RFP_26-500-02_CalHR_Dental_PPO_and_HMO_Program.pdf

welcome to brighter

Monday, October 13, 2025

REQUEST FOR PROPOSAL

CALHR DENTAL PPO AND HMO PROGRAM

RFP 26-500-02

CalHR Benefits Dental PPO and HMO Plans

The State of California, Department of Human Resources (CalHR) invites you to review and respond to this Dental Request for Proposal (RFP), titled CalHR Dental PPO and HMO RFP 26- 500-02. The anticipated term of this contract is three years, beginning January 1, 2027. In submitting your proposal, you must comply with these instructions.

Note that all contracts with CalHR, incorporate, by reference, the state’s General Terms and Conditions (GTC 02/2025) and Contractor Certification Clauses (CCC 04/2017) that may be viewed and downloaded at the Department of General Services websites:

https://www.dgs.ca.gov/OLS/Resources

The CCC package contains clauses and conditions that may apply to your contract and to anyone doing business with CalHR. The certification will be kept on file in a central location and must be renewed every three years or updated as changes occur.

Organizations will submit the RFP response via ProposalTech. To review the questionnaire in advance of submitting the Intent to Bid, request access with the subject line “CalHR Dental PPO and HMO RFP 26-500-02 – <bidder name> ProposalTech Access” to:

Melanie.Stangl@mercer.com, Trish.Brown@mercer.com, David.Beltran@mercer.com, and haleigh.m.burnett@mercer.com.

If your organization intends to bid on this RFP, submit your intent to bid no later than 4:00 p.m.

Pacific Standard Time (PST) on Tuesday, October 21, 2025 with the subject line “CalHR Dental PPO and HMO RFP 26-500-02 – <bidder name> Intent to Bid” with confirmation of your intent, and your organization’s name to: Melanie.Stangl@mercer.com, Trish.Brown@mercer.com, David.Beltran@mercer.com, and haleigh.m.burnett@mercer.com.

In CalHR’s opinion, this RFP is complete and without need of explanation. However, if you have questions or need clarifying information, submit your question(s) no later than 4:00 p.m. Pacific Standard Time (PST) on Tuesday, October 28, 2025, in accordance with the RFP instructions to: Melanie.Stangl@mercer.com, Trish.Brown@mercer.com, David.Beltran@mercer.com, and haleigh.m.burnett@mercer.com.

https://www.dgs.ca.gov/OLS/Resources mailto:Melanie.Stangl@mercer.com mailto:Trish.Brown@mercer.com mailto:David.Beltran@mercer.com mailto:haleigh.m.burnett@mercer.com mailto:Melanie.Stangl@mercer.com mailto:Trish.Brown@mercer.com mailto:David.Beltran@mercer.com mailto:haleigh.m.burnett@mercer.com mailto:Melanie.Stangl@mercer.com mailto:Trish.Brown@mercer.com mailto:David.Beltran@mercer.com mailto:haleigh.m.burnett@mercer.com

RFP #: 26-500-01

Proposal Timeline:

RFP available to prospective bidders on October 13, 2025

Prospective bidders request access to ProposalTech October 13 and after

Intent to bid must be submitted to Mercer by

Note: It is required for bidders to state their intent to bid in order to be considered in the evaluation process

October 21, 2025, by 4:00 p.m. (PST)

Bidder questions must be submitted to Mercer by October 28, 2025, by 4:00 p.m. (PST)

Answers to bidder questions will be disseminated by November 6, 2025, by 4:00 p.m. (PST)

Geo Access and Provider disruption reports due to Mercer by

November 7, 2025, by 4:00 pm (PST)

Financial Proposals due to Mercer by November 14, 2025, by 4:00 p.m. (PST)

Anticipated date of interviews in Sacramento (optional at CalHR’s discretion)

Week of January 12, Anticipated intent to award notification January 20, 2026

Anticipated last day to protest the award January 27, 2026

Anticipated award of the contract January 30, 2026

Anticipated contract start date January 1, 2027

Completed proposals must be received by electronic submission no later than 4:00 p.m. PST on Friday, November 14, 2025.

Please send documents asked in the RFP via ProposalTech. If you experience technical difficulties contact:

CalHR Dental PPO and HMO RFP 26-500-02

Melanie.Stangl@mercer.com, Trish.Brown@mercer.com, David.Beltran@mercer.com, mailto:Trish.Brown@mercer.com

Note that no verbal information given is binding upon CalHR unless such information is issued in writing as an official RFP addendum.

