QandA #1 (DBM Health_SLEOLA_MDOT-MTA Medical_BPM051063) 9.22.2025 FINAL.pdf

Questions and Answers #1

Request for Proposals (RFP) for

DEPARTMENT OF BUDGET AND MANAGEMENT, OFFICE OF PERSONNEL SERVICES AND

BENEFITS (DBM OPSB)

HEALTH PLAN ADMINISTRATION AND SERVICES

[PREFERRED PROVIDER ORGANIZATION, SELF-FUNDED (PPO-SF) AND EXCLUSIVE

PROVIDER ORGANIZATION, SELF-FUNDED (EPO-SF); INTEGRATED HEALTH MODEL,

FULLY-INSURED (IHM-FI); AND POINT SOLUTIONS]

SOLICITATION NUMBER: F10B6600001 / BPM051063

AND

STATE LAW ENFORCEMENT OFFICERS LABOR ALLIANCE (SLEOLA) MEDICAL PLAN

ADMINISTRATION AND SERVICES (PPO, EPO, & POS, SELF-FUNDED)

SOLICITATION NUMBER: F10B6600004 / BPM051063

AND

MARYLAND DEPARTMENT OF TRANSPORTATION MARYLAND TRANSIT ADMINISTRATION

(MDOT-MTA)

MDOT-MTA REPRESENTED MEDICAL & STOP LOSS INSURANCE (PPO-SF AND HMO-SF)

AND VISION (SELF-FUNDED) PLAN HEALTH BENEFITS ADMINISTRATION AND SERVICES

[PREFERRED PROVIDER ORGANIZATION, SELF-FUNDED (PPO-SF) AND HEALTH

MAINTENANCE ORGANIZATION, SELF-FUNDED (HMO-SF)]

SOLICITATION NUMBER: AGY-24-026-SR-A / BPM051063

September 22, 2025

Dear Prospective Offeror:

This list of Questions and Answers #1, questions #1 through # 98, is being issued to clarify certain information contained in the above RFP.

In most instances the Department’s response to the submitted questions merely serves to clarify the existing requirements of the RFP. Sometimes, however, in submitting questions potential Offerors may make statements or express interpretations of contract requirements that may be inconsistent with the Department’s intent. To the extent that the Department recognizes such an incorrect interpretation, the provided answer will note that the

RFP No. F10B6600001 / F10B6600004

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interpretation is erroneous and either state that the question is moot once the correct interpretation is explained or provide the answer based upon the correct interpretation.

No provided answer to a question may in and of itself change any requirement of the RFP. If it is determined that any portion of the RFP should be changed based upon a submitted question, the actual change may only be implemented via a formal amendment to the RFP.

In this situation the answer provided will reference the amendment containing the RFP change.

1. Is the MDOT-MTA’s RFP allowing for standalone vision plan proposals? Or are they only allowing bundled proposals that include medical and vision?

RESPONSE: For Functional Areas 5 and 6, MDOT-MTA is seeking proposal responses that include both medical and vision plans. A proposal response for a standalone vision plan will not be acceptable.

2. Regarding section 2.1.3.4, if a vendor is listed as a subcontractor providing services to an insurance carrier who is responding to Functional Areas 1 and 2, does that preclude the subcontracting vendor from submitting its own proposal for Functional Area 3?

RFP Section 2.1.3.4 states, “If an Offeror submits a proposal for Functional Areas 1, 2, or 4, it IS NOT eligible to submit a proposal for Functional Area 3. Conversely, if a Offeror submits a proposal for Functional Area 3, it IS NOT eligible to submit a proposal for Functional Areas 1, 2, or 4.”

RESPONSE: No, a subcontractor providing services to an insurance carrier who is responding to Functional Areas 1 and 2, does not preclude the subcontracting vendor from submitting its own proposal for Functional Area 3.

3. A full census is requested for FA1, FA4, and FA5 to appropriately analyze discounts, etc.

requested. When will a census be available?

RESPONSE: Once a completed and signed Non-Disclosure Agreement (Offeror) (Attachment 3), identifying the specific functional area which the data is being requested, is received and confirmed by the Procurement Officer, the Procurement Officer will authorize the release of the applicable confidential data to the offeror in a secure manner.

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4. Will a historical claim file be provided (from the previous carrier) to upload to the new carrier’s web portal if October 1, 2026 is the effective date of that portal must be up and running? This would be needed once the award is announced.

RESPONSE: A historical claim file will be provided to the awarded Contractor by either DBM or MDOT-MTA using a secure portal.

5. What is the expected bid notification date?

RESPONSE: Award recommendation(s) and Maryland Board of Public Works approvals are anticipated to occur prior to July 1, 2026, excluding the award for Functional Area 3 (Point Solutions) which is anticipated to be awarded on a separate timeline from the remaining Functional Areas (with a likely effective date later than January 1, 2027).

6. Confirming that these listed below documents DO NOT need to be completed until

NOTICE OF AWARD_ please confirm

Regarding Section 6.6 Documents Required upon Notice of Recommendation for Contract Award RFP Attachments (Table B), please confirm that all documents listed in Table B, except for Attachment D-1A and E-1, E-1A and E-1B, do not need to be submitted with the initial RFP submission.

