PPO_Medical_Claims_Administration_RFP_(revised).pdf

County of Orange CEO/Human Resource Services/Employee Benefits

RFP #017-202403-MC

Claims Administration for the Self-

Insured Preferred Provider Organization (PPO) Health Plans

File Folder No.: 017-2569102

COUNTY OF ORANGE

HUMAN RESOURCE SERVICES

EMPLOYEE BENEFITS

REQUEST FOR PROPOSAL

FOR

CLAIMS ADMINISTRATION FOR THE SELF-INSURED PREFERRED PROVIDER

ORGANIZATION (PPO) HEALTH PLANS

RFP NO. 017-202403-MC

Services/Employee Benefits

RFP #017-202403-MC

Claims Administration for the Self-

Insured Preferred Provider Organization (PPO) Health Plans

REQUEST FOR PROPOSAL

DATE: February 15, 2024

REQUEST FOR PROPOSAL (RFP) COVER PAGE

The County of Orange Human Resource Services, Employee Benefits Division, (hereinafter “County”), is soliciting proposals (“Proposals”) from interested and qualified firms (hereinafter “Offeror” or “Offerors”) to provide Claims Administration for the Self-Insured Preferred Provider Organization (PPO) Health Plans, as well as the potential addition of High Performance Network (HPN) self-insured PPO health plans for active and retiree members. The proposed HPN plan designs should mimic the current Wellwise and Sharewell plans. Offerors are invited to propose for the Claims Administration for the Self-Insured PPO Health Plans, as well as the potential addition of HPN self-insured PPO health plans for active and retiree members in accordance with the terms and conditions set forth in Section III – Model Contract of this Request for Proposal (“RFP”), including all Attachments and Exhibits. The awarded contract, if any (hereinafter “Contract”), will be awarded to a single Offeror and will be based on the fee terms specified in the Contract between the County and awarded Offeror. Awarded Offeror will be referred to in the Model Contract as “Contractor.” Refer to Section III, Attachment A of this RFP for a description of the Scope of Services

This Request for Proposal (RFP) is set out in the following format:

SECTION I: Introduction and Instructions to Offerors SECTION II: Proposal Response Requirements SECTION III: Model Contract

PROPOSALS ARE DUE March 15, 2024; BY 4:00 PM PACIFIC TIME.

Proposals must be submitted electronically. See complete instructions in Section I.

All questions and inquiries related to this RFP must be directed to Melvin Chua (“Deputy Purchasing Agent” or “DPA”) via e-mail through OPENGOV at https://procurement.opengov.com [RFP #017-202403-MC]. For OPENGOV assistance, please contact the OPENGOV Support Team via chat at https://procurement.opengov.com or via email at procurement-support@opengov.com. Offerors are not to contact other County personnel with any questions or clarifications concerning this RFP.

The DPA will provide all official communication concerning this RFP. With respect to this RFP, any County response other than from the DPA and in writing will be unauthorized and the County shall bear no responsibility for any and all reliance upon the unauthorized communication.

Instructions:

1. Submit and upload your electronic proposal via https://procurement.opengov.com

2. Return this page, digitally signed, with proposal.

3. All proposals are to be identified with

RFP #017-202403-MC.

For further information, contact Melvin Chua via e-mail through OPENGOV at https://procurement.opengov.com

RFP #017-202403-MC.

PROPOSALS MUST BE RECEIVED ON OR

BEFORE

March 15, 2024 By

4:00 P.M. PT

RFP Number

017-202403-MC

File Folder No: 017-2569102

Human Resource Services, Employee Benefits 400 W Civic Center Dr 1st Floor, Suite 111 Santa Ana, CA 92701 https://procurement.opengov.com/ https://procurement.opengov.com/ mailto:procurement-support@opengov.com https://procurement.opengov.com/

Services/Employee Benefits

RFP #017-202403-MC

Claims Administration for the Self-

Insured Preferred Provider Organization (PPO) Health Plans

* If a corporation, this document must be signed by two corporate officers. The first signature must be either the Chairman of the Board, President, or any Vice President. The second signature must be the Secretary, an Assistant Secretary, the Chief Financial Officer, or any Assistant Treasurer.

**INCLUDE THIS SHEET DIGITALLY SIGNED WITH YOUR RESPONSE**

I HAVE READ, UNDERSTOOD, AND AGREE TO ALL STATEMENTS IN THIS REQUEST FOR PROPOSAL (RFP) AND TO

THE TERMS, CONDITIONS, ATTACHMENTS, EXHIBITS AND APPENDICES REFERENCED HEREIN.

Company Name (as it appears on your invoice and W9) Fed ID#

Address

*Authorized Signature Title Date

*Authorized Signature Title Date

Services/Employee Benefits

RFP #017-202403-MC

Claims Administration for the Self-

Insured Preferred Provider Organization (PPO) Health Plans

TABLE OF CONTENTS

Page No.