TABLE OF CONTENTS

Description Page

Letter of Authorization 4

Purpose and Description of Services 5

Bidder Minimum Qualifications 8

Proposal Questionnaire, Requirements, and Information 10

Proposal Key Action Dates 12

Location Where Work Will Be Performed 12

Questions and Answers 12

Submission of Proposal 13

Evaluation and Selection Process 16

Tax Delinquent Status Verification 22

Notice of Intent to Award and Protest 22

Disposition of Proposals 23

Standard Conditions of Service 23

Payee Data Record 23

Darfur Contracting Act Certification 24

Economic Incentive Program 24

Small Business Preference Program 24

Non-Small Business Preference Request Form and Instructions 25

Disabled Veteran Business Enterprise Incentive 28

California Code of Regulations 1896.99.100 28

Proposal Checklist 33

Attachment I – Proposal/Proposing Firm Certification Sheet / Instructions 33

Attachment II – Proposing Firm References 35

Attachment III – Proposing Minimum/Desirable Qualifications Certification 36

Attachment IV – Technical Proposal Questionnaire 38

Attachment V – Network Provider Disruption and GeoAccess Reports 39

Attachment VI - Darfur Contracting Act Certification 40

Attachment VII – DVBE Declarations (STD 843) 41

Attachment VIII – Proposer Declaration (Form GSPD-05-105) 51

Exhibit A – Scope of Work 55

Exhibit B – Budget Detail and Payment Provisions 67

Exhibit C – General Terms and Conditions (GTC 610), Sample Standard Contract

(STD 213)

Exhibit D – Special Terms and Conditions 69

Exhibit E – Additional Provisions 74

Exhibit E, Attachment 1 – Protection of Confidential and Sensitive Information 78

Exhibit E, Attachment 2 – Non-Disclosure Certificate 81

Exhibit E, Attachment 3 – DVBE Activity Report Form (CalHR) 83

Exhibit E, Attachment 4 – Small Business/DVBE Subcontractor Payment Certification 85

Exhibit F – Technical and Procedural Directives 86

Exhibit G – Information Management Services Requirements 87

Exhibit H – Bidder Confirmation of Plan Design 97

Acronym List 98

October 13, 2025

To Whom It May Concern, This letter authorizes Mercer, CA Insurance License # 0E75483 to act on behalf of the State of California, Department of Human Resources as its representative in conducting a Request for Proposal (RFP) for the Dental PPO and HMO plans. This program is provided to active and retired state employees, spouses/domestic partners and eligible dependents.

Please cooperate and provide Mercer with any and all information they may require to complete this RFP process. All questions or concerns related to this process should be directed to Mercer at Melanie.Stangl@mercer.com, Trish.Brown@mercer.com, David.Beltran@mercer.com, Sincerely, Nicole Griffith, Chief

CalHR Benefits Division mailto:Trish.Brown@mercer.com

1. PURPOSE AND DESCRIPTION OF SERVICES

The State of California, Department of Human Resources (CalHR) is releasing this Request for Proposal (RFP) to obtain bids for Dental PPO and HMO plans that provide comprehensive benefits, broad availability of network providers, excellent customer and claims services.

Bidders should understand that, due to collective bargaining, any modification to the current benefits structure must be approved by CalHR, and it is the intent that the current level of Dental PPO or HMO coverage will not be reduced.

As an agent of the taxpayers of California, the state feels a strong responsibility for making prudent purchases of all services, including the benefits of employees of the state.

A. Background

CalHR serves as the central human resources authority for the state of California, overseeing policies and programs that impact an estimated 245,000 eligible employees within over 140 departments, agencies and boards and an estimated 242,000 eligible retirees. Unlike a singular employer, the State operates as a group of diverse entities, each with unique missions and workforce needs. CalHR’s role is to establish cohesive policies and provide strategic guidance that ensures consistency and equity across this landscape.

CalHR provides Dental PPO and HMO plans through statewide agreements with multiple provides that provide services to state employees and retirees as well as their spouses/domestic partners and eligible dependents. To effectively administer the Dental PPO and HMO plans, the CalHR Benefits Division works through the HR professionals at the 153 State Departments who support employees in understanding and accessing their dental benefits. This means the selected bidder may work with over 200 HR departments who need support to serve their department employees.

