RFP #2021-01 Healthcare Administration, Pharmacy _ Stop Loss.pdf

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Clayton County, GA RFP Type: Healthcare Administration, Pharmacy & Stop Loss Request for Proposal

Due Date: Thursday, July 3rd,2025 at 3:00 p.m. EST

Client Size: Approximately 2,800 Benefits Eligible Employees

Effective Date: January 1, 2026

Section I – Executive Summary, Background and Administrative Information Introduction

Clayton County, GA is seeking proposals from qualified vendors who can assume administrative services for their medical and pharmacy plans along with related managed care and clinical services.

Proposals may include medical with integrated pharmacy and stop loss, standalone medical Third Party Administrative (TPA) Services, standalone pharmacy services and standalone stop loss insurance. Proposals are due from interested vendors by Thursday, July 3, 2025 at 3:00 p.m.

EST.

The County currently offers medical & pharmacy benefits through two different vendors. The County partners with Anthem to offer three medical & prescription drug plans on a self-funded arrangement.

Also, the County partners with Kaiser Permanente of GA to offer two HMO medical & prescription drug plans on a fully insured basis.

Bidders will be asked to propose medical & pharmacy coverage for the Anthem covered members only (Option 1). Additionally, bidders will be asked to propose medical & pharmacy coverage for both the Anthem & Kaiser covered members (Option 2).

For initial pricing purposes, it is important that you match the plan designs as closely as possible. If you have deviations to the plans, you must clearly indicate all the deviations.

Welcome Bids

Marsh McLennan Agency is the Broker of Record for employee benefit consulting services for the County. Bids for this RFP are welcome from direct insurance carriers, direct Third-Party Administrators, direct Stop Loss carriers, and direct Pharmacy Benefit Managers (PBM’s). Bids for consulting, brokerage or any other engagement with the County’s benefits that result in compensation to a non-direct party will not be accepted.

You must respond with an Intent to Bid by Friday, June 13, 2025 at 2:00 p.m. EST. If an Intent to Bid form is submitted, as soon as reasonably feasible, bidders will receive an email with login instructions to MMA’s Accellion/Kiteworks secure email portal. All census data, claims experience, rates and summaries of benefits & coverage will be available.

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Confidentiality

All information presented in the RFP, including information subsequently disclosed during the proposal process is confidential. Information and materials supplied during the RFP process should not be released to parties external to the bidding organization without the express written consent of the County and Marsh McLennan Agency.

All proposals submitted will be retained permanently by the County and Marsh McLennan Agency and shall remain confidential.

Organization Description

Clayton County, GA is the sixth largest County in the state of Georgia based on population. You can log onto their website at https://www.claytoncountyga.gov to learn more.

The County utilizes Alight for employee benefit administration and enrollment functionality.

Eligibility and Enrollment information will be sent to the carriers & administrators via an electronic interface file from Alight.

Eligibility Requirements

Eligible persons can elect or waive benefits during annual open enrollment. New employees can elect or waive coverage within 30 days of hire. Existing employees with an employment status change can elect or waive coverage within 30 days of work status event. Enrollment elections may not be changed until the next open enrollment period unless there is an IRS-qualified change in status.

Contribution Levels Active employees, and Regular1 retirees less than age 65, contribute 25% and the County contribution is 75%. Early1 retirees less than age 65 contribute 35% and the County contribution is 65%. All retirees are eligible for the commercial medical plan until age 65. At that time, they are required to transition to a Medicare Advantage Plan.

1 based on years of service

Groups Description

Full Time Employees and Retirees <65

Active Employees working 30 or more hours per week, and Retirees, less than age 65, are eligible to enroll in benefits. Coverage becomes effective on the first of the month following a 60-day waiting period.

