Revised Attachment A - Administrative Requirements.pdf

ITN No.: DMS-24/25-232 Group Term Life Insurance Page 1 of 13

REVISED ATTACHMENT A: ADMINISTRATIVE REQUIREMENTS

The Contractor shall comply with and provide Services in accordance with the Administrative Requirements (which have been designated “AR” numbers) contained herein.

Should the Contractor become aware at any time that they are not in compliance with any AR, the Contractor will notify the Department’s Contract Manager immediately in writing. The Contractor is solely responsible for all costs associated with complying with and demonstrating to the Department compliance with these ARs.

I. Implementation

AR-1 The Contractor shall submit the Final Implementation Plan to the Department for approval no later than ten (10) Business Days from the Effective Date of the Contract. If the Final Implementation Plan is not determined by the Department to be sufficient, the Contractor will diligently work to revise and deliver a final Implementation Plan which is satisfactory to the Department. The Final Implementation Plan shall be based on the proposed plan submitted in response to question four (4) of Attachment C: Technical Reply.

The Final Implementation Plan shall fully detail all steps necessary to begin full performance of the Contract on January 1, 2026, 12:00 A.M., ET, specify expected dates of completion of all steps, and identify the person(s) responsible for each step. The Final Implementation Plan shall include, but is not limited to, the following implementation milestones:

(1) The development and execution of the Final Implementation Plan is subject to PG-1A-C of Attachment B: Performance Guarantees and Section 7.3 of the Contract for failure to meet the milestones identified therein.

(2) Establishing Department- approved website exclusively for State of Florida Participants by August 1, 2025, functioning toll-free phone line(s) available to Participants by August 1, 2025, and Department-approved communications in advance of the Fall 2025 Open Enrollment period.

(3) Participating in Fall 2025 Open Enrollment benefit fairs and meetings coordinated by the Department or its designee.

(4) Scheduling weekly implementation status meetings with the Department’s Contract Manager. The Contractor shall record detailed meeting minutes and follow-up action items on behalf of all team members during implementation meetings.

(5) Conducting background checks in accordance with Section 4.2.4 of the Contract.

(6) Prior to Open Enrollment, the mailing of an announcement to all potential enrollees for the first year of the Contract.

(7) Testing eligibility files, reviewing key procedures and program process controls (i.e., approval, design, testing, acceptance, user involvement, segregation of duties and documentation) to the extent required by the Department. The Department must approve and accept the key elements listed prior to the Implementation Date of January 1, 2026.

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(8) Designing and presenting to the Department for approval all communication materials to be used for Plan Participants prior to dissemination.

Communication materials include, but are not limited to, brochures, paper Claims (reimbursement) forms, standard letters, system generated letters, templates, envelopes, posters and any other materials used to communicate with Plan Participants.

(9) Providing evidence of a disaster recovery plan sufficient to meet the requirements of this Contract. A disaster is defined as any unexpected event that disrupts normal business operations, threatens critical systems, or compromises data integrity. The disaster recovery plan information should include how often the systems backup and disaster recovery procedures are tested, when the last tests were and what the results were and should indicate how quickly the services can be replaced in the event of permanent disaster to both the hardware and software or during a natural disaster or other unplanned or planned event that may affect service. At a minimum, the Contractor shall maintain backup of State files/data and shall be fully operational within twenty-four (24) hours of a disaster. At a minimum, the disaster recovery plan shall include daily backup of Plan-related files/data, a contingency provision so that critical services are provided within twenty-four

(24) hours, and a fully operational provision so that all services are provided within forty-eight (48) hours of activating the disaster recovery plan at the same or better level of service as before the disaster recovery plan was activated. Any changes to the plan throughout the term of the Contract must be sent to and approved by the Department.

(10) Identification of an implementation team. Identifying roles for each member of the implementation team.

AR-2 The Contractor and all applicable Services shall be one hundred percent (100%) operational prior to the Implementation Date of January 1, 2026, 12:00 A.M., ET.

