RFP 251-26-185 - Group Dental Insurance.pdf

Wake County Public School System – RFP #251-26-185 – Group Dental Insurance

<August 2025>

Request for Proposal #251-26-185

1551 Rock Quarry Rd – Bldg. F Group Dental Insurance

Raleigh, NC 27610 Contract Type: Agency Specific Term Contract

Refer ALL Inquiries to: Petra Gooding

Telephone No: 919-588-3456 DUE DATE: September 26, 2025 @ 2:00 pm

E-Mail: bids-pgooding@wcpss.net Using Agency Name: WAKE COUNTY PUBLIC SCHOOL SYSTEM

NOTICE TO VENDORS

Sealed proposals, subject to the conditions made a part hereof, will be received at this office (1551 Rock Quarry Road, Building F, Raleigh, NC) until 2:00 p.m. on the day of opening and then opened, for furnishing and delivering the commodity as described herein. Refer to page 2 for proper mailing instructions.

Proposals submitted via facsimile (FAX) machine or email in response to this Request for Proposal will not be acceptable.

Proposals are subject to rejection unless submitted on this form.

EXECUTION

In compliance with this Request for Proposal, and subject to all the conditions herein, the undersigned offers and agrees to furnish and deliver any or all items upon which prices are proposed, at the prices set opposite each item within the time specified herein. By executing this proposal, I certify that this proposal is submitted competitively and without collusion.

Failure to execute/sign this page prior to submittal may render bid invalid. Late proposals are not acceptable.

VENDOR: FEDERAL ID OR SOCIAL SECURITY NO.

STREET ADDRESS: P.O. BOX: ZIP:

CITY & STATE & ZIP: TELEPHONE NUMBER: TOLL FREE TEL. NO

(800)

PRINCIPAL PLACE OF BUSINESS ADDRESS IF DIFFERENT FROM ABOVE

TYPE OR PRINT NAME & TITLE OF PERSON SIGNING: FAX NUMBER:

AUTHORIZED SIGNATURE: DATE: E-MAIL:

Offer valid for 120 days from date of proposal opening unless otherwise stated here: ____ days Prompt Payment Discount: _______ % __________________ days.

