Post DAS Cost Sheet_Revised 100726.xlsx
XLSX spreadsheet 31 KB Posted
- Attached to
- Nebraska Medicaid Enrollment Broker
- Solicitation number
- 125920 O3
- Issued by
- Nebraska
About this file
This is a Cost Sheet for the Nebraska Medicaid Enrollment Broker, RFP #125920 O3, used to capture bidder pricing for both operations and implementation phases of the contract. The solicitation requests pricing for enrollment broker services supporting a planned member volume of 350,000 members. Bidders must complete all yellow-highlighted fields on the form, with pricing submitted on a per-member-per-month basis across five contract years plus five option years. The cost sheet requires detailed expense build-up documentation including direct labor (salaries and benefits), consultants, subcontractors, hardware, software licenses, telecommunications, facility costs, equipment, office supplies, and administrative expenses.
Pricing must be submitted as net pricing with all transportation and delivery charges fully prepaid and F.O.B. destination, with no additional charges permitted for packing or partial deliveries. The cost sheet specifies that all quoted prices must include all applicable fees necessary to perform project requirements and deliverables as outlined in the RFP's section (S) and related attachments. Mathematical errors in price extensions will be corrected using the unit price as the governing figure. The form includes separate pricing tables for the base contract period and option years, with an expense build-up template allowing bidders to expand line items as needed while maintaining formula consistency.
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Text version
Operations Vendor's Company Name: ERROR:#REF!
| Nebraska Medicaid Enrollment Broker |
| Cost Sheet |
| of RFP # 125920 O3 |
Bidder Name:_________________________________________________ Important Instructions: Bidders must complete all fields highlighted in yellow. Do not alter the existing format or content within this Cost Sheet. Prices quoted shall be net, including transportation and delivery charges fully prepaid by the bidder, F.O.B. destination named in the Solicitation. No additional charges will be allowed for packing, packages, or partial delivery costs. Important: In case of a mathematical error in extension of price, unit price shall govern.
The prices indicated in Part I and II below shall reflect all applicable fees necessary to perform the project requirements and deliverables as outlined in section (S) of the Request for Proposal (RFP) document and any related attachments and/or documents.
Instructions For Bidders:
| Planned Member Volume | 350,000 | Year One | Year Two | Year Three | Year Four | Year Five | Total Base Contract Price |
| Expense Type | Member Volume Up To | Price Per Member Per Month | Price Per Member Per Month | Price Per Member Per Month | Price Per Member Per Month | Price Per Member Per Month | |
| Base Price | 1 | ||||||
| Additional Price Per Member Per Month | 350,000 |
Total Planned Member Volume $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
| Planned Member Volume | 350,000 | Option Year One | Option Year Two | Option Year Three | Option Year Four | Option Year Five | Total Price All Option Years |
| Expense Type | Member Volume Up To | Price Per Member Per Month | Price Per Member Per Month | Price Per Member Per Month | Price Per Member Per Month | Price Per Member Per Month | |
| Base Price | 1 | ||||||
| Additional Price Per Member Per Month | 350,000 |
Total Planned Member Volume $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
| Expense Build-Up - Base Price | ||
| Expense Type | Description | Monthly Expense Total |
| Direct Labor | ||
| Salaries | ||
| Benefits | ||
| Additional Expenses Types Not Related to Direct Labor | ||
| Consultants | ||
| Subcontractors | ||
| Hardware | ||
| Network support | ||
| Software (including license fees) | ||
| Telecommunications lines | ||
| Facility | ||
| Equipment | ||
| Office supplies | ||
| Postage/deliveries | ||
| Printing | ||
| Administrative support |
| Indirect rate cost | |
| Administrative fee | |
| Total of All Expenses | $ - 0 |
| Expand Schedule as Needed (keep formulas consistent) | |
| Pricing is based on the Total Price, which sums the total price for the price of self-selection and auto-assignment per member. | |
| Expense Build-Up is to provide the detail used by the bidder to achieve its price. The expense types shown are examples only. If more expense types are needed, add rows and link formulas if necessary. Total of All Expenses should equal the sum of all rows. |
Implementation Vendor's Company Name: ERROR:#REF!
| Nebraska Medicaid Enrollment Broker |
| Cost Sheet |
| of RFP # |
Enrollment Broker Implementation
| Expense Type | Description | Price |
| Direct Labor | ||
| Salaries | ||
| Benefits | ||
| Additional Expense Types Not Related to Direct Labor | ||
| Consultants | ||
| Subcontractors | ||
| Hardware | ||
| Network support | ||
| Software (including license fees) | ||
| Telecommunications lines | ||
| Facility | ||
| Equipment | ||
| Office supplies | ||
| Postage/deliveries | ||
| Printing | ||
| Administrative support |
| Indirect rate cost | |
| Administrative fee | |
| Total of All Expenses | $ - 0 |
| Expand Schedule as Needed (keep formulas consistent) | |
| The expense types shown are only examples. If more expense types are needed, add rows and link formulas if necessary. Total of All Expenses should equal the sum of all rows. |
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