RFP_21-057-DP_Appendix A - Part 1.docx

APPENDIX A

QUESTIONNAIRE

PART 1

RFP NO. 21-057/DP

A. GENERAL

1. Please describe the history of your organization specific to offering and administering long term and short term disability group coverage.

2. What is your current national enrollment, as well as Florida enrollment in disability coverage?

3. How long has your company been in business and how long has your company offered group long term and short term disability insurance?

4. Please fully describe any and all assistance that is required from the GROUP in order to administer one or more of the products being solicited, as well as the types of enrollment and communication assistance you will provide the GROUP.

5. Please provide sample copies of policies for all plan(s) you are proposing.

6. Provide copies of your communications/enrollment materials and certificates of coverage (and any other types of materials that will be used in the administration of the proposed products).

7. Provide your financial ratings (from AM Best’s, Standard & Poor’s, Moody’s, etc.). If you are not rated by these companies, please provide your company’s most recent audited financial statement.

8. Disclose and describe any and all commission and service fees included in the proposed rates and to whom they are paid, and the purpose/services the GROUP would receive.

9. Who is the assigned Group Account Executive? Where is he/she located? Is he/she a licensed Florida agent?

10. Please include the names and biographical information and location of all individuals who would be assigned to the GROUP to service this/these program(s).

11. Do the rates reflect all services including but not limited to employee communication materials and the certificates of coverage? _____ Yes _____ No.

12. Please describe your approach to customer service. Include hours, number of claims reviewers assigned to the GROUP, average times “on hold”, etc.

13. A toll free telephone number shall be made available for the convenience of employees. Confirm that you will comply. _____ Yes _____ No.

What hours are telephones answered: Hours __________.

14. Describe any services, benefits or features associated with this proposal that sets your company apart from your competitors. Are these enhancements included in the rates presented? Be as specific as possible with your answers.

15. Describe and provide samples of any reports you will provide the GROUP in order to show claims experience, enrollment, or other pertinent information. How often will the reports be provided? Will there be a charge for the reports?

16. Are your current medical management and claims administration systems online? Do these systems interface with each other? Will the GROUP have access to online to their data?

17. Do you have electronic capabilities/processes where the GROUP can data enter/data interface Evidence of Insurability applications online during Open Enrollment periods? Please explain.

18. COUNTY and PALM TRAN currently uses electronic reporting of Evidence of Insurability process, instead of using a paper process. Palm Beach County Supervisor of Elections may want to use a paper process to report Evidence of Insurability to the proposer. Can you accommodate this? _____ Yes _____ No.

19. Do any of the products you are proposing require medical underwriting for employees who enroll when first eligible? _____ Yes _____ No. Please indicate which plans require medical underwriting.

20. Do any of the products you are proposing require medical underwriting for employees who DO NOT enroll when first eligible? Please indicate which plans require medical underwriting and describe the process.

21. The County currently transfers enrollment data to the vendor. Will you accept an electronic enrollment file in lieu of paper enrollment forms? ______ Yes ______ No.

If Yes, please provide your desired file specifications.

22. Do you provide a secure web site that gives employers access to online claims reports?

_____ Yes ______ No. If Yes, is there an additional charge for this access?

_____ Yes _____ No. If Yes, what is the charge?

23. The County prefers to pay insurance vendors on a “self-billing” basis based on County enrollment records. However, the Supervisor of Elections and PALM TRAN may require a monthly roster billing. Confirm that you will accommodate self-billing. _____ Yes _____ No.

24. When are monthly premiums due to your company?

25. Is there a grace period, if premiums are not perceived by the due date?

_____ Yes _____ No. If so, how long?

GROUP prefers a grace period of 45 days.

26. Describe your position on refunding or making retroactive adjustments on enrollment problems. Please describe any timing or frequency limitations.

27. Describe any rate guarantees for your proposal.

28. Proposer must be willing and able to render enrollment assistance to the GROUP, including in person attendance of all scheduled annual open enrollment meetings and sessions scheduled for BOARD, PALM TRAN, and Palm Beach County Supervisor of Elections employees. Open enrollment meetings held may overlap among the various agencies and more than one enroller may be required at times. It is the expectation that proposer shall provide sufficient personnel to take a lead role during annual and other enrollment processes by holding multiple group meetings as well as providing resources and support for other communication methods (e.g. recorded sessions, webinars, PowerPoint presentations, videos, etc.). What will you do to assist during implementation and annually during Open Enrollment periods, and thereafter – be specific.