II. Account Management

AR-3 Account Manager

The Contractor shall designate an Account Manager as the primary contact for the Department.

a. The Account Manager shall participate on the implementation team and coordinate, troubleshoot, advance, and track the State’s interests and requests throughout the organization.

b. If requested by the Department, the account manager shall be replaced with one that the Department approves.

AR-4 Account Management Team

The Contractor shall assign an Account Management Team, as identified in Section 1.1 of the Contract. The Account Management Team shall include an executive sponsor and an Account Manager. The Account Management Team shall meet the following requirements:

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a. Devote the time and resources needed to successfully manage the State of Florida account including, but not limited to, being available for virtual, telephonic, email and on-site consultations.

b. Be thoroughly familiar with the Contractor’s functions and operations related directly or indirectly to the Department and the Plan including, but not limited to, customer service operations, claims and enrollment systems, and systems reporting capabilities.

c. Maintain a current Account Management Team organizational chart.

d. Promptly notify the Department of any changes to the Account Management Team, including provision of an updated organizational chart.

AR-5 Meetings / Conference Calls

a. Weekly Meetings: The Contractor shall hold weekly implementation status meetings with the Department’s Contract Manager. The Contractor shall record detailed meeting minutes and follow-up action items on behalf of all team members during implementation meetings.

Account Management Team meetings shall be conducted as follows:

b. Quarterly Meetings: The Contractor’s Account Management Team (excluding the executive sponsor) shall attend and actively participate in all Department scheduled quarterly performance review meetings in-person at the State offices in Tallahassee, Florida, via web conferencing, or via telephone conference call, as determined by the Department. Quarterly reports are due within forty-five (45) Calendar Days following each quarter’s end and quarterly reviews to be scheduled within sixty (60) Calendar Days following each quarter’s end unless an extension is requested and granted by the Department. The meeting to review the fourth quarter of a calendar year is considered both a quarterly and year-end meeting. The fourth quarter meeting shall include review of both quarterly and annual calendar year reports and Deliverables.

c. Agenda: At the Department’s request, Contractor may provide a draft agenda two

Business Days in advance of a meeting, allowing changes to the agenda and a reasonable opportunity to prepare for the meeting. The Contractor and Department will discuss issues such as Performance Guarantees, quality assurance, operations, network status and access, benefit and program changes or enhancements, legislative matters, audits, cost trends, utilization patterns, program outcomes, customer service issues, future goals and planning and other issues reasonably related to the Contract. Contractor shall address performance and compare the Plan(s)’s experience to 1) national trends, 2) Contractor’s total book of business, and 3) other governmental clients.

d. Minutes: Minutes may include a clear and detailed account of the meeting, a list and description of any deliverables, identify the responsible party(ies) and provide projected delivery dates.

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e. Other Meetings: Progress meetings, issue meetings and emergency meetings shall be held as needed. Either Party may call such a meeting, subject to reasonable notice. Any meeting held in person shall be at the State offices in Tallahassee, Florida. Contractor shall be available to attend any and all contract oversight meetings as may be required by the Department in compliance with section 287.057(26), Florida Statutes.

III. Support Services AR-6 Open Enrollment Benefit Fairs

The Contractor shall participate at all locations of the annual Open Enrollment Benefit Fairs that are sponsored by the Department or its designee. The number of fairs and locations may vary each year or may be held through webinars or other virtual options at the discretion of the Department. Contractor representatives attending the Benefit Fairs shall be adequately trained and knowledgeable about the Life Insurance Plan. In past years, the Department held approximately twenty-four (24) in-person fairs statewide in the Fall; however, the Contractor should be prepared for either format as well as additional locations as required by the Department.

Contractor shall educate Participants and prospective Participants on Plan benefits, services, and other tips to ensure a positive participant experience. The Contractor shall be responsible for all costs associated with participating in benefit fairs including, but not limited to, travel and a proportionate share of facility fees. A notification regarding open enrollment should be sent to all potential Subscribers before the commencement of open enrollment for the initial year of the Contract.

The Contractor shall not discuss with Participants or prospective Participants or in any manner allude to coverage, products, or materials other than those explicitly related to the Plan without the permission of the Department.

