RFP 250000002730 Schedule A1 - Healthcare Actuary and Consulting (ORS).docx

SCHEDULE A1 – STATEMENT OF Work Request for Proposal No.250000002730 Healthcare and Benefit Auditing, Actuarial, and Consulting Services for Department of Technology, Management and Budget – Office of Retirement Services (ORS) This schedule identifies the anticipated requirements of any Contract resulting from this RFP. The term “Contractor” in this document refers to a bidder responding to this RFP, as well as the Contractor who is awarded the contract. The term “Bidder” is used to identify where specific responses to the RFP are required.

The Contractor must respond to each requirement and provide comprehensive responses to questions Attach any supplemental information and appropriately reference within your response.

IMPORTANT NOTE TO CONTRACTORS/BIDDERS: There are specific requirements for which acceptance must be simply acknowledged through a checkbox(es), and others that require further explanation. Click the appropriate checkbox and complete the entries as appropriate.

BACKGROUND

The Michigan Public School Employees’ Retirement System (MPSERS) began actively addressing the rising cost of funding health benefits for retirees in the late 1980s. Efforts began with a move to self-insuring the plan to allow greater flexibility with plan design issues. The second step was to engage consulting services to assist in strategic planning and the management issues related to self-insuring. The third step was the development of an initial strategic plan that included a mission statement and cost/quality goals in a process that involved the Retirement Board, the Department of Technology, Management, and Budget (DTMB), and active/retired school employee organizations. The fourth and ongoing step involves the identification, development, approval and implementation of strategic planning initiatives toward accomplishing the established goals.

The Office of Retirement Services (ORS, Plan Sponsor) offers self-funded medical, prescription drug, dental, and vision plans for MPSERS. Additionally, MPSERS has a pilot program offering Health Maintenance Organization (HMOs) on a voluntary basis that has included from two to seven HMOs.

The medical plan is currently administered by Blue Cross Blue Shield of Michigan (BCBSM). Prescription drug benefits are currently being administered by Optum Rx. The hospital/medical contract will expire December 31, 2027, and may be re-bid with an effective date of January 1, 2028. The prescription drug contract will expire December 31, 2027, and may be re-bid with a January 1, 2028, effective date. Individuals electing hospital/medical benefits may also enroll in prescription drug benefits, or they may waive this coverage. Individuals waiving hospital/medical benefits may not enroll in prescription drug benefits.

As of December 31, 2024, there were 130,163 contracts for hospital/medical coverage. This translates to 198,539 covered individuals, including dependents. 84% of this covered population is Medicare eligible. Non-Medicare subscribers are in a Preferred Provider Organization (PPO), and Medicare subscribers are in a Medicare Advantage PPO Plan. Gross benefit expenses for the twelve-month period ending December 31, 2024, were $2.09 billion.

As of December 31, 2024, there were 128,946 contracts for prescription drug coverage. This translates to 196,531 covered individuals, including dependents. 84% of covered participants are Medicare eligible. Medicare subscribers are in a Medicare Advantage Prescription Drug Plan (Employer Group Waiver Plans (EGWP) Plus Wrap). Gross claims costs for the twelve-month period ending December 31, 2024, were $857 million.

The dental and vision plan benefits cover approximately 169,000 pension recipients and 94,300 dependents at a cost of $92.4 million for the dental plan and $7.5 million for the vision plan for the twelve-month period ending December 31, 2024. Both plans are currently self-funded. The dental contract, currently administered by Delta Dental, will expire December 31, 2028, and may be re-bid with an effective date of January 1, 2029. The vision contract, currently administered by EyeMed, will expire December 31, 2026, and a new contract will be re-bid with an effective date of January 1, 2027.

ORS also has a contract for a Health Insurance Database Management System. The Data Management Vendor is contracted to provide claims data management services with a contract expiration of February 28, 2026, and will be re-bid with an effective date of March 1, 2026.

The successful implementation of this Contract largely depends upon the expertise of the Health Care Actuary and Consultant team members. It is expected that a close professional relationship will exist between the Contractor’s team and the Plan Sponsor including close interaction with the Retirement Board’s Health Insurance Committee, key ORS staff as assigned by the Program Manager, and key health plan Contractor staff as assigned by the Program Manager.

