QandA #3 (DBM Health_SLEOLA_MDOT-MTA Medical_BPM051063) 9.26.2025 FINAL.pdf

Questions and Answers #3

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 26, 2025

Dear Prospective Offeror:

This list of Questions and Answers #1, questions #159 through #195, is being issued to clarify certain information contained in the above RFP. This numerical sequencing begins with question #159; questions #1 through #98 were answered in Questions and Answers #1, issued on September 22, 2025; and questions #99 through #158 were answered in Questions and Answers #2, issued on September 25, 2025.

As previously advised, 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

RFP No. F10B6600001 / F10B6600004

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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 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.

159. On page 6 of the solicitation the subject of multiple or alternate proposals states the following: “Multiple or alternate proposals for a single Functional Area of this RFP will not be accepted.” Which leads to a question we view as proprietary. Allow us to explain.

Our firm has several provider networks PPO which we can combine into one network allowing provider reimbursement to be made at the lowest possible contracted amount.

We would like to re-price the claims files using both network reimbursement models.

We do not want to violate any of the procurement rules so our question is: May we submit two claims repricing files to allow the state to choose the most financially advantageous network reimbursement model?

RESPONSE: Multiple pricing models will not be accepted for submission at this stage of the procurement process. However, the State will conduct internal discussions on this matter and may consider allowing multiple pricing models to be submitted during the BAFO stage.

160. To better understand the potential impact of our solution we can perform analyses and share savings opportunities. To support these analyses, we are requesting the below data:

a. Employee or member (preferred) census fi le with zip, age, sex, date of hire, plan elections, plan coverage tier. If employee census, then coverage ratio is needed. No PHI

i. Average age, sex, tenure by plan with roll up of enrollment by plan and coverage tier, and list of member zip codes is sufficient.

b. Actuarial value or metallic level of plans offered

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c. 24 months aggregate enrollment by month

d. 24 months aggregate allowed & paid incurred medical & rx claims with 3 months of runout by month

e. HCC reporting for claimants above $150,000 with medical and Rx spend (separate), HCC diagnosis, member age and gender (other HCC thresholds accepted)

f. 2 years top 10 conditions by spend

g. 2 years of historical carrier ABRs/annual reports

h. 12 months of rendering provider NPI

i. 24 months utilization and allowed cost by site of care split out by year (incurred with 3 months of runout) (see table below)

Site of Care Utilization per 1000 Allowed Cost PMPM ER Facility Inpatient Facility - Medical/Surgical/Maternity

Inpatient Facility - Other Inpatient Psych Facility Ambulance DME and Supplies Other Facility Other nonfacility OP Facility - Surgery OP Facility - Other Pharmacy Professional - All Other Professional - Behavioral Professional - Cardiovascular Professional - Emergency Room Professional - Office Visits - PCP Professional - Office Visits - Spec Professional - Pathology/Lab Professional - Radiology Professional - Surgery

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Professional - Urgent Care

RESPONSE: Accordingly, the Proposals Due (Closing) Date and Time for Functional Area 3 (Point Solution) has been extended to allow DBM OPSB adequate time to devote to the review, evaluation, and award of these functional areas within a separate timeframe from Functional Areas 1, 2, and 4. It will also allow DBM OPSB sufficient time to provide the requested data in the above-referenced table. See also Amendment #4, Item 1.

161. For FA6 MDOT-MTA Vision: Please provide monthly vision claims experience with employee enrollment for the current plan, ideally for the past 3+ years if available?

RESPONSE: This information is located on the secure portal, which the portal and login credentials were provided to all Offerors who submitted a completed and signed Non- Disclosure Agreement (Offeror) (Attachment 3) to the Procurement Officer identifying the specific functional area for which the data is requested.

The MS Excel spreadsheet is titled "Paid Vision Claims."

162. For FA6 MDOT-MTA Vision: Can the current vision ASO fee or any fee history be provided?

RESPONSE: This information is not currently available.

163. For FA6 MDOT-MTA Vision: Can employees elect vision coverage independently of medical, or is the vision plan tied to the medical coverage election?

RESPONSE: Yes. employees may elect vision coverage independently of its medical coverage election.