AR-7 Plan Material

The Contractor shall provide all marketing, promotional, educational, or any other materials, or written communication related to the Plan, to the Department for review and written approval at least 30 calendar days prior to its use and dissemination. The Department shall be provided the opportunity to customize all such communications. The final materials used by the Contractor must not differ in form or utility from those approved by the Department. The Contractor shall be responsible for the development of Plan benefit information including, but not limited to, 1) open enrollment brochures and promotional pieces and 2) other Plan-related printed materials (e.g., Summary Plan Description and benefit brochures). The Contractor shall also meet the following requirements:

a. Be responsible for writing, printing, and distributing (electronically or by mail as required) Plan materials and any additional educational materials as needed.

b. Upon Department request, provide Participants printed materials in a language other than English and in a medium widely accepted for the hearing and/or visually impaired.

c. Provide all printed material in electronic format with final versions submitted to the Department in PDF file format.

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d. Provide Plan materials in formats widely accepted for participants with hearing or visual impairments within 30 Calendar days of Department’s request.

e. After initial enrollment, Participants shall receive communication materials welcoming Participant to the Plan.

AR-8 Public Records Requests and Subpoenas

The Contractor shall, upon request, provide the Department with any necessary data, documents, etc., to enable the Department to timely (as defined by the Department) respond to Public Record Requests and subpoenas.

The Contractor may receive public records inquiries or subpoenas relating to the Plan. The Contractor shall notify the Department immediately in writing of such inquiries. Any response or material responding to such an inquiry shall be submitted to the Department for approval prior to dissemination by the Contractor.

AR-9 Responding to Requests

The Contractor shall, upon request of the Department or its attorneys, make available all necessary resources to assist the Department in responding to any aspect of Services delivered under the Contract including, but not limited to, Departmental inquiries or those received by the Department from Participants, providers, or any other persons or entities.

Such requests shall 1) be given a priority status, 2) be subject to a method of tracking, 3) result in the delivery of all requested information, documentation, etc., and 4) be overseen by a lead staff person specific to the subject matter area. When the Department is required to provide immediate responses to inquiries, the Contractor shall immediately assist the Department in preparing its reply including providing data and documentation within the timeframes prescribed by the Department at that time.

AR-10 Responding to Requests for Legislative Initiatives

The Contractor shall make available all necessary resources to assist the Department in responding to bill analysis, legislative inquiries, and requests related to any aspect of Services delivered under the Contract. The Contractor shall respond in the timeframe set by the Department, which shall be determined at the time of inquiry depending on the scope and complexity of the request.

AR-11 Returned Mail

The Contractor shall hold returned mail for thirty (30) Calendar Days, during which time the Contractor shall search for an updated address within each subsequent enrollment file received from People First and, if located, re-send the communication. After thirty (30) Calendar days, if no updated address information is provided via the subsequent enrollment file, the Contractor shall store copies on its document imaging system and destroy the returned mail.

AR-12 Grievance Procedures

The Contractor shall develop and maintain formal and informal grievance procedures designed to fairly and expeditiously resolve problems related to the Plan. The procedures shall be made available to the Department during Implementation. The Contractor shall

Group Term Life Insurance Page 6 of 13 maintain a record of all grievances from Participants and shall provide a summary of grievances to the Department via Quarterly Reports, or more frequently upon request.

The Contractor’s system must indicate type or topic of the written correspondence and corresponding dates that individual mailings are provided to specific Participants.

IV. Customer Service

AR-13 Customer Service Operations

The Contractor shall maintain a Customer Service Unit to perform all aspects of customer service to assist Participants, prospective Participants, etc., regarding all aspects of the Plan.

