QandA #4 (DBM Health_SLEOLA_MDOT-MTA Medical_BPM051063) 2025.11.24 FINAL.pdf
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- Attached to
- 3-MDOT-MTA Medical/Vision Plan Admin&Svcs, Functional Areas 5 (Medical PPO-SF/HMO-SF) & 6 (Vision)
- Solicitation number
- BPM053905
- Issued by
- Anne Arundel County, Maryland
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Questions and Answers #4
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)
SOLICITATION NUMBER: F10B6600001 / BPM053905
AND
HEALTH PLAN ADMINISTRATION AND SERVICES
POINT SOLUTIONS
SOLICITATION NUMBER: F10B6600014 / BPM053327
AND
STATE LAW ENFORCEMENT OFFICERS LABOR ALLIANCE (SLEOLA) MEDICAL PLAN
ADMINISTRATION AND SERVICES (PPO, EPO, & POS, SELF-FUNDED)
SOLICITATION NUMBER: F10B6600004 / BPM053905
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 / BPM053905 BPM051063
November 24, 2025
Dear Prospective Offeror:
This list of Questions and Answers #4, questions #196 through #204, 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; questions #99 through #152 were answered in Questions and
RFP No. F10B6600001 / F10B6600004 / BPM051063
F10B6600014 / BPM053905
AGY-24-026-SR-A / BPM053905
Answers #2, issued on September 25, 2025; and questions #159 through #195 were answered in Questions and Answers #3, issued on September 26, 2025. As Questions and Answers #3 was incorrectly numbered, there are no questions or answers beginning #153 through #158.
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 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.
196. Formerly Q#162 (from Q&A#3) For FA6 MDOT-MTA Vision: Can the current vision
ASO fee or any fee history be provided?
RESPONSE: Line-item (e.g. administrative fees) pricing for incumbent vendors will not be released. Detailed pricing information is confidential, proprietary, and commercial information which, if disclosed, would potentially damage the competitive position in the marketplace of the current contractor.
197. Formerly Q#165 (from Q&A#3) 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 share of MTA’s annual open enrollment costs”, specifically how is the vendor share determined.
RESPONSE: The Contractor shall share the expenses for producing and distributing all open enrollment materials, including the benefits guide, universal enrollment forms, and other notices or information included in the enrollment kits. The total cost will be shared equally among all active benefit plans and MDOT-MTA. The estimated cost is $3,125.00 per year per plan/program. See also Amendment #11, item 3.
198. Formerly Q#166 (from Q&A#3) MTA_EnrollmentExtract_202504 lists multiple rows per member. Please confirm if we should only include rows with a term date of
F10B6600014 / BPM053905
AGY-24-026-SR-A / BPM053905
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?
RESPONSE: The revised confidential document entitled “CenusExtract11242025.xlsx” uploaded to the MDOT secure ShareFile site provides this requested information
199. Formerly Q#167 (from Q&A#3) MTA_EnrollmentExtract_202504 only lists participating members. Would you please confirm the total number of eligible (Active EE’s and eligible Retirees)?
RESPONSE: The revised confidential document entitled “CenusExtract11242025.xlsx” uploaded to the MDOT secure ShareFile site provides this requested information
200. Formerly Q#173 (from Q&A#3) MTA_MedicalClaimsExtract_Full (12 mo., 16 mo. &
12 mo. recent): 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.
RESPONSE: The revised confidential documents entitled “FP7 Attachment 6b PPO 2024 claims reprice (2).xlsx” and “FP7 Attachment 6c HMO 2024 claims reprice.xlsx” uploaded to the MDOT secure ShareFile site provide this requested information. Current allowed amounts are not shown because those amounts are contracted rates between the current Plan Administrator Network and their participating medical providers. Offerors should enter into the ‘Allowed Amount’ column the contracted rates of their network's participating providers for services identified in each claims line. Sufficient detail has been provided to allow this. Billed amounts are not relevant information necessary for this purpose.