COVER PAGE

TABLE OF CONTENTS

SECTION I: INTRODUCTION AND INSTRUCTIONS TO OFFEROR

A. Introduction B. Proposed Time Schedule C. Instructions to Offerors and Procedures for Submittal D. Evaluation Process and Criteria E. Selection/Award Process F. Protest Procedure G. EDD Independent Contractor Reporting Requirements H. County of Orange Local Small Business (OCLSB) and Disabled Veteran Business

Enterprise (DVBE) Preference I. County of Orange Campaign Contribution Disclosure (Levine Act)

SECTION II: PROPOSAL RESPONSE REQUIREMENTS

Minimum Qualifications

Part 1

1. Cover Page

2. Validity of Proposal

3. Certification of Understanding

4. Minimum Qualifications Statement

5. Certificate of Insurance

6. Financial Information…………………………………………………

7. Bankruptcy Information

8. Pending Litigation………………………………

9. Conflict of interest

10. Statement of Compliance

11. Confidential or Proprietary Information or Documents

12. Civil Rights

13. Debarment

14. Network Analysis Disclosure

15. Cybersecurity

Part 2 Offeror’s Proposal Questionnaire (Exhibit 4)

1. Tab A. Cover Sheet

2. Tab B. Table of Contents

3. Tab C. Company Profile

4. Tab D. General Information

5. Tab E. Minimum Qualifications

6. Tab F. Required Attachments

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7. Tab G. Plan Designs

8. Tab H. Plan Design Alternatives

9. Tab I. ASO Fees & Credits – SQ

10. Tab J. ASO Fees & Credits – HPN

11. Tab K. Financial

12. Tab L. Staffing & Communications Plans

13. Tab M. Implementation, Ongoing Administration, Customer Service, Pharmacy

14. Tab N. Provider Network

15. Tab O. Claims and Reporting

16. Tab P. Claim System Matrix

17. Tab Q. Proposed Data Interfaces

18. Tab R. High Performance Networks

19. Tab S. Medicare

20. Tab T. Other

21. Tab U. Disruption Analysis

29. Tab V. Geo Access

30. Tab W. References

SECTION III: MODEL CONTRACT

Table of Contents Model Contract

ATTACHMENTS

Attachment A – Scope of Services Attachment B – Payment/Compensation Attachment C – Staffing Plan Attachment D – Proposed Implementation Plan/Project Schedule Attachment E – Communications Plan Attachment F – Performance Standards Attachment G – Account Management Report Card Attachment H – Data Interfaces Attachment I – Contractor Named Claim Fiduciary Attachment J – Business Associate Contract Attachment K – Claim Funding Arrangements Attachment L – County of Orange Information Technology Security Provisions Attachment M – County of Orange Information Technology Security Guidelines

EXHIBITS

Exhibit 1 – EDD Independent Contractor Reporting Requirements Exhibit 2 – County of Orange Local Small Business and/or Disabled Veteran Business Enterprise Preference Certification Requirements Exhibit 3 – County of Orange Campaign Contribution Disclosure Form Exhibit 4 – RFP Offeror Questionnaire

APPENDICES

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RFP #017-202403-MC

Claims Administration for the Self-

Insured Preferred Provider Organization (PPO) Health Plans

Appendix A - Wellwise Choice Health Plan Document Appendix B – Sharewell Choice Health Plan Document Appendix C – Wellwise Retiree Health Plan Document Appendix D – Sharewell Retiree Health Plan Document Appendix E – Monthly Medical Claims Information and Enrollment Appendix F – Active Employee and Retiree PPO Plan Census Appendix G – Plan Enrollment and Average Age Appendix H – Active Employee and Retiree Health Rates

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RFP #017-202403-MC

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SECTION I

INTRODUCTION

AND

INSTRUCTIONS TO OFFERORS

Services/Employee Benefits

RFP #017-202403-MC

Claims Administration for the Self-

Insured Preferred Provider Organization (PPO) Health Plans

SECTION I: INTRODUCTION AND INSTRUCTIONS TO OFFERORS

A. INTRODUCTION

This Request for Proposal (RFP) is soliciting interested and qualified Offerors to submit responses for the provision of Claims Administration for the Self-Insured Preferred Provider Organization (PPO) Health Plans and potential High-Performance Network (HPN) and a California and National Medical PPO network with access to providers and negotiated discounts for its employees and retirees. This RFP is an opportuntiy for vendors to present proposals in order to ensure the County is receiving the optimum level of services and network features for a competitive, cost effective price. The existing contract will expire December 31, 2024.

Background Information The County currently provides four self-insured preferred provider organization (PPO) health plans (two for employees and two for retirees) with claims administration provided by Blue Shield of California (Blue Shield).

This RFP includes the existing four self-insured PPO health plans, as well as the potential addition of new High- Performance Network (HPN) self-insured PPO health plans. The HPN plans will be available to both retirees and employees and will mimic the current plan designs for Sharewell and Wellwise.

For calendar year 2022, Blue Shield processed medical claims for approximately 5,600 employees and retirees.

Medical expenditures for calendar year 2022 under the County's self-insured PPO health plans totaled approximately $52.7 million.

Eligible employees and retirees of the County of Orange have a choice of health plans. During 2024, employees could choose from two self-insured PPO plans administered by Blue Shield: Wellwise Choice and Sharewell Choice. Employees could also choose from three HMO plans: Kaiser, Cigna Choice (Full Network), and Cigna Select (Narrow Network). During 2024, retirees and their dependents with and without Medicare were eligible to enroll in two separate self-insured PPO plans: Wellwise Retiree and Sharewell Retiree. In addition, depending on their Medicare eligibility, retirees could choose from other options including Medicare Advantage plans. Only the four self-insured PPO health plans are part of this Contract.