Calls to this unit must be promptly accepted and answered by a live customer service representative or an Interactive Voice Response Unit (IVRU) during business hours (8:00 AM to 5:00 PM ET, Monday through Friday, excluding State holidays as outlined in Section 110.117, F.S.). Additionally, the IVRU must be available 24/7 to ensure continuous access to support. These requirements must be met in full compliance with PG-8, PG-9 and PG-10 of Attachment B: Performance Guarantees. The Customer Service Unit shall have the capability to adequately provide service and issue resolution, as well as sufficient numbers of qualified personnel trained in the administration of the Plan to meet or exceed related Performance Guarantees.

a. The Contractor shall ensure a sufficient number of toll-free phone lines are available at the required times to specifically address Participant inquiries. It is the responsibility of the Contractor to determine the appropriate number of lines required to effectively serve all Participants and prospective Participants.

b. The Contractor shall ensure the calls to the toll-free phone lines are answered within thirty (30) seconds or less.

c. The call abandonment rate for the dedicated toll-free customer service phone lines, where the caller disconnects before reaching a live customer service representative, shall not exceed three percent (3%) of total calls.

d. Toll-free phone lines downtime must be reported to the Contract Manager including the expected timeframe and a detailed reason for the downtime.

e. The Contractor shall furnish to the Department within 24 hours of the request a recorded call to the Customer Service Unit.

f. The Customer Service Unit shall have the ability to monitor and gauge call center statistics encompassing metrics like average speed to answer, abandonment rate, average length of call, average hold time, Interactive Voice Response (IVR) self-service interactions, and reasons for calls and generate reports including such metrics.

AR-14 Written Inquiries

The Contractor is responsible for acknowledging and resolving written inquiries pertaining to the Plan, which encompass communications via mail, email, and fax from Participants, within twenty-one Calendar Days. The Contractor must conduct an audit on written inquiries received from Plan Participants, utilizing a statistically valid sample. This audit shall be

Group Term Life Insurance Page 7 of 13 performed by the Contractor or the Contractor's Subcontractor. The audit shall be conducted by Contractor or Contractor’s Subcontractor on a statistically valid sample. The Contractor is required to submit the audit report to the Department quarterly.

AR-15 Plan Website

The Contractor shall provide and maintain a Plan-specific Participant website, with access twenty-four (24) hours a day, seven (7) days a week, for general Plan information. The design and content of the Plan website must be approved in advance by the Department. This website shall include links to the Department website, the Contractor (non-Participant) website, and other sites as appropriate to make a variety of information related to the Plan available to Participants. Such web-based access shall include, at a minimum, the ability to access forms and brochures. Members and non-members must be able to access information regarding the Plan.

Unscheduled website downtime shall be reported to the Contract Manager immediately, including the expected timeframe for the patch or repair and a detailed reason for the downtime. Any period of downtime where the website is not functional that exceeds twenty-four (24) hours from start to finish will be subject to the associated financial consequence in Attachment B, Performance Guarantees.

AR-16 Medical Underwriting

Medical underwriting determinations shall be completed within ten (10) Business Days of receipt of approved enrollment information.

AR-17 Notice of Approved Coverage

The Contractor shall provide Participants with a notice of approved coverage within five (5) Business Days of receipt of approved enrollment information.

AR-18 Beneficiary Designation

The Contractor shall create and make available a beneficiary form for Participants to designate a beneficiary and make changes to a beneficiary designation online. The Contractor shall also enable members to make beneficiary designations and changes via paper form. The Contractor is responsible for storing beneficiary records.

V. Data and Interface

AR-19 The Contractor shall be fully capable of accepting and implementing enrollment and other data files via a secure file transfer protocol (SFTP) on or before October 1, 2025.

AR-20 The Contractor shall not use, or otherwise disseminate, sell, copy, or make available to any person or entity data obtained through or relating to any aspect of the performance of the Services, without prior written authorization of the Department. This requirement shall survive the termination of the Contract.

AR-21 Enrollment File Transfer from the Department

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The Contractor shall maintain an information system capable of electronically receiving and updating Participant eligibility information (e.g., eligibility, name, address, coverage code).

The Contractor shall accurately convert and load the Department’s eligibility files.