SCOPE

Contractors will provide Healthcare and Benefit Auditing, Actuarial and Consulting Services necessary to complete DTMB, ORS projects.

The resulting Contract from this solicitation process will replace existing Contract 180000001298.

No payments will be made to the Contractor during the Implementation Period. The Implementation Period means the period of time between the Contract Begin or Effective Date and when Services commence on January 1, 2026.

The primary purpose of this Contract is to: (1) facilitate the development of bid specifications for the current medical, prescription drug, dental, vision, HMO, and the Data Management Vendor’s expiring contracts, (2) provide expertise and leadership in the ongoing development, implementation and monitoring of strategic planning cost/quality initiatives, (3) perform claims and program audits of the vendors administering the self-funded health plans, (4) conduct annual premium rate setting for the self-funded and HMO plans, and (5) perform ongoing actuarial and consulting duties relating to plan administration including but not limited to the following specifications below:

1. Requirements Contractor must provide all Contract Activities/Services and staff, and must do all things necessary for or incidental to the performance of the work set forth below.

1.1. General Requirements.

The Contractor must:

1.1.1. Assist in negotiations on the Plan Sponsor’s behalf with contractors, health care providers, insurance carriers, etc.

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1.1.2. Submit testimony to the State Legislature, the Michigan Public School Employees’ Retirement System’s (MPSERS) Board, etc. at the request of the Plan Sponsor.

List all exception(s):

Bidder must describe bidder’s experience submitting testimony to public bodies such as the State Legislature and the MPSERS Board.

1.1.3. Provide counsel and assistance to deal with issues of plan design, cost containment, communications, negotiations, and other matters, which are part of managing the health care plans.

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1.1.4. Provide guidance on state and federal legislative changes that impact the Plan Sponsor or its Plans. This also includes rules / regulations that are issued by the Centers for Medicare and Medicaid Services (CMS), Department of Health and Human Services (HHS) or other oversight agencies that may impact the ORS as a Plan Sponsor and/or as a HIPAA Covered Entity.

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Bidder must describe its process for monitoring and reporting on legislative and rule/regulation changes at both the federal and state levels.

1.1.5. Provide assistance with and day-to-day oversight of research projects, audits, data analyses and strategic planning initiatives.

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1.1.6. Be responsible for receiving, analyzing, and interpreting health data in order to provide actuarial, budgetary, legislative, and system management recommendations necessary to administer the plans.

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Bidder must describe how they comply with the above requirement:

1.1.7. Give presentations to the Plan Sponsor staff, the MPSERS Board, the Board’s Health Insurance Committee, and the Health Initiative Review Committee (comprised of key educational administrators, union personnel, retiree organization leadership, and the general public), as requested by the Plan Sponsor.

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1.1.8. The Contractor’s system, processes, subcontractors, and partners must comply with all applicable requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), as amended. The Business Associate Agreement (BAA) between Contractor and Plan Sponsor is attached to and incorporated herein as Schedule F1 – HIPAA Business Associate Agreement. The Contractor may be required to annually recertify compliance with the BAA.

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1.1.9. If the Contractor is notified by the Plan Sponsor of any critical issues related to the administration of the program, the Contractor must respond within 24 hours with a resolution and execution plan.

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1.1.10. The Contractor must notify the Program Manager within twenty-four hours of any issues affecting any aspect of the program or administration thereof.

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Bidder must describe its notification process for issues that may affect any aspect of the program or administration thereof.

1.2. Request for Proposal (RFP) Development and Vendor Sourcing Support

1.2.1. General Requirements for RFP Development and Evaluation The Contractor must:

1.2.1.1. Work collaboratively with the Plan Sponsor in determining the need to re-bid a contract. This may include but is not limited to: monitoring and evaluating contract expiration dates and prospective renewal periods across Plan Sponsor’s portfolio, employing industry knowledge to determine the most favorable cadence of executing option years and/or rebidding a contract, evaluating renewal offers and estimating the financial impact of renewal as compared to a full rebid.

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1.2.1.2. Participate in the development of project plans and schedules as requested by the Plan Sponsor and/or DTMB Central Procurement.