RESPONSE: As referenced in RFP Section 6.6 (Table B – Documents Required upon Notice of Recommendation for Contract Award), all referenced documentation in Table B for Attachments D (MBE Forms D-1B, D-1C, D-2, D-3A, D-3B) and E (VSBE Forms E-1C, E- 1D, & E-1E, E-2, E-3) are only required to be submitted by the apparent awardee(s) upon receipt of notification from the Procurement Officer of recommended award for a specific functional area, as follows:

MBE

D-1B [Waiver Guidance, Guidance for Documenting Good Faith Efforts to Meet MBE Participation Goal] ~ a separate D-1B is only required if the offeror is requesting a waiver (in whole or in part) of the applicable MBE goal as established for the functional area being proposed;

D-1C [Good Faith Efforts Documentation to Support Waiver Request] ~ a separate D-1C is only required if the offeror is requesting a waiver (in whole or in part) of the applicable MBE goal as established for the functional area;

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D- 2 [Outreach Efforts Compliance Statement];

D-3A [Certified MBE Subcontractor Participation Certification] ~ a separate D-3A form, signed by both the offeror and MDOT Certified MBE Subcontractor, individually identifying the MDOT Certified MBE Subcontractor as identified on the Attachment D-1A; and

D-3B [MBE Prime Project Participation Certification] ~ only required if the offeror is also an MDOT Certified MBE and has proposed its own firm on Attachment D-1A to perform up to 50% of the applicable MBE goal established for the functional area being proposed, signed solely by the offeror.

VSBE

E-1C [Waiver Guidance, Guidance for Documenting Good Faith Efforts to Meet VSBE Participation Goal] ~ a separate E-1C a separate D-1B is only required if the offeror is requesting a waiver (in whole or in part) of the applicable VSBE goal as established for the functional area being proposed;

E-1D [VSBE Subcontractor Unavailability Certificate];

E-1E [VSBE Waiver Request Affirmation and Good Faith Efforts Documentation to Support Waiver Request];

E-2 [VSBE Outreach Efforts Compliance Statement]; and

E-3 [VSBE Subcontractor Participation Statement].

However, as referenced in RFP Section 5.3.2 [TABLE A – Attachments and Documents Required with the Proposal, Tab P for Attachments D [MBE Forms D-1A] and Attachment E [Veteran-Owned Small Business Enterprise (VSBE) Form E-1, E-1A, & E-1B], for the referenced documentation in Table A for Attachments D (MBE Forms D-1B, D-1C, D-2, D- 3A, D-3B) and E (VSBE Forms E-1C, E-1D, & E-1E, E-2, E-3), offerors are required to submit the following separate forms in its technical proposal response for functional area being proposed:

MBE

D-1A [MBE Utilization and Fair Solicitation Affidavit & MBE Participation Schedule, Part 1 through Part 4] ~ a separate D-1A for each functional area being proposed, signed by the offeror, individually identifying the MDOT Certified MBE Subcontractor(s) being proposed to equal the established goal percentage

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VSBE

E-1 [VSBE Utilization Affidavit and Prime/Subcontractor Participation Schedule], E-1A [VSBE Subcontractor Participation Schedule], and E-1B [Signature Page] ~ a separate E-1 for each functional area being proposed, signed by the offeror, individually identifying the eMMA Certified VSBE Subcontractor(s) being proposed to equal the established goal percentage.

7. Hospital Bill Audit Performance Guarantee – ON SITE requirement - FA1: PG-18, FA2:

PG-15, and FA4: PG-18.

PG-18 Annual Hospital Records Claims Audit

Conduct hospital records (including clinical and billing issues) audits for every admission with paid claims in excess of $50,000, subject to a minimum of 2.00% of all hospital claims (See RFP Section 2.3.4.1).

Audits are to be conducted on-site to ensure accuracy of billed charges in relation to the clinical services delivered.

Report Card

Provide quarterly reporting of the number and amount of total paid claims, number of audits performed on claims in excess of $50,000, and the amount of total recoveries to the State Plan.

Frequency of measurement:

Quarterly

$20,000 if performance does not meet minimum standards/goal s in addition to repayment of any necessary recoveries.

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Can this language be updated to consider that the latest hospital procedure is to complete audits electronically? Audit is agreed to but asking for it to be “on-site” is antiquated.

RESPONSE: The State maintains the language as written requiring hospital records claims audits to be conducted on-site. Audits are to be conducted on-site to ensure the accuracy of billed charges in relation to the clinical services delivered.

8. Does responding to the Compliance Checklist in Exhibit 5 satisfy the response requested in the first paragraph of Tab F in Table A of the Proposal Submission Information and Instructions (shown below)?

(The Offeror shall address each RFP requirement (RFP § 2) in its Technical Proposal with a cross-reference to the requirement and describe how its proposed goods and services, including the goods and services of any proposed subcontractor(s), will meet or exceed the requirement(s). If the State is seeking Offeror agreement to any requirement(s), the Offeror shall state its agreement or disagreement. Any paragraph in the Technical Proposal that responds to an RFP requirement shall include an explanation of how the work will be performed.)

RESPONSE: Although there are elements of RFP §2 included in the Technical Proposals (Exhibit 5), solely responding to the Compliance Checklist in Exhibit 5 does not fully satisfy the required responses requested in the first paragraph of Tab F in Table A of the Proposal Submission Information and Instructions.

9. Please confirm pharmacy is not included in the scope of this RFP.

RESPONSE: Pharmacy is not included in the scope of this RFP.

10. Ext_5.TechProp_FA6_Vision_Plan_2025.8.9 contains several references to dental products:

a. Compliance Checklist, items# CC-1, CC-28, CC-38, CC-40, CC-43, CC-47, CC-50, CC-55, CC-56 and CC-60

b. Questionnaire, items # Q-10, Q-20, Q-27, Q-28, Q-33 and Q-45

c. Performance Guarantees, PG-10

Please confirm if the dental references/questions can be ignored and/or provide a version of this document without them.

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RESPONSE: All references/questions related to dental services may be discarded. MDOT- MTA confirms that dental services are not included in the scope of this RFP. See also Amendment #3, item 3.