The Contractor shall also:

a. Maintain enrollment records for all Participants based on the Department’s eligibility files submitted to the Contractor.

b. Maintain enrollment records in compliance with the required Gramm-Leach-Bliley Act standards.

c. Not overwrite, update, or in any way change the enrollment information without express direction from the Department. The Department’s enrollment file shall be the official system of record.

d. Accept from the Department the enrollment files in a format and frequency as required by the Department. The current enrollment file format and delivery schedule is in Attachment E, Interface Files Layouts and Enrollment Schedule, of the Contract.

e. Accept routine enrollment files and an annual Open Enrollment file (generally provided at the end of November following Open Enrollment). The Open Enrollment file shall not be loaded into production by the Contractor.

f. Process the enrollment files as required in PG-16 of Attachment B: Performance Guarantees.

VI. Reporting and Deliverables

AR-22 Ad Hoc Reports The Contractor shall provide ad hoc reports in formats required by the Department. The Contractor shall provide the Department with priority positioning for delivery of ad hoc report requests made by the Department or its designee regarding Plan-specific financial and statistical data, Participant Services, and utilization and claims reports.

The Contractor shall acknowledge report requests within one (1) Business Day and shall provide, as part of its acknowledgment, an expected timeline for completion and delivery.

AR-23 Reports Format Reports shall be provided in a format subject to customization and approval of the Department that provides utilization and claims reporting by Plan and by subgroup. The subgroups at a minimum are Active (includes all active employees including OPS/Variable hour employees), Vested Legislators, retirees, spouses, and dependent children. Reports shall contain all such data/details as required by the Department. Reports shall be delivered electronically to the Department and/or its designee, and in hard copy by request. Reports that contain proprietary, trade secret and/or confidential information shall also be delivered in a redacted format at the same time as the non-redacted format.

a. Complete and detailed backup/supporting documentation must be provided with submission of each report. Backup/supporting documentation must identify the source of the material.

b. Each report and/or deliverable shall be subject to the applicable PG in Attachment B: Performance Guarantees.

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c. Reporting must include the ability for the Department to have online access to data accessible in real time and permits the Department to create on-demand reports.

AR-24 Monthly Reports

Enrollment Discrepancy Reports. Contractor shall deliver enrollment discrepancy reports to People First based on the monthly enrollment file, indicating (where applicable) (i) duplicate records, (ii) reject records and (iii) address errors.

AR-25 Quarterly Reports

a. Claims Experience Report. The Contractor shall provide a summary by month of enrollment, premium collected, claims paid in the month, claims incurred in the month and incurred loss ratio. The report shall provide subtotals for the reporting period(s) and the Plan Year.

b. Benchmark Utilization Report. The Contractor shall provide benchmark utilization data for clients of similar size and complexity.

c. Performance Guarantees Summary Report. Contractor shall provide the

Performance Guarantee Summary Report (PG Report) as developed and provided by the Department (or as developed by the Contractor if one cannot be provided by the Department). The PG Report shall include the following details:

• Grievances Summary. The Contractor shall provide a summary of grievances for Participants to the Department.

• Written Inquiries Response Report. The Contractor shall provide an audit report detailing the quantity of written inquiries received, a summary of inquiry subjects, and the number of inquiries resolved within the required timeframe of PG-13.

• Notice of Approved Coverage Summary. The Contractor shall provide a summary outlining the count of Participants approved for coverage and the percentage of Participants to whom notifications were distributed within five (5) Business Days.

• Call Abandonment Rate Summary. The Contractor shall provide a summary of the percentage of calls received and how many calls were abandoned in the queue where the caller disconnects before reaching a live customer service representative.

• Medical Underwriting Timeliness Summary. The Contractor shall provide a summary of the number of forms received for the quarter and the number of forms processed within ten (10) Business Days of receipt of approved enrollment information.

• Claims Timeliness Summary. The Contractor shall provide a summary of the total number of claims processed and the total number of claims processed within twenty (20) calendar days.

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• Claims Payment Accuracy Summary. The Contractor shall provide a summary detailing the total number of accurately paid claims and the total number of claims sampled.

• Average Speed to Answer Summary. The Contractor shall provide a summary of the percentage of calls received by the Customer Service Unit phone line, the average response time of all calls, and the percentage of calls answered in thirty (30) seconds or less.