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1.2.1.3. Adhere to any agreed upon schedules or timeframes, including those set by the Plan Sponsor and/or DTMB Central Procurement.

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1.2.1.4. Provide real-time analysis and recommendations on how to provide a high-quality plan that is affordable to both the members and employers. In support of this work, the Plan Sponsor will provide previous RFP documents, a list changes/additions to coverage, and the Plan Sponsor’s Health Care Strategic Plan, which includes Plan Sponsor’s claims experience reporting.

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1.2.1.5. Employ knowledge of current industry trends, including knowledge of the potential bidder pool, in development of RFP document(s).

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Bidder must describe how they comply with this requirement:

1.2.1.6. Provide support to and/or project management of RFP development, including assembly and organization of subject matter expertise, as requested by the Plan Sponsor.

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1.2.1.7. Provide, through subject matter experts, support and consultation to the Plan Sponsor in the development of RFP content, bidder evaluation, bidder selection, and post-award implementation of service(s).

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Bidder must describe their plan for meeting this requirement:

1.2.1.8. Advise the Plan Sponsor on information to provide bidders in order to ensure competitive and complete RFP bid responses.

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1.2.1.9. Establish and include criteria for the audit process as part of the RFP. This includes, but is not limited to, advising the Plan Sponsor on the desirable performance standards for the claims administrators when developing the bid specifications.

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1.2.1.10. Recommend service level agreement (SLA) standards.

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1.2.1.11. Establish and include requirements for management data and reports that will support the Plan Sponsor’s efforts in strategic planning, plan compliance, and administrative oversight.

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1.2.1.12. Provide and/or participate in the development of templates or worksheets that bidders must complete and submit with their proposal(s).

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1.2.1.13. Establish and recommend, in conjunction with subject matter experts, pricing methodologies and tools to be used in the evaluation of competitive bids. Provide and/or assist in the development of pricing templates as needed.

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1.2.1.14. Recommend and include criteria for selecting the winning bid as part of the RFP.

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1.2.1.15. Recommend any other information necessary for the RFP.

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1.2.1.16. Conduct a technical and qualitative review of competitive bids using Plan Sponsor approved methodologies and tools. Advise Plan Sponsor of any inconsistencies between bidder responses and the RFP documents.

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1.2.1.17. Complete a financial evaluation of selected bids at the direction of the Plan Sponsor and/or DTMB Procurement. The financial evaluation must:

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1.2.1.17.1. Include a comparison of price points to determine the overall savings to the Plan Sponsor under a new contract term.

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1.2.1.17.2. Consider all pricing arrangements for which Plan Sponsor solicited bidder responses. Depending on the plan, this may include separate analyses for non-Medicare and Medicare populations, self funded vs. fully insured arrangements, alternate risk/gain sharing arrangements, etc. See also Sections 1.2.2.1 Medical Plan Specific RFP Requirements, 1.2.2.2 Prescription Drug Plan Specific RFP Requirements, 1.2.2.3 Dental Plan Specific RFP Requirements, 1.2.2.4 Vision Plan Specific RFP Requirements, and 1.2.2.5 HMO Specific RFP Requirements for additional plan-specific requirements.

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1.2.1.18. Healthcare RFPs Only: Conduct detailed analysis of network adequacy/provider access analysis, disruption analysis, claims repricing, and any additional items as requested by the Plan Sponsor.

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1.2.1.19. Participate in all aspects of the bid response review committee. Anticipated activities may include but are not limited to drafting written responses to bidders’ proposal questions and/or participation in a bidders' question and answer meeting, analyzing and scoring the proposals, participation in Joint Evaluation Committee (JEC) meetings, interviews, on-site claim facility visits with the finalists, and any negotiations meetings.

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1.2.1.20. Give presentations to the Plan Sponsor and staff, DTMB Procurement staff, the MPSERS Board, and the Board’s Health Insurance Committee, as required.