11. DBM_SLEOLA_MDOT-MTA_Medical_JointRFP_6FAs_Final_8.9.25_, section 2.

Contractor Requirements: Scope of Work, 2.2 Background and Purpose, 2.2.2.4 states:

Due to the large number of SLEOLA employees, diverse population and numerous employee work locations, the State sponsors annual benefit fairs during each annual open enrollment period. The State expects to conduct up to 60 open enrollment and health fairs plus 40 or more annual wellness events throughout the State each year to answer employee and retiree questions and enhance engagement in the plans offered. The Contractor(s) shall be required to attend all open enrollment health fairs and wellness events, both in-person and virtually when specified. The State reserves the right to adjust the number of events if needed. The State reserves the right to adjust the number of events if needed.

Please confirm if the 60 OE/health fairs and 40+ wellness events are currently combined events for DBM and SLEOLA (FA1&2 and FA4). If so, please confirm that if we are only responding to SLEOLA (FA4), we would also be expected to attend all meetings.

RESPONSE: The OE/Health Fairs and Wellness events are combined events for DBM and SLEOLA. Yes, if responding to FA4 only, the expectation is that all events will be attended by the Contractor.

12. Exhibit 5 Functional Area 5: Please confirm if Exhibit 5 for Functional Area 5 contains only an attachment list and no questionnaire. Will a questionnaire be provided later?

RESPONSE: There are 6 separate Technical Proposals (each included in Word as Exhibit 5) for each functional area, which are included on eMMA as follows:

Ext 5.TechProp FA1(PPO_EPO-SF) DBMHealth RFP 2025.8.9 Ext 5.TechProp FA2(IHM-FI) DBMHealth RFP 2025.8.9 Ext 5.TechProp FA3(PointSol) DBMHealth RFP 2025.8.9 Ext 5.TechProp FA4(PPO.EPO.POS) SLEOLA Medical RFP 2025.8.9 Ext 5.TechProp FA5 (Medical HMO-PPO Plans) 8.8.2025 Ext 5.TechProp FA6 (Vision Plan) 8.8.2025

The question references Attachment 5, which is an Excel file for offerors to include its List of All Subcontractors Anticipated/Used During Contract per functional area. It has been noted that a separate Attachment 5 for Functional Areas 1 through 4 was unintentionally omitted on eMMA in its original RFP posting. The missing documents representing Functional Areas 1 through 4

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are included as part of this Questions and Answers #1 response and have been posted to eMMA, as follows:

Atch 5 - FA1 List of All Subcontractors (DBM Health) RFP 2025.9.11 Atch 5 - FA2 List of All Subcontractors (DBM Health) RFP 2025.9.11 Atch 5 - FA3 List of All Subcontractors (DBM Health) RFP 2025.9.11 Atch 5 - FA4 List of All Subcontractors (DBM Health) RFP 2025.9.11

13. RFP Minimum Qualifications 1.1: Minimum Qualifications 1.1 require the offeror to be a registered Third-Party Administrator for the State of Maryland, which currently applies to Functional Areas 1 and 2. Should this only apply to Functional Area 1? Functional Area 2 is a fully insured Integrated HMO, which is not typically registered as a TPA.

RESPONSE: There is a misstatement in the latter part of this question. Functional Area 2 is for a fully insured Integrated Health Model, not a fully insured HMO. The minimum qualifications for Functional Area 2 are accurately stated in RFP Section 1.1.

14. Contract Awards: Could you please provide the expected timeline for awarding contracts associated with all proposals?

RESPONSE: Award recommendation(s) and Maryland Board of Works approvals are anticipated to occur prior to July 1, 2026, excluding the award for Functional Area 3 (Point Solutions) which is anticipated to be awarded on a separate timeline from the remaining Functional Areas (with a likely effective date later than January 1, 2027).

15. RFP 5.2 Proposal Delivery and Packaging: The instructions mention print delivery, but requirement 5.2.1 says hard copy proposals aren’t accepted. Please confirm if hard copy proposals are not required.

RESPONSE: Mention of print delivery in the instructions could not be located in the RFP by the Procurement Officer. However, the State confirms that all proposals shall be uploaded to eMMA Project ID BPM051063 as a Two Part (Double Envelope) Submission, as stated in RFP Sections 5.2.6 and 5.2.7. Proposals delivered by facsimile, e-mail or hard copy paper (hand delivery, USPS mail, courier, FedEx, UPS, etc.) shall not be permitted, accepted, or considered as stated in RFP Section 5.2.1.

16. eMMA Response Portal: There are three RFPs and one set of Technical and Financial envelopes on the eMMA portal, each with a size limit. Are we supposed to submit all

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three proposals in this one set of envelopes, or will separate envelopes be provided for each proposal?

RESPONSE: Technical Proposals for all functional areas for which an offeror is proposing to shall be uploaded to the technical proposal envelope in eMMA. Similarly, Financial Proposals for all functional areas for which an offeror is proposing to shall be uploaded in the financial proposal envelope in eMMA.

17. RFP 2.3 Scope of Work: For requirement 2.3.1.3, would the State please define what is included in the "administrative functions" that cannot be offshored?

RESPONSE: Examples of administrative functions include but are not limited to; customer service operations, claim processing, and data management.

Technical Proposals include the following instructions:

NOTE: If a Response/Explanation/Deviation is being provided, a "No" response must be selected and addressed in "FA1EXHIBIT 5-2: Explanations and Deviations.” This instruction is applicable to all functional area technical proposals.

18. Tab I Reference Checks: Is there any required reference information beyond what Section

5.1 of Exhibit 5 lists? What content is expected under Tab I?

RESPONSE: Reference information is required to be provided in response to the Minimal Qualifications (per functional area) identified in RFP Section 1 (see RFP Section 5.3.2 TABLE A - Attachments and Documents Required with the Proposal, Tab E – Minimum Qualifications), as well as in response to Section 5.3.2 (Table A: Attachments and Documents Required with the Proposal) Tab I, Exhibit 5-1 – Reference Checks.