Currently, CalHR contracts with one dental PPO provider that administers the following plans:

• Basic Indemnity: Available to all employees in Bargaining Units (BU) 1 through 21 except for BU5 and dues-paying BU6 employees who must be enrolled in their own union-sponsored indemnity dental plan.

• Enhanced Indemnity: Available to managerial, supervisory, confidential, exempt and excluded employees, constitutional officers, employees of the Judicial Council and all state superior, appellate and supreme court judges and their dependents.

• PPO: Available to all employees, except those with Union-Sponsored plans.

CalHR also contracts with four dental HMO providers that administer five dental HMO plans to State employees and retirees. There are four

All eligible newly hired represented employees in BUs 1, 3, 4, 5, 9, 10, 11, 12, 14, 15, 20 and 21 have the option of enrolling in a prepaid plan for the first 24 months of employment. At the end of the 24-month period, and without a permanent break in service, those employees will have 60 days to change their enrollment to an indemnity or PPO plan.

All eligible newly hired represented employees in BUs 2, 7, 8, 16, 17, 18, 19 and excluded employees (non-represented) may elect the Delta Dental PPO or Delta Dental PPO plus Premier plan at the time of hire and are not subject to the 24-month restriction period.

CalHR will award a three-year contract, with the option of two one-year extensions based on performance and mutual agreement. Since the program could potentially run for up to five years, the dental website and mobile app content must be visually refreshed and updated, as determined jointly by CalHR and the contractor(s) (e.g., new graphics, content and educational resources).

OBJECTIVES

The objectives of the RFP are:

• To provide a comprehensive, accessible, and affordable dental benefits program for their Active & Retiree populations.

• To ensure timely and efficient claims processing and customer service.

• To promote preventive dental care and overall oral health among members.

• To deliver innovative and flexible plan options tailored to the needs of the State.

The selected vendor shall provide the following services:

A. Dental Plan Administration

• Design, implement, and manage dental insurance plans, including PPO, Indemnity and DHMO plan options as specified.

• Enrollment processing for active employees, retirees, dependents and COBRA beneficiaries.

• Plan communication and education materials for members, including custom or personalized communications when needed.

• Ongoing plan management, including updates and modifications.

B. Claims Processing and Management

• Efficient and accurate claims adjudication and reimbursement.

• Handling of pre-authorizations, referrals, and coordination of benefits.

• Management of denied claims and appeals process.

C. Provider Network Management

• Development and maintenance of a broad, accessible network of licensed dental providers.

• Credentialing, contracting, and ongoing provider relations.

• Provider directory maintenance and updates.

D. Member Services

• Call center support for member inquiries and assistance.

• Member portal access for plan information, claims status, and provider search.

• Educational resources on dental health and preventive care.

E. Compliance and Reporting

• Must be registered with the Secretary of State to do business in the State of

California.

• Ensure compliance with all applicable federal and state regulations.

• Regular reporting on plan utilization, financials, and member satisfaction.

• Data security and confidentiality in accordance with HIPAA and other relevant laws.

F. Quality Assurance and Improvement

• Monitoring of service quality and member satisfaction.

• Implementation of continuous improvement initiatives.

• Coordination with CalHR for monthly feedback and program enhancements.

• Annual Stewardship Meeting and Mid-Year Utilization meetings

G. Additional Services

• Wellness programs and preventive care initiatives.

• Dental health education campaigns.

• Support for special needs or unique member populations.

• Claims Fluctuation Reserve

H. Deliverables

• Detailed project plan and timeline.

• Regular status reports and performance metrics.

• Final report summarizing outcomes, challenges, and recommendations.

• Monthly meetings with the CalHR team

• Enrollment, Billing and Payroll coordination with State departments, bargaining units, and State Controller’s Office (SCO), as applicable

• Assign an Account Executive and Account Manager based in California. This individual will be proactive in providing both strategic and operational support, readily available for in-person meetings, including an annual Stewardship and Mid-Year Utilization meeting at CalHR, and will actively support Open Enrollment and other outreach events as requested.

I. References

• Provide three customer references who can be contacted to verify the complexity and responsiveness of quality, and efficiency of customer and employee service levels.

B. Description

A. VENDOR PROFILE EXPERIENCE

A. Contractor must provide an organizational chart with resumes that identifies key state contacts, including the implementation team, IT/developer team, and account team. Contractor must provide full legal name of the company and parent company, if applicable.

B. Contractor must provide the state with an Account Executive based in California that has the capacity and availability to provide exceptional customer service to the State.

