RFP_26_041-DJ_Appendix B Price Proposal Pages 04212026.xlsx
XLSX spreadsheet 15 KB Posted
- Attached to
- Multiple Option Dental Program
- Solicitation number
- RFP 680 26-041/DJ 4
- Issued by
- Palm Beach County, Florida
About this file
This is a Price Proposal Appendix for RFP 26-041/DJ issued by a Florida county for a Multiple Option Dental Program. The solicitation seeks pricing for five dental plan options: Option I (DHMO Plan Basic), Option II (DHMO Plan Enhanced), Option III (DPPO Low), Option IV (DPPO High), and Option V (PPO Premier). Proposers may submit rates under two structures: a multiple-year rate guarantee commencing January 1, 2027, through an unspecified end date, or single-year rate guarantees for calendar year 2027 with optional subsequent single-year proposals subject to rate caps. All rates must be quoted on a monthly basis across four coverage tiers: Employee Only, Employee + 1, Employee + 2, and Employee + 3 or more. Proposers must confirm that rates reflect current benefit offerings or improvements, that all services and materials are included in the quoted rates, and that DHMO and DPPO plans will be quoted together rather than as standalone options at subsequent renewals if selected.
Proposers must submit complete pricing information as total contract cost including all out-of-pocket expenses and certify the accuracy and completeness of their proposals. The submission requires proposer certification regarding fair competition without collusion or fraud, financial stability to perform contract obligations, compliance with commercial non-discrimination requirements, and disclosure of any legal proceedings. Failure to submit the completed Appendix B with all required signatures and certifications will result in immediate rejection of the entire proposal. The form provides space for proposer name, title, company, address, contact information, and authorized signature, with the completed pages marked as confidential and proprietary.
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Appendix B
| APPENDIX B | |
| PRICE PROPOSAL PAGES | |
| RFP NO. 26-041/DJ | |
| I. | CURRENT MULTIPLE DENTAL PROGRAM STRUCTURE - |
| MULTIPLE YEAR RATE GUARANTEE FROM 01/01/2027 - | 99/99/9999 | |
| A. | Option I - DHMO PLAN (Basic) | MONTHLY RATE |
| Employee Only | $0.00 | |
| Employee + 1 | $0.00 | |
| Employee + 2 | $0.00 | |
| Employee + 3 or more | $0.00 | |
| B. | Option II - DHMO PLAN (Enhanced) | MONTHLY RATE |
| Employee Only | $0.00 | |
| Employee + 1 | $0.00 | |
| Employee + 2 | $0.00 | |
| Employee + 3 or more | $0.00 | |
| C. | Option III - DPPO Low PLAN | MONTHLY RATE |
| Employee Only | $0.00 | |
| Employee + 1 | $0.00 | |
| Employee + 2 | $0.00 | |
| Employee + 3 or more | $0.00 | |
| D. | Option IV - DPPO High PLAN | MONTHLY RATE |
| Employee Only | $0.00 | |
| Employee + 1 | $0.00 | |
| Employee + 2 | $0.00 | |
| Employee + 3 or more | $0.00 | |
| E. | Option V - PPO Premier PLAN | MONTHLY RATE |
| Employee Only | $0.00 | |
| Employee + 1 | $0.00 | |
| Employee + 2 | $0.00 | |
| Employee + 3 or more | $0.00 | |
| 1. | The Option I - DHMO Plan (Basic) Plan rates are guaranteed from 01/01/2027 through: | 99/99/9999 |
| 2. | The Option II - DHMO Plan (Enhanced) rates are guaranteed from 01/01/2027 through: | 99/99/9999 |
| 3. | The Option III - DPPO Low Plan rates are guaranteed from 01/01/2027 through: | 99/99/9999 |
| 4. | The Option IV - DPPO High Plan rates are guaranteed from 01/01/2027 through: | 99/99/9999 |
| 5. | The Option V - DPPO Premier Plan rates are guaranteed from 01/01/2027 through: | 99/99/9999 |
| 6. | Will you provide a rate cap for optional years not included in your multiyear rate guarantee? | Yes/No |
| Rate cap percentage | 0% | |
| 7. | Do rates reflect the current benefits as presented in current DHMO Option I and II Benefit Slates or better? | Yes/No |
| If no, specify any differences. | ||