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1.2.1.21. Contractor must provide negotiations support as it pertains to the technical evaluation. This support must include but is not limited to:

1.2.1.21.1. Review bidder-submitted red lines to technical documents.

1.2.1.21.2. Provide advice to Plan Sponsor as to the countering or acceptance of bidder-submitted red lines.

1.2.1.21.3. Provide support for multiple rounds of technical negotiations.

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Bidder must describe their experience providing negotiations support as it pertains to RFP technical evaluation(s).

Bidder must provide their plan for meeting the requirements stated in 1.2.1.21-1.2.1.21.3.

1.2.1.22. Contractor must provide negotiations support as it pertains to the financial evaluation. This support must include but not be limited to:

1.2.1.22.1. Advise the Plan Sponsor on potential areas of financial negotiation. This must include both price points as well as any additional financial terms imposed by the bidder.

1.2.1.22.2. Participate in multiple rounds of financial negotiation, potentially with multiple bidders, as requested by the Plan Sponsor.

1.2.1.22.3. Assist the Plan Sponsor in soliciting and evaluating competitive Best and Final Offers from selected bidder(s).

1.2.1.22.4. Conduct a review of all Bidder-submitted financial terms. Identify any areas of bidder-submitted terms that conflict with Plan Sponsor’s RFP documents. Identify any terms that could negatively impact the Plan Sponsor or Members. Provide red lines to bidder’s terms, as requested by the Plan Sponsor. Assist the Plan Sponsor through multiple rounds of negotiation, as requested by the Plan Sponsor.

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Bidder must describe their experience providing financial negotations support as part of the RFP process.

Bidder must describe their plan for meeting requirements 1.2.1.22-1.2.1.22.4

1.2.1.23. The Contractor must support the Plan Sponsor with new vendor implementation activities as requested by the Plan Sponsor.

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1.2.2. Healthcare Specific RFP Development and Evaluation. The Contractor must provide all support and consultation activities listed in this Statement of Work for the following RFPs:

1.2.2.1. Medical Plan Specific RFP Requirements

The Contractor must provide healthcare and actuarial consultation for the development of the RFP(s) for the re-bid of the contract for the Plan Sponsor’s Medical Plan. Consultation must include, but not be limited to:

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1.2.2.1.1. Analysis of the costs and benefits of various contracting alternatives for non-Medicare and Medicare health care services in both administrative-services only and fully insured models. Advice to the Plan Sponsor as to which pricing arrangements should be solicited as part of the RFP.

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1.2.2.1.2. Analysis and modeling of various bidder-submitted pricing arrangements such as administrative-service only, fully insured, risk sharing, or other alternative pricing models. This analysis may be needed for multiple bidders as determined by the Plan Sponsor.

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Bidder must describe bidder’s experience providing analysis and moedling of administrative service only, fully insured, risk sharing and other alternative pricing models.

1.2.2.1.3. If analysis indicates the need for multiple RFPs (for example, creating separate RFPs for the Medicare and non-Medicare populations), the Contractor must provide these services for each RFP written.

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1.2.2.2. Prescription Drug Plan Specific RFP Requirements

The Contractor must provide healthcare and pharmacy industry and actuarial consultation for the development of the RFP(s) for the re-bid of the pharmacy benefit management (PBM) services contract for the prescription drug plan. Note: This process has historically been completed as part of the medical plan RFP. As of current, the medical and prescription drug plan contracts are held by separate Contractors, so this work is being labeled separately for clarity. Consultation must include, but not be limited to:

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1.2.2.2.1. Analysis of the costs and benefits of various contracting alternatives for non-Medicare and Medicare prescription drug services in both administrative-services only and fully insured models. Advice to the Plan Sponsor as to which pricing arrangements should be solicited as part of the RFP.

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1.2.2.2.2. Analysis and modeling of various bidder-submitted pricing arrangements such as administrative-service only and fully insured. Additional modeling may be required for prescription drug-specific pricing items including but not limited to discounts, dispensing fees, rebates, CMS subsidies, etc. This analysis may be needed for multiple bidders as determined by the Plan Sponsor.

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Bidder must describe prescription drug-specific modeling abilities.

1.2.2.2.3. If analysis indicates the need for multiple RFPs (for example, creating separate RFPs for the Medicare and non-Medicare populations), the Contractor must provide these services for each RFP written.