http://www2.wcpss.net/ http://www2.wcpss.net/ mailto:bids-pgooding@wcpss.net

Table of Contents

SECTION 1: Introduction and Mandatory Requirements…………………………………………. 5

1.1 Introduction……………………………………………………………………………………… 5

1.2 Definitions………………………………………………………………………………………. 5

1.3 Notification of Intent to Propose………………………………………………………..…….. 6

1.4 Questions/Inquiries…………………………………………………………………..…..……. 6

1.5 RFP Coordinator………………………………………………………..………………..……. 6

1.6 Schedule of Events……………………………………………………………………………. 6

1.7 Insurance Contract Term and Award…………………………………………………….….. 6

1.8 Insurance Contract Renewal and Cancellation………………………………………….…. 7

1.9 Evaluation/Award…………………………………………………..………………………….. 7

1.10 Financial Statements………………………………………………………………………….. 7

1.11 Clarifications/Revisions……………………………………………………………………….. 7

1.12 Warranties………………………………………………………..…………………………….. 8

1.13 Insurance Contract and Proposer Requirements………………………………………….. 8

1.14 Availability of Funds……………………………………….………………………………….. 10

1.15 Payment Terms……………………………………………………………………………….. 10

1.16 Rates

1.17 Limitation of Proposer’s Liability………………………….………………………………….. 10

1.18 Prohibition Against Assignment………………………..…………………………………….. 10

1.19 Collusion…………………………………………………………………….………………….. 10

1.20 Consultant Review…………………………………………………………………………….. 10

1.21 Resolution of Disputes………………………………………………………………………… 10

1.22 Waivers…………………………………………………………………………………………. 11

1.23 Cost of Proposal Preparation………………………………………………………………

1.24 Subcontractors or Third Party Vendors……………………………………………………… 11

1.25 Indemnification………………………………………………………………………………

1.26 Confidential, Proprietary, Trade Secret……………………………………………………… 11

1.27 Non-Warranty of Specifications……………………………………………………………

1.28 Substitute Form W-9…………………………………………………………………………... 12

1.29 Confidentially and Prohibited Communications During Evaluation………………………..12

SECTION 2: Insurance Contracts Procured……………………..………………………………….. 12

2.1 Group Dental Insurance Contracts…………………………………………………………... 12

SECTION 3: Scope of Services………………………………………………………………………… 12

3.1 Scope …………………………………………………………………………………………… 12

3.2 Insured………………………………………………………………………………………….. 12

3.3 Group Dental Insurance Plan………………………………………………………………… 12

3.4 Group Dental Insurance Coverage………………………………………………………….. 13

3.5 Maximum Benefit Increase…………………………………………………………………… 13

3.6 Waiting Period………………………………………………………………………………… 13

3.7 Continuation of Coverage…………………………………………………………………

3.8 Claims…………………………………………………………………………………………... 14

3.9 Customer Service……………………………………………………………………………… 14

3.10 Account Manager and Assistance…………………………………………………………… 14

3.11 Reporting Requirements……………………………………………………………………… 14

3.12 Usual, Customary and Reasonable Fees (UCR)………………………………………….. 15

3.13 Other Requirements…………………………………………………………………………… 15

3.14 Underwriting Information……………………………………………………………………… 15

3.15 Enhancements…………………………………………………………………………………. 16

3.16 Statement of Compliance……….…………………………………………………………… 16

3.17 Performance Guarantees and Liquidated Damages……………………………………… 16

3.18 Project Implementation Milestones and Due Dates……………………………………….. 16

3.19 Problem Escalation Procedures..…………………………………………………………… 17

SECTION 4: Required Proposal Documentation…………………………………….………………18

4.1 Proposal Warranty…………………………………………………………………………….. 18

4.2 Economy of Presentation…………………………………………………………………….. 18

4.3 Submission of Proposals…………………………………………………………………….. 18

4.4 Part 1 - Administrative Documents and Technical/Reference Proposal Content……… 18

4.4.1 Administrative Documents…………………………………………………………………… 18

4.4.2 Technical/Reference Proposal Copies……………………………………………………... 18

4.4.3 Technical/Reference Proposal Content…………………………………………………….. 18

4.5 Part 2 – Premium (Cost) Proposal…………………………………………………………... 19

SECTION 5: Evaluation

5.1 Overview……………………………………………………………………………………….. 19

5.2 Overall Evaluation of Technical/Reference Proposal……………………………………… 19

5.3 Evaluation of Technical/Reference Proposal……………………………………………….. 20

5.3.1 Technical/Reference Evaluation……………………………………………………………… 20

5.3.2 References……………………………………………………………………………………… 20

5.4 Evaluation of Premium (Cost) Proposals……………………………………………………. 20

5.5 Overall Proposal Evaluation………………………………………………………………….. 20

5.6 Selection of Successful Proposer and Insurance Contract Award……………………….. 20

Appendices:

Appendix A Current Group Dental Insurance Policy

Appendix B Census

Appendix C History of Rates

Appendix D Dental Procedure Experience Report

Appendix E Dental Experience and Premium Report

Appendix F Notice of Intent to Propose

Appendix G References

Appendix H Non-Collusion Statement

Appendix I Disclosure Information

Appendix J Mandatory Warranties and Requirements (Questionnaire)

Appendix K Technical/Reference Proposal (Questionnaire)

Appendix L Premium (Cost) Proposal (Rate Form-Three Year Insurance Contract Term)

Appendix M General Business Information

Appendix N Drug Free Workplace Certification Form

Appendix O Electronic Verification Compliance

Appendix P Performance Guarantees

Appendix Q Proposer’s Checklist

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SECTION 1: Introduction and Mandatory Requirements

1.1 Introduction

The Wake County Public School System (WCPSS) is seeking proposals from responsible and qualified Proposers to administer and provide a high-quality, cost-effective Group Dental Insurance Plan. Proposers may submit proposals as either an Administrative Services Only (ASO) provider or as a provider offering a Fully Insured Plan (FIP). Proposers must demonstrate the experience, financial stability, and capability to deliver dental benefits in accordance with the requirements outlined in Section 3: Scope of Services of this Request for Proposal (RFP). WCPSS’s objective is to select a financially secure and service-oriented provider that is responsive to the needs of covered individuals and offers a competitive, comprehensive dental benefits plan.Minority-owned businesses are strongly encouraged to participate in this RFP process.

1.2 Definitions

The intent of the following definitions is to provide a general interpretation of the terms provided within this solicitation and to provide the WCPSS’s interpretation of such terms. It is not the intent of the WCPSS to alter a Proposer’s current insurance contract provisions. However, significant deviations from the interpretations herein must be documented within the Technical/Reference Questionnaire – Appendix K.

1.2.1 Benefit Percentage means the specific percentage of the cost of treatment the insurer will pay for all covered dental expenses.

1.2.2 Benefit Period means a twelve-month period beginning January 1st and ending the following

December 31st of the Group Dental Insurance plan.

1.2.3 COBRA means the Consolidated Omnibus Budget Reconciliation Act of 1985 that gives eligible insureds and their families who lose their dental insurance the right to choose to continue dental insurance benefits. Such benefits may be provided by the WCPSS’s Group Dental Insurance plan for up to 18 months, but not more than 36 months, subject to a qualifying event as defined by COBRA. COBRA participants are provided within Appendix B.

1.2.4 Deductible means the portion of the cost of treatment that the insured is required to pay before a dental insurance payment is made by the insurer.

1.2.5 Dental Procedures means all dental procedures for which benefits are payable under a dental insurance contract, including but not limited to the prevention of dental diseases, dental procedures to repair and restore individual teeth, endodontics, periodontics, surgical procedures, restorative, prosthodontics, and anesthesia.

1.2.6 Effective Date means the date on which the initial Group Dental Insurance contract term begins between the WCPSS and the successful Proposer.

1.2.7 Exclusions mean conditions for which benefit payments are not eligible.

1.2.8 Explanation of Benefits means a detailed explanation of claims paid that indicate the portion of claims paid to the dentist and the portion due by the insured.