Dependent

Eligible dependents include your legal spouse, your or your spouse's child who is under age 26, including a natural born child, a stepchild, a legally adopted child, a child for whom you or your spouse is the legal guardian, or a child age 26 or older incapable of self-support due to a mental or physical condition incurred prior to age

26. A completed Disabled Certification form may be required prior to the child attaining age 26. A dependent child also includes a child for whom health care coverage is required through a Qualified Medical Child Support Order or other court or administrative order. Domestic Partners are not eligible.

https://www.claytoncountyga.gov/

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Compensation

Please quote all fees and rates on a "no commission" basis.

Additional Considerations

The County enforces a Spousal Surcharge of $50 / month to cover spouses who have access to health insurance at their place of employment. Also, the County offers a premium discount of $50 / month to employees who complete an annual physical exam. Also, the County contributes to HDHP plan participants H.S.A. accounts ($800 annually for single coverage and $1,600 annually for family coverage).

Medical Administration Contract / Rate Guarantee Periods

Clayton County, GA plans to enter into an agreement with the selected vendor(s) effective January 1, 2026 for an initial period of 36 months (through Dec. 2028), with two optional one-year renewals, for a total of five years. The vendor must guarantee first contract period rates/fees through December 31, 2028 for both medical and pharmacy. Please see “Exhibit A” posted on Bidnet and refer to Section

1.2 Term of Contract for details.

Section II – Communications, Questions and Proposal Submission All communications and questions are to be sent through BidNet.

All Vendors, and/or representatives of Vendors, seeking an award of a Clayton County contract may not initiate or continue any verbal or written communications regarding a solicitation with any County officer, elected official, employee or other County representative other than the Department of Central Services employee named in the solicitation, between the date of the issuance of the solicitation and the date of the final contract award by the Board of Commissioners, unless specified otherwise herein. Attempting to influence the outcome of any given contract prior to a recommendation of award to the Board of Commissioners is strictly prohibited. The Chief Procurement Officer (CPO) of Central Services will review alleged violations of this prohibition. If the CPO determines that such a communication has compromised the competitive process, the proposal submitted by that Vendor may be disqualified from consideration for award. Violations of this prohibition may also be subject to prosecution under federal, state, or local laws. Clayton County employees, officials, and their family members are prohibited from seeking, requesting, or receiving any material payment, gift, job offer, security, promise of future benefit, or any other tangible or intangible thing of value when such receipt has the potential to influence a procurement decision or to gain unfair advantage in a procurement competition, and as outlined in the County's Ethics Code found in Article 2, Section 70-61, et seq. and all other applicable policies.

Under no circumstances should anyone at Marsh McLennan Agency be contacted.

Please submit all questions you have about this RFP, or the data / information provided not later than Friday, June 20th, 2025 at 3 pm EST. Answers will be provided Friday, June 27th by 4 pm EST in the form of an Amendment.

This RFP is subject to the Georgia Open Records Act (O.C.G.A. § 50-18-70), et seq. since the County is a public entity. If there are elements of your proposal response that are confidential and not subject to public disclosure, you should provide a separate response that clearly indicates all the contents which are considered “trade secrets”.

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Requirements and Cost of Submitting Proposal All costs associated with your proposal, including preparation and presentation, will be borne by your organization and not the County.

Vendor’s Errors/Omissions

Neither the County nor MMA will be responsible for errors or omissions made in your proposal. You may not revise or withdraw a submitted proposal after the applicable deadline. After submission, revisions to your original submission will not be allowed. Therefore, please take care to make your bid sound and competitive.

Completeness The County asks that your proposal be complete and that it comply with all aspects of these specifications. Unless you note to the contrary, it will be assumed that your proposal conforms to the requested specifications in every way.

Included below is a list of files provided for the Health Care Administration RFP. There is a brief description of each file along with how it applies, and if it should be completed and included with your proposal submission. Please review carefully and take note of the bolded files that must be completed and submitted.

Health Care Administration RFP Cover Letter: this document you are reading now and contains information about Clayton County, GA and the RFP instructions, timetable of activities and other important information regarding the RFP process.