164. For FA6 MDOT-MTA Vision: Were any plan changes made to the vision plan over the last few years? If so, what were the changes and when were they effective?

RESPONSE: There have been no changes over the past few years.

165. For FA6 MDOT-MTA Vision: Apdx_2.FinProp_FA6_Medical_Vision_Plans, Atch

4 Admin and NAF tab – Please clarify what the expectation is around the “vendor

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share of MTA’s annual open enrollment costs”, specifically how is the vendor share determined.

166. MTA_EnrollmentExtract_202504 lists multiple rows per member. Please confirm if we should only include rows with a term date of 12/31/9999 or if all rows should be included. This file does not clearly note which subscribers are active employees and which are retirees, not does it supply vision coverage elections. Would you please clarify or provide a revised census that includes subscriber status and vision coverage election?

167. MTA_EnrollmentExtract_202504 only lists participating members. Would you please confirm the total number of eligible (Active EE’s and eligible Retirees)?

168. Ext_5.TechProp_FA5__Medical_HMO-PPO_Plans__8.8.2025, General

Information, Q#11: Please confirm if you would like 2022-2023 data or 2023-2024 data for this question.

RESPONSE: MDOT-MTA is seeking 2023-2024 data in response to this question.

169. Ext_5.TechProp_FA5__Medical_HMO-PPO_Plans__8.8.2025, Network

Management, Q#40: Please confirm if you would like 2022, 2023, or 2024 data for this question.

170. Ext_5.TechProp_FA5__Medical_HMO-PPO_Plans__8.8.2025, General

Information, Q#9: Please confirm if you would like 2022-2023 data or 2023-2024 data for this question?

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171. Ext_5.TechProp_FA5__Medical_HMO-PPO_Plans__8.8.2025, Claims

Administration, Q#111 & Q#112: Please confirm if you would like 2022-2023 data or 2023-2024 data for this question?

172. Please provide monthly medical claims experience, with enrollment #s, for the most recent 36 months.

RESPONSE: See the response to Question #161.

173. MTA_MedicalClaimsExtract_Full (12 mo., 16 mo. & 12 mo. receent): Files do not contain billed or allowed amount for each claim. We need at least billed or allowed amount in order to utilize these reports.

174. FP7 Attachment 6b PPO 2024 claims reprice & FP7 Attachment 6c HMO 2024 claims reprice: The provided files do not contain all data fields necessary for us to complete a repricing. Please provide revised files that include all of the following:

• Unique member identifier

• Provider TIN

• Provider Name

• Provider City

• Provider state

• Provider zip code

• Diagnosis Code 1

• Diagnosis Code 2

• Diagnosis Code 3

• Provider type indicator

• Place of service indicator

• Revenue code

• Bill type indicator - if provider type indicator cannot be provided

• Service units

• CPT Code

• CPT code modifier

• Eligible billed charges

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175. Please provide the broker/consultant name and firm name, if applicable. Line-by-line claims reprice results requires a signed NDA; however, we have extant NDAs with several firms we would be able to utilize depending on current broker/consultant.

176. Please clarify the out-of-network allowed benefit/MRC (80th, 100th, 125th etc.).

177. Ext_5.TechProp_FA5_Medical_HMO-PPO_Plans_8.8.2025, III. Medical Delivery

Systems, #5 Participants Access to Currently Utilized Providers states: It is important to MTA that your proposed networks(s) offer In-Network Participating Status for healthcare providers utilized by its enrolled medical plan population. Using FA5 Exhibit 1 Medical HMO and PPO Census, FA5 Exhibit 1 Medical HMO Claim File and FA5 Exhibit 1 Medical PPO Claim File provide detailed network match/disruption report(s) and summarize the findings in the tables below for each plan network you are proposing (HMO, PPO). Prepare the reports using the following:

1. Current HMO claims and enrollment against your proposed HMO network and 2.

Current PPO claims and enrollment against your proposed PPO network. Provide the detailed report files containing details supporting these summarized results in unlocked Excel format in the same order of presentation that was provided by MTA for your use in developing these reports. Do not send the data in a read-only file.

The census and claim data needed to perform this reporting is available for download upon execution and return of the RFP Exhibit 3 Non-Disclosure Agreement (Contractor). Label the completed detail report as “FA5 Exhibit 5: Medical HMO and PPO Network Match/Disruption Report.”