1.2.9 Group Dental Insurance Plan means the insurance contract that provides dental benefits to eligible insureds for dental claims incurred.

1.2.10 Insurance Contract means the insurance policy that defines the rights and duties of the insured and insurer. WCPSS is self-insured.

1.2.11 Insured means all active permanent full-time employees who work 30 hours or more per week, including all eligible dependents and COBRA participants. Employees may not be dually covered under each other’s dental plan while employed at WCPSS.

1.2.12 Insured Dependent means those dependents eligible for Group Dental Insurance which includes an insured’s spouse and the insured’s dependent children or the insured’s spouse’s dependent children. At a minimum, the insured dependent child means at least until the end of the month in which the dependent child reaches age 26 and is unmarried, dependent upon the insured for support, and is either living in the household of the insured or is a full-time/part-time student.

Dependents that are physically or medically impaired shall be covered indefinitely.

1.2.13 Insurer means the insurance company providing Group Dental Insurance coverage.

1.2.14 Maximum Benefit Amount means the maximum benefit amount payable by the insurer.

1.2.15 Non-Participating Provider (NPP) means a licensed dentist who has not contracted with the insurer to be a participating provider.

1.2.16 Participating Provider (PP) means a licensed dentist who has contractually agreed to provide dental treatment according to the guidelines of the insurer’s dental plan.

1.2.17 Preferred Provider Organization (PPO) Plan means a dental plan that allows each insured to obtain dental services by using either a participating provider or a non-participating provider, with a benefit differential between a participating provider and a non-participating provider.

1.2.18 Payment Basis means the amount payable by the insurer for covered dental expenses.

1.2.19 Policyholder is Wake County Public School System.

1.2.20 Schedule of Benefits means the services for which payment will be made by the insurer.

1.2.21 Table of Allowances means a list of covered services with an assigned percentage amount that represents the total obligation of the insurer for the dental plan with respect to payment for such services, which may not represent the dentist’s full fee for services.

1.2.22 Usual, Customary and Reasonable (UCR) means the established maximum amount payable by the insurer for covered dental expenses.

1.2.23 Waiting Period means the period after employment before the insured becomes eligible for dental insurance benefits.

1.3 Notification of Intent to Propose

The NOTIFICATION OF INTENT TO PROPOSE (Appendix F) MUST be completed and submitted by mail or hand-delivery to the RFP Coordinator specified in Section 1.5 following and received on Monday August 18, 2025, at 5pm EST. Notifications received after this date will not be considered.

1.4 Questions/Inquiries

Questions for additional information or clarification may be submitted in writing (by mail, hand-delivery, fax or e-mail to the RFP Coordinator specified in Section 1.5, and received no later than Monday August 25, 2025, at 5pm EST.

All questions should be addressed as follows: QUESTIONS RFP - Group Dental Insurance. All questions with responses will be e-mailed to the proposer’s point of contact on Friday August 29, 2025 by 5pm EST.

It is the responsibility of each proposer to monitor their e-mail for new and changing information.

1.5 RFP Coordinator

Upon receipt of this RFP, all Proposer communications concerning this RFP, including but not limited to the “NOTIFICATION OF INTENT TO PROPOSE” and the “QUESTIONS/INQUIRIES,” must be directed to the RFP Coordinator listed below. Unauthorized contact regarding this RFP with other WCPSS employees may result in disqualification. Any oral communications will be considered unofficial and non-binding to the WCPSS. Proposers should reply only in writing (mail, hand-delivered, or e-mail bids-pgooding@wcpss.net) to:

Wake County Public School System – Purchasing Department ATTN: Petra Gooding, Purchasing Manager 1551 Rock Quarry Road, Raleigh, NC 27610

Note: A person or affiliate who has been placed on the Convicted Vendor List following a conviction for a public entity crime may not submit a Proposal to provide goods or services for a period of 36 months from the date of being placed on the Convicted Vendor List.

1.6 Schedule of Events

Issuance of RFP August 7, 2025

Submission of Notification of Intent to Propose (received after this date will not be considered)

August 18, 2025

Last date to submit written questions August 25, 2025

Written responses to all questions e-mailed August 29, 2025

Proposals Due (received after 2pm will not be considered) September 26, 2025, by 2:00 pm

Evaluation of Proposals Completed October 31, 2025

Anticipated Selection of Top Proposer February 27, 2026 mailto:bids-pgooding@wcpss.net

1.7 Insurance Contract Term and Award

The initial insurance contract term will begin on January 1, 2027. The WCPSS anticipates that the initial term of this insurance contract shall be from the effective date until the insurance contract expiration date, which will be for a three-year term with the option to renew in one year increments for up to two additional years. The award will consist of this RFP, any amendments to this RFP, the successful Proposer’s Proposal to this RFP, the insurance contract, and any other terms and conditions agreed between the parties that may be necessary to the WCPSS.

1.8 Insurance Contract Duration, Renewal and Cancellation

The Contract that results from this solicitation shall commence as of the date the Contract is signed by the Wake County Public School System following approval of the Contract by the Wake County Board of Education, if such approval is required (“Contract Commencement”).

