Attachment_7_-_Quality_Assurance_Surveillance_Plan.pdf

QUALITY ASSURANCE SURVEILLANCE PLAN

Performance Standards

Offerors must complete this Quality Assurance Surveillance Plan (QASP) as part of their proposal. In your response to Section L, you will propose your profit as a percentage of annualized premium (rounded to the nearest dollar). You must propose a profit formula that puts a significant percentage of your profit at risk based on performance in the following areas.

These performance standards represent the measures OPM considers appropriate to the performance evaluation of the services that OPM expects to receive from the Contractor. You may propose more stringent Target Values. We will use the information provided as part of our evaluation of your offer. Your proposed profit formula will be important to our evaluation. Submit this completed table with both your technical and price proposals.

Profit Formula: (Fully describe your proposal here)

Customer Service

# Performance Standard Measuring Method*

Target Values** Percent of Profit at Risk (to be proposed by Offeror)

1 CUSTOMER SERVICE Total Customer Service

1.1 Calls answered within 20 seconds Call Center Reports ≥ 85%

1.2 Timely callbacks Call Center Reports 93% in one business day and 99% in 2 business days

1.3 Call Monitoring and Quality

The Contractor will record FLTCIP customer calls.

Post-call assessment and quality review of 5% of calls recorded from customers using standard assessment tool approved by OPM.

Calls recorded to total volume

Sample review of 5% of call center calls using the OPM approved assessment tool

≥ 99.5%

Review at least 5% of calls and calls reviewed are assessed at ≥ 97% accuracy

1.4 Timely response to

written/email inquiries (Excludes auto-replies)

Call Center Reports 95% in 5 business days 99% in 10 business days

1.5 Accurate and appropriate

correspondence is generated and sent to FLTCIP

Random sampling of correspondence using standard assessment tool approved by

Review at least 5% and correspondence assessed at ≥ 97% accuracy better

1.6 Percent of customers who rate

overall satisfaction with customer service

Contractor survey of at least 2% of annual customer service calls, as approved by OPM.

(must include all responses)

≥ 88% rate overall satisfaction very satisfied or satisfied

1.7 Percent of customer service

representatives certified as long term care insurance specialists

Contractor report 95% of customer service representatives responsible for providing detailed plan/insurance information will hold professional certification as long term care insurance specialists within 9 months of assuming duties.

2 CLAIMS Total Claims

Method* Target Values** Percent of Profit at Risk (to be proposed by Offeror)

2.1 Accuracy of payments Contractor report

Total claims audited must be statistically significant

98% of claims will be paid accurately the first time.

Claim accuracy defined by these formulas:

Processing Accuracy:

Total # of audited accurate claims Total claims audited

98% of claims will be paid accurately the first time

Financial Accuracy:

Total # of audited claims with financial errors Total claims audited

AND

Total dollars of audited claims paid correctly Total benefits dollars paid in audited group

2.2 Timeliness of payments Contractor report 98% of fully documented claims paid with 5 business days

3 UNDERWRITING Total Underwriting

3.1 Applications underwritten timely Contractor report Initial Underwriting Decisions: 95% within 5 business days and 97% in 10 business days of complete information

3.2 Reconsiderations handled timely Contractor report Initial Reconsiderations: 95% within 10 business days and 97% within 15 business days of complete information

Second Level Reconsiderations: 99% within 25 business days of complete information

4 CARE COORDINATION Total Care Coordination

# Performance Standard Measuring Method* Target Values** Percent of Profit at

Risk (to be proposed by

Offeror)

4.1 Benefit determinations made timely Contractor report 95% within 5 business days of receipt of all information;

99% within 10 business days

4.2 Customer Satisfaction with Care

Coordination

Contractor survey

The “customer” is defined as the person/patient for whom care coordination services are being rendered, or the person responsible for care coordination service receipt and implementation, on behalf of that person/patient.

≥ 95%rate overall satisfaction very satisfied or satisfied

5 COORDINATION WITH BENEFEDS: Total BENEFEDS Quarterly enrollment reconciliation completed timely BENEFEDS Report Contractor must send a master enrollment file to BENEFEDS for reconciliation between the BENEFEDS system and the FLTCIP Contractor’s system within 2 business days of the agreed upon schedule.

Discrepancies resolved within 10 business days upon receipt of analysis verification from

BENEFEDS.

6 SYSTEM ARCHITECTURE AND WEBSITE Total System Architecture and Web Site

6.1

Systems that support customer service representatives, care coordination representatives, claims processing and other FLTCIP functions are available during stated hours

Contractor Report 99%

Target Values** Percent of Profit at Risk

(to be proposed by Offeror)

6.2 Website availability Website Report 99% uptime (percentage of time web servers remain connected to the internet as well as accessible and fully functional by FLTCIP customers). Agreed upon maintenance windows are excluded from this measurement.