Reference information must also be provided within each technical proposal (Exhibit 5), as follows:

1) FA1 EXHIBIT 5-1: Plan Information, V. References in Exhibit 5.Technical Proposal

FA1(PPO_EPO-SF) DBMHealth

2) FA2 EXHIBIT 5-1: Plan Information, V. References in Exhibit 5.TechProp FA2(IHM-

FI) DBMHealth

3) FA3 EXHIBIT 5-1: Plan Information, V. References in Exhibit 5. Technical Proposal

FA3(PointSol) DBMHealth

4) FA4 EXHIBIT 5-1: Plan Information, V. References in Exhibit 5. Technical Proposal

FA4(PPO.EPO.POS) SLEOLA

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5) FA5 Exhibit 5-1: Plan Information. V. References in Exhibit 5. Technical Proposal FA5 (Medical HMO-PPO Pla Plans)

6) FA6 Exhibit 5-1: V2ision Technical Proposal in Exhibit 5. Technical Proposal FA6 (Vision Plan)

19. MBE, VSBE, and SBE Requirements: Can a bidder’s subcontracted vendors overlap with the three entities?

RESPONSE: An offeror’s subcontracted vendors may overlap in its response to each individual functional area. However, it shall be noted that if an offeror is awarded a contract for more than one functional area, achievement of the specific MBE and VSBE goals for each functional area are separate and distinct. Functions performed by MBE and VSBE subcontracted vendors under a contract must be achieved, tracked, and reported separately for each awarded functional area.

20. MBE, VSBE, and SBE Requirements: Can VSBE be included in the MBE availability?

RESPONSE: No. The MBE Participation program and VSBE Participation program are two separate and distinct programs. Thus, achievement of each identified MBE and VSBE goal(s) must be achieved, tracked, and reported separately.

21. MBE, VSBE, and SBE Requirements: Are the MBE and VSBE forms required for each functional area? Or can one set of forms be provided?

RESPONSE: As stated in Appendix 4 (MBE Participation Goal) and Appendix 5 (VSBE Participation Goal), separate MBE and VSBE forms must be submitted for each functional area being proposed.

22. Exhibit 1 MBE, VSBE, and SBE Research Factors Template: There are two Exhibit 1 documents. One addresses Functional Areas 1 and 3. The other addresses Functional Areas 5 and 6. Please provide MBE, VSBE, and SBE Research Factors for Functional Areas 2 and 4.

RESPONSE: Exhibit 1 (MBE, VSBE, and SBR Research Factors Template) has been revised to include research factors for Functional Areas 2 and 4. See Amendment #3, Item 4.

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23. Exhibit 5, Compliance Checklist CC-94: Does Segal have a separate data warehouse for fully insured versus self-funded claims data?

RESPONSE: No.

24. eMMA Response Portal "Accept this RFP": We have accepted the RFP multiple times on the eMMA response portal. We also received an email notification indicating we must advance our response from the previous round and that we are now in round 3. Can you please clarify what is needed to "advance our response" between now and when it is time to submit?

RESPONSE: As additional documentation and amendments to the RFP are issued by the State, the eMMA system “advances” its responses to the next available “round.” BPM051063 in eMMA is currently utilizing Round 4, however, it will automatically advance to Round 5 with the posting of this Questions and Answers #1 release.

25. Exhibit 5, Questions related to Medicare: Within the Exhibit 5 questionnaires there are questions related to Medicare. Is SLEOLA looking for coordination of benefits with Medicare or they are seeking a Self-Funding Medicare Plan?

RESPONSE: The Plan is requiring compliance with Medicare COB and MSP regulations in circumstances where Medicare is primary. FA4 is not seeking a self-funded Medicare Plan.

26. Referencing Table A - Attachments and Documents Required with the Proposal (RFP

Document, pg. 83), the following language states, “The Offeror shall address each RFP requirement (RFP § 2) in its Technical Proposal with a cross-reference to the requirement and describe how its proposed goods and services, including the goods and services of any proposed subcontractor(s), will meet or exceed the requirement(s). If the State is seeking Offeror agreement to any requirement(s), the Offeror shall state its agreement or disagreement. Any paragraph in the Technical Proposal that responds to an RFP requirement shall include an explanation of how the work will be performed. The response shall address each requirement in RFP § 2 in order and shall contain a cross-reference to the requirement.”

Please clarify if the vendor’s response to Exhibit 5 satisfies this request/requirement, or does the State want a separate “narrative” level response to each of the specific items in the Scope of Work (RFP § 2).

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RESPONSE: The State confirms that the vendor’s response to Exhibit 5 Does NOT satisfy this requirement. In response to RFP § 5.3.2 (Table A - Attachments and Documents Required with the Proposal), Tab F ~ Exhibit 5 (Offeror Technical Response to RFP Requirements and Proposed Work Plan), the State requires offerors to provide separate “narrative” level responses with a cross-reference to each requirement in the Scope of Work (RFP § 2).

27. Referencing 11A - Subcontractors Questionnaire (Exhibit 5, pgs. 95-100), please clarify if these questionnaires should be completed for both “actual” and “anticipated” subcontractors during the contract period.

RESPONSE: Yes, all questionnaires (per Functional Area) should be completed to include both "actual" and "anticipated" subcontractors, including proposed MBE and VSBE subcontractors.

28. There are many references (noted below) to Dental Plan services within the FA6 MDOT-

MTA Technical Proposal (Ex_5_TechProp_FA6_Vision_Plan) for Vision. Our additional concern is there are compliance checklist items and questions that are not applicable for Vision Plan services. Please confirm if this was simply an error and that we should respond only to those items that we can effectively provide a vision response.