C. Contractor agrees that any planned change in the Account Management team will be communicated to CalHR by phone and in writing as soon as practicably possible, however no later than 14 calendar days prior to the effective date. New team members are expected to have received training equivalent to that of the previous team members.

D. CalHR shall have the right to interview and approve in advance any intended replacement of the Account Executive. CalHR shall provide written approval of all proposed replacements.

E. Contractor must disclose if using a subcontractor and the work to be performed.

F. Contractor must identify and provide details on any litigation, arbitration, disciplinary, or other official actions not in the ordinary course of business related to your company. Contractor must provide the company’s most recent financial statements.

B. CUSTOMER SERVICE

A. Contractor shall inform CalHR in a timely manner of any material or technical issues related to delivering services during the course of the contract, including concerns raised by employees.

B. Contractor provides a designated state contact who shall be available during normal business hours (8:00 a.m. – 5:00 p.m. PST, Monday – Friday) for CalHR.

C. Contractor provides customer service access telephonic access for employees and retirees Monday – Friday 6 am – 8 pm pacific time.

D. Contractor shall have the scalability to handle an increased number of employees during critical times such as open enrollment and the beginning of a plan year.

E. Contractor will provide a defined process for notifying CalHR of upcoming changes to dental programs.

C. MEMBER COMMUNICATIONS

A. Contractor shall provide a communication and marketing plan, implementation plan with timelines, and examples of marketing materials from previous campaigns.

B. Contractor shall provide CalHR with marketing materials, including emails, flyers, posters, and digital board for CalHR general promotion and registration. Contractor shall use diverse and inclusive imagery.

C. Contractor shall remediate all digital materials for accessibility compliance for those using assistive technology, using CommonLook®.

D. Contractor shall have a communication plan to educate members on preventive care utilization, including but not limited to preventive care reminders.

E. Contractor shall collaborate with CalHR in developing communication campaigns on effectively utilizing their benefits, relevant dental health topics as well as wellness related topics.

F. Conractor websites and mobile apps shall be responsive design for viewing on PC, MAC, phone, tablet, etc. Program must contain a mobile application or responsive design. Contractor shall utilize CalHR logo or graphics.

G. Contractor shall ensure compatibility of program with the state supported web browser (i.e., Internet Explorer, Microsoft Edge).

D. PROGRAM QUALITY

A. Contractor shall maintain a documented process for dental provider credentialing, selection, and monitoring. Upon request, Contractor shall provide details as to how it maintains quality in your providers and the services they offer.

B. Contractor shall record all calls to the 800# and have a written process for monitoring the quality of the interactions.

C. Contractor shall have a written process around complaint resolution.

D. Contractor shall facilitate and cooperate with a third-party audit at CalHR’s discretion.

E. CLAIMS ADJUDICATION

A. Contractor shall pay claims in accordance with agreed upon plan designs.

Timeliness of payments shall follow State-specific performance guarantees.

B. Contractor shall review current provider lists on an annual basis and investigate complaints and take action to improve customer service satisfaction.

C. Contractor shall establish and maintain criteria to determine if dental services are appropriate when provided by either a network or a non- network dentist.

D. Contractor shall provide a grievance resolution process to employee and family members.

F. IMPLEMENTATION AND TRANSITION

A. Contractor shall ensure that the customer service center is operational and able to accept and answer call from employees and retirees as of September 1, 2026.

B. Contractor shall, in collaboration with the State, develop customized communications materials for distribution both during open enrollment as well as in early December 2026 in anticipation of the January 1, 2027, effective date.

C. Coordinate with incumbent vendor on any files needed to support transition.

G. QUALITY OF TRAINING

A. Contractor shall deliver statewide training via Microsoft Teams or Zoom, webinars, and/or conference calls to department HR Coordinators and/or directly to employees on topics mutually agreed upon with CalHR.

B. Contractor will adjust or customize training (e.g., registration and platform capabilities) to meet the needs of the state and provide recorded online tutorials for employees.

H. DATA QUALITY AND PROGRAM EVALUATION

A. Contractor will assist in determining both data elements to be included in the reporting and provide metrics on program engagement and effectiveness.

B. Contractor shall provide monthly claims experience reports including paid premium, paid claims and enrollment. The format and content shall be mutually agreed upon by CalHR and Contractor.

C. Contractor shall provide ad-hoc reporting on an as needed basis and at the request of CalHR at no additional cost.

D. Contractor shall store and maintain historical data records in electronic format, accessible to CalHR for a period of seven years beyond the Agreement termination or expiration of the Agreement.