From the date of Contract Commencement through approximately December 31, 2026, the Contractor shall perform start-up activities (See RFP Section 3.18 “Project Implementation Milestones and Due Dates”) such as are necessary to enable the Contractor to begin the successful performance of Contract activities as of the Go-Live Date of January 1, 2027. The Contractor shall begin performing all activities required by the Contract, including the requirements of the solicitation, and the offerings in the Technical Proposal, for the compensation contained in the Financial Proposal.

No compensation will be paid to the Contractor for any start-up activities it performs between the date of Contract Commencement and the Go-Live Date. Following the end of this Contract, the Contractor shall be responsible for handling claims payments for claims incurred prior to the end of the Contract; the Contractor’s obligations as insurer with respect to covered services during a period of coverage shall survive the expiration of the Contract.

The duration of the Contract will be from the date of Contract Commencement through approximately a period up to five (5) plan years for the provision of all services required by the Contract, and the requirements of the RFP. The contract shall commence as described and cover implementation prior to the first plan year and run-out, audits, and reconciliation processes following the last covered plan year. It is anticipated that the first plan year covered by the contract will begin as of the Go-Live Date of January 1, 2027, and that run-out, audits and reconciliation processes will conclude no later than 18 months following the last day of the last plan year covered by the Contract.

The Contractor’s obligations to pay invoices to subcontractors that provided services during the Contract term, as well as the audit, confidentiality, document retention, and indemnification obligations of the Contract shall survive expiration or termination of the Contract and continue in effect until all such obligations are satisfied.

The initial contract term will be a three-year term with a two-year renewal option that will be granted at the sole discretion of the WCPSS. Renewals are not guaranteed and are contingent upon funding and favorable performance of the successful Proposer.

This award may be canceled at the sole discretion of the WCPSS with 30 days advance written notice to the successful Proposer. In the event an award is terminated by such notice from the WCPSS, the successful Proposer shall be paid for services provided through the date of termination. Notice shall be sufficient if it is delivered personally or mailed by certified mail to the successful Proposer.

1.9 Evaluation/Award

Evaluation and award of this Proposal shall be made based upon the total number of points awarded for all areas as outlined under Section 5: Evaluation of this RFP. The WCPSS reserves the right to reject all Proposals and to waive any minor technicalities where it is determined to be in the best interest of the

WCPSS.

1.10 Financial Statements

Insurers must provide an audited financial statement that proves fiscal solvency and demonstrates net profitability. WCPSS reserves the right to, at any time, examine the insurer’s most recent years audited financial statements.

1.11 Clarifications/Revisions

Before the award, the WCPSS reserves the right to seek clarifications and to request any information deemed necessary for proper evaluation from all Proposers deemed eligible for award.

1.12 Warranties

Each Proposer shall warrant that it understands, represents, and acknowledges that it is professionally qualified and possesses the requisite skills, knowledge, qualifications, and experience to provide the required services. The mandatory requirements included in Appendix J must be verified as follows (if the Proposer cannot certify to any of following, the Proposer shall submit with its Proposal a written explanation of why it cannot do so within Appendix J, Mandatory Warranties and Requirements Questionnaire).

Proposers failing to submit Appendix J, Mandatory Warranties and Requirements Questionnaire in compliance with the requirements set forth herein may be disqualified and removed from further evaluation.

1.12.1 The insurer has a minimum of five years’ experience in writing, underwriting, and servicing Group

Dental Insurance Plans.

1.12.2 The experience of the insurer’s current book of business includes at least two Group Dental Insurance contracts (policies) having a minimum of 1,500-2,000 covered employees.

1.12.3 All organizations associated with this RFP or the resultant insurance contract, including the agent or any other organization, have experience with at least two Group Dental Insurance contracts (policies) having a minimum of 1,500-2,000 covered employees.

1.12.4 All insurance agents associated with this RFP, or the resultant insurance contract (policy) possess a North Carolina resident or non-resident license.

1.12.5 All organizations associated with this RFP, or the resultant insurance contract (policy) have a minimum of three years’ experience in marketing a Group Dental insurance contract.

1.12.6 The Proposer, including the insurer, agent or any other organization associated with this RFP or the resultant insurance contract (policy) is currently or will be registered with the State of North Carolina, prior to the insurance contract award.

1.12.7 The Proposer, including the insurer, agent or any other organization associated with this RFP or the resultant insurance contract (policy) is not currently under suspension or debarment by the State or any other governmental authority.

1.12.8 Insurers will submit the most recent years audited financial statement if requested by the WCPSS.

1.12.9 To the best knowledge of the person signing the Proposal, the Proposer, its affiliates, subsidiaries, directors, officers, employees or any other organization associated with this RFP or the resultant insurance contract (policy) are not currently under investigation by any governmental authority and have not in the last ten years been convicted or found liable for any act prohibited by law in any jurisdiction involving conspiracy or collusion with respect to bidding on any public contract.

1.12.10 To the best knowledge of the person signing the Proposal, the Proposer, its affiliates, subsidiaries, directors, officers, or any other organization associated with this RFP, or the resultant insurance contract, have no delinquent obligations to the State, including a claim by the State for liquidated damages under any other contract.