29. The awarded firm may need to assist PALM TRAN and/or the Supervisor of Elections with initiating a separate monthly premium payment process and provide a presence at PALM TRAN’s open enrollment meeting. Will you comply? _____ Yes _____ No

30. Confirm that you will agree to customize all enrollment materials/forms to fit this GROUP at no additional charge.

31. Do you agree to create and print an enrollment form for each entity in the GROUP using its logo and format? The form should be customized and not request information not relevant to this case. The cost for this should be included in the rates/quotes within your proposal with no additional expense to the GROUP.

32. Assuming notification as the selected carrier, how to you propose to organize the transition and implementation schedule for a contract for coverage? Briefly summarize the specific tasks required, actions involved, anticipated implementation timeline and the responsibilities of all parties during the process.

33. Please confirm that you will provide the GROUP with all financial/utilization reports including premiums collected, claims, renewal work-ups and utilization reports during the duration of the contract, as well as when GROUP administers the necessary competitive procurement process for future program renewals.

B. LONG TERM DISABILITY

1. Please give the location of the claims office that will handle claims for Palm Beach County. How many claims reviewers will be assigned to the County?

2. How many LTD claims are currently administered by the LTD claims office listed?

3. Please provide a sample copy of your standard LTD policy.

4. Have you duplicated or improved upon the current benefit levels? Please describe any deviations in detail.

5. Are you proposing any alternative plans? Please fully describe all deviations from the current plans, reasons for change, impact on rates.

6. Please describe your rehabilitation provisions and operational procedures.

7. Do you have any in-house rehabilitation staff? _____ Yes _____ No.

Do you utilize an outside vendor for rehabilitation assessments? If yes, explain.

8. Describe the claims handling process from first notification to acceptance/denial.

9. Who handles the claims process and when does the process transition from a case manager to a nurse to a doctor for review?

10. Confirm and describe your process and timelines of a short term disability claim transitioning to a long term disability claim. Confirm that this will occur without any EOI or actively at work limitations. _____ Yes _____ No. If no, explain.

11. Provide the grievance/appeals procedures for your insureds. Outline the steps and timeframes of the process from initiation to final resolution.

12. How does your standard contract define total disability? Can the definition of disability be customized by the GROUP? Please explain.

13. Does your proposed plan(s) have benefits for partial disability? _____ Yes _____ No. If yes, provide your plan’s definition of partial disability.

14. Please describe your Social Security filing assistance capabilities. What were your SSDI approval/denial rates in 2014?

15. Please describe your standard contractual limitations for mental disorders, substance abuse and other limited conditions; list the conditions. Are you able to comply with or better the current two (2) year provision?

16. Are any disabilities not covered? Please explain.

17. Please confirm that you will waive the actively at work provision for the initial enrollment? _____ Yes _____ No. If no, please explain.

18. Do the provisions of the policy differ if the illness is recurrence of the previous illness or a new illness? Please explain in detail.

19. Please define and describe all eligibility conditions in your proposed plan(s).

20. Please describe how the waiting period applies to a disability caused by:

A sickness _____________________ An accident _____________________

21. Please describe your survivor benefit.

22. Will your firm be able to accommodate Domestic Partners of the employees of the GROUP as named beneficiaries to any proposed survivor benefits? _____ Yes _____No

23. What is the proposed elimination period?

24. Please describe your conversion/portability provisions and provide rates. Describe any costs associated with conversion. Please indicate the type of policy available for conversion.

25. When do you begin RTW evaluation? What are your evaluation procedures?

26. Describe your disability management program, including your handling of:

a. Duration management

b. Benefit integration

c. Confidentiality

d. Psychiatric claims

e. Early return to work

f. Closing claims missing “necessary” information. What is your organization’s definition of “necessary”?

27. By what means, and how often do you verify eligibility for benefits?

28. Do you utilize independent medical examiners? _____ Yes _____No. If yes, describe your process.

29. How to you control for and minimize fraud?

30. Describe the minimum benefit of the proposed policy – list and explain any deviations from the current policy.

31. Describe in detail the takeover provisions of the proposed policy – list and explain any deviations from the current policy.

32. List and describe Other Income Benefits of the proposed policy – list and explain any deviations from the current policy.