MEDICAL HMO NETWORK MATCH/DISRUPTION SUMMARY RESULTS

TOTAL RECORDS EVALUATED

CURRRENT NETWORK HMO CONTRACTOR PROPOSED

HMO NETWORK

Number Out-of- Network

Number In- Network

% In- Network

Number Out-of- Network

Number In- Network

% In- Network

Inpatient Facility Click here Click here Click here Click here Click here

Click here

Click here

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Outpatient Facility Click here Click here Click here Click here Click

Click here

Click here

Professional Services

Click here Click here Click here Click here Click here

Click here

Click here

Lab/Radiology Click here Click here Click here Click here Click here

Click here

Click here

Claimants Click here Click here Click here Click here Click here

Click here

Click here

Total Charges (Dollars)

Click here Click here Click here Click here Click here

Click here

Click

MEDICAL PPO NETWORK MATCH/DISRUPTION SUMMARY RESULTS

TOTAL RECORDS EVALUATED

CURRRENT NETWORK PPO CONTRACTOR PROPOSED

PPO NETWORK

Number Out-of- Network

Number In- Network

% In- Network

Number Out-of- Network

Number In- Network

% In- Network

Inpatient Facility Click here Click here Click here Click here Click here

Click here

Click here

Outpatient Facility Click here Click here Click here Click here Click here

Click here

Click here

Professional Services

Click here Click here Click here Click here Click here

Click here

Click here

Lab/Radiology Click here Click here Click here Click here Click here

Click here

Click here

Claimants Click here Click here Click here Click here Click here

Click here

Click here

Total Charges (Dollars)

Click here Click here Click here Click here Click here

Click here

Click

The files provided for disruption analysis, FP7 Attachment 6d PPO 2024 Provider Match and FP7 Attachment 6e HMO 2024 Provider match, do not include current network status or billed amounts (dollars) and do not break out provider types as specified in the file. We are unable to complete this chart using the files provided.

Please provide clarification on how we are to proceed with this request.

178. DBM_SLEOLA_MDOT-MTA_Medical_JointRFP_6FAs_Final_8.9.25_, 4 Proposal

Submission Information and Instructions, 4.14.3 states: If the Offeror is the subsidiary of another entity, all information submitted by the Offeror, including but not limited to references, financial reports, or experience and documentation (e.g. insurance policies, bonds, letters of credit) used to meet minimum qualifications, if any, shall pertain exclusively to the Offeror, unless the parent organization will guarantee the performance of the subsidiary. If applicable, the Offeror’s Proposal shall contain an

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explicit statement, signed by an authorized representative of the parent organization, stating that the parent organization will guarantee the performance of the subsidiary.

The above RFP section mandates that any requested documentation pertains exclusively to the bidding entity; however, to comply with this request and provide the requested financials for our bidding entity, we respectfully request that MODT-MTA and SLEOLA sign the NDA that we have provided with the submission of these questions. Separate signed NDAs would be required for each group.

RESPONSE: Please note that DBM OPSB and MDOT-MTA, and other Maryland State agencies, always treats the submission of company financials (which are not publicly reported or available) as confidential and proprietary, and confirms that this information/documentation is never released to any requestor in response to a Public Information Act (PIA) submission. As a result, DBM OPSB and MDOT-MTA declines to sign the requesting organization’s NDA.

179. Are there plans to offer FA3 – Point Solutions to the MDOT and SLEOLA groups ?

RESPONSE: The State currently has no plans to extend Point Solutions (FA3) to members insured under Functional Areas 4, 5, or 6.

180. Given that signatures and various forms are required as part of this submission, will the State accept a Technical Proposal submission in searchable PDF format only (formal bid and confidential/redacted), instead of Microsoft Word AND PDF?