1.12.11 To the best knowledge of the person signing the Proposal, the Proposer, its affiliates, subsidiaries, directors, officers or any other organization associated with this RFP or the resultant insurance contract (policy) have not within the preceding three years been convicted of or had a civil judgment rendered against them or is presently indicted for or otherwise criminally or civilly charged for: commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a federal, state, or local government transaction or public contract; violation of federal or state antitrust statutes; or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property.

1.12.12 To the best knowledge of the person signing the Proposal, the Proposer, its affiliates, subsidiaries, directors, officers, or any other organization associated with this RFP, or the resultant insurance contract (policy) have not within a three-year period preceding this certification had one or more federal, state, or local government public transactions terminated for cause or default.

1.13 Insurance Contract and Proposer Requirements

Each Proposer shall acknowledge and verify the insurance contract and proposer requirements listed herein. The mandatory requirements included in Appendix J must be verified as follows (if the Proposer cannot certify to any of the following, the Proposer shall submit with its Proposal a written explanation of why it cannot do so within Appendix J, Mandatory Warranties and Requirements Questionnaire).

1.13.1 The proposed Group Dental Insurance contract shall be provided by one insurer; however, insurers may submit proposals through multiple agents and agents may submit proposals through multiple insurers.

1.13.2 All commissions, if any, should be provided and shall be included in the rate quoted to the WCPSS.

The WCPSS is unaware of any commissions, if any, under the WCPSS’s current Group Dental Insurance contract.

1.13.3 The proposed Group Dental Insurance contract (policy) shall meet or exceed all Group Dental Insurance benefits provided in the WCPSS’s current Group Dental Insurance contract (policy).

1.13.4 The person signing the Proposal has the authority to bind the Proposer.

1.13.5 The Proposer must have a detailed plan to provide continued service and support of the resultant insurance contract (policy) in the event the Proposer’s company is no longer the servicing carrier for any reason, including going out of business, merging with another company or otherwise unable to fulfill its obligation under the insurance contract.

1.13.6 The Proposer will satisfactorily provide all services requested as specified in the RFP, and the completion of those services will be the responsibility of the successful Proposer.

1.13.7 The Proposer shall always remain responsive & responsible during the insurance contract term.

1.13.8 The Contractor shall maintain Commercial General Liability Insurance with limits sufficient to cover losses resulting from, or arising out of, Contractor action or inaction in the performance of the Contract by the Contractor, its agents, employees, or subcontractors, but no less than a Split Limit for Bodily Injury, Property Damage, and Personal and Advertising Injury Liability of $1,000,000 per occurrence and $2,000,000 aggregate.

1.13.9 The Contractor shall maintain Errors and Omissions/Professional Liability insurance with minimum limits of $1,000,000 per occurrence.

1.13.10 The Contractor shall maintain Automobile and/or Commercial Truck Insurance as appropriate with Liability, Collision, and PIP of $100,000 per occurrence and $300,000 aggregate where the vehicle(s) is registered but in no case less than those required by the State of North Carolina.

1.13.11 The Contractor shall maintain Employee Theft Insurance with minimum limits of $250,000 per occurrence.

1.13.12 Within five (5) Business Days of execution of a Contract with the WCPSS, the Contractor shall provide the Contract Monitor. Certificates of insurance must remain current and Contract Monitor shall provide an updated certificate upon renewal of coverages or change in carrier, no less than annually in multi-year contracts. Such a copy of the Contractor’s current certificate of insurance shall contain at minimum the following:

a. Workers’ Compensation – The Contractor shall maintain such insurance as necessary and/or as required under Workers’ Compensation Acts and the Federal Employers’ Liability Act.

b. Commercial General Liability as required in Section 1.13.8.

c. Errors and Omissions/Professional Liability as required in Section 1.13.9.

d. Automobile and/or Commercial Truck Insurance as required in Section 1.13.10.

e. Employee Theft Insurance as required in Section 1.13.11.

1.13.13 The Wake County Board of Education (WCBOE) shall be as an additional named insured on the policies except for Worker’s Compensation Insurance and Professional Liability Insurance.

Certificates of insurance evidencing coverage shall be provided prior to the commencement of any activities in the Contract. All insurance policies shall be endorsed to include a clause that requires that the insurance carrier provide the WCPSS, by certified mail, not less than 45 days’ advance notice of any non-renewal, cancellation, or expiration. In the event the WCPSS receives a notice of non-renewal, the Contractor shall provide the WCPSS with an insurance policy from another carrier at least 30 days prior to the expiration of the insurance policy then in effect. All insurance policies shall be with a company licensed by the State to do business and to provide such policies.

1.13.14 The Contractor shall require that any subcontractors providing services under this Contract obtain and maintain similar levels of insurance and shall provide the WCPSS with the same documentation as is required of the Contractor.

1.14 Availability of Funds

The performance under any awards from this RFP shall be subject to and contingent upon the availability of appropriated funds from which payment for Contract purposes can be made.