Med & Rx Census May 2025: The census data file has two tabs. Tab 1 is the entire eligible medical census. It includes all full-time benefit eligible employees and retirees less than age

65. Elections for Anthem & Kaiser plans are denoted. Tab 2 includes only those full-time employees and retirees who are insured under the Anthem self-funded medical plan. Please make sure you propose medical & pharmacy coverage for the Anthem covered members only (Option 1). Additionally, please propose medical & pharmacy coverage for both the Anthem & Kaiser covered members (Option 2).

Kaiser 2025 Benefit Summaries and Evidence of Coverage: Contains a summary of two Kaiser HMO medical and pharmacy group benefit plans in PDF format.

Anthem 2025 Benefit Summaries and SBCs: Contains a summary of three Anthem Open Access POS medical and pharmacy group benefit plans in PDF format.

Medical Administration Fees, Stop Loss Rate History & Kaiser Fully Insured Rates:

Contains three-years plus current year history of ASO fees, stop loss rates & Kaiser fully insured rates.

Medical & Pharmacy Claims & Enrollment Reports.zip: Contains de-identified historical claims, High-Cost claimant reports and enrollment information from Anthem & Kaiser.

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MMA RX Solutions RFP Template: This is an excel document containing the following workbooks for you to fill out with your pharmacy information:

o Tab 0 – Bid Info o Tab 1 – Contract Terms o Tab 2 – Financials o Tab 3a – Formulary Disruption o Tab 4 – Alternative Funding o Tab 5 - Humira o Tab 6 – Stelara o Tab 7 – AMP Cap Offset o Tab 8 – Reconciliation Template

Pharmacy Reprice File.zip: Contains pharmacy claims files for repricing so that you may provide a reprice file for each pharmacy formulary and/or plan type you are quoting. Please label your file as “Vendor Pharmacy Reprice”.

Geo Access Reporting Please provide a Geo-Access report(s) for each medical network and/or plan type that you are quoting on using the parameters in the table below. Note that it is important that you follow the exact parameters. The report should show hospital and provider availability by physician specialty for each zip code using the “Center of Zip Code” method. Report output is required for those with access and those without access, based upon the stipulated parameters. The report output should show the average distance to each provider group.

The information you need to perform this mapping for is provided in the Census. Label completed Geo-Access report as “Vendor Geo-Access Report.”

Practice Specialty Number of Providers Available

Miles from associates Residence

Adult Physicians (Family Practice, General Practice, General Internal Medicine) 2 10

General Pediatricians 2 10

Obstetricians/Gynecologists 2 10

Acute Care Hospitals 1 20

Evaluation of Responses and Finalist Presentations (Scorecard)

All proposals and supporting documentation will be submitted by bidders in Bidnet. The medical questionnaire and pharmacy questionnaire will be answered directly in Bidnet. Marsh McLennan Agency (MMA) will assist with analyzing proposals, finalist interviews, negotiations, and contracting. The Scoring Committee will review the proposal details (questions answered and files submitted in Bidnet) as necessary to select finalists.

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Relative Weight Item for Evaluation Maximum Points

20% Understanding Scope of Service 20

20% Qualifications of Organization 20

20% Competence of Personnel and Project Management Capabilities 20

20% Quality of References and Past Experience 20

20% Cost Proposal 20

100% TOTAL SCORE 100

Optional Oral and Capabilities Presentations

Optional Oral Presentation and Capabilities Presentations maybe required before the final selection and award. Additional points for presentations, interviews and capabilities presentations will be added to the proponent’s score.

Scoring Value Maximum Points

TOTAL SCORE 15

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Section III – ASO Questionnaire General Information

1) Provide an overview of your organization including history, organizational structure, subsidiaries and affiliates, financial ratings for your organization, services and product offerings, and mission statement.

2) Please provide the specific name of the individuals responsible for the contents of the offer.

Additionally, provide the names, titles and roles of individuals that will be servicing and handling this account and the physical location in which they reside.