RESPONSE: No. As stated in RFP § 5.2.7, Technical Proposals shall be submitted as a Two Part (Double Envelope) Submission and shall consist of (1) Technical Proposal and all supporting material in Microsoft Word format, version 2010 or greater, and (2) Technical Proposal in searchable Adobe PDF format, and (3) a second searchable Adobe copy of the Technical Proposal, with confidential and proprietary information redacted (see RFP §

5.3.2. Table A, Tab B “Claim of Confidentiality”).

Additionally, Financial Proposals shall be submitted as a Two Part (Double Envelope) Submission and shall consist of (1) Financial Proposal entered into the price form spreadsheet within eMMA and all supporting material in Excel format, and (2) Financial Proposal in searchable Adobe PDF format, and (3) a second searchable Adobe copy of the Financial Proposal, with confidential and proprietary information removed (see RFP §

5.3.2. Table A, Tab B “Claim of Confidentiality”).

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However, the State will accept electronic signatures on all Word and PDF documents for which a signature is required.

181. Ext_4.IT_ProfSvcsSuptl_DBM_Health_SLEOLA_MDOT_MTA_RFP_2025.8.9.

Within this appendix document, in Section 1.6 - Required Project Policies, Guidelines and Methodologies, the referenced links listed below appear to be broken, and once clicked we receive a “page you requested cannot be found” error. Please send working links, so our team is able to review the information:

○ A. The State of Maryland System Development Life Cycle (SDLC) Methodology:

https://doit.maryland.gov/SDLC/Pages/agile-sdlc.aspx

○ B. The State of Maryland Information Technology Security Policy and Standards at: https://doit.maryland.gov/policies/Pages/ContractPolicies.aspx

○ C. The State of Maryland Information Technology Non-Visual Standards at:

https://doit.maryland.gov/policies/Pages/nva.asp

○ D. The State of Maryland Information Technology Project Oversight at:

https://doit.maryland.gov/epmo/Pages/ProjectOversight.aspx

RESPONSE: See a revised version of Exhibit 4. Information Technology (IT) and Professional Services Supplemental in Amendment #4, Item 4.

182. Ext_4.IT_ProfSvcsSuptl_DBM_Health_SLEOLA_MDOT_MTA_RFP_2025.8.9”.

Within this appendix document, in Section 1.6 - Required Project Policies, Guidelines and Methodologies, we would like to confirm that Reference H, ‘Purchasing and Recycling Electronic Products’ policy is applicable to FA3 Point solution bidders, if we are not proposing to deliver “Electronic and IT Products” to Maryland State or agencies that are covered under this specification/policy.

RESPONSE: Yes, the State confirms that Reference H, ‘Purchasing and Recycling Electronic Products’ policy is applicable to FA3 (Point Solution).

183. FA3 EXHIBIT 5-4: Compliance Checklist -Question CC-28. Is the State of Maryland requesting that a unique ID be included in all communications to members, both pre and post enrollment?

RESPONSE: Yes, the State of Maryland is requiring the Contractor to generate/utilize a unique ID in all communications to members, both pre and post enrollment.

https://doit.maryland.gov/SDLC/Pages/agile-sdlc.aspx https://doit.maryland.gov/policies/Pages/ContractPolicies.aspx https://doit.maryland.gov/policies/Pages/nva.asp https://doit.maryland.gov/epmo/Pages/ProjectOversight.aspx

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184. FA3 EXHIBIT 5-4: Compliance Checklist -Question CC-29. Please provide additional details on the frequency and what these meetings entail; for purposes of this proposal, shall we assume monthly (12) meetings annually?

RESPONSE: The primary focus for these meetings is data analysis and review. The initial frequency will be quarterly and is subject to change.

185. FA3 EXHIBIT 5-4: Compliance Checklist -Question CC-36. Please confirm that this applies specifically to the State of Maryland’s members.

RESPONSE: Yes, this requirement applies specifically to the State of Maryland’s members.

186. Attachment 5 FA5 List of Subcontractors. Column C will not allow us to wrap text.

Can this be fixed in the template?

RESPONSE: See a revised version of Attachment 5 FA5 List of Subcontractors in Amendment #4, Item 2.

187. Attachment 5 FA6 List of Subcontractors. Column C will not allow us to wrap text.

Can this be fixed in the template?

RESPONSE: See a revised version of Attachment 5 FA5 List of Subcontractors in Amendment #4, Item 3.

188. DBM_SLEOLA_MDOT-MTA Medical JointRFP 6FAs (FINAL 8.9.25). Do

Veteran VSBE's need be listed as vendors in MDOT if they are listed as vendors in Emma?