I. ELIGIBILITY REQUIREMENTS

A. CalHR shall have the sole responsibility for determining eligibility and setting eligibility requirements. Contractor agrees to support all current and future eligibility rules.

J. ENROLLMENT REQUIREMENTS

A. Contractor must be able to support the State’s unique enrollment process which is based on paper enrollment forms and future California State Payroll System.

B. Current Enrollment Process for Actives

(i) Employee enrolls via paper via STD Form 692 and submits to Department HR for processing

(ii) Department sends to the State Controller’s Office (SCO)

(iii) Vendor downloads enrollment files from SCO

1. Deduction file identifying deductions taken for the employee

2. Demographic file with census data for the employee only (see appendix for listing of fields)

3. For dependents, vendor retrieves scanned STD Form 692 from SCO weekly for dependent demographic data

a. Any changes to dependents are handled through scanned STD Form 692

b. Vendor is responsible for capturing and updating information from STD Form 692

(iv) Contractor agrees to combine Deduction and Demographic Files to create complete enrollment data file

1. Enrollment Form cutoff is the 10th of the month.

2. If form received on or prior to cutoff, member coverage is effective in the current month. Otherwise, member will be effective 1st of following month

(v) Vendor compares combined files to enrollment data in the system.

Reconciliation is done through “term by omission”. Exceptions are members reported on the Demographic file, and members who are effective 2 months prior to the processing month

C. Direct Pay Departments – California Exposition & State Fairs and California Fairs Services Authority

(i) Employees of the California Exposition & State Fairs and California Fairs Services Authority are not eligible to enroll online and must fill out an enrollment or by sending an email to the Contractor.

(ii) Employees must return the enrollment form to their departmental personnel office.

(iii) Personnel offices are responsible for verifying eligibility.

(iv) The personnel specialist shall email the form to contractor.

D. Current retiree Enrollment Process

(i) Retirement System (CalPERS)CalPERS Health Account Services (HAS) is responsible for processing all dental enrollment/change documents for retired state employees. It is the responsibility of each department to complete an STD. 692 for retiring employees and forward it to CalPERS for processing. In addition, employees may not change dental plans when they retire unless their dental plan is no longer available to them within a 50-mile service area.

E. California State Payroll System (CSPS)

(i) The CSPS Project is an initiative to modernize the current Uniform State Payroll System (USPS). This aligns with the SCO's organizational goal to "deliver core services and products more effectively through innovative business processes and technology solutions." The CSPS Project Team is responsible for providing leadership and oversight for the project's scope, schedule and resources to ensure the successful implementation of a modernized personnel and payroll system.

(ii) Contractor agrees to collaborate with CalHR during the implementation of CSPS and understands this will be a multi-year phased implementation.

During such time, Contractor agrees to continue the current enrollment method for Departments that have not yet transitioned while utilizing electronic eligibility files for Departments that transition to CSPS.

K. PREMIUM PAYMENT REQUIREMENTS RETIREES

A. Prepaid Plans No monthly premium; the State pays 100% of the premium for EE + eligible dependents

B. Indemnity & PPO Plans: A monthly premium cost share will be deducted from their retirement warrant [Note to bidder: The State Controller’s Office (SCO) issues the retirement warrants (payments) for CalPERS retirees.

While CalPERS is responsible for calculating and managing retirement benefits, the actual disbursement of monthly retirement payments (warrants or direct deposits) is handled by the SCO, which is the official agency that processes state payments in California.]

L. COBRA ADMINISTRATION

A. Contractor shall support COBRA Administration, including eligibility, premium billing, and sending COBRA Qualifying notices to qualified beneficiaries.

M. CLAIMS FLUCTUATION RESERVE

A. Contractor agrees to develop and manage a claims fund reserve (CFR) which may also be known as a claims stabilization fund for the State programs it administers according to the following process flow:

(i) Contractor shall provide monthly updates to the CFR with statements due to the State designees by the end of the following month.

(ii) Within 180 days following the close of the agreement year, contractor shall conduct a final annual accounting of the program which will identify all claims incurred in the program year plus administrative expenses which shall equal expenses.

(iii) Contractor shall identify all premium paid in the program year plus any applicable interest earned on the CFR balanced maintained by contractor to equal total income. Contractor shall deduct expenses from income and any surplus shall be returned to the State within 30 days of request.

