Network Discounts Attachment 2223-001.pdf
PDF 191 KB Posted
- Attached to
- Group Health Insurance
- Solicitation number
- RFP-02728
- Issued by
- Seminole County, Florida
About this file
This document is a request for network discounts related to a Request for Proposal (RFP) issued by the Suwannee River Water Management District (District) for Group Health Insurance coverage. The District is seeking fully insured proposals from qualified insurance carriers to provide group health coverage for employees and retirees in the geographic area of Suwannee, Columbia, and Alachua Counties in Florida. The data requested covers the time period of claims incurred from April 1, 2021 through March 31, 2022 and paid through June 30, 2022, and is limited to the selected counties, excluding Medicare, prescription drug, dental, and vision hardware claims.
The RFP requires respondents to provide detailed network discount information for PPO, POS, and HMO plans, including total billed amounts, total allowed amounts, and the calculated discounts for hospital inpatient, hospital outpatient, emergency room, and physician services. This information will be used to evaluate the proposed group health insurance coverage for the District's employee benefits program.
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Text version
Network Discounts for 2022 – Suwannee River Water Management District RFP #22/23-001
Geographic Area: Suwannee, Columbia, and Alachua County, FL Dates: Claims incurred 04/01/2021 through 3/31/2022 and paid through 06/30/2022
Using paid claims information on your Group book of business, please provide the following information for Suwannee, Columbia, and Alachua County, FL for the time period indicated for each network you are proposing. Please limit this to the selected counties. This should not include your Medicare book of business.
Exclude pending, denied, duplicate, Medicare-primary, and other secondary claims.
Exclude prescription drug (retail and mail-order), dental, and vision hardware claims.
Exclude individual denied services within a valid claim. For example, if one service provided during an office visit is not covered, exclude that service.
PPO Network
Category a) Total $ Billed b) Total $ Allowed* Discount**
Hospital Inpatient
Hospital Outpatient
Emergency Room
Physicians – MDs and DOs
POS Network
Category a) Total $ Billed b) Total $ Allowed* Discount**
Hospital Inpatient
Hospital Outpatient
Emergency Room
Physicians – MDs and DOs
HMO Network
Category a) Total $ Billed b) Total $ Allowed* Discount**
Hospital Inpatient
Hospital Outpatient
Emergency Room
Physicians – MDs and DOs
*Total $ Allowed = allowed amount before application of any deductibles, copays, coinsurance, etc.
** Discount = a) minus b) divided by a)
| Category: |
| a Total BilledHospital Inpatient: |
| b Total AllowedHospital Inpatient: |
| DiscountHospital Inpatient: |
| a Total BilledHospital Outpatient: |
| b Total AllowedHospital Outpatient: |
| DiscountHospital Outpatient: |
| a Total BilledEmergency Room: |
| b Total AllowedEmergency Room: |
| DiscountEmergency Room: |
| a Total BilledPhysicians MDs and DOs: |
| b Total AllowedPhysicians MDs and DOs: |
| DiscountPhysicians MDs and DOs: |
| Category_2: |
| a Total BilledHospital Inpatient_2: |
| b Total AllowedHospital Inpatient_2: |
| DiscountHospital Inpatient_2: |
| a Total BilledHospital Outpatient_2: |
| b Total AllowedHospital Outpatient_2: |
| DiscountHospital Outpatient_2: |
| a Total BilledEmergency Room_2: |
| b Total AllowedEmergency Room_2: |
| DiscountEmergency Room_2: |
| a Total BilledPhysicians MDs and DOs_2: |
| b Total AllowedPhysicians MDs and DOs_2: |
| DiscountPhysicians MDs and DOs_2: |
| Category_3: |
| a Total BilledHospital Inpatient_3: |
| b Total AllowedHospital Inpatient_3: |
| DiscountHospital Inpatient_3: |
| a Total BilledHospital Outpatient_3: |
| b Total AllowedHospital Outpatient_3: |
| DiscountHospital Outpatient_3: |
| a Total BilledEmergency Room_3: |
| b Total AllowedEmergency Room_3: |
| DiscountEmergency Room_3: |
| a Total BilledPhysicians MDs and DOs_3: |
| b Total AllowedPhysicians MDs and DOs_3: |
| DiscountPhysicians MDs and DOs_3: |
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