1.15 Payment Terms

1.15.1 Group Dental Insurance Premiums

1.15.1.1 Group Dental Insurance premiums are self-administered by WCPSS & collected monthly

1.15.1.2 The initial premium for Group Dental Insurance will be collected by WCPSS based on the

Premium Proposal accepted from the successful Proposer after the insurance contract effective date.

1.15.1.3 All monthly premiums will be collected by WCPSS based on the Premium Proposal accepted from the successful Proposer, and in accordance with the appropriate Policies and Procedures. WCPSS will be responsible for their own administration of collecting monthly premiums.

1.15.2 Benefit Payments

All benefit payments shall be paid by the Proposer to the insured or the dental services provider if authorized by the insured. The Proposer will be reimbursed weekly or as agreed upon, by WCPSS.

1.16 Rates

Rates shall apply per insured person and per insured person with dependents and shall be guaranteed for the entire length of the insurance contract period awarded. The Proposer shall be bound by its proposal for a period of one hundred fifty (150) calendar days from the proposal due date.

1.17 Limitation of Proposer’s Liability

No party shall be liable for lost profits, lost revenue, or lost institutional operating savings. The WCPSS may, in addition to other remedies available to it in law or equity, and upon notice to the successful Proposer, retain such monies from amounts due to the successful Proposer as may be necessary to satisfy any claim for damages, penalties, costs and the like asserted by or against it. The WCPSS may offset any liability or other obligation of the successful Proposer under this insurance contract.

1.18 Prohibition Against Assignment

An award of this RFP is for Group Dental Insurance and associated services, which shall be provided by the successful Proposer. The award may not be assigned by the successful Proposer in whole or in part, unless approved by the WCPSS.

1.19 Collusion

Proposal-rigging is a crime. The Sherman Antitrust Act prohibits agreements among actual or potential competitors as to which firm will win a contract put out for proposal. The antitrust law also prohibits other forms of price-fixing, including agreements and conspiracies among actual or potential competitors with the purpose or effect of raising, fixing, pegging, or stabilizing prices, or allocating (dividing) geographic markets or contracts. Any suspicion of anticompetitive conduct in connection with this Proposal should be reported to the State of North Carolina Attorney General.

1.20 Consultant Review

The WCPSS reserves the right to share with any consultant of its choosing this RFP and Proposals received to secure a second opinion.

1.21 Resolution of Disputes

Any disputes between the successful Proposer and the WCPSS as to the application, meaning, or interpretation of any part of an award because of this RFP shall be resolved in Wake County, North Carolina, by application of North Carolina law.

1.22 Waivers

The WCPSS shall not be deemed to have waived any of its rights or remedies hereunder unless such a waiver is in writing and signed by the WCPSS. No delay or omission on the part of the WCPSS in exercising any rights or remedies shall operate as a waiver of such right or remedy or any other rights or remedies. A waiver on any one occasion shall not be construed as a bar or waiver of any right or remedy on future occasions.

1.23 Cost of Proposal Preparation

The cost of preparing the Proposal is the sole responsibility of the Proposer, whether any award results from this solicitation.

1.24 Subcontractors or Third-Party Vendors

The successful Proposer will be responsible for all services and costs associated with a subcontractor or third-party vendors contracted by the Proposer. Unless in the event of an emergency, third-party agreements are discouraged and must be vented and approved by WCPSS prior to entering into an agreement with the successful Proposer.

1.25 Indemnification

The successful Proposer at all times, agrees to indemnify and hold harmless the WCPSS and its agents and employees from any and all costs, loss, damage, liability, expense, claim, demand, judgments, court costs and attorneys’ fees, that may arise from or be claimed against the WCPSS by any person(s) for any injuries, death, damage to property or damage of whatever kind arising from the use of, products or services provided by the successful Proposer, the successful Proposer’s subcontractors or its third party vendors, or arising from any neglect or fault of the successful Proposer, the successful Proposer’s subcontractors or its third party vendors from any products or services including the resultant insurance contract, now or thereafter in force; and if suits or proceedings shall be brought against the WCPSS, or its agents or employees as provided hereunder, the successful Proposer, upon request of the WCPSS, shall defend the same and shall pay whatever judgment(s) that may be obtained against the WCPSS, its agents and/or employees. The successful Proposer, the successful Proposer’s subcontractors, or its third-party vendors always, agrees to comply with all laws, statutes, rules and regulations of the State of North Carolina and the United States of America.

1.26 Confidential, Proprietary, Trade Secret

If the Proposer considers any portion of the documents, data or records submitted with this RFP to be confidential, trade secret or otherwise not subject to disclosure, then the Proposer must also simultaneously provide the WCPSS with a separate redacted copy of its documents, data or records and briefly describe in writing the grounds for claiming exemption from the public records law, including the specific statutory citation for such exemption. This redacted copy shall contain the RFP number and Proposer’s name on the cover and shall be clearly titled “Redacted Copy.” The Redacted Copy shall be provided to the WCPSS at the same time Proposer submits the document, data, or records to the WCPSS and must only exclude or obliterate those exact portions that are claimed to be confidential, proprietary, or trade secret. The proposer shall be responsible for defending its determination that the redacted portions of its documents, data or records are confidential, trade secret or otherwise not subject to disclosure. Further, Proposer shall protect, defend, and indemnify the WCPSS for all claims arising from or relating to Proposer’s determination that the redacted portions of its proposal are confidential, proprietary, trade secret or otherwise not subject to disclosure. If Proposer fails to submit a Redacted Copy with its reply, the WCPSS may produce the entire documents, data or records submitted by Proposer in answer to a public record request for these records.