3) Have you had recently, or do you anticipate any mergers, acquisitions, layoffs, or major system changes?

4) Do you outsource/sub-contract any of the services for which you are quoting? If yes, please explain.

5) What capabilities and expertise do you have specific to Public Sector Clients? Can you share specific examples of cost-saving innovations for other Public Sector Clients?

6) Are you willing to propose and administer the plans according to the specifications outlined in this proposal?

7) Does your firm or any team member have an open dispute with Clayton County?

8) Provide three (3) Public Sector client references of existing accounts to verify the bidder’s direct experience in servicing accounts of a similar size and industry. In addition, please provide three (3) references of former accounts that no longer do business with your company.

Failure to provide references will be a consideration in the final evaluation. (Reference form will be included when other with data files are sent).

Claim Administration

1) Please specify the location and operating hours for the claims processing office that will process claims for the County.

2) Will you have a dedicated claim team for the County?

3) What are the authority levels of the claim’s processors? Supervisors? Who will be paying the County’s claims?

4) What type of claim audit procedure is currently in place? Please indicate the percentage of total claims that are auto adjudicated and the percentage that are audited. What is the claims dollar threshold in which a claim is audited?

5) Do you have a formal fraud detection program? If so, please describe and include savings as well as a description of what sets you apart from the competition.

6) Does your claims system check for duplicate charges? What are the criteria used?

7) Is your system set up to automatically pend Stop Loss claim so an audit can be performed prior to issuing the check? What is the turnaround time for this to happen?

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8) Do you require Stop Loss insurance to be placed with your firm? If Stop Loss insurance can be carved out, what is the additional monthly PEPM fee for claims reporting to the Stop Loss carrier?

9) Assuming Stop Loss is “carved out” and placed with an outside firm, please describe the Stop Loss filing process that will be used for Clayton County and cite any specific preferred Stop Loss vendors in which you have file integration today.

10) What are your procedures for recovery of overpayments? Do you keep a percentage of what is collected?

11) Do you have a person responsible for subrogation claims and following up on subrogation reimbursement due to the plan sponsor? How are subrogation claims handled? Is there an additional fee? What percentage do you retain?

Reporting

1) Provide a sample reporting package including any online reporting tools. Please describe and give examples.

2) Please describe the claims data reports that will be available to the County. Reports in an easy-to-read standard format (for example Excel, pdf., etc.) are preferred.

3) What is the process by which you will make claims information available and submit it to MMA’s PATH Data Analytics Department?

4) What is your process for Ad Hoc reports and what do you charge?

Medical Management

1) Please describe your firm’s core Medical Management, Chronic Disease Management & High- Cost claimant services.

a. When do these core services begin during a member’s care journey?

b. How are they effective in proactively managing the rising cost of health care?

c. What differentiates your medical management programs from your competitors?

d. Are these programs provided at an added cost?

e. Which diseases and/or chronic conditions do you target?

f. What are the expected benefits and savings?

g. How are savings identified and shared with the County?

h. How do you determine which members are “at-risk”?

i. Is this integrated with your medical claims system?

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j. Is this integrated with your RX vendor and Stop Loss carrier?

2) Does a member have to be enrolled in a specific product to be eligible for these programs?

3) How are members with specific diseases identified for purposes of your disease management programs?

4) How are members that are identified as having or being at risk for specific diseases contacted and informed about the availability of the above programs?

5) What percentage of contacted members normally participate in the programs?

6) Do you have experience coordinating and integrating with disease management vendors, health coaching services, or with your client's internal resources?

7) Describe the reporting and measurement system your organization is using to determine the success of the above programs. Include sample reports with your response.

8) Do you provide on-line Health Risk Assessments at no additional cost? If so, does the assessment feed into your disease management program?

9) What external Point Solution vendors does your firm work with and have data integration with to provide an enhanced level of care for certain targeted conditions? (i.e. Diabetes, Hypertension, Musculoskeletal, Behavioral Health, Cancer, etc.) Please provide details.