The current four self-insured PPO health plans identified above have varying plan provisions and benefits, with Wellwise Choice and Wellwise Retiree closely aligned, and Sharewell Choice and Sharewell Retiree closely aligned. The four self-insured PPO health plan documents are included as Appendices A, B, C, and D.

A key plan design difference between the Wellwise and Sharewell health plans is the Sharewell health plans are high deductible health plans (HDHP). Both Wellwise and Sharewell health plans have prescription drug coverage carved out to a pharmacy benefit manager (PBM), OptumRx. The Wellwise Retiree Medicare PPO pharmacy benefit is an Employer Group Waiver Plan (EGWP). All Sharewell PPO Plans are non-creditable coverage.

A key plan design difference between the Choice (employee) and retiree health plans is that the Choice plans cover applied behavior analysis (ABA) therapy when provided by a network provider, whereas the retiree health plans do not cover ABA therapy. Another key difference is only the Wellwise Retiree plan offers an annual $50 Non-Smoker Incentive to the subscriber.

Potential key changes to the self-insured PPO health plan design effective January 1, 2025:

1) Possible addition of High-Performance Network (HPN) self-insured PPO health plans (that will match current

Wellwise and Sharewell plan designs for Actives and Retirees).

2) Plan design changes to cover the following (details included in Exhibit 4, Tab H. Plan Design Alternatives)

a) Coverage for hearing aids

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RFP #017-202403-MC

Claims Administration for the Self-

Insured Preferred Provider Organization (PPO) Health Plans

b) Coverage for foot orthotics

c) Coverage for fertility

d) Coverage for abortions

e) Deductible and Out-of-Pocket changes for Sharewell only

Wellness Program:

The County’s Your Pathway to Wellness Program (Wellness Program) allows employees to earn lower employee contributions by participating in this program. Retirees are not eligible to participate in the Wellness Program.

WebMD administers the Wellness Program, tracks completion of activities, provides a website with articles, videos, self-paced online classes as well as provides telephonic and virtual coaching. The County works with its HMO and PPO health plan partners to identify complimentary programs and has implemented pre-diabetes programs using Omada with each of the vendors.

Onsite Wellness Center In February 2020, the County opened its doors to a state of the art wellness center. The center offers access to gym equipment, classes, mental health support, health coaching as well as virtual capabilities. During COVID, the center expanded to online classes.

Benefits Service Center:

County employees and retirees (Participants) receive benefits information, make all benefit elections, and direct all benefits customer service inquiries to the County of Orange Benefits Service Center (Benefits Center). These services are provided through Alight Solutions LLC (Alight). Participants can make their elections on the County of Orange MyOCBenefitsTM website or by calling the Benefits Center toll-free and speaking with a Customer Care Representative. The Benefits Center is the owner of eligibility on behalf of the County and therefore: 1) maintains and distributes all eligibility and coverage information to vendors for all the County’s benefits programs; 2) provides full customer service for benefits enrollment and eligibility; 3) provides Flexible Spending Account (FSA) administration for health care and dependent care reimbursement accounts; 4) calculates and provides reports regarding premium billing (ASO fees); 5) calculates and applies retiree medical grant subsidies; 6) submits all data necessary to collect and calculate premiums through payroll and pension files; 7) provides monthly direct billing for employees on leave of absence and retirees not yet on the pension file; 8) administers COBRA when coverage terminates; and 9) provides support for eligibility determination and reporting data for Employer Shared Mandate of the Affordable Care Act.

Alight manages all calls regarding eligibility and enrollment as follows:

• Respond to questions from Participants and County staff.

• Assist Participants with web enrollment/access needs.

• Serve in a participant advocate role to facilitate inquiries related to eligibility issues with carriers.

• Verify eligibility, update vendors when applicable and provide verification of coverage to providers.

• Verify coverage date, provide Participants with carrier/administrator contact information and/or transfer the employee/retiree to carrier if appropriate.

• Assist Participants by taking benefit elections/transaction (Open Enrollment, life events, etc.).

• Advise the County of any employee/retiree benefit issues and/or problems and provides solution where applicable.

• Conduct customer service performance surveys and provide results to the County quarterly.

• Handle exceptions that require manual processing, as defined in implementation and/or on an ongoing basis.

Services/Employee Benefits

RFP #017-202403-MC

Claims Administration for the Self-

Insured Preferred Provider Organization (PPO) Health Plans

Alight provides electronic eligibility and premium billing files to the County’s vendors and administrators. Alight receives confirmation of all file transmissions and will work with the County’s vendors in resolving discrepancy reports. It is the responsibility of the vendor to correct their eligibility records to match Alight’s. All enrollment requests must be directed to Alight.

The County desires that its selected Contractor(s) be capable of working with Alight via linked access through a unified web portal.

Key Laws and Regulations:

The County meets the definition of an applicable large employer (ALE) and therefore is subject to Internal Revenue Code (IRC) Section 4980H, Affordable Care Act (ACA). The Wellwise Retiree and Sharewell Retiree health plans are considered to be retiree only plans and as such, are not subject to all provisions of the ACA.