(iv) At the State’s sole discretion, contractor may retain any CFR balance only if funds are kept in a separate account which meets the requirements of the State of California and with prior authorization. On an annual basis, the contractor does a reconciliation and transfer of CFR funds to the State Account.

(v) Contractor shall transfer and disburse CFR funds in a timely manner.

B. The following process mirrors current and the State desires to maintain this process, however, carriers may propose alternate processes that will provide similar or better outcomes for the State

(i) Interest credit will be applicable to any balance maintained in the CFR, including any incurred but not reported (IBNR) balance using the fund rate provided by the State Controller or Treasurer Finance Management

Group. current Merrill Lynch 1-3 year Government Corporate Rate in effect as of the 15th of each month. Monthly IBNR estimates will be updated in the subsequent monthly income-cost experience report based on more current claims run-out data.

(ii) Contractor will credit interest applicable to the monthly premium held by Contractor from the state prior to payment to providers, hereby referred to as the “float.” Interest credit on the float will be calculated monthly using the Wells Fargo Advantage one hundred percent Treasury Money Market rate in effect as of the 15th of each month. For ease of calculation, the float amount to be credited interest will be equivalent to fifty percent of the state’s actual monthly premium received.

(iii) Contractor will credit all compound interest applicable to current positive balances in the Experience Stabilization Reserve, and going forward, with compound interest to be credited quarterly, with the Experience Stabilization Reserve held by Contractor for the state. Interest credit on the Experience Stabilization Reserve will be calculated quarterly using the current Merrill Lynch 1-3 year Government Corporate Rate in effect as of the last day of the each applicable quarter.

(iv) Contractor will establish a separate accounting referred to as the “state fund” or the “Fund,” for the purposes of tracking interest credit balances and calculating associated monthly interest earnings. Contractor will provide monthly reports within 30 days following the close of each month.

The monthly reports will show a separate interest credit for the IBNR, a separate interest credit on the monthly float amount, a separate interest credit on the Experience Stabilization Reserve, and a combined estimated total. The report will also show fund balances, compound interest amounts and accumulated interest totals. Monthly reports will show current month and year-to-date estimates. A final year-end report will be provided after three months of claims run-out.

N. CONTRACT TERMINATION PROVISIONS

A. Upon termination of this Contract, the Contractor will cooperate with CalHR in an orderly transfer of administrative responsibilities and records to the new contractor and continue to provide all ongoing services through the termination date of the Contract. If CalHR chooses a mid-year transition, CalHR and Contractor shall mutually agree upon a date to transfer all ongoing and historical CalHR Participant data.

B. Contractor shall, at no additional cost to CalHR:

i. Provide all necessary data to the new dental benefit provider, including claim history and accumulators for all members in the format requested by the provider. Contractor agrees to transfer data in a timely manner so the new provider can upload and test data prior to the start of the new contract implementation, including correcting any errors discovered during testing.

ii. Referrals or redirect to the new contractor’s IVR for 30 calendar days after Contractor has stopped provision of services under this Contract, if phone number is not ported to new contractor.

iii. Participate in conference calls with the new contractor to ensure coordination and fulfillment of transition responsibilities. Provide a single point of contact for such planning meetings. Point of contact to prepare for and participate on a weekly basis throughout transition process.

Contractor shall provide staff, as well as preparation and weekly meetings over the course of the transition to the new contractor.

iv. Finalize all appeals on hand. Should some appeals result at a later date, Contractor agrees to review the appeals for claims incurred during the contract period, and coordinate with CalHR.

C. At termination of Contract, CalHR shall own any requirements documents that The State may terminate this Agreement for any reason or for no reason upon 90 days advanced written notice to Contractor. In the event this Agreement is terminated, the State shall be relieved of making any payments to Contractor accruing subsequent to the date of termination.

Should the State determine that Contractor had materially breached this agreement and then terminates this agreement, upon discovery Contractor material breach of any of its obligations under this Agreement provided, the State may provide Contractor with at least 30 days’ notice of termination specifying the reason for termination, and may afford Contractor a reasonable opportunity to cure the breach or demonstrate a substantial effort to cure the breach within the notice period, at the State's discretion.

i. Upon receipt of notice of termination by the Contractor, Contractor shall:

1. Prepare to terminate and mitigate costs for all subcontracts related to the terminated portion(s) of the contract, or the contract in its entirety.

2. Take any and all action(s) necessary to protect, secure and maintain the property, data, and/or information in the contractor's possession or in the possession of the contractor's subcontractor(s) that the State has provided the contractor or, has an interest therein.