• Enrollment File Upload Summary. The Contractor shall provide a summary detailing the total number of enrollment files uploaded and the number of enrollment files loaded within two Business Days of receipt.

d. Internal Audit Report. Based on the results of the Contractor’s internal audits as specified in section X, Audits, the Contractor shall provide a report detailing the audit, its findings and financial impact on the Plan and Participants.

AR-26 Annual Reports

a. Participant Satisfaction Survey Report. The Contractor shall annually survey a statistically valid sample of Participants using Plan Services to verify satisfaction levels relating to the Contractor’s customer service unit and other related services and to gauge satisfaction with the Plan. The Contractor will provide a copy of the survey instrument and results to the Department. The survey instrument and results reporting format shall be prescribed or otherwise approved in advance by the Department. Approval of the survey entails both the methodology used for the survey and the calculation method to determine satisfaction as a percentage. This survey must incorporate an overall satisfaction question formulated by the Department. This data should be reported in the fourth quarter of the Plan Year.

b. Performance Bond and Insurance Report. Within thirty (30) Calendar Days of executing the Contract, and by December 31 of each Plan Year thereafter, the Contractor shall provide the Department with verification that a sufficient bond and insurance policies are valid and will remain in force for the calendar year as prescribed in Section 8 of the Contract.

c. Annual Plan Report. Contractor shall submit to the Department plan experience documentation including, at a minimum, the overall loss ratio and the loss ratios for each group coverage type (i.e., basic life, optional life, dependent child, spouse, etc.), claims data, annual cause of death report, and a participation summary. This report is due within 60 Calendar Days of the end of the Plan year, January 1 through December 31.

VII. PERFORMANCE GUARANTEES AND FINANCIAL CONSEQUENCES

The parties acknowledge that Department’s actual damages likely to result from Contractor’s failure to satisfy a Performance Guarantee is difficult to estimate as of the Effective Date and do not intend for the Financial Consequences to serve as punishment. Further, the parties do not intend to create a Performance Guarantee for every material obligation under the Contract.

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Accordingly, failure by the Contractor to satisfy an Administrative Requirement (or other requirement of the Contract) that does not have a corresponding Performance Guarantee may nevertheless constitute an Event of Default, as more particularly described in Section 9.1 of the Contract.

AR-27 The Department may require the Contractor to propose and implement a reasonable corrective action plan to address and correct the root cause of any missed Performance Guarantee. The corrective action plan must include a proposed implementation timeline and shall be subject to the Department’s approval.

AR-28 Contractor will advise the Department in writing as soon as possible of any circumstance or occurrence which could excuse or affect Contractor’s ability to achieve any of the Performance Guarantees. In all such cases, Contractor will cause to make all reasonable efforts to achieve the Performance Guarantees.

VIII. Renewal Report

AR-29 By May 1, 2028, and annually thereafter if the Contract is renewed pursuant to section 3.1.2 of the Contract, the Contractor shall submit to the Department a rate renewal report prepared and signed by an actuary with a Fellow of the Society of Actuaries (FSA) designation, subject to the Department’s approval, to validate premiums for the renewal term. The report shall include at least the following information:

i. Projection of incurred claim costs, a description of the methodology used to project incurred claims costs and justification of the use of any data not specific to the State of Florida.

ii. Detailed description of the methodology used to estimate claims trend.

iii. Disclosure of the targeted loss ratio used in the renewal calculation; and

iv. Disclosure of supporting data used in calculations, including enrollment, large claim analysis, trend analysis, demographic analysis, etc.

IX. Claims Processing

AR-30 The Contractor shall establish and perform all aspects of claims processing, adjudication, and payment in accordance with the Plan design.

AR-31 Accounting System

The Contractor shall maintain an accounting system and employ accounting procedures and practices conforming to generally accepted accounting principles and standards. The Contractor’s accounting records and procedures shall be open to inspection by the Department, or its authorized representatives, at any time during the Contract period and for so long thereafter as the Contractor is required to maintain records. Such inspections shall be subject to reasonable confidentiality requirements agreed to by the parties and as permitted by applicable law. All charges, fees, costs, expenses, and supporting documentation applicable to the Contract shall be readily ascertainable from such records.