10) The County implemented the Virta Pre Diabetes, Diabetes Management and Weight Loss Program with Anthem effective May 1, 2025. Does your firm offer a similar program? If so, please describe and provide pricing.

Care Coordination, Participant Navigation & Advocacy Services

1) Does your firm offer an enhanced level of care coordination, participant navigation and advocacy services? If so, please describe.

a. How and at what point in the care journey does your firm identify and / or intervene in high-cost or catastrophic healthcare events?

b. How are these enhanced services effective in proactively managing the rising cost of health care?

c. Is your firm willing to put performance guarantees in place and fees at risk to ensure the effectiveness of this enhanced level of care advocacy?

d. Will your firm provide a dedicated call center service team to the County? If so, please describe.

e. Do members have the same customer service representative for all issues / questions, or will a different care coordinator support the member for each issue?

2) Assuming these concierge services are offered, please explain what happens once a member calls into the call center with an inquiry for the first time.

a. Who answers the call and are they routed to other team members?

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b. How many team members might the member be handed off to?

c. What information is the caller required to provide (Name, Date of Birth, Address, etc.)

for verification purposes?

d. How does a call typically end? Is the member provided a written summary?

e. Also, how are repeat callers handled?

3) Describe the process, tools, resources, approach to getting the member to the right care and right place.

4) Describe what happens if team members are not able to resolve the member’s inquiry.

a. Does the member receive a call back?

b. What channels are used to get back to the member (i.e. telephone. secure email, voice mail, etc.?)

5) Please describe your interaction / process for working with family members of an employee if they are ill.

a. What information can be provided to them?

b. What documentation do you need prior to engaging in care discussions with family members?

6) Please detail how much advance notice you need to implement a care coordination and consumer navigation program for the County.

7) Please describe your implementation process and onboarding philosophy and how you would transition the client from their current model to your proposed model. What experiences do you have in this type of transition? Please include any best practice recommendations.

8) What type of custom branded communications materials and support do you provide with respect to onboarding and throughout the program? Is there an additional cost?

9) Provide evidence of the impact of your enhanced care management program with regard to identification, engagement, behavior change, clinical outcomes and financial outcomes.

10) The County implemented Anthem’s Total Health Complete Care Coordination, Participant Navigation & Advocacy Services effective March 1, 2025. Does your firm offer a similar program? If so, please describe and provide pricing.

Network Management

1) Describe your network management strategy for your broad, open access POS network.

2) Do you offer centers of excellence providers? If so, please explain what is offered and how the member accesses it.

3) Briefly define your provider payment strategy for your broad, open access POS style network?

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4) For Primary Care Physicians, what is the primary method for reimbursement? (FFS, % of Charge, Capitation). If FFS, what is the average % of Resource Based Relative Value Scale

(RBRVS)?

5) For Specialists, what is the primary method for reimbursement? (FFS, % of Charge, Capitation)

6) For Hospitals, what is the primary method for reimbursement? (% of Charge, DRG, Per Diem, Capitation)

7) For the physicians in your broad, open access POS network, what is the negotiated reimbursement level as a percent of Medicare RBRVS for:

a. Primary Care Physicians

b. Specialists

8) Which year is used in the formula? Describe any anticipated changes in your network payment strategies for 2026.

9) The County expects to be notified if a large provider group or a hospital in our service area drops out or joins the network. Will this present a problem?

10) Does The County receive the full financial impact of the negotiated discounts within your proprietary network? Is there any shared savings language in your contract?

11) Are providers allowed to balance bill for in-network services?

12) How do you indicate quality or cost-effective providers for easy member identification?

13) Do you offer a pay-for-performance program? If so, please explain.

14) Describe how you educate providers on your processes and work with them when they have questions.

15) What is your PCP and specialist turnover rate for the past two years?

16) Do you currently offer quality and efficiency scoring of providers within your broad access network – aka which providers have met quality and efficiency thresholds? Does it apply to PCPs, all Specialists. Please explain.

