Questionnaire No. 5 - Group Benefit Vision Plan.pdf

City of Miami Questionnaire for RFP No. 2130386

Questionnaire 5 Group Benefit Vision Plan(s)

Completion of this questionnaire is not mandatory, but it is strongly encouraged as failure to do so could negatively impact the overall evaluation score of the

Proposal. Responses will strengthen your technical evaluation and may contribute to your overall proposal score. Please answer in the order presented.

Incomplete responses may affect scoring.

I. General Organization and Experience

1. How long has the Proposer been providing vision care services nationally?

2. How many total covered members and municipal/governmental clients do you currently serve?

3. Provide company profile, including the name, address of the office that will serve the City, and key account contacts.

4. List your three largest municipal or governmental clients by enrollment, with contact information.

5. Disclose any mergers, litigation, or regulatory issues in the past seven (7) years.

II. Plan Design and Member Access

1. Confirm whether members may receive an exam from one provider and obtain materials from another.

2. Describe how members can obtain glasses or contact lenses (e.g., retail, online, app, mail order).

3. Confirm if providers with in-office facilities may dispense materials directly.

4. What are the allowable frequencies for exams, materials, and lenses (calendar year vs. date of service)?

5. Indicate if your plan provides discounts for laser surgery.

6. Can the Proposer match or enhance current benefits?

III. Network Composition and Maintenance

1. Provide the number of Optometrists, ophthalmologists, opticians, and dispensing facilities in the following counties and a column for National: You may use the chart below.

Location

Number of

Optometrists

Ophthalmologists

Opticians

Number of

Dispensing

Facilities

Miami- Dade

Broward

Palm Beach

Monroe

National

2. Break down the participating providers by independent practitioners and/or chain stores for each of the above-listed counties and nationally. You can use the chart below.

County

Number of Independent

Providers

Number of Chain Stores

Miami- Dade

Broward

Palm Beach

Monroe

National

3. Describe how the Proposer would manage situations where a provider refuses to honor agreed-upon discounts to the member.

4. Provide a current 2025 directory in a usable Excel format (NOT .PDF) of the

Proposer’s network providers, by location, including Tax Identification Number

(“TIN”), Name, address and zip code, for your proposed network(s).

5. Is the Proposer willing to add providers specifically requested by the City?

IV. Enrollment and Communication

1. Describe enrollment assistance offered for Open Enrollment, including sample materials.

2. Indicate how members access provider directories (e.g., website, app, phone, print).

3. What communication tools are offered for benefit education and ongoing support?

V. Claims and Eligibility Administration

1. Describe your claims processing system and average turnaround time.

2. Outline your claims appeal process.

3. What information is accessible to employees via phone, website, or app?

4. Confirm if ID cards are issued. Are they provided annually or only once? Is there a charge for replacements?

5. Can the Proposer accept enrollment and eligibility data electronically via a third party?

6. Describe any pre-certification or voucher requirements.

VI. Customer Service

1. What are your customer service hours and protocols for after-hours support?

2. Provide average wait times and call abandonment rates for 2023 and 2024.

3. Describe your member satisfaction guarantee (e.g., warranties, quality guarantees).

4. Is multilingual support available?

VII. Reporting and Data

1. List all standard reports available and whether any involve additional costs.

2. Indicate report frequency (monthly, quarterly, etc.) and provide sample reports.

VIII. Implementation and Support

1. Describe your anticipated role and the City’s role in the implementation process.

2. Identify account management team members, roles, and contact details.

3. Describe how provider and member issues will be escalated and resolved.

4. Can the Proposer accept open enrollment and new hire data electronically through a third party?