As a governmental entity, the County’s self-insured PPO health plans are not subject to ERISA (Employment Retirement Income Security Act). In addition, the County is required to be compliant with federal mental health parity requirements. Please be aware that the County is in the process of reviewing its current program. The County will work with the selected Contractor in the event of necessary plan design changes required for compliance. Under HIPAA privacy requirements, the selected Contractor will be required by the County to follow all privacy guidelines required under the law and comply with all contractual provisions in the Proposed Contract related to HIPAA.

Eligibility:

The eligibility provisions for County are:

• All regular and limited-term employees who are regularly scheduled to work 20 hours or more per week are eligible for health benefits on the first day of the month following 30 days from the date of hire.

• All extra help employees who are regularly scheduled to work 30 hours or more per week are eligible for health benefits on the first day of the month following 60 days from the date of hire.

• Retirees who meet certain conditions, such as eligible to receive an OCERS pension and separated from an eligible bargaining unit, are eligible for a retiree health plan on the first day of the month following retirement.

• Spouses and domestic partners are eligible for coverage.

• Dependent children are eligible for coverage to the end of the calendar month in which they turn 26.

• Dependent children who are permanently disabled before age 26 are eligible for coverage as a dependent child after age 26.

• Additional eligibility provisions may be added to meet the ACA – Employer Shared Responsibility provisions.

Stop Loss:

The County implemented Stop Loss coverage for the Wellwise and Sharewell programs effective January 2024.

Stop Loss coverage is provided by Voya and the individual stop loss deductible is $1.5 million on a 15/12 contract basis.

Health Savings Account:

Members enrolled in the County’s Sharewell high deductible health plans are eligible to participate in a Health Savings Account (HSA). Currently, members open accounts on their own, which are not sponsored by the County.

The County may consider adding access to an HSA through the County in future years. The County may consider working with a health plan or third party in the future to manage and administer HSAs.

Contract Intent:

Services/Employee Benefits

RFP #017-202403-MC

Claims Administration for the Self-

Insured Preferred Provider Organization (PPO) Health Plans

The intent of this Contract is to provide complete claims administration services, including customer service, for the County’s four existing self-insured PPO health plans and potentially new HPN PPO health plans, and a California and National Medical PPO network with access to providers and negotiated discounts for its employees and retirees. The County desires to have all implemented services and plans requested through this RFP, including the new potential HPN self-insured PPO health plans, be awarded to a single Contractor, should any Contract be awarded. The County will not entertain a division of medical services by two or more Contractors.

The County’s goal is to find a single Contractor who has demonstrated a history of successfully providing health claims administration services for public employers of a similar size and complexity as the County of Orange. The desired Contractor will provide our County Participants with high quality customer service, industry standard technologies and systems, and best practice methods to ensure accurate administration of claims in accordance with the health plan documents, as well as efficient, effective, and timely claims processing and reporting. The desired Contractor will provide access to a large network of quality PPO providers with discounts negotiated to provide optimum savings to the County of Orange and its Plan Participants

B. PROPOSED TIME SCHEDULE

Date Action

February 15, 2024 RELEASE OF RFP

February 23, 2024 Questions from Offerors to be submitted electronically via OPENGOV, https://procurement.opengov.com [RFP #017- 202403-MC] by 4:00 P.M. (Pacific Time)

March 1, 2024 Issuance of Addendum (Questions and Answers)

March 15, 2024 Deadline for Proposals (Closing Date) – On or before March 15, 2024 at 4:00 P.M. (Pacific Time)

March 15, 2024 – April 15, 2024 EVALUATION OF PROPOSALS

April 22, 2024 – April 26, 2024 Finalist Interviews/Offerors’ Oral Presentations – The most responsive proposals may be asked to give an oral presentation within seven (7) calendar days of notification.

July 2024 Submission for Approval of Final Contract by the Board of Supervisors

January 1, 2025 Contract Start Date

* Please note the County reserves the right to modify the proposed RFP time schedule in its sole and absolute discretion if the County determines a modification is necessary.

C. INSTRUCTIONS TO OFFERORS AND PROCEDURES FOR SUBMITTAL

By submitting a Proposal, the Offeror represents that it has thoroughly examined and agrees to provide the services required under this RFP as detailed in Section III: Model Contract, and that it is capable of providing the services to achieve the County’s objectives. Offeror must abide by all provisions of the Model Contract unless Offeror notes

Services/Employee Benefits

RFP #017-202403-MC

Claims Administration for the Self-

Insured Preferred Provider Organization (PPO) Health Plans its objections in its Proposal. As noted below, if the Offeror cannot abide by any provisions of the Model Contract, Offeror must make notice of which provisions it cannot comply with in its Proposal.

Each Offeror must submit its Proposal in strict accordance with all requirements of this RFP and compliance must be stated in the Proposal. Deviations, clarifications and/or exceptions must be clearly identified and listed separately as alternative items for the County’s consideration.

1. Proposal Close Date and Time: Proposals are due on or before March 15, 2024, no later than 4:00

P.M. (Pacific Time) and must be submitted electronically via OPENGOV, https://procurement.opengov.com [RFP #017-202403-MC]. For assistance on uploading proposals to OPENGOV, please contact the OPENGOV Support Team via email at procurement-support@opengov.com.

The County will not accept proposal(s) after the due date and time specified above in section B.

RE: RFP No. [017-202403-MC] for Claims Administration For the Self-Insured Preferred Provider Organization (PPO) Health Plans

Paper, Facsimile and Email proposals will NOT be accepted.