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1.2.2.3. Dental Plan Specific RFP Requirements

The Contractor must provide advice on industry standards, actuarial analysis, and expert consultation for the development of an RFP for the re-bid of dental plan services. Consultation must include, but not be limited to:

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1.2.2.3.1. Analysis of the costs and benefits of both administrative- services only and fully insured models to assist the Sponsor in determining which types of pricing to solicit as part of the RFP.

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1.2.2.3.2. Evaluation of the various pricing models as submitted by bidders. This analysis may be needed for multiple bidders, as determined by the Plan Sponsor.

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1.2.2.4. Vision Plan Specific RFP Requirements

The Contractor must provide advice on industry standards, actuarial analysis, and expert consultation for the development of an RFP for the re-bid of vision plan services. Consultation must include, but not be limited to:

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1.2.2.4.1. Analysis of the costs and benefits of both administrative-services only and fully insured models to assist the Sponsor in determining which types of pricing to solicit as part of the RFP.

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1.2.2.4.2. Evaluation of the various pricing models as submitted by bidders. This analysis may be needed for multiple bidders, as determined by the Plan Sponsor.

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1.2.2.5. HMO Specific RFP Requirements

The Contractor must provide advice on industry standards, and expert consultation for the development of an RFP for the re-bid of HMO services. Consultation must include, but not be limited to:

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1.2.2.5.1. Evaluation of the various pricing models as submitted by bidders. This analysis may be needed for multiple bidders, as determined by the Plan Sponsor.

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1.2.3. Data Management Vendor Specific RFP Development and Evaluation The Contractor must provide consultation for the development of an RFP for the re-bid of the Data Management Vendor contract or contract renewal. The contractor must:

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1.2.3.1. Provide real-time analysis and recommendations on how to secure data management services that support the Plan Sponsor’s objectives. In support of this work, the Plan Sponsor may supply to the Contractor the following: previous RFP documents, existing contract terms and conditions, and/or input from the Plan Sponsor on desired additions/edits to the current agreement.

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1.2.3.2. Participate in strategy meetings to assist Plan Sponsor in defining data management needs.

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1.2.3.3. Employ knowledge of current industry trends, including knowledge of the potential Bidder pool in the development of RFP document(s).

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Bidder must describe how they comply with this requirement:

1.2.3.4. Assist the Plan Sponsor in conducting market research to determine the potential Bidder pool.

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Bidder must describe its process for conducting market research.

1.2.3.5. Schedule and/or participate in technical demonstrations as part of the market research process as directed by the Plan Sponsor. Solicitation of demonstrations from multiple potential vendors may be required.

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1.2.3.6. Advise Plan Sponsor as to RFP requirements that should be modified based upon lessons learned in the technical demonstrations.

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1.2.4. Healthcare and Data Management Vendor Contract Modifications

1.2.4.1. The Contractor must review and recommend changes to facilitate rapid and uncontested implementation of benefit and procedural modifications resulting from strategic planning initiatives or industry-wide changes in health provider practice procedures.

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1.2.4.2. As requested by the Plan Sponsor, the Contractor must review any proposed contract amendments. If the amendment impacts the stated financials, a financial impact analysis may be required. This may also include additional negotiations with the vendor.

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1.2.5. Healthcare and Data Management Vendor Contract Renewals

1.2.5.1. If, in any given year, analysis indicates that the use of available option years is the Plan Sponsor’s most advantageous position, the Contractor must support the renewal efforts. This may include, but is not limited to:

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1.2.5.2. Assist with the development of project plans or schedules, as requested by the Plan Sponsor, and adhere to all agreed-upon timeframes.

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1.2.5.3. Evaluate Contractor-submitted pricing proposals; conduct actuarial analysis as needed.

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1.2.5.4. Participate in vendor negotiations, including technical negotiations and the solicitation of a competitive best and final offer, as requested by the Plan Sponsor.

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1.2.5.5. Participate in meetings as needed to support the renewal process.

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1.3. Actuarial Underwriting.