Pharmacy Benefit Management

1) Please describe your retail pharmacy network including its relationship to your organization (e.g. owned or leased)?

2) Is the PBM owned by a pharmacy manufacturer? If so, who?

3) Please confirm that prescription drugs prescribed by any licensed health care provider, including a dentist, are covered by the pharmacy program.

4) Which nationally recognized pharmacies are in your network and what is their contracting arrangement? Do you have smaller/performance networks that provide a lower cost? If so, please describe.

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5) Does the pharmacy plan proposed using a formulary or preferred-drug list? If so, how do you determine what drugs are on the formulary or preferred drug list?

6) How are manufacturer rebates handled? Will the County share in the rebates? If so, what percentage? Can you offset your medical administration fee if you maintain the rebates?

7) Do you offer a mail order prescription drug program? If so, do you own your mail order facility?

8) What is the average turnaround time for mail order pharmacy?

9) Can mail order prescriptions be ordered on-line?

10) Do you offer creative alternatives in the pharmacy program (i.e. Patient Assistance Program (PAP), Variable Copay Program, International Mail, Site of Care Program, & others) that can help control or reduce the plan costs? If so, please provide details and approximate savings for each feature.

11) Please explain your Drug Utilization Review process for these programs:

a. Prospective

b. Concurrent

c. Retrospective

2) You may be requested to attend annual open enrollments to help educate Clayton employees in the best way to access services from the PBM. Would this present a problem?

3) Please submit a sample of your standard reporting package. Please submit a sample of non-standard reports that are available, and any associated costs, and how these are requested.

4) Is there any case management to help avoid over utilization at different pharmacies, etc.?

Alternative Health Plans

1) What creative solutions does your firm offer to help address the rising costs of healthcare?

2) Does your firm offer Alternative Health Plans to encourage / financially incent members to seek care from the highest quality, lowest cost of care providers for elective procedures? If so, please explain and discuss the average claims savings from this type of care and provide documentation if available.

3) If your firm does offer Alternative Health Plans, are they another plan option under the self-funded arrangement? Please describe how claims reporting and billing would work as part of the larger group.

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Stop Loss Insurance

The County’s Stop Loss insurance is currently “carved out” with VOYA for the Anthem self-funded medical plan. We are interested in receiving competitive proposals for Specific Stop Loss coverage only. Coverage will need to include (1) a “No New Laser” at renewal rider, (2) a not greater than 40% rate cap renewal rider, and (3) an accelerated reimbursement provision. Please propose Specific Stop Loss coverage for the Anthem covered members only (Option 1). Additionally, please propose stop loss coverage for both the Anthem & Kaiser covered members combined (Option 2). Stop Loss carriers will be required to provide “firm proposals” with claims data through 08-31-2025, for a 01-01- 2026 effective date. Specifics of the coverage levels and parameters for each option are listed below.

Option 1 (Anthem membership only) (Approx. 1,200 ees & 2,200 total members) Individual Stop Loss Limit Deductible Options: $200,000, $250,000 & $300,000 Contract Basis: Incurred in 36 months, Paid in 12 months Riders: No New Laser at Renewal & not greater than 40% Rate Cap

Option 2 (Anthem & Kaiser membership) (Approx. 2,095 ees & 4,000 total members) Individual Stop Loss Limit Deductible Options: $400,000, $500,000 & $600,000 Contract Basis: Incurred in 36 months, Paid in 12 months Riders: No New Laser at Renewal & not greater than 40% Rate Cap

Quotes should assume establishing an interface with the self-insured Administrator and if applicable Pharmacy Benefits Manager. The preferred approach is to establish interfaces so claims data can be sent by all applicable administrators with a common identifier so that the selected Stop Loss vendor will have all necessary claims detail needed to begin the claims process. Any additional costs or administrative conditions that apply should be specifically described.