HUMAN RESOURCE SERVICES, EMPLOYEE BENEFITS REGULAR BUSINESS HOURS:

Monday through Friday 8:00 A.M. to 5:00 P.M. (PT)

COUNTY OFFICES WILL BE CLOSED FOR THE FOLLOWING HOLIDAYS:

Lincoln’s Birthday February 12, 2024 President’s Day February 19, 2024 Memorial Day May 27, 2024

2. Clarifications: The County has attempted to provide all information available. It is the responsibility of each

Offeror to review, evaluate, and, where necessary, request any clarification prior to submission of a Proposal.

If any person contemplating submitting a Proposal for the proposed contract is in doubt as to the true meaning of any part of this RFP or finds discrepancies in or omissions from the specifications, he/she may submit a written request for clarification to the assigned Deputy Purchasing Agent, via https://procurement.opengov.com [RFP #017-202403-MC]. For OPENGOV assistance, please contact the OPENGOV Support Team via chat at https://procurement.opengov.com or via email at procurement-support@opengov.com.

3. Addenda: Any interpretation of, or correction to, this RFP will be made only by addendum issued by the

Deputy Purchasing Agent or through OPENGOV. It is the Offeror’s responsibility to access the website, https://procurement.opengov.com,throughout the entire process to obtain the most up-to-date information regarding this procurement process. The County will not be responsible for any other explanations, corrections to, or interpretations of the documents, including any oral information.

There will be No Pre-Proposal Conference for this RFP. Questions regarding the contents of this Proposal must be submitted electronically (via https://procurement.opengov.com [RFP #017-202403-MC] on or before February 23, 2024, at 4:00 pm. (Pacific Time), and directed to the Deputy Purchasing Agent.

4. Validity of Proposals: Proposals must be valid for a period of at least three hundred and sixty-five (365) days from the Closing Date. No Proposal may be withdrawn after the Closing Date.

mailto:procurement-support@opengov.com https://procurement.opengov.com/ https://procurement.opengov.com/ mailto:procurement-support@opengov.com mailto:procurement-support@opengov.com

Services/Employee Benefits

RFP #017-202403-MC

Claims Administration for the Self-

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5. Submission Format: Each Respondent must provide: (1) complete electronic copy of their proposal.

Proposals shall be formatted in the requested format type (PDF, Excel or Word). All pages must be identified sequentially as listed below. Please try to limit file names to 80 characters or less.

Note: Special signature requirements for Corporations

Part 1 – Offeror’s Concurrence/Compliance (PDF format)

Part 2 – Proposal Description (PDF format)

Offeror’s Proposal Questionnaire (Excel format)

Part 3 – Redlined Model Contract, including Attachments A through M, with any additions or deletions shown using “tracked changes”. (Word format)

Part 4 – Additional Items:

• Section III, Exhibit 1 – EDD Independent Contractor Reporting Requirements (PDF format), if not applicable please omit;

• Section III, Exhibit 2 – County of Orange Local Small Business Preference Certification Requirement (PDF format), if not applicable please omit;

• Section III, Exhibit 3 – County of Orange Campaign Contribution Disclosure Form, required for all Offerors (PDF format).

Part 5 – Attachments requested in Proposal Questionnaire

• Implementation Plan

• Communications Plan

• Team Biographies and Organizational Chart

• Plan Summaries

• Network Discount

• Explanation of Benefits

• Annual Report

• Service Organization Controls (SOC) Report

• Cybersecurity Policies

It is imperative that all Respondents responding to this RFP comply exactly and completely with the instructions set forth herein. All responses to this RFP shall be word-processed (except where otherwise provided or noted), concise, straightforward, and must fully address each requirement and question.

Although not as a substitute for a complete written response, additional material, such as technical documents, may be referenced in any response, if the material is included in the same section as additional information.

Note: Allow sufficient time to upload all required files. OPENGOV will not allow any uploads after the due date and time specified herein, e.g., if Part 1 and 2 uploaded successfully at 3:58:38 P.M. and Part 3 is in progress of being uploaded at 4:00:01 P.M., Part 3 will not upload successfully.

6. Confidential, Proprietary or Trade Secret Information: Proposals are not to be marked as confidential or proprietary and must not constitute or contain confidential, proprietary, or trade secret information.

The County may refuse to consider any Proposal so marked.

All Proposals shall become the property of the County. The County reserves the right to make use of any information or ideas in the Proposals submitted. Proposals submitted in response to this RFP may become subject to public disclosure per the requirements of the California Public Records Act, Government Code

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Section 6250 et seq. Please be advised that all information and documents submitted to the County by Offeror shall become non-confidential, non-proprietary, non-trade secret, public records without exception and subject to public disclosure by the County at any time without prior notice to Offeror. The County shall not be liable in any way for disclosure of any such records or part thereof related to this RFP or any Proposal, including, but not limited to, evaluations, proposals, or any other information or records. In submitting the information and documents, the Offeror is agreeing to the County’s release of such information and documents in response to a Public Records request without further notice to the Offeror and is agreeing to indemnify and hold harmless the County for release of such information and documents.

Furthermore, all Proposals shall become the exclusive property of the County. The County reserves the right to make use of any information or ideas contained in the Proposals submitted without exception.

By submitting information and documents to the County as part of this RFP, Offerors acknowledge and agree to the terms of this Section 6.

