premium by coverage or illustrative rate by coverage

c. Administrative fees

d. Commissions

e. Taxes

9. How was the premium, or illustrative rate, calculated (include methodology and utilization percentages)?

10. Do you provide reports consistent with Public Employees Health Benefit Act, MCL 124.71 et seq (PA106), as amended, on a regular basis or only upon request? If you provide the reports regularly, explain the intervals at which you issue the reports. Include a sample of your PA 106 reporting.

11. Do you provide members materials on the plan designs? If so, how and how often?

12. Is a separate vision card required? If so, how are cards issued? What is the time line for issuance for both new enrollees and replacement cards?

Section 9: Disability Questions and Specifications to Quote See attached long-term disability plan highlights. In addition to the below pricing information, all bidders must provide response to the questions below.

1. Who will be providing the disability insurance? Include address, contact, phone number, fax number, etc.

2. How are rates determined?

3. What are the plan details? Address percent of monthly salary up to max of, alcohol / drug conditions, mental / nervous conditions, pre-existing conditions, COLA, Social Security offset, etc.

Section 10: Life Insurance Questions and Specifications to Quote See attached negotiated life/AD&D plan highlights. In addition to the below pricing information, all bidders must provide response to the questions below.

1. Who will be providing the life insurance? Include address, contact, phone number, fax number, etc.

2. How are rates determined?

3. Explain any conversion provisions, if any.

Section 11: Proposal Certification Form The undersigned, duly authorized to represent the person, firms and corporations joining and participating in this Proposal, states that it is complete and is in full compliance with the RFP’s requirements.

Montrose Community Schools Carrie Sekelsky, Executive Director of Finance 300 Nanita Drive, PO Box 3129, Montrose, MI 48457 Phone: 810-591-8817 Fax: 810-591-7268 csekelsky@montroseschools.org Date: February 13, 2019