The Contractor must complete the following:

1.3.1. Consolidated Cost Report Development / Healthcare Rating Process

1.3.1.1. On an annual basis, and by a date determined by the Plan Sponsor, complete a healthcare rating process utilizing the most recent experience to determine the expected costs, on a per member per month basis, of the MPSERS healthcare plans (medical, prescription drug, dental, vision and HMOs). Where applicable, Medicare and Non-Medicare plans must be evaluated separately, unless otherwise specified by the Plan Sponsor. Medical and prescription drug data must be combined or separated based on the needs and direction of the Plan Sponsor.

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1.3.1.2. Create a report that consolidates historical cost information from multiple vendors (medical, prescription drug, dental, vision and HMOs) and projects expected expenses for the upcoming year. Report must, at a minimum:

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1.3.1.2.1. Provide 5 years of historical net costs per member per month, separated by program, with average annualized trend. This includes separating medical and prescription drug data by Medicare and Non-Medicare segments.

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1.3.1.2.2. Provide medical and prescription drug plan detail, including membership, benefit expenses, administrative expenses, rebates, federal government subsidies, and net costs, for the most recent 2 plan years. This includes separating data by Medicare and Non-Medicare segments.

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1.3.1.2.3. Address developing trends, federal and/or state legislation, federal subsidy changes, and planned benefit changes that will have an impact on the upcoming year’s costs.

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1.3.1.2.4. Apply historical costs, trend assumptions, benefit change adjustments, administrative expenses, federal subsidies and other discounts, rebates or revenue to project expected program costs for the upcoming year. Net costs must be calculated for the separate benefits offered under the MPSERS healthcare plan (medical, prescription drug, dental, vision and HMOs), unless otherwise specified by the Plan Sponsor.

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1.3.1.3. Present report to the Plan Sponsor by a date determined by the Plan Sponsor.

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1.3.1.4. Collaborate with the Plan Sponsor to make adjustments to the report, as requested by the Plan Sponsor.

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1.3.1.5. Present report to the MPSERS Board and committee(s) as requested by the Plan Sponsor.

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1.3.1.6. Implement changes to the healthcare rating process at the direction of the Plan Sponsor. This may include, but is not limited to: healthcare rating methodology, timeframe and timeline for establishing rates.

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1.3.2. Member Premium / Retiree Contribution Setting

1.3.2.1. On an annual basis, and by a date determined by the Plan Sponsor, complete a process to establish member premiums, the monthly amount that must be paid by members to be enrolled in any of the MPSERS healthcare plans (medical, prescription drug, dental, vision and HMOs). These premiums will represent the total, unsubsidized monthly cost to enroll in the plan(s).

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1.3.2.2. Establish premiums using a methodology approved by the Plan Sponsor, which may or may not align with the trends and expected program costs established in Section 1.3.1.1. This includes, but is not limited to:

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1.3.2.2.1. Developing premiums for individuals based on their relationship to the contract holder/retiree (i.e. separate premiums for self, spouse, children, parents, etc.)

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1.3.2.2.2. Combining or separating medical and prescription drug data to consolidate or separate premiums, at the direction of the Plan Sponsor.

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1.3.2.2.3. Where applicable, developing separate premiums for Medicare and Non-Medicare enrollees.

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1.3.2.2.4. Developing separate premiums for each HMO, if requested by Plan Sponsor.

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1.3.2.3. Present member premiums to the Plan Sponsor by a date determined by the Plan Sponsor.

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1.3.2.4. Collaborate with the Plan Sponsor to make adjustments to the premiums, as requested by the Plan Sponsor.

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1.3.2.5. Present information to the MPSERS Board and committee(s) as requested by the Plan Sponsor.

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1.3.2.6. Assist Plan Sponsor with completing documentation to update Plan Sponsor’s vendor payment and retiree payroll system.

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1.3.2.7. Upon Plan Sponsor request, provide suggestions for alternate premium setting methodologies/options. Factors to consider in the premium setting process may include, but are not limited to:

1.3.2.7.1. Funded ratio of the MPSERS healthcare plan.

1.3.2.7.2. Range limits on annual changes to member premiums.

1.3.2.7.3. Historical experience of MPSERS healthcare plan.

1.3.2.7.4. Gross medical and pharmacy trends.

1.3.2.7.5. Criteria for establishing no change in premiums.

1.3.2.7.6. Social Security Cost of Living Adjustments.

1.3.2.7.7. Medicare Part B premiums.

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Bidder must describe how they will comply with the above requirements:

1.3.2.8. Implement changes to premium setting process at the direction of the Plan Sponsor. This may include, but is not limited to: methodology to establish premiums, timeframe and timeline for establishing premiums.