6.3 Website satisfaction Contractor survey of

enrollees (must include all responses)

≥ 95% rate overall satisfaction very satisfied or satisfied.

6.4 The timeliness of OPM requested

changes (additions or deletions) to the dedicated FLTCIP website.

OPM Experience 99%

# Performance Standard Measuring Method* Target Values** Percent of Profit at Risk (to be proposed by Offeror)

7 RESPONSIVENESS TO OPM Total Responsiveness to

OPM

7.1 Contractor reports to the Contracting Officer and

Program Office (by phone or email) those incidents/potential incidents that Contractor believes could have significant adverse impact to FLTCIP customer service, enrollee satisfaction, or OPM constituencies within two hours of Contractor becoming aware.

Contractor provides the Contracting Officer and Program Office with a preliminary incident report within 24 hours.

Thereafter, Contractor monitors and tracks the incident, and provides the Contracting Officer and Program Office with updates, new information and corrective plan of action at least weekly until final resolution.

OPM contractors must report any breach or potential breach to the OPM Situation Room and the Contracting Officer within 30 minutes of becoming aware of the risk -regardless of the time or day of the week. Breaches should be reported, even if it is believed the breach is limited, small, or insignificant.

Contractor report and OPM evaluation from all sources

99%

7.2 Contractor compliance with the Notice of

Significant Events contract clause

Contractor notification by phone or email to the OPM Contracting Officer.

Significant events reported to OPM within 10 business days after Contractor becomes aware of it

OPM has the right to make a downward adjustment to this factor or withhold profit payments to protect the interests of enrollees upon learning of a significant event, regardless of whether Contractor notifies OPM on a timely basis.

7.3 Contractor compliance with the Correction

of Deficiencies contract clause.

Detailed plans for correction of deficiencies provided within 10 business days following OPM notification of deficiencies.

Measurement will be based on tracking documents for deficiency correction in a form prescribed by the Contracting Officer.

OPM has the right to make a downward adjustment to this factor or withhold profit payments to protect the interests of enrollees pending submission or

7.4 General working relationship As measures of general working relationship, OPM will consider such elements as (but not be limited to)

(1) the volume and validity of complaints received by OPM,

(2) the timeliness, accuracy and adequacy of requested reports,

(3) responsiveness to OPM offices, enrollees, applicants, Federal agencies and Congress, etc.,

(4) the number of incident reports and PII breaches (including repeat ones) during the performance year and successful use of Contractor-initiated innovations that enhance FLTCIP operations.

Measurement of negative performance will be based upon documentation provided by OPM to Contractor. Contractor may provide a written response to such documentation for OPM consideration.

Performance Standard

Measuring Method* Target Values** Percent of Profit at Risk (to be proposed by Offeror)

8 MARKETING/EDUCATION EFFECTIVENESS Total Marketing/Education Effectiveness

8.1

Success in increasing Federal family positive awareness of

FLTCIP

(1) Marketing & Outreach Plan; (1) Achieve # of marketing & outreach activities per plan as agreed to annually

(Direct mail, ads, webinars, seminars, conferences, phone calls, health fairs, website visits)

8.2 Contractor Survey of web users, callers to

CLTC phone reps, seminar/webinar attendees

95% satisfied that their awareness of FLTCIP has increased.

# Performance Standard

Measuring Method* Target Values** Percent of Profit at Risk

(to be proposed by Off ) 9 FINANCIAL MANAGEMENT Total Financial

Management

9.1 Premium accounting

files Accounting files containing aggregated premium, reversals, and waiver are sent and processed timely. Accounting files are used for experience fund investment management.

95% of files sent are complete, accurate and on time within 2 business days of receiving premium and reversals from BENEFEDS.

9.2 Actual administrative

expenses less than expected

Annual expense report vs. approved budget ≤100% of budget

9.3 Cost Control Measures initiated by the Contractor that result in productivity improvements and other cost containment accomplishments that are of benefit to FLTCIP.

Contractor report; audited financial statements

Target Values** Percent of Profit at Risk (to be proposed by

Offeror) 10 EXPERIENCE FUND/INVESTMENT STRATEGY Total

Experience Fund/Investment Strategy

10.1 The Contractor asset mix meets the target range as

outlined in the OPM approved investment strategy.

Quarterly asset report

99.9% meet the target range

10.2 The Contractor investment portfolios meet their

respective investment benchmark as outlined in the OPM approved investment strategy.

Quarterly asset report

Meet or beat the respective benchmark such as the Standard and Poor's 500 (S&P

500) Index

* This is the method OPM will use to monitor performance and determine the extent to which performance has met the standard. Offerors are encouraged to propose a sound process for verifying the accuracy of performance data on a continuing or recurring basis. Regardless of the method or degree of monitoring, we reserve the right to audit all performance data to independently verify its accuracy.

** For each Target Value, your proposal must specify a profit reduction that will take effect if you fail to meet the Target Value and/or profit incentives for performance that exceeds the Target Value.