Compliance Checklist: CC1, CC27, CC28, CC29, CC30, CC31, CC32, CC33, CC34, CC38 (l), CC40, CC43, CC47, CC50, CC55, CC56, CC60, CC75 (references vision claims but then talks about dental classes), CC77, CC82

General Questions: Q10, Q13, Q20, Q22, Q27, Q28, Q29, Q33, Q45, Q51, Q58, Q82 Performance Guarantee: PG-10

RESPONSE: All references/questions related to dental may be discarded. MDOT-MTA confirms that dental services are not included in the scope of this RFP. See Amendment #3, Item 3.

29. Referencing 5.3.1 (RFP Document, pg. 81); considering proposal responses are being submitted electronically through many separate files, we respectfully request the State reconsider its requirement to consecutively number all pages for both proposal volumes (i.e., Technical and Financial).

RESPONSE: As stated in RFP § 5.3.1, all pages of both Proposal volumes (Technical and Financial) shall be consecutively numbered from beginning (Page 1) to end (Page “x”) and shall identify the specific and responsive Proposal Tab per page ((as indicated in Table A § 5.3).

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30. Referencing FA1, Exhibit 5-12, Performance Guarantees:

Will the State consider the vendor/carrier’s observed holidays as exceptions to the

24/7 service requirement?

Will the State consider revising performance guarantee language in FA1 Exhibit 5-12, Performance Guarantee section, with the following edits in red font below?

- PG 11: Processing of the State’s Enrollment Eligibility Update Information The Contractor shall process electronic interchange of enrollment data within twenty-four (24) hours of receipt based on the agreed upon schedule.

Explanation: This additional language acknowledges there is a planned schedule in place for ongoing enrollment files.

- PG 18: Annual Hospital Records Claims Audit Conduct hospital records (including clinical and billing issues) audits for every admission with paid claims in excess of $50,000, subject to a minimum of 2.00% of all hospital claims (See RFP Section 2.3.4.1). Audits are to be conducted on-site or remotely to ensure accuracy of billed charges in relation to the clinical services delivered.

Explanation: We request consideration for virtual audits to align with facility preferences and current technology capabilities. Remote audits reduce health risks—especially during flu season or outbreaks—and accommodate facilities with remote teams. Supporting virtual audits reflects a shared commitment to safety, flexibility, and modern practices.

- PG 23: DBM/State of Maryland Claims Eligibility Audits Contractor shall provide response files to Department’s Audit Unit within twenty-five fourteen (14) Business Days of receipt of error report from Department based on the planned quarterly audit schedule.

Explanation: This aligns with the current performance guarantee, which is measured at 25 business days. We also respectfully request that a quarterly audit schedule be provided to ensure sufficient notice and allow the carrier to allocate appropriate resources for the audit.

RESPONSE: FA1 - PG-11: the State declines to consider or implement the alternate/proposed language.

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FA1 - PG-18 – the State declines to consider or implement the alternate/proposed language.

FA1 – PG-23 – the State declines to consider the change in the timresponse timeframe. As the audits are conducted annually, the State declines to consider or implement the alternate/proposed language.

Exceptions to the 24/7 service requirement for observed holidays may be considered but are not guaranteed.

31. Referencing FA4, Exhibit 5-12, Performance Guarantees:

Will the SLEOLA consider the vendor/carrier’s observed holidays as exceptions to the 24/7 service requirement?

Please confirm if it was SLEOLA’s intention for the penalties associated with claims PGs #14, 15, and 16 to have the same penalty amounts as those for the DBM/State of Maryland?

Will the SLEOLA consider revising performance guarantee language in FA1 Exhibit 5-12, Performance Guarantee section, with the following edits in red font below?

- PG 11: Processing of the State’s Enrollment Eligibility Update Information The Contractor shall process electronic interchange of enrollment data within twenty-four (24) hours of receipt based on the agreed upon schedule.

Explanation: This additional language acknowledges there is a planned schedule in place for ongoing enrollment files.

- PG 18: Annual Hospital Records Claims Audit admission with paid claims in excess of $50,000, subject to a minimum of 2.00% of all hospital claims (See RFP Section 2.3.4.1). Audits are to be conducted on-site or remotely to ensure accuracy of billed charges in relation to the clinical services delivered.

Explanation: We request consideration for virtual audits to align with facility preferences and current technology capabilities. Remote audits reduce health risks—especially during flu season or outbreaks—and accommodate facilities with remote teams. Supporting virtual audits reflects a shared commitment to safety, flexibility, and modern practices.

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- PG 23: DBM Claims Eligibility Audits Contractor shall provide response files to Department’s Audit Unit within twenty-five fourteen (14) Business Days of receipt of error report from Department based on the planned quarterly audit schedule.

Explanation: This aligns with the current performance guarantee, which is measured at 25 business days. We also respectfully request that a quarterly audit schedule be provided to ensure sufficient notice and allow the carrier to allocate appropriate resources for the audit

RESPONSE:. FA1 - PG-11: the State will not reconsider the language.

FA1 - PG-18 – the State will not consider the addition FA1 – PG-23 – the State will not consider the change in timeline for a response.

The State will not consider the addition to language as the audits are conducted annually.

Exceptions to the 24/7 service requirement for observed holidays may be considered but not guaranteed.

32. Referencing FA5, Exhibit 5-7, Performance Guarantees:

Would the MDOT/MTA consider revising performance guarantee language in FA5

Exhibit 7, Performance Guarantees, with following edits in red font below?

- PG 1: Telephone Call Availability Average speed of answer by a live service representative is thirty (30) seconds or less during call center live hours. 98% of telephone calls are answered by a live service representative within 30 seconds. The representative must have knowledge of the MDOT/MTA account and be able to address the members’ issue/question.