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1.3.3. HMO Rate Setting

1.3.3.1. On an annual basis, and by a date determined by the Plan Sponsor, complete a process to establish fully insured monthly rates to be paid to the Plan Sponsor’s HMOs.

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1.3.3.2. Establish rates using a methodology approved by the Plan Sponsor which may or may not align with the trends and expected program costs established in Section 1.3.1.1. This includes, but is not limited to:

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1.3.3.2.1. Developing rates for individuals based on their relationship to the contract holder/retiree (i.e. separate rates for self, spouse, children, parents, etc.)

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1.3.3.2.2. Developing separate rates for Medicare and Non-Medicare enrollees.

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1.3.3.2.3. Developing separate rates for each HMO, if requested by Plan Sponsor.

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1.3.3.3. Present rates to the Plan Sponsor by a date determined by the Plan Sponsor.

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1.3.3.4. Collaborate with the Plan Sponsor to adjust the rates, as requested by the Plan Sponsor.

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1.3.3.5. Facilitate meetings with the HMO vendor(s), as needed and requested by the Plan Sponsor, to present the rates and explain the methodology used in rate development.

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1.3.3.6. Present information to the MPSERS Board and committee(s) as requested by the Plan Sponsor.

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1.3.3.7. Assist Plan Sponsor with completing documentation to update Plan Sponsor’s vendor payment and retiree payroll system.

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1.3.3.8. Upon Plan Sponsor request, provide suggestions for alternate rate setting methodologies/options.

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1.3.3.9. Implement changes to rate setting process at the direction of the Plan Sponsor. This may include, but is not limited to: rate setting methodology, timeframe and timeline for establishing rates.

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1.3.4. Review and validate information provided by Plan Sponsor’s healthcare vendors, which Plan Sponsor may use for strategic planning purposes, assessing financial settlements with vendors, budgeting, and fiscal year-end financial statements. Topics may include, but are not limited to:

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1.3.4.1. Monitoring projected claims and benefit expenses, federal government revenue, rebates or other discounts, and net costs reported by Plan Sponsor’s healthcare vendors. If Plan Sponsor has a risk/gain sharing arrangement with any vendor, Contractor must monitor related projections and validate final settlements.

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Bidder must explain their experience monitoring projections and validating settlements releative to risk/gain sharing arrangements.

1.3.4.2. Monitoring claims, other benefit and program expenses, and cost projections as reported by Plan Sponsor’s healthcare vendors in routine meetings.

List all exception(s):

1.3.4.3. Reviewing program expenses and implementation costs for new programs being offered by Plan Sponsor’s healthcare vendors, and either validating reasonableness and alignment with industry standards or providing recommendations on if/how to proceed with implementation. See also Section 1.2.4 Contract Modifications.

List all exception(s):

Bidder must explain its process for evaluating program expenses and implementation costs and providing new program implementation recommendations.

1.3.4.4. Validating healthcare vendors’ incurred but not reported claims and other benefit expenses at Plan Sponsor’s fiscal year end.

List all exception(s):

1.3.4.5. Validating Medicare Advantage savings, compared to a Medicare Supplement plan, as reported by Plan Sponsor’s medical vendor. Such validation must compare, for the current and next calendar year, the projected net costs of Medicare Advantage participation versus net costs that would be experienced if offering a Medicare Supplemental plan. This validation must be provided upon request of the Plan Sponsor by a date determined by the Plan Sponsor.

List all exception(s):

1.3.5. Strategic Initiative Support

1.3.5.1. The Contractor must develop cost estimates (and/or verify cost estimates from health vendors) for consideration in plan design changes.

List all exception(s):

Bidder must describe how they comply with the above requirement:

1.3.6. Collaborate with the Plan Sponsor’s Pension and Actuary Consulting Contractor as needed and as directed by the Plan Sponsor. This includes, but is not limited to:

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