7. Qualifications: By submitting a Proposal, the Offeror represents that it has thoroughly examined and become familiar with the services required under this RFP and that it is capable of providing the services to achieve the County’s objectives.

8. Compliance: Each Offeror must submit its Proposal in strict accordance with all requirements of this RFP and such compliance must be stated in the Proposal. Deviations, clarifications and/or exceptions must be clearly identified and listed separately as alternative items for the County’s consideration, as specified in Section II, Part 1, Subsection 10, Statement of Compliance. The County, in its sole and absolute discretion, may reject a Proposal if it is conditional, incomplete or deviates from the specifications in this RFP.

9. Presentations/Demonstrations: After the Closing Date, evaluation and Proposal clarification will commence. Offerors who submit Proposals most responsive to the County’s requirements in this RFP, and therefore receive the highest score in the evaluation process, may be invited to give a presentation/demonstration of their Proposal to County staff. This presentation/demonstration will be provided to the County at no cost to the County.

Invited Offeror(s) should be prepared to make their oral presentation/demonstrations within seven (7) calendar days after notifications and be prepared to discuss all aspects of the Proposal in detail, including technical questions regarding the Proposal. Invited Offeror(s) shall not be allowed to alter or amend the Proposal through the use of the virtual presentation/demonstration process. Invited Offeror(s) who cannot attend the virtual presentation/demonstration scheduled as requested may be subject to elimination from the selection process at the County’s sole and absolute discretion.

10. County Rights: The County reserves the right to negotiate modifications with any Offeror as necessary to serve the best interests of the County. Any Proposal may be rejected as non-responsive if it is conditional, incomplete or deviates from specifications in this RFP. The County reserves the right to waive, at its discretion, any procedural irregularity, immaterial defects or other improprieties which the County deems reasonably correctable or otherwise not warranting rejection of the Proposal. No such waiver will excuse a proponent from full compliance.

11. Expenses: Pre-contractual expenses are not to be included in, or as part of Attachment B –

Payment/Compensation for Contractor Services, under the Model Contract. Pre-contractual expenses are defined as including, but not limited to, expenses incurred by the Offeror such as costs incurred in; a.)

preparing its Proposal in response to this RFP; b) submitting that Proposal to the County; c) negotiating with the County any matter related to the Offeror’s Proposal; and d) any other expenses incurred by the Offeror prior to the date of award and execution, if any, of the Contract.

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12. Notice: The County reserves the right to: a) negotiate the final Contract with any Offeror(s) as necessary to serve the best interests of the County; b) withdraw this RFP, in whole or in part, at any time without prior notice; c) award its total requirements to one Offeror or to apportion those requirements among two or more Offerors as the County may deem to be in its best interests; and d) reject any Proposal if it is conditional, incomplete or deviates from the specification in this RFP.

The County makes no representations that any Contract will be awarded to any Offeror responding to this RFP.

Moreover, the County may decide to forego negotiations with the Offeror and accept the Proposal submitted;

therefore, the Proposal submitted should contain the Offeror’s most favorable terms and conditions.

13. Joint Venture: Where two or more Offerors desire to submit a single Proposal in response to this RFP, they should do so on a prime/subcontractor basis rather than as a joint venture. The County intends to contract with a single firm or multiple firms but not with multiple firms doing business as a joint venture.

14. Lobbyist: The County does not require and neither encourages nor discourages the use of lobbyists or other consultants for the purpose of securing business.

15. D-U-N-S Number: The County requires a valid Data Universal Number System (D-U-N-S) number prior to Contract Award. If needed, your company may obtain one at no cost at www.dnb.com. If you are unable to provide/obtain a D-U-N-S number, please indicate so in your proposal/bid submission response.

D. EVALUATION PROCESS AND CRITERIA

Proposals will be evaluated on the basis of the response to all requirements in this RFP. The County DPA will determine which Proposals meet the minimum qualifications stated in Section II of this RFP. Proposals that meet the minimum qualifications will be forwarded to the RFP Evaluation Panel (Panel). The Panel will evaluate and score each Proposal using established criteria that have been weighted based on the purposes of this RFP. The Panel will assign points that measure the responsiveness to each established criterion. The County shall use the following criteria in its evaluations and comparisons of Offeror(s). No inference is to be drawn concerning relative importance of criteria based on the order presented.

Contract award shall be made to the responsive and responsible Offeror(s) whose proposal is most advantageous to the County, taking into consideration the applicable evaluation criteria set forth below. Please note, however, that the listing of fees as an evaluation criterion does not require the County to select the Offeror(s) with the lowest fee proposal.

Proposals will be evaluated on the basis of responsiveness to the questions and requirements in this RFP by an evaluation panel.

Proposals will be competitively evaluated on the basis of the following criteria listed in random sequence not in the order of importance:

• Administrative Capability: Ability to Offeror to demonstrate administrative competence in areas such as implementation, customer service, claim system capability, funding arrangements, etc.

• Cost: Offerors will be evaluated on the Proposed cost to County (Claims cost with network discounts, administrative fees, guaranteed network discounts, and additional costs).

• High-Performance Network (HPN): Ability of Offeror to provide HPN networks and proposed cost savings.

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• Network: Ability of Offeror to minimize network disruption by furnishing a provider network similar to the current network for Wellwise and Sharewell plans.