Response Requirements

1) Medical & Rx (Option 1) – The Anthem insureds only - Match the three Anthem plans of benefits as closely as possible.

2) Medical & Rx (Option 2) – The Anthem & Kaiser insureds – Map the Kaiser insureds to the Anthem plans as follows.

Kaiser Medical Plans Map to Anthem Medical Plans

Low Deductible HMO Copay Plan Low Deductible Copay Plan

Mid Deductible HMO Copay Plan Mid Deductible Coinsurance Plan

N/A High Deductible H.S.A. Plan

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Proposers shall have as their primary response the matching of current benefits but can provide clearly identified alternatives, if desired. However, each proposal should point out any significant differences in contract provisions between the proposed benefits and the current benefits.

Additional information may be included if any alternative program is proposed. It must be fully explained. If no differences or alternatives are clearly identified and proposed, Clayton County will assume that the Proposer will be able to match the current plans with no material changes.

Implementation and Transition

1) Provide team organizational charts for implementation and ongoing account management teams - including specific functions and responsibilities of each individual. Provide biographies of each team member and anticipated commitment level to the County for implementation and ongoing account management. Include specific experience working with Public Sector Clients and how many clients are managed.

2) If the County elects to retain the current plan, you will be expected to duplicate the current plan. How do you minimize problems related to “plan interpretation”? Who is involved in writing and interpreting the plan? What individuals within your organization do you involve making sure that claims are paid consistent with the prior administrator?

3) Can you provide examples of proven client implementations with compelling engagement stories/examples? Do you have examples of the savings you’ve generated for existing clients?

4) How do you ensure a smooth transition for individuals who are high users or who are in the midst of complex medical treatment prior to the effective date?

5) Provide a detailed implementation plan with specific tasks and key activities that would be handled by you and what would need to be completed by the County.

6) Will you provide a representative dedicated to supporting the implementation? Will you have representatives on the implementation team focused on the implementation of the self-funded plan?

7) Is your firm willing to provide an implementation credit for the County to spend for implementation related expenses? If so, please provide the amount and details regarding the use of these funds.

Communications

1) What is your philosophy, and what experience have you had regarding the ongoing education of plan members? What kind of information would you provide employees on an ongoing basis to proactively communicate with them about problem areas?

2) How are provider changes communicated to members? Frequency? If a provider is terminated, are members who have used that provider notified? How and within what timeframe?

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3) What are you including in your proposal in terms of employee education and support to ensure a smooth transition and assist employees and dependents with understanding any new benefits or administration changes?

4) Provide a listing of all web-based services and education/information available to participants.

If selected as a finalist, you will be asked to provide access to your participant website for review.

5) What communication strategies are used to sustain participation long-term? Please provide sample communications and explain the behavior change theory or constructs used in strategy development.

6) Will you customize communication materials that support your services?

7) Does the EOB show the charged amount, negotiated savings amount, and paid amount? Can customized comments be added to the EOB by the claims examiner? Are there any options on the EOB that the County can choose? Please include a sample of your EOB.

8) Please provide all materials used in marketing your product. Can this material be modified specifically for The County?

9) Is your firm willing to provide a communication allowance for the County to spend for communication related expenses? If so, please provide the amount and details regarding the use of these funds.

Customer Service

1) Please describe the qualifications of your customer service staff and average tenure for the proposed location. In addition, please outline the type of training they receive.

2) Do you have a call tracking system? Please describe the system including any plan sponsor reporting capabilities and planned enhancements for the coming year.

3) How do you define first-call resolution? What is your initial call resolution rate?

4) Will there be one toll-free number available to plan participants to handle claims and customer service issues?

5) Can members contact customer service representatives via email?

6) What information is available to members via a voice response system?

7) What information is available to members on a self-service basis through a secure member website?

Technology

1) Please identify the services/tools that are available to members on your website.

2) Please describe the tools on your website that are designed to help promote consumerism.