33. Describe your income offset process, including SSDI.

34. Describe any Pre-Existing Condition Limitations of the proposed policy – list and explain any deviations from the current policy.

35. The COUNTY requires employees to first use available sick time before receiving benefits from the long term disability plan. Can your plan accommodate this administratively?

36. How does your plan typically work with vacation leave used by employees during period of disability?

37. How does your plan typically handle donated vacation leave an employee may receive from co-workers to use during a period of disability. The current policy does not offset/reduce disability benefits by donated vacation leave used during period of disability.

38. Describe the options you offer for tax treatment of disability benefit payments. What methods do you use? How do you determine if all, none, or a portion of a benefit is taxable. Which methods can you administer?

39. What tax instruments and services will be provided?

40. Describe your Incurred But Not Yet Reported (IBNR) calculation, including factors used to determine reserve amounts.

C. SHORT TERM DISABILITY

1. Please describe policy provisions for a scenario in which an employee takes short-term disability, returns to work, and then goes out on disability again? Do the provisions of the policy differ if the illness is a recurrence of the previous illness or a new illness? Please explain in detail.

2. Please define and describe all eligibility conditions in your proposed plan.

3. Please describe how the waiting period applies to a disability caused by:

a. A sickness _________________________

b. An accident ________________________

4. The GROUP intends for this voluntary insurance policy to provide a payment of weekly benefits during disability if the employee becomes wholly and continuously disabled from accidental injury or sickness which prevents the employee from performing any and every duty pertaining to the employee’s occupation, provided the employee does not engage in any other work for remuneration or profit. Please fully disclose and describe any and all conditions, limitations, and/or exclusions in your proposed plan(s).

5. If the employee’s insurance terminates because all the weekly benefits payable to the employee are exhausted, or because of the employee’s absence from work is on account of disability for which no benefits are payable, will you allow for employee’s insurance to be reinstated if and when the employee returns to active work on a full-time basis? _____ Yes _____ No.

6. The COUNTY requires employees to first use available sick time before receiving benefits from the short term disability plan. Can your plan accommodate this administratively?

7. How does your plan typically work with vacation leave used by employees during period of disability?

8. How does your plan typically handle donated vacation leave an employee may receive from co-workers to use during a period of disability. The current policy does not offset/reduce disability benefits by donated vacation leave used during period of disability.

9. Does your proposed plan(s) include benefits for Partial Disability? If so, provide your plan’s definition of partial disability.

10. How many open STD claims are currently administered by the claims office that will service this contract?

11. Describe what, if any, rehabilitation provisions and operational procedures exist in your proposed plan(s).

12. Will you offer the proposed plan on a guaranteed issue basis? _____ Yes _____ No.

13. Are any disabilities not covered? Please provide specifics.

14. Please confirm that you will waive the actively at work provision for the initial enrollment? _____ Yes _____ No. If no, please explain. ____________________________________________________________________________________________________________________________________________

15. What is the proposed elimination period for the policy?

16. Describe the claims handling process from first notification to acceptance/denial.

17. Provide the grievance/appeals procedure for your insureds. Outline the steps and timeframes of the process from initiation to final resolution.

18. Describe your disability management program, including your handling of:

a. Duration management

b. Benefit integration

c. Confidentiality

d. Psychiatric claims

e. Early return to work

f. Closing claims missing “necessary” information. What is your organization’s definition of “necessary”?

19. What are your claim turnaround standards?

20. When do you begin RTW evaluation? What are your evaluation procedures?

21. Describe the minimum benefit of the proposed policy – list and explain any deviations from the current policy.

22. Describe in detail the takeover provisions of the proposed policy – list and explain any deviations from the current policy.

23. List and describe Other Income Benefits of the proposed policy – list and explain any deviations from the current policy.

24. Describe any Pre-Existing Condition Limitations of the proposed policy – list and explain any deviations from the current policy. Note: the current short term disability policy does not include a Pre-Existing Condition Limitation.

25. Have you duplicated or improved upon the current benefit levels? Please describe any deviations in detail.

26. Are you proposing alternative plans? Please fully describe all deviations from the current plans, reasons for change, impact on rates.

27. Please complete and submit a response to all items listed in Appendix A, Part 2, STD Current Benefits (provided as a separate Excel spreadsheet as an attachment on the Purchasing Department’s VSS website:

https://pbcvssp.co.palm-beach.fl.us/webapp/vssp/AltSelfService).