• Performance Guarantees: Ability to duplicate or enhance proposed performance guarantees.

• Plan Design: Ability of the Offeror to provide the current/proposed plan design, including the ability to auto-adjudicate plan provisions, outlined in the RFP.

• Qualifications and Experience: Experience of Offeror including qualifications, financial condition, prior experience and performance record with similarly sized public entities, including references, technical innovation, transition planning.

• Responsiveness to RFP: Offerors will be evaluated on the extent to which they can accept existing contract provisions (See Model Contract).

Proposals deemed to meet all minimum RFP requirements will be scored based on established criteria, which have been weighted and will be assigned points that measure the responsiveness to each identified criterion.

The total number of points earned will be tallied for each Proposal, and the Proposals will be rank ordered, based upon the Offeror(s) submitted written materials.

Following the initial evaluation process, the highest-ranking Offeror(s) (if deemed necessary by the evaluation panel) may be required to complete an additional questionnaire regarding more specific processes and capabilities, as well as provide additional pricing information. In addition, Offeror’s may be required to provide an on-site interview or clarification as it relates to the requested and/or proposed services.

The cybersecurity questions on Tab T - Other of Exhibit 4 for the highest-ranking Offerors must be reviewed and approved by Orange County Information Technology Enterprise Privacy and Cybersecurity Officer(s).

Offerors may be required to provide additional information as requested. Award of final contract is subject to review and approval of Offerors’ cybersecurity policies and practices.

E. SELECTION/AWARD PROCESS

Upon completion of the evaluation process, the Evaluation Panel will make a recommendation for award to the DPA. Contract award shall be made to the responsible Offeror whose proposal is most advantageous to the County. Upon successful completion of negotiations, the award and executed Contract will be submitted to the Board of Supervisors for approval. In addition, County reserves the right to verify and validate any information prior to Contract Award and during the entire Term of the Contract. The recommendation for award may be presented to the County’s Board of Supervisors for approval of the Contract for the services requested in this solicitation.

The Model Contract contained in Section III of this RFP is the Contract proposed for execution. It may be modified to incorporate negotiated items and other pertinent terms and conditions set forth in this RFP, including special conditions and requirements and those added by addendum, necessary attachments, and to reflect the Offeror’s Proposal and qualifications. The County reserves the right to add or delete provisions, terms or conditions to support the final proposed Contract.

Negotiations may or may not be conducted with the finalist(s); therefore, the proposal submitted should contain Offeror’s most favorable terms and conditions, since the selection and award may be made without further discussion or need for clarification. Any exceptions to the terms and conditions of the proposed Contract or the statements regarding Offeror’s inability to comply with any of the provisions thereof are to be declared in the Offeror’s proposal: Section II entitled Proposal Response Requirements. Any additional exceptions to the terms and conditions made by any Offeror after submission of its proposal may result in elimination from further consideration.

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If a satisfactory Contract cannot be negotiated in a timely manner, the County, in its sole discretion, may terminate negotiations with the selected Contractor and begin Contract negotiations with the next finalist.

F. PROTEST PROCEDURES

Any actual or prospective Offeror, who alleges a grievance in the solicitation or award of the Contract may submit a protest to the Deputy Purchasing Agent. All protests shall be type written on the protester’s letterhead and submitted in accordance with the provisions stated herein.

1. Procedure

All protests shall be typed under the protester’s letterhead and submitted in accordance with the provisions stated herein. All protests shall include at a minimum the following information:

• The name, address and telephone number of the protestor;

• The signature of the protestor or protestor’s authorized representative;

• The solicitation number;

• A detailed statement of the legal and/or factual grounds of the protest;

• The form of relief requested.

2. Protest of Bid/Proposal Specifications

All protests related to bid or proposal specifications must be submitted to the Deputy Purchasing Agent no later than five (5) business days prior to the close of the proposal. Protests received after the five (5) business day deadline will not be considered by the County.

In the event the protest of specifications is denied and the protester wishes to continue in the solicitation process, they must still submit a bid prior to the close of the solicitation in accordance with the bid/proposal submittal procedures provided in the bid/proposal.

3. Protest of Award of Contract:

In protests related to the award of a Contract, the protest must be submitted no later than five (5) business days after the notice of the proposed contract award is provided by the Deputy Purchasing Agent. Protest relating to a proposed contract award which is received after the five (5) business day deadline will not be considered by the County.

4. Protest Process

In the event of a timely protest, the County shall not proceed with the solicitation or award of the contract until the Deputy Purchasing Agent, the County Purchasing Agent or the Procurement Appeals Board renders a decision on the protest.

Upon receipt of a timely protest, the Deputy Purchasing Agent will within ten (10) business days of the receipt of the protest, issue a decision in writing which shall state the reasons for the actions taken.

The County may, after providing written justification to be included in the procurement file, make the determination that an immediate award of the Contract is necessary to protect the substantial interests of the County. The award of a Contract shall in no way compromise the protester’s right to the protest procedures outlined herein.

If the protester disagrees with the decision of the Deputy Purchasing Agent, the protestor may submit a written notice to the Office of the County Purchasing Agent requesting an appeal to the Procurement Appeals Board, in accordance with the process stated below.