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3) Please describe any online transparency tools you have available to members and the accuracy of these provider costs (historical data vs. actual provider fee schedule).

4) Describe access to clinical care decision tools describing procedure indications, options, benefits, and risks.

5) Do you provide real-time navigator assistance (online and telephonic) during designated hours?

6) Is a nurse advisory toll-free number available? Is there any associated cost?

7) Does your response include a Telemedicine benefit? If so, please describe.

8) Can you help employees purchase medications online?

9) What information/tools are available to members via mobile functionality?

10) Describe any additional consumer tools not already discussed.

11) Should The County make a change in their HRIS system, describe the process and costs associated with reestablishing file feed connections. What resources would be available to assist The County with these changes?

12) Is your firm willing to provide a technology budget for the County to spend each year for benefit administration and other technology related expenses? If so, please provide the amount and details regarding the use of these funds.

Wellness Initiatives

1) Indicate which of the following on-site wellness programs are available through your organization. Please describe the overall architecture and mode of delivery (i.e., group-led, telephonic, online, print materials, etc.) of each program, and indicate the name of any third-party vendors used to administer the program.

a. Biometric measurements (on-site and off-site)

b. Weight management

c. Nutrition counseling

d. Tobacco cessation

e. Fitness promotion

f. Depression / Anxiety / Stress

g. Safety promotion (work, home, recreation, vehicular)

h. Cancer prevention awareness

i. Chronic back problem management and injury prevention

j. Flu vaccination

k. Walking program

l. Lunch and Learn workshops

m. Medical self-care program

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n. Health education/awareness campaigns

o. Healthcare consumer education training courses

p. Lifestyle management education/coaching (hypertension, pre-diabetes, cholesterol)

q. Fitness facility discounts

r. Hypertension screening and education

s. Risk profiling/stratifying

t. Education members about self-management tools

u. Member communications, including follow-up calls (outreach coaching), email activation, online coaching, education modules, mail, webinars, wellness newsletters, Awareness and Prevention CD’s

v. Health fairs & health screening

w. Drug Information and information on how to take prescription drugs

2) Do you have the ability to offer proposed wellness programs to the County employees not participating in the medical plan?

3) What is your experience regarding the use of financial incentives to improve participation in Health Risk Assessments, biometric screenings, online tools, and outreach coaching?

4) How do you define participation and completion of your individual wellness programs (weight management, nutrition, tobacco cessation, fitness, etc.)?

5) What are your success rates with your wellness programs and how do you define and measure success (weight management, nutrition, tobacco cessation, fitness, etc.)?

6) Please describe your training and designation of wellness teams supporting The County.

7) Please describe your tobacco cessation program. Describe your experience implementing programs with reduced or no co-pays for tobacco cessation medications.

8) As a vendor, will you work with the County on wellness programs and initiatives? If so, provide a suggested plan or sample plan you have used for other employers. Are there additional services available for an additional cost? If so, please describe.

9) Is your firm willing to provide a wellness budget for the County to spend each year for wellness related expenses? If so, please provide the amount and details regarding the use of these funds.

Banking Arrangements Banking Arrangement

1) Please discuss the banking arrangements available. Be sure to address the following: Service Provider-owned account or Client-owned account, Timing of fund requests (i.e., weekly, daily, specified dollar limit), Account reconciliation duties, Types of transfers (wire, ACH) and interface with preferred stop-loss carriers.

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Performance Guarantees

1) The County & MMA may conduct an annual performance review of each service provider for the services provided during the preceding contract year. Please confirm your willingness to adhere to this requirement.

2) Provide a sample performance guarantee results summary report you provide to clients.

Please confirm you can provide this report no less than quarterly.

3) Please provide performance guarantees in the following categories: Implementation, Account Management, Member Services and Claims Administration, and Reporting. What other guarantees are you willing to offer?

4) Provide a network discount guarantee and explain your methodology in calculating discounts.

The County expects the carrier to guarantee a percent discount from net eligible billed charges.