RESPONSE: No, Veteran VSBE’s are not required to be listed as a vendor in the MDOT MBE database. However, Veteran-Owned companies must complete their self-certification in eMMA in order to establish itself as a VSBE vendor. Upon completion of the self-certification, the State of Maryland will follow-up with the company for the submission of certain required documentation. Once its Veteran-Owned status is confirmed, the company will be assigned a VSBE Certification Number and expiration date.

189. DBM_SLEOLA_MDOT-MTA Medical JointRFP 6FAs (FINAL 8.9.25)_ Section

1.8.7; 2. States “notify the State within 72 hours if there is a threat to Contractor’s

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solution as it pertains to the use, disclosure, and security of State data; and”. Could you please clarify what this means?

RESPONSE: An email notification to the Contract Office, at a minimum, shall be sent within 72 hours if there is a threat to Contractor’s solution as it pertains to the use, disclosure, and security of State data.

190. Sample Contracts Section 45. Could you please provide the “Vendor Green Sales Report template” that is mentioned in the Sample Contract Section 45 Maryland’s Green Purchasing Reporting Requirements?

RESPONSE: See the attached DGS Green Purchasing Reporting Template also available at the following weblink: Resources for Vendors.

191. DBM_SLEOLA_MDOT-MTA Medical JointRFP 6FAs (FINAL 8.9.25) FA 5. Is

MDOT open to a partner Stop Loss Carrier?

RESPONSE: RFP Section 2.4 Scope of Work FA 5 includes stop-loss coverage for medical benefits. Current funding for the MDOT-MTA Medical Plans is self-insured with specific (individual) Stop-loss at $475,000 for medical claims. There is no aggregate stop-loss insurance.

There is no stop loss required for FA 6 vision benefits.

192. Apdx 2- FinProp_FA5_MDOT. Appendix 2.6 contains existing data in the "Trend Factor" row 15. Are we to override this data with the Offeror's trend information?

RESPONSE: No, the trend factor data should not be overwritten.

193. Apdx 2- FinProp_FA5_MDOT. Tab 1 Financial Instruction references an attachment

FA5 FP HMO Attachment 7: HMO provider match. An attachment by this title was not provided. Please confirm that the attachment titled "FP7 Attachment 6e HMO 2024 Provider Match" is what we should use to conduct a disruption analysis.

RESPONSE: This information may be used to conduct a disruption analysis.

https://dgs.maryland.gov/Pages/GreenPurchasing/Resources/ForVendors.aspx

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194. Apdx 2- FinProp_FA5_MDOT Atch 4 Admin and NAF. Tab Atch 4 Admin and

NAF, item b. in the "Notes" section references functional areas 7 and 8. Please provide more information about functional areas 7 and 8.

RESPONSE: There should not be any reference to FA 7 and 8 for MDOT-MTA. Any reference to FA 7 and 8 for MDOT-MTA should be disregarded. See also Amendment #4, Item 5 for a revised Appendix 2. Financial Proposal FA5 (Medical HMO Plans).

195. Ext 5.TechProp FA5 (Medical HMO-PPO Plans) 8.8.2025 (AMEND 3) 2025.9.22.

the attached Exhibit 5 that was provided for response to MDOT FA5 is not editable in the answer column. This is a new MDOT request and document which requires us to complete. Please provide an editable document, so that we can comply with this request.

RESPONSE: This is an editable document, however the setting needs to be changed. Once the document is opened, click the “Viewing” dropdown at the top right and select “Editing.”

The required fields can be edited with this setting change.

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NOTE: This represents the final Answers from the State of Maryland to all prospective offeror questions which were received by the Questions Due Date and Time deadline of September 12, 2025 # 3 PM Local Time.

Should you require clarification of the information provided, please contact me at Andrea.Simmons@maryland.gov as soon as possible.

Date Issued: September 26, 2025 Authorized By: /s/ Andrea R. Simmons

Andrea R. Simmons Procurement Officer

Attachment(s):

SAMPLE Section 5.3.2 'Tabs' in Word 9.26.25 DGS Green Purchasing Reporting Template (Contract Sec. 45) mailto:Andrea.Simmons@maryland.gov