1.27 Non-Warranty of Specifications

Due care and diligence have been exercised in the preparation of the Scope of Services herein. All information contained herein is believed to be substantially correct. However, the responsibility for determining the full extent of the exposure to risk and verification of all information herein shall rest solely with those submitting a Proposal. Proposers are responsible for ensuring that the proposed Group Dental Insurance contract provides, at a minimum, the coverage afforded under the current insurance contract.

Any deviation in coverage terms, conditions or exclusions must be clearly outlined within Appendix K, Technical/Reference Proposal (Questionnaire). The WCPSS shall not be responsible for any error or omission in the Scope of Services provided herein, nor for the failure on the part of the Proposer to determine the full extent of the exposure.

1.28 Substitute Form W-9

The successful Proposer will be required to register and submit a Form W-9 before WCPSS is permitted to make payments to the successful Proposer. Submission of a Form W-9 ensures that the WCPSS’s vendor records and Form 1099 reporting are accurate.

1.29 Confidentially and Prohibited Communications During Evaluation During the proposal process from the date proposals are issued through the date the contract is awarded— each Vendor submitting a proposal (including its representatives, sub-contractors and/or suppliers) is prohibited from having any communications with any person inside or outside the using agency, issuing agency, other government agency office, or body (including the WCPSS Board of Education, purchaser named above, department secretary, agency head, members of the general assembly and/or governor’s office), or private entity, if the communication refers to the content of Vendor’s proposal or qualifications, the contents of another Vendor’s proposal, another Vendor’s qualifications or ability to perform the contract, and/or the transmittal of any other communication of information that could be reasonably considered to have the effect of directly or indirectly influencing the evaluation of proposals and/or the award of the contract. A Vendor not in compliance with this provision shall be disqualified from contract award. A Vendor’s proposal may be disqualified if its sub-contractor and supplier engage in any of the foregoing communications during the time that the procurement is active (i.e., the issuance date of the procurement to the date of contract award). Only those discussions, communications or transmittals of information authorized or initiated by the issuing agency for this RFP, or general inquiries directed to the purchaser regarding requirements of the RFP (prior to proposal submission) or the status of the contract award (after submission) are excepted from this provision.

SECTION 2: Insurance Contracts Procured

2.1 Group Dental Insurance Contracts

Delta Dental Inc currently provides Group Dental Insurance benefits for the WCPSS, for those employees for whom an insurance premium payment has been made. All Group Dental Insurance benefits are competitively procured through a solicitation when the WCPSS deems it is in the best interest of the WCPSS to solicit the marketplace.

SECTION 3: Scope of Services

The Scope of Services defined in Section 3 are those desired by the WCPSS. Proposers are cautioned that any deviation from this Scope of Services shall be clearly stated in the Proposer’s Proposal within the Technical/Reference Questionnaire.

3.1 Scope

The Scope of Services includes the provision of a PPO Group Dental Insurance Plan that offers dental benefits to eligible employees and their dependents. The plan should provide comprehensive coverage for dental services and associated expenses, as outlined in this RFP.

Proposals must:

• Align fully with the specifications detailed herein.

• Not include deviations unless such deviations offer enhancements that are demonstrably superior to the current Group Dental Insurance contract with WCPSS.

• Clearly outline all fees associated with the administration of the dental insurance plan, including any implementation, claims, customer service, or network access costs.

Proposers may also submit an alternative option for a dental insurance provider, provided the proposed plan meets or exceeds the current benefit levels and service standards.

Each proposal must demonstrate the provider’s ability to:

• Deliver comprehensive dental coverage;

• Administer claims in a timely and accurate manner;

• Provide access to a broad and competitive provider network; and

• Support effective customer service and account management.

3.2 Insured’s

All eligible insureds for Group Dental Insurance shall include those insureds and insured dependents and COBRA participants who are defined in Section 1 - Definitions herein. The Census included herein as Appendix B includes all currently eligible insureds defined. The WCPSS will process records and updates to the insurer for all insureds in a similar manner. One provider will service active and COBRA members.

COBRA payment checks must be received in the WCPSS accounting department monthly by the 15th of the month for the previous month’s receipts. A COBRA representative must be assigned to WCPSS to serve as a point of contact for questions, errors, and discrepancies.

3.3 Group Dental Insurance Plan

Proposals shall only include a preferred provider organization dental plan which will allow each insured to obtain dental services by using either a participating provider or a non-participating provider, with no covered service differential between a participating provider and a non-participating provider.

3.3.1 The insurer must maintain and provide a directory of participating providers for all insureds throughout the State of North Carolina. Refer to Appendix B - Census included herein for zip code information. The insurer must demonstrate ongoing continuous efforts to develop new participating providers to expand existing providers.