Explanation: 30 second average speed of answer (ASA) is a strong indicator of client satisfaction for answering member calls. This metric was adjusted in the DBM/State of Maryland and SLEOLA proposals to 30 second ASA. If approved by MDOT/MTA, this metric would be consistent across the 3 groups.

- PG 13: Employee Satisfaction A 90% or higher member satisfaction rate. Measured through a random sample of 10% of all members enrolled in each respective Plan and assessed by MDOT/MTA’s annual Customer Satisfaction Survey. Survey results of MDOT/MTA’s annual Customer Satisfaction Survey. A minimum of 20% of

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surveyed members must respond for the survey results to be valid.

Explanation: The MDOT/MTA survey is conducted by the carrier using paper surveys with a low response rate. We respectfully request that we add a 20% minimum response requirement to the metric.

- PG 12: Annual Hospital Records Claims Audit admission with paid claims in excess of $100,000, subject to a minimum of 2% of all hospital claims. Audits are to be conducted on-site or remotely to ensure accuracy of billed charges in relation to the clinical services delivered.

Explanation: We request consideration for virtual audits to align with facility preferences and current technology capabilities. Remote audits reduce health risks—especially during flu season or outbreaks—and accommodate facilities with remote teams. Supporting virtual audits reflects a shared commitment to safety, flexibility, and modern practices.

- PG 19 Provider Turnover The turnover rate of less than 3% annually for the HMO, PPO, and Vision networks.

Explanation: There are separate vision networks PGs in FA-6 Exhibit 5-12. This reference to vision doesn’t appear to align with those performance guarantees.

Currently, the carrier is conducting the MDOT/MTA employee satisfaction survey.

Starting in 2027, will the annual survey be conducted by the MDOT/MTA as described in PG #13 for medical?

RESPONSE: The State accepts the alternate/proposed language. See Amendment #3, Item 2.

33. Referencing FA6 Exhibit 5-7 Performance Guarantees (Vision):

Would the MDOT/MTA consider revising performance guarantee language in FA6

Exhibit 7, Performance Guarantees, with following edits in red font below:

- PG 1: Telephone Call Availability Average speed of answer by a live service representative is thirty (30) seconds or less during call center live hours. 98% of telephone calls are answered by a live service representative within 30 seconds. The representative must have

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knowledge of the MDOT/MTA account and be able to address the members’ issue/question.

Explanation: 30 second average speed of answer (ASA) is a strong indicator of client satisfaction for answering member calls. This metric was adjusted in the State of Maryland and SLEOLA proposals to 30 second ASA. If approved by MDOT/MTA, this metric would be consistent across the 3 groups.

- PG 12: Employee Satisfaction A 90% or higher member satisfaction rate. Measured through a random sample of 10% of all members enrolled in each respective Plan and assessed by MDOT/MTA’s annual Customer Satisfaction Survey. Survey results of MDOT/MTA’s annual Customer Satisfaction Survey. A minimum of 20% of surveyed members must respond for the survey results to be valid.

Explanation: The MDOT/MTA survey is conducted by the carrier using paper surveys with a low response rate. We respectfully request that we add a 20% minimum response requirement to the metric.

Currently, the carrier is conducting the MDOT/MTA employee satisfaction survey.

Starting in 2027, will the annual survey be conducted by the MDOT/MTA as described in PG #12 for vision?

RESPONSE: The State accepts the alternate/proposed language. See Amendment #3, Item 3.

34. Referencing FA5, Exhibit 5-1, Sections I-V contain “window sub-cells.” When data is entered into the areas where a written response is required, it will move the cells below downward to make room for the entered response. This forces the cells below to move out of view. Because the file is protected we cannot expand the window to view and enter the remaining items within those latter fields/lines of entry. Please reference the “before” and “after” screenshots provided below.

We request a revised file that provides a fix for this problem so that we can effectively enter the data requested for all required fields.

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BEFORE

AFTER

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RESPONSE: When testing the form by MDOT-MTA, the Exhibit appears to be functioning properly. The cell moving "downward" when entering data (as pictured in the screenshot) will not be considered an issue as the document is locked/protected.

35. Should Attachment 1 (No proposal Notice/Vendor Feedback Form) be submitted in advance of the submission date or with our proposals on September 23rd?

RESPONSE: Attachment 1 can be sent any time between now and the 10/6/2025 due date for receipt of proposals.

36. Will there be an extension to the submission date as we are still waiting for data needed to complete our submission?

RESPONSE: The Proposal Due (Closing) Date and Time has been extended to October 6, 2025 @ 3 PM Local Time. See also Amendment #3, item 1.

37. RFP Section 3.19 Non-Disclosure Agreement: When will the State release data files to enable carriers to perform rating analysis?

RESPONSE: Once a completed and signed Non-Disclosure Agreement (Offeror) (Attachment 3), identifying the specific functional area which the data is being requested, is received and confirmed by the Procurement Officer, the Procurement Officer will release the applicable confidential data to the offeror in a secure manner.

38. Proposal Deadline: Due to the delay in receipt of critical information, would the State consider extending the RFP timeline to recover the time lost by not receiving data?

RESPONSE: The Proposal Due (Closing) Date and Time has been extended to October 6, 2025 @ 3 PM Local Time. See also Amendment #3, item 1.

39. Attachment 5 FA5 List of Subcontractors: Attachment 5 is listed as a required attachment for Technical Proposal Tab M for all Functional Areas. There were only two versions provided for FA5 and FA6. Will an Attachment 5 version be provided for the other functional areas?

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RESPONSE: There are 6 separate Technical Proposals (each included in Word as Exhibit 5) for each functional area, which are included on eMMA as follows.