| 8. | Do rates reflect the current benefits as presented in current DPPO Benefit Slate Options III, IV, and V or better? | Yes/No |
| If no, specify any differences. | ||
| 9. | Are rates inclusive of all services and materials? | Yes/No |
| 10. | Confirm that the DHMO and DPPO rates will be quoted together rather than stand-alone at subsequent renewals (if one Carrier is selected). | Yes/No |
II. CURRENT MULTIPLE DENTAL PROGRAM STRUCTURE -
| SINGLE YEAR RATE GUARANTEE FROM 01/01/2027 - 12/31/2027). USE DUPLICATE COPIES TO PROPOSE RATE CAPPED SUBSEQUENT SINGLE YEARS. | ||
| A. | Option 1 - DHMO PLAN (Basic) | MONTHLY RATE |
| Employee Only | $0.00 | |
| Employee + 1 | $0.00 | |
| Employee + 2 | $0.00 | |
| Employee + 3 or more | $0.00 | |
| B. | Option II - DHMO PLAN (Enhanced) | MONTHLY RATE |
| Employee Only | $0.00 | |
| Employee + 1 | $0.00 | |
| Employee + 2 | $0.00 | |
| Employee + 3 or more | $0.00 | |
| C. | Option III - DPPO Low PLAN | MONTHLY RATE |
| Employee Only | $0.00 | |
| Employee + 1 | $0.00 | |
| Employee + 2 | $0.00 | |
| Employee + 3 or more | $0.00 | |
| D. | Option IV - DPPO High PLAN | MONTHLY RATE |
| Employee Only | $0.00 | |
| Employee + 1 | $0.00 | |
| Employee + 2 | $0.00 | |
| Employee + 3 or more | $0.00 | |
| E. | Option V - PPO Premier PLAN | MONTHLY RATE |
| Employee Only | $0.00 | |
| Employee + 1 | $0.00 | |
| Employee + 2 | $0.00 | |
| Employee + 3 or more | $0.00 | |
| 1. | Do rates reflect the current benefits as presented in current DHMO Option I and II Benefit Slates or better? | Yes/No |
| If no, specify any differences. | ||
| 2. | Do rates reflect the current benefits as presented in current DPPO Benefit Slate Options III, IV, and V or better? | Yes/No |
| If no, specify any differences. | ||
| 3. | Are rates inclusive of all services and materials? | Yes/No |
| If no, specify all excess charges in detail. |
| 4. | Confirm that the DHMO and DPPO rates will be quoted together rather than stand-alone at subsequent renewals (if one Carrier is selected). | Yes/No | |
| The proposer certifies by signature below the following: | |||
| a. | This pricing is current, accurate complete, and is presented as the Total Pricing, including "out-of-pocket" expenses (if any), for the performance of this Contract in accordance with the Requirements/Scope of Work/Services of this RFP. | ||
| b. | This Proposal is current, accurate, complete, and is presented to the County for the performance of this Contract in accordance with all the requirements as stated in this RFP. | ||
| c. | The Proposal is submitted without prior understanding, agreement, or connection with any corporation, firm, or person submitting a Proposal for the same materials, services, and supplies and is, in all respects, fair and without collusion or fraud. | ||
| d. | The financial stability to fully perform the terms and conditions as specified herein. The County reserves the right to request financial information from the proposer at any time during the solicitation process and in any form deemed necessary by the County. | ||
| e. | The information in Section 3.8 Commercial Non-Discrimination Certification is true and correct to the best of the Proposer's knowledge. | ||
| f. | There are no legal proceedings required to be disclosed, as required by Section 3.8 Commercial Non-Discrimination, except as disclosed in Proposer's proposal, if any. | ||
| Note: Failure to certify and submit the required information, if applicable, shall deem your proposal non-responsive. | |||
| IMPORTANT: FAILURE TO SUBMIT THESE PAGES, INCLUDING ALL REQUIRED INFORMATION AND SIGNATURES, WILL BE CAUSE FOR "IMMEDIATE REJECTION" OF THE ENTIRE PROPOSAL RESPONSE. | |||
| NAME (PRINT/TYPE): | |||
| TITLE: | |||
| COMPANY: | |||
| ADDRESS: | |||
| CITY/STATE/ZIP: | |||
| TELEPHONE NO.: | |||
| SIGNATURE: |
APPENDIX B - PRICE PROPOSAL PAGES CONFIDENTIAL AND PROPRIETARY Page &P of &N
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