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5. Appeal Process If the protester wishes to appeal the decision of the Deputy Purchasing Agent, the protester must submit, within three (3) business days from receipt of the Deputy Purchasing Agent’s decision, a written appeal to the Office of the County Purchasing Agent.

Within fifteen (15) business days, the County Purchasing Agent will review all materials in connection with the grievance, assess the merits of the protest and provide a written determination that shall contain his or her decision on whether the protest shall be forwarded to the Procurement Appeals Board.

The decision of the County Purchasing Agent on whether to allow the appeal to go forward will be final and there shall be no right to any administrative appeals of this decision.

G. EDD INDEPENDENT CONTRACTOR REPORTING REQUIREMENTS

Effective January 1, 2001, the County is required to file federal Form 1099-Misc for services received from a “service provider” to whom the County pays $600 or more or with whom the County enters into a contract for $600 or more within a single calendar year. The purpose of this reporting requirement is to increase child support collection by helping to locate parents who are delinquent in their child support obligations.

The term “service provider” is defined in California Unemployment Insurance Code Section 1088.8, subparagraph B.2 as “an individual who is not an employee of the service recipient for California purposes and who received compensation or executes a contract for services performed for that service recipient within or without the state.” The term is further defined by the California Employment Development Department to refer specifically to independent contractors. An independent contractor is defined as “an individual who is not an employee of the government entity for California purposes and who receives compensation or executes a contract for services performed for that government entity either in or outside of California.”

The reporting requirement does not apply to corporations, general partnerships, limited liability partnerships, and limited liability companies.

Additional information on this reporting requirement can be found at the California Employment Development Department website located at:

http://www.edd.ca.gov/Payroll_Taxes/FAQ_-_California_Independent_Contractor_Reporting.htm.

H. COUNTY OF ORANGE LOCAL SMALL BUSINESS (OCLSB) AND DISABLED VETERAN BUSINESS

ENTERPRISE (DVBE) PREFERENCE

1. OCLSB: Effective January 1, 2020, County of Orange Board of Supervisors adopted the County of OCLSB Preference policy. Implementation of the OCLSB Preference policy supports local businesses, the local economy and the development of the County’s tax base.

To be certified as a Local Small Business by the County of Orange, a business shall meet (1) and (2) below:

1) Local Business requirements:

a. maintains their principal center of operations (i.e., headquarters) within Orange County, and;

b. has:

i. a business address located in the County of Orange that is not a post office box, or http://www.edd.ca.gov/Payroll_Taxes/FAQ_-_California_Independent_Contractor_Reporting.htm

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ii. a valid business license or certificate of occupancy issued by the County of Orange or by an Orange County city, or other documentation acceptable to the County of Orange.

2) Small Business Requirements:

a. must be certified as a Small Business by the State of California Department of General Services (DGS); and,

b. DGS Small Business requirements must be valid at the time of bid/proposal submittal.

2. DVBE: Effective January 1, 2021, County of Orange Board of Supervisors adopted the DVBE Preference policy. The DVBE Preference policy supports local business opportunity, economy and the development of the County’s tax base, and in addition recognizes the service and sacrifice given by the men and women of our Armed Forces.

To be certified as a Disabled Veteran Business Enterprise by the County of Orange, a business shall meet

(1) below:

(1) Disabled Veteran Business Enterprise Requirements:

b. must be certified as a DVBE by the State of California Department of General Services

(DGS); and,

c. DGS DVBE requirements must be valid at the time of bid proposal submittal.

To participate as an OCLSB and/or DVBE, please read and follow the process outlined on EXHIBIT 2 –

COUNTY OF ORANGE LOCAL SMALL BUSINESS (OCLSB) AND DISABLED VETERAN BUSINESS

ENTERPRISE (DVBE) PREFERENCE CERTIFICATION REQUIREMENTS.

I. COUNTY OF ORANGE CAMPAIGN CONTRIBUTION DISCLOSURE (LEVINE ACT)

Exhibit 3, the Campaign Contribution Disclosure Form, must be completed by applicants for, or persons who are the subject of, any proceeding involving a license, permit, or other entitlement for use, including most contracts and franchises, pending before the Board of Supervisors (“Board”) of the County of Orange or any of its affiliated agencies.

IMPORTANT NOTICE

Government Code section 84308 (also known as the “Levine Act”) contains requirements that are summarized generally as follows:

A. If you are an applicant for, or the subject of, any proceeding involving a license, permit, or other entitlement for use, you are prohibited from making a campaign contribution of more than $250 to any member of the Board of Supervisors or other County official who may participate in your proceeding. This prohibition begins on the date your application is filed or the proceeding is otherwise initiated, and the prohibition ends 12 months after a final decision is rendered by the Board of Supervisors or other County officer. In addition, no Board member or other County official who may participate in your proceeding alternate may solicit or accept a campaign contribution of more than $250 from you during this period.

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B. These prohibitions also apply to your agents, and, if you are a closely held corporation, to your majority shareholder as well. These prohibitions also apply to your subcontractor(s), joint venturer(s), and partner(s) in this proceeding. Also included are parent companies and subsidiary companies directed and controlled by you, and political action committees directed and controlled by you.

C. You must file the attached disclosure form and disclose whether you or your agent(s) have in the aggregate contributed more than $250 to any Board member or other County officer who may participate in your proceeding during the 12-month period preceding the filing of the application or the initiation of the proceeding.

D. If you or your agent have…