Ext 5.TechProp FA1(PPO_EPO-SF) DBMHealth RFP 2025.8.9 Ext 5.TechProp FA2(IHM-FI) DBMHealth RFP 2025.8.9 Ext 5.TechProp FA3(PointSol) DBMHealth RFP 2025.8.9 Ext 5.TechProp FA4(PPO.EPO.POS) SLEOLA Medical RFP 2025.8.9 Ext 5.TechProp FA5 (Medical HMO-PPO Plans) 8.8.2025 Ext 5.TechProp FA6 (Vision Plan) 8.8.2025

The question references Attachment 5, which is an Excel file for offerors to include its List of All Subcontractors Anticipated/Used During Contract per functional area. It has been noted that a separate Attachment 5 for Functional Areas 1 through 4 was unintentionally omitted on eMMA in its original RFP posting. The missing documents representing Functional Areas 1 through 4 are included as part of this Questions and Answers #1 response and have been posted to eMMA, as follows:

Atch 5 - FA1 List of All Subcontractors (DBM Health) RFP 2025.9.11 Atch 5 - FA2 List of All Subcontractors (DBM Health) RFP 2025.9.11

40. FA2 EXHIBIT 5-12: Performance Guarantees: Will performance be assessed based on quarterly or annual reporting?

RESPONSE: Each Performance Guarantee includes the information included under the Reporting Measurement Column.

41. FA2 EXHIBIT 5-12: Performance: Is there a reason the State is requesting the average speed of answer be measured to the second decimal place? Please share the State’s goal for this type of measure.

RESPONSE: All measurements are required to the second decimal place for consistency in management of contracts.

42. FA2 EXHIBIT 5-12: Performance Guarantees PG7: The reporting measurement is a one-time measure for implementation. Is the implementation measure applicable for incumbent health plans or does this apply to new implementations only?

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RESPONSE: PG-7 is applicable to and required by all Contract Awardees.

43. FA2 EXHIBIT 5-12: Performance Guarantees PG15: Could the State clarify the 2.00% requirement? Does this indicate that if less than 2.00% of claims are under $50,000, then further claims below $50,000 will be subject to audit?

RESPONSE: PG-15 means that is the number of claims over $50,000 is less than 2% of the total paid within the quarter. The hospital records claim audit must be expanded to include claims below $50,000.

44. FA2 EXHIBIT 5-12: Performance Guarantees PG21: Could the State please clarify whether this measure is intended solely for fully insured products, in which recoveries from fraud or errors would result in funds being returned to DBM for claims payments?

RESPONSE: This measure is applicable to the Contract(s) awarded under Functional Area 2 – Fully-Insured Integrated Health Model.

45. Who are the current incumbents on the contracts?

RESPONSE: The current incumbents on the current contracts are as follows:

DBM Health Plan Administration and Services CareFirst of Maryland, Inc. ~ EPO and PPO United Health Care Services, Inc. ~ EPO and PPO Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. ~ IHM

DBM SLEOLA Medical Plan Administration and Services CareFirst of Maryland, Inc. ~ EPO, PPO, and POS

MDOT-MTA Union Benefit Plans Services and Administration CareFirst of Maryland, Inc. ~ Medical Services (Self-Funded Preferred Provider Organization (PPO-SF) and Self-Funded Health Maintenance Organization (HMO-SF), both including Pharmacy and Vision Benefits AND Dental PPO

46. Regarding the insurance requirements on the solicitation, are the subcontractor required to have the $10,000,000 Cyber Security insurance policy like the Primes in order to be consider as a subcontractor on the solicitation?

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RESPONSE: Provided that the Prime Contractor’s Cyber Security insurance policy (in the minimum amount of $10,000,000, if awarded a State contract) covers the work performed by its subcontractors, the subcontractor is not required to maintain a separate $10,000,000 Cyber Security insurance policy.

47. What are the statistical number of claims processed per year on each of the plan on the solicitation?

RESPONSE: This information is included in the confidential data provided for each functional area. Once a completed and signed Non-Disclosure Agreement (Offeror) (Attachment 3), identifying the specific functional area which the data is being requested, is received and confirmed by the Procurement Officer, the Procurement Officer will release the applicable confidential data to the offeror in a secure manner.

48. Who are the incumbent on the each of the plan listed on the solicitation?

RESPONSE: See the response to Question #46.

49. Is the solicitation new or renewal bid?

RESPONSE: This is a new solicitation requesting proposals addressing the work to be provided under the functional areas as identified in the RFP.

50. What are the challenges faced on the previous contract if the solicitation is a renewal bid?

RESPONSE: This is a new solicitation requesting proposals addressing the work to be provided under the functional areas as identified in the RFP. This is not a renewal bid.

51. Would an entity in the same corporate family where an organization has indirect control be allowed to provide a bid on this functional area?

RESPONSE: It is unclear which functional area is being referenced in this question, however, if an entity in the same corporate family where an organization has indirect control intends to submit a proposal for Functional Areas 1, 2, or 4, it IS NOT eligible to submit a proposal for Functional Area 3. Conversely, if an entity in the same corporate family where an organization

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has indirect control intends to submit a proposal for Functional Area 3, it IS NOT eligible to submit a proposal for Functional Areas 1, 2, or 4.

52. Referencing the file titled “MTA_VisionClaimsExtract_202504”, please confirm that this file is intended to be used for the vision claims repricing (as indicated in the FA5 Financial Workbook). If so, there are no established column(s) indicated where to input repriced data. Please provide instructions to remedy the existing file or provide a revised version.

RESPONSE: Prospective offerors should use data files provided by the Procurement Officer on the secure portal to prepare and submit its own re-pricing data file.

53. Referencing the files titled “FP7 Attachment 6c HMO 2024 claims reprice” and “FP7

Attachment 6bPPO 2024 claims reprice”, a key data element (Provider Tax ID# (TIN)) is not provided. Only an NPI number is provided. A TIN number (with an NPI) will provide more accurate provider disruption and claims repricing results.