D. Should the State and Contractor agree to an agreement extension and/or should Contractor or the State desire to change the Premiums or Benefits that shall be effective at the beginning of a new Agreement Term, Contractor and/or the State shall give at least 60 days advance written notice of such changes to the applicable party. The State is under no obligation to extend this Agreement, nor is the State under any obligation to accept any change(s) in the Benefit or Premium structure of the current Agreement or any future extension(s). The State reserves the right to approve any changes in Benefits, Benefit structure and Premium amounts stated in this Agreement, or any future extension(s) of this Agreement the State may decide to enter into with Contractor. Furthermore, this Agreement, and any future extensions of this Agreement that the State may enter into with Contractor are subject to the conditions set forth in collective bargaining agreements made between the State and its employees.

E. If Contractor accepts the proper amount of Premiums after termination of this Agreement and without requiring a new application, that acceptance will reinstate the Agreement as though never terminated, unless Contractor within 20 business days after it receives such payment, either refunds the payment so made or within 45 business days of receipt of such payment Contractor and the State agree to a new Agreement accompanied by written notice stating clearly those aspects in which the new Agreement differs from the terminated Agreement in Benefits, coverage or otherwise and subject to approval by the State and collective bargaining.

F. In the event this Agreement is terminated by the Contractor, each Eligible Person shall be notified by mail by Contractor, following approval by CalHR.

Contractor shall promptly provide the State with proof of mailing of said notice and the date thereof.

G. The State shall owe no duty or obligation of any kind to any subcontractor engaged by Contractor to perform services for said Contractor.

H. Contractor shall not be relieved of any obligation arising under this Agreement due to a labor strike or other work stoppage by Contractor's work force or the work force of any subcontractor engaged by Contractor to provided services under this Agreement. Contractor provides.

NOTE: The sample Scope of Work is based on requirements outlined in the RFP for the contract award.

The actual Scope of Work contained in the final contract between CalHR and the contractor may be amended to reflect any additions or modifications outlined in the RFP response from the selected contractor. If the final terms of the contract are not mutually agreed upon between CalHR and the selected contractor, CalHR retains the right to select the contractor with the next highest awarded points.

A) BACKGROUND

Contractor will provide the Department of Human Resources (CalHR) with a comprehensive Dental plan as described herein.

As noted in the Request for Proposal (RFP) for contract award the actual Scope of Work contained in the final contract between CalHR and the contractor may be amended to reflect any additions or modifications outlined in the RFP response, including performance guarantees (e.g., system availability, data accessibility or loss, transition services, other requirements pursuant to Exhibits A-G, reports, and timely administration of pre- and post-intervention surveys) and its related fiscal penalties.

B) LOCATION:

Services shall be available online. Any meetings with CalHR will be via conference call or at 1515 S Street, North Building, Sacramento, CA 95811.

C) CONTACT INFORMATION

The contract representatives during the term of this agreement will be:

Department of Human Resources (CalHR)

Name of Selected Contractor

Name WILL BE PROVIDED WITH

THE AWARDED CONTRACT

(Name)

Address 1515 S Street, North Building, Suite 500 Sacramento, CA 95811

(Street Address)

Phone (Phone)

Fax (Fax)

Email (Email)

Contract representatives may be changed by written notice to the other party.

D) PURPOSE

CalHR serves as the central human resources authority for the state of California, overseeing policies and programs that impact an estimated 245,000 eligible employees within over 140 departments, agencies and boards and an estimated 242,000 eligible retirees. Unlike a singular employer, the State operates as a group of diverse entities, each with unique missions and workforce needs. CalHR’s role is to establish cohesive policies and provide strategic guidance that ensures consistency and equity across this landscape.

CalHR provides Dental PPO and HMO plans through statewide agreements with multiple provides that provide services to state employees and retirees as well as their spouses/domestic partners and eligible dependents. To effectively administer the Dental PPO and HMO plans, the CalHR Benefits Division works through the HR professionals at the 153 State Departments who support employees in understanding and accessing their dental benefits. This means the selected bidder may interface with 200 HR professionals who need support to serve their department's employees.

CalHR will award a three-year contract, with the option of two one-year extensions based on performance and mutual agreement. Since the program could potentially run for up to five years, the dental website and mobile app content must be visually refreshed and updated, as determined jointly by CalHR and the contractor(s) (e.g., new graphics, content and educational resources).