X. Audits

AR-32 The Contractor shall give the Department full access rights to perform audits, or have audits performed by a third party (selected by the Department), as determined necessary or required by the Department to ensure and validate that premiums are being

Group Term Life Insurance Page 12 of 13 expended timely, efficiently and within compliance of all governing laws and the Contract (such audits being collectively referred to herein as “AR-32 Audits” or “Audits”). Other audit rights of the Department (i.e., non-AR 32 Audits) are provided for in the Contract and are not subject to the terms of this Attachment A (Administrative Requirements).

AR-33 The Contractor shall make a designated, internal audit representative available to the Department or its designee throughout the entire AR-32 Audit process. This representative will facilitate communication and cooperation between the Contractor and the Department.

AR-34 Upon identification of any discrepancies during an Audit, the Contractor is responsible for promptly researching and analyzing the identified discrepancies.

The results of this research and analysis, along with explanations for the discrepancies, must be reported to the Department in writing within ten (10) Business Days of identification.

AR-35 The Contractor shall review draft Audit reports and provide written replies to the Department within ten (10) Business Days of receipt. Contractor’s reply will be included in final audit report.

AR-36 The Contractor shall provide one non-redacted reply to the Audit and one redacted reply to the Audit in the event confidential or proprietary information is contained within the report. Only confidential or proprietary information may be redacted.

AR-37 The Contractor shall provide a corrective action plan to address all Audit findings in the manner and timeframe designated by the Department. All Audit findings are to be completely remediated (system corrections, financial impact analyses and reimbursement, where applicable) within sixty (60) Calendar Days of the issuance of the Audit report.

AR-38 The Contractor shall reimburse impacted Participants for any financial findings identified during the internal Audit within twenty (20) Business Days of notification from the Department as to the final amount due.

AR-39 The Contractor shall perform, no less than quarterly, internal or external audits on a statistically valid sample of claims and shall report results to the Department quarterly.

At a minimum, the quarterly audits must provide the Department with sufficient information to apply the measurement methodologies of PG-14 and PG-15 of Attachment B: Performance Guarantees, of the Contract.

AR-40 Before commencing any Audit, the State, the auditor, and the Contractor shall agree to the Audit process including, but not limited to, the scope of the Audit and any confidentiality and privacy provisions pertaining to the information obtained or disclosed during the Audit, including any provisions required by law. In the event that the State, auditor, and Contractor are unable to agree on all terms of the Audit process, Contractor shall unconditionally submit to (i) any terms that the State, auditor, and Contractor are able to agree upon and (ii) all terms established by the State and the auditor that are not agreed to by the Contractor that the State determines are reasonably related to this Contract.

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XI. Payment Specifications

AR-41 Direct Deposit EFT

The Contractor shall accept payments from the Department processed through the Department’s standard transmittal process (i.e., electronic funds transfer (EFT) to the Contractor and by the Department-determined due dates. The Contractor must complete a direct deposit authorization form (currently form number DFS-A1-26E).

AR-42 The Contractor shall provide any payments to the Department through the normal transmittal process (i.e., EFT transfer from the Contractor) and by the Department determined due dates.

AR-43 All payments to the Department shall be made separately by EFT from any payment balances due to the Department. The netting of payments related to the Plan is prohibited.

XII. Special Provisions

AR-44 Notify the Department

The Contractor shall notify the Department in writing, within twenty-four (24) hours of occurrence, if the Contractor loses any accreditation, licenses, liability insurance coverage, or breach of AR-46 below.

AR-45 Confidential Information

The Contractor agrees to adhere to leading industry practices in the development, implementation, and application of administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity and availability of the confidential information that the Contractor creates, receives, maintains or transmits in the Contractor’s administration of the Plan, as required by the Gramm-Leach-Billey Act security standards. Records shall be retained by the Contractor for ten (10) years after the later of (i) the final disposition of a claim, (ii) the expiration of this Contract, (iii) the conclusion of any judicial or administrative proceedings or audits or other action. Records may be retained in a digital imaging format.