RESPONSE: The MDOT-MTA is not requiring a TIN number. Claims repricing results with a National Provider Identifier (NPI) will be sufficient.

54. Unlike FA1 and FA4, we do not see where Geo Access Reporting is being requested for the HMO and PPO offering under FA5. Please confirm; and if Geo Access Reports are requested, please confirm if the access parameters should match those provided in FA1 and FA4

RESPONSE: Geo Access reporting is not needed for Functional Area 5.

55. We do not see where Geo Access Reporting is being requested for the Vision offering under FA6. Please confirm; and if Geo Access Reports are requested, please provide the access parameters.

RESPONSE: The MDOT-MTA is not requesting Geo Access parameters for Vision plans.

56. Who are the current incumbents on the contracts?

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57. Regarding the insurance requirements on the solicitation, are the subcontractor required to have the $10,000,000 Cyber Security insurance policy like the Primes in order to be consider as a subcontractor on the solicitation?

RESPONSE: See the response to Question #47.

58. What are the statistical number of claims processed per year on each of the plan on the solicitation?

RESPONSE: The available data from calendar year 2023 is provided in the chart below by

DBM.

The MDOT-MTA does not have this data at this time.

59. Who are the incumbent on the each of the plan listed on the solicitation?

60. Is the solicitation new or renewal bid?

RESPONSE: See the response to Question #52.

61. What was the subcontractor requirements on the previous contract if the solicitation is a renewal bid?

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62. What are the challenges faced on the previous contract if the solicitation is a renewal bid?

63. What are the statistical number of claims processed in the past 5 years for each plan benefits?

64. Is it possible to see the breakdown of the processed claims for each plan benefits for the past 5 years?

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65. Can you share the evaluation criteria/scoring for Point Solutions under a fertility benefit?

RESPONSE: The evaluation criteria will incorporate the measurable need incorporate internal data, the minimum qualifications outlined in the RFP Documents, and references from employers who have seen proven results.

66. Do the MBE and VSBE subcontractor goals for Point Solutions apply to individual offerors or to the entire candidate pool for Functional Area 3?

RESPONSE: The MBE and VSBE subcontractor goals for Point Solutions apply to each awarded contract for Functional Area 3 and must be achieved separately from one another The MBE Participation program and VSBE Participation program are two separate programs.

Thus, achievement of each identified MBE and VSBE goal(s) must be achieved and reported separately.

67. Can you provide the State's preferred address for inclusion in our certificates of insurance?

RESPONSE: A copy of the offeror(s) certificate of insurance must be included in its response to RFP § 5.3.2 TABLE A - Attachments and Documents Required with the Proposal, Tab L, Certificate of Insurance.

68. In the Exhibit 5 (for Functional Area 3) compliance checklist, Q-55 asks for information on our billing, member services, and eligibility enrollment systems. Can you clarify if you're looking for specific platforms or vendors - or how we manage those systems (if they're all done in-house)?

RESPONSE: An offeror(s) response to Q-55 (for Functional Area 3) should include specifics regarding platforms and vendors as applicable. Include all necessary and applicable detail.

69. Referencing FA1, Exhibit 5-12, Performance Guarantees:

Will the State consider revising performance guarantee language in FA1 Exhibit 5-12, Performance Guarantee section, with the following edits in red font below?

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- PG 4: Complaint Resolution Time Contractor shall:

a) acknowledge receipt of the 98% of written complaints to the State and Member within five (5) two (2) Business Days of receipt of the complaint letter;

b) provide a 98% written complaint response rate to the State and Member within thirty (30) twenty-one (21) Business Days following receipt of the initial complaint letter.

a) $1,000 for each percentage point below 98%. Business Day late, beginning after the due date of the acknowledgment receipt letter.

b) $1,000 for each percentage point below 98%. Business Day late, beginning after the due date of the late written complaint response.

Explanation: We are concerned that both the acknowledgment and the response letters would contain protected health information that when provided to the State for this purpose may not be in compliance with the minimum necessary standard of HIPAA.

We are also concerned with the rigidity of this metric’s requirement. We currently have Service Level Agreements (SLAs) related to our correspondence with strategic vendors that would place us out of compliance with the performance guarantee as originally drafted.

Lastly, we respectfully request reconsideration for the penalty structure of this metric. Rather than a fee for each business day, we ask the State to consider the penalty as a flat rate for each percent point below the threshold similar to other metrics in the bid.

- PG 21: Disease Management Outreach 95.00% of members meeting criteria for receiving an outreach call (and have a telephone number in the State’s eligibility system) or an email (if there is an email address in the State’s eligibility system)

Explanation: We find we are more effective in connecting with members when we first send an email to alert the member they should expect an outreach call.

RESPONSE:

FA1 - PG-4: The State declines to consider or implement the alternate/proposed language.

FA1 - PG-21 – The State declines to consider or implement the alternate/proposed language as we do not share email addresses through the eligibility system.

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70. Referencing FA4, Exhibit 5-12, Performance Guarantees:

Will the SLEOLA consider revising performance guarantee language in FA4 Exhibit 5-12, Performance Guarantee section, with the following edits in red font below?

- PG 4: Complaint Resolution Time

Contractor shall:

a) acknowledge receipt of the 98% of written complaints to the State and Member within five (5) two (2) Business Days of receipt of the complaint letter;

b) provide a 98% written complaint response rate to the State and Member within thirty (30) twenty-one (21) Business Days following receipt of the initial complaint letter.

a) $1,000 for each percentage point below 98%. Business Day late, beginning after the due date of the acknowledgment receipt letter.

b) $1,000 for each percentage point below 98%. Business Day late, beginning after the due date of the late written complaint response.

Explanation: We are concerned that both the acknowledgment and the response letters would contain protected health information that when provided to the State for this purpose may not be in compliance with the minimum…