3.3.2 The insurer must update changes (additions, deletions, and corrections) to the directory on a regular basis. Updated directories may be available to insureds through on-line access or toll-free telephone access.

3.3.3 The insurer is encouraged to implement a quality review procedure to proactively identify and work to resolve possible overtreatment, under treatment or inappropriate care.

3.4 Group Dental Insurance Coverage

It is the intent of the WCPSS to meet or exceed the WCPSS’s current Group Dental Insurance contract.

The following provides a summary of the Group Dental Insurance coverage required by the WCPSS. Refer to Appendix A - Current Group Dental Insurance Policy included herein for more specifics.

3.4.1 The following schedule represents the minimum dental expense benefits for each insured & insured dependent. Proposers are encouraged to offer enhanced benefits that would better serve the insured, provide broader benefits and/or exceed the minimum requirements provided herein.

Such enhancements may include but are not limited to a higher percentage for the obligation of the insurer, a higher maximum benefit amount, a bonus for insured’s who do not absorb the maximum benefit amount during a benefit period or any other feature that is considered an enhanced benefit.

SCHEDULE OF BENEFITS TABLE OF ALLOWANCE

Type 1 Procedures-Preventive & Diagnostic Services Deductible Amount $0 Benefit Percentage 100% Payment Basis UCR

Type 2 Procedures-Basic Services Deductible Amount $50 Benefit Percentage 80% Payment Basis UCR

Type 3 Procedures-Major Services Deductible Amount $50 Benefit Percentage 50% Payment Basis UCR Maximum Benefit Amount per benefit period $1000 (NonPPO) Maximum Benefit Amount per benefit period $1250 (PPO)

Orthodontia Services Deductible Amount $0 Benefit Percentage 50% Payment Basis UCR Maximum Benefit Amount per lifetime $1000

3.4.2 At a minimum, but not limited to, Proposers shall offer the same dental procedures for dental benefits that are offered under the current insurance contract. Refer to Appendix A - Current Group Dental Insurance Policy included herein.

3.5 Maximum Benefit Increase

Benefits shall include a carry-over provision for insureds that did not exceed the benefit threshold.

3.6 Waiting Period

Group Dental Insurance benefits will be available on the effective date of the insurance contract for those insureds listed herein or employed on or before the effective date. Insureds employed after the effective date shall be eligible for Group Dental Insurance benefits on the first of the month following employment.

3.7 Continuation of Coverage

While the Group Dental Insurance contract is in force, the WCPSS shall have the right to continue coverage for insureds who terminate employment up to a maximum of 30 days after termination and for which a premium payment is collected.

3.8 Claims

The successful Proposer shall have a systematic claim filing process, including an established process for assuring timely and easy access to claims history and status of current claims. All claims must be processed within 14 days after receiving receipt.

3.9 Customer Service

3.9.1 The successful Proposer will be expected to provide ongoing customer service to insurers throughout the term of the resultant insurance contract period. Telephonic customer services shall include a toll-free telephone number with access to trained staff to answer questions for insured;

such services shall be available Monday through Friday, 8:00 am to 5:00 pm Eastern Standard Time with extended hours for open enrollment. Insured’s must be able to receive accurate and timely information via telephone regarding benefits, claims, electronic ability to print ID cards and non-participating and participating providers. The successful Proposer is encouraged to use advanced technology to ensure that an insured’s questions can be answered at times convenient to all insureds. Automated help/assistance at any time.

3.9.2 The successful Proposer will be required to develop and administer a customer service satisfaction tool specific to the Group Dental Insurance plan. Such tools may include surveys, postcards, or other tools available to capture the service satisfaction level. Results of evaluations must be provided to the WCPSS.

3.9.3 The successful Proposer must be capable of recording and maintaining information regarding service-related issues including complaints reported by an insured.

3.9.4 The successful Proposer shall provide all customer service functions at its own expense.

3.9.5 Providing an authentication process in identifying employees without the use of social security number.

3.10 Account Manager and Assistance

The Contractor shall assign a dedicated (but not necessarily exclusive) Account Manager as the primary contact for the WCPSS Compensation Services Benefits staff who will participate on the implementation team. The account manager must be able to make decisions or report to a person who can make decisions concerning process changes, reporting requirements and updates, as requested. The account manager will be expected to maintain an up-to-date understanding and knowledge of the resultant Group Dental Insurance contract, the WCPSS’s account and the insurer's policies and procedures. The successful Proposer will be required to meet on a quarterly basis with the WCPSS, or more frequently, as determined by the WCPSS. If requested by the WCPSS, the Account Manager will be replaced with one that the WCPSS is allowed to interview. The WCPSS reserves the right to accept or decline the Contractor's designated Account Manager for any reason at any time.

The Contractor shall provide adequate staffing for effective management and performance of its obligations in at least the following areas: account management, claims processing, claims appeals, customer/member services, reporting, open enrollment and data management and production. Open enrollment will include informational sessions at locations to provide clarification of the dental offerings. The Contractor shall identify the number and types of staff proposed to be utilized under the Contract.