201. Formerly Q#174 (from Q&A#3) 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
F10B6600014 / BPM053905
AGY-24-026-SR-A / BPM053905
• 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
RESPONSE: The documents entitled “FP7 Attachment 6b PPO 2024 claims reprice (2).xlsx” and “FP7 Attachment 6c HMO 2024 claims reprice.xlsx” confidential documents to the MDOT secure ShareFile site provide this requested information. Provider NPI numbers (National Provider Identifier) have been supplied in lieu of Tax ID numbers to enable affirmative provider identification using a unique and legally required identifier. The remaining data fields outlined in this question are included in this data file. Eligible billed charges are not relevant information necessary for this purpose.
202. Formerly Q#175 (from Q&A#3) 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.
RESPONSE: MDOT-MTA declines to provide the name of the broker/consultant firm as this is not relevant information necessary for the purpose of a prospective offeror’s preparation and submission of a proposal response to FA5 and FA6.
203. Formerly Q#176 (from Q&A#3) Please clarify the out-of-network allowed benefit/MRC (80th, 100th, 125th etc.).
RESPONSE: See Exhibit 9 (FA5) Evidence of Coverage (MDOT-MTA PPO) and Exhibit 9.FA5 Evidence of Coverage (MDOT-MTA HMO) for references to allowed amounts for services provided by Non-Preferred providers. These amounts vary and are determined in part by the provider’s location (in-area vs. out-of-area). The MDOT-MTA HMO exhibit will not have an out-of-network amount as all providers are required to be in-network, except for cases of emergencies.
F10B6600014 / BPM053905
AGY-24-026-SR-A / BPM053905
204. Formerly Q#177 (from Q&A#3) 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- Networ k
Number In- Networ k
% In- Networ k
Numbe r Out-of- Netwo rk
Numbe r In- Netwo rk
% In- Netwo rk
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
F10B6600014 / BPM053905
AGY-24-026-SR-A / BPM053905
Total Charges (Dollars)
Click here Click here
Click here
Click here
Click here
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Click
MEDICAL PPO NETWORK MATCH/DISRUPTION SUMMARY RESULTS
TOTAL RECORDS
EVALUATED
CURRRENT NETWORK
PPO
CONTRACTOR
PROPOSED PPO
NETWORK
Number Out-of- Networ k
Number In- Networ k
% In- Networ k
Numbe r Out-of- Netwo rk
Numbe r In- Netwo rk
% In- Netwo rk
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.
RESPONSE: The documents entitled “FP7 Attachment 6d PPO 2024 Provider Match.xlsx” and “FP7 Attachment 6e HMO 2024 Provider Match.xlsx” confidential documents to the MDOT secure ShareFile site provide this requested information to identify the providers currently being used by MTA enrollees. Offerors must complete the yellow shaded areas (Participating/Non- Participating) of this chart to enter its Contractor Proposed HMO Network and Contractor Proposed PPO network.
Number Out-of-Network and Number in-Network in the chart are the total number of providers in your proposed network that fall into these categories by service type. The % In-Network is the Total In-Network number/Total Out-of-Network + Total In-Network. The Specialty Code Description field indicates provider type category under which the provider is contracted in the
F10B6600014 / BPM053905
AGY-24-026-SR-A / BPM053905
current network. Use this data to identify whether the listed providers are participating in your networks under the same provider-type. Indicate status participating (PAR) or not participating (Non-PAR) fields in the columns provided in the data files. Current network provider status are not required of offerors, and billed amounts are not relevant information for purposes of this analysis.
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.
Date Issued: November 24, 2025 Authorized By: /s/ Andrea R. Simmons
Andrea R. Simmons Procurement Officer
Attachment(s):
Appendix 2 Financial Proposal FA5 (Medical HMO Plans) 2025.8.9 (AMEND 11) 2025.11.24 Appendix 2 Financial Proposal FA5 (Medical PPO Plans) 2025.8.9 (AMEND 11) 2025.11.24 Appendix 2 Financial Proposal FA6 (Medical Vision Plans) 2025.8.9 (AMEND
11) 2025.11.24
File details come from the government source that posted it. Updated .