OBJECTIVES

• To provide a comprehensive, accessible, and affordable dental benefits program for their Active & Retiree populations.

• To ensure timely and efficient claims processing and customer service.

• To promote preventive dental care and overall oral health among members.

• To deliver innovative and flexible plan options tailored to the needs of the State.

The selected vendor shall provide the following services:

A. Dental Plan Administration

• Design, implement, and manage dental insurance plans, including PPO, Indemnity and DHMO plan options as specified.

• Enrollment processing for active employees, retirees, dependents and COBRA beneficiaries.

• Plan communication and education materials for members, including custom or personalized communications when needed.

• Ongoing plan management, including updates and modifications.

B. Claims Processing and Management

• Efficient and accurate claims adjudication and reimbursement.

• Handling of pre-authorizations, referrals, and coordination of benefits.

• Management of denied claims and appeals process.

C. Provider Network Management

• Development and maintenance of a broad, accessible network of licensed dental providers.

• Credentialing, contracting, and ongoing provider relations.

• Provider directory maintenance and updates.

D. Member Services

• Call center support for member inquiries and assistance.

• Member portal access for plan information, claims status, and provider search.

• Educational resources on dental health and preventive care.

E. Compliance and Reporting

• Must be registered with the Secretary of State to do business in the State of California.

• Ensure compliance with all applicable federal and state regulations.

• Regular reporting on plan utilization, financials, and member satisfaction.

• Data security and confidentiality in accordance with HIPAA and other relevant laws.

F. Quality Assurance and Improvement

• Monitoring of service quality and member satisfaction.

• Implementation of continuous improvement initiatives.

• Coordination with CalHR for monthly feedback and program enhancements.

• Annual Stewardship Meeting and Mid-Year Utilization meetings

G. Additional Services

• Wellness programs and preventive care initiatives.

• Dental health education campaigns.

• Support for special needs or unique member populations.

• Administer a Claims Fluctuation Reserve per CalHR requirements.

H. Deliverables

• Detailed project plan and timeline.

• Regular status reports and performance metrics.

• Final report summarizing outcomes, challenges, and recommendations.

• Monthly meetings with the CalHR team

• Enrollment, Billing and Payroll coordination with State departments, bargaining units, and State Controller’s Office (SCO), as applicable

E) VENDOR PROFILE EXPERIENCE

A. Contractor must provide an organizational chart with resumes that identifies key state contacts, including the implementation team, IT/developer team, and account team. Contractor must provide full legal name of the company and parent company, if applicable.

B. Contractor must provide the state with an Account Executive based in California that has the capacity and availability to provide exceptional customer service to the State.

C. Contractor agrees that any planned change in the Account Management team will be communicated to CalHR by phone and in writing as soon as practicably possible, however no later than 14 calendar days prior to the effective date. New team members are expected to have received training equivalent to that of the previous team members.

D. CalHR shall have the right to interview and approve in advance any intended replacement of the Account Executive. CalHR shall provide written approval of all proposed replacements.

E. Contractor must disclose if using a subcontractor and the work to be performed.

F. Contractor must identify and provide details on any litigation, arbitration, disciplinary, or other official actions not in the ordinary course of business related to your company. Contractor must provide the company’s most recent financial statements.

F) CUSTOMER SERVICE

A. Contractor shall inform CalHR in a timely manner of any material or technical issues related to delivering services during the course of the contract, including concerns raised by employees.

B. Contractor provides a designated state contact who shall be available during normal business hours (8:00 a.m. – 5:00 p.m. PST, Monday – Friday) for CalHR.

C. Contractor provides customer service access telephonic access for employees and retirees Monday – Friday 6 am – 8 pm pacific time.

D. Contractor shall have the scalability to handle an increased number of employees during critical times such as open enrollment and the beginning of a plan year.

E. Contractor will provide a defined process for notifying CalHR of upcoming changes to dental programs.

G) MEMBER COMMUNICATIONS

A. Contractor shall provide a communication and marketing plan, implementation plan with timelines, and examples of marketing materials from previous campaigns.

B. Contractor shall provide CalHR with marketing materials, including emails, flyers, posters, and digital board for CalHR general promotion and registration. Contractor shall use diverse and inclusive imagery.

C. Contractor shall remediate all digital materials for accessibility compliance for those using assistive technology, using CommonLook®.

D. Contractor shall have a communication plan to educate members on preventive care utilization, including but not limited to preventive care reminders.

E. Contractor shall collaborate with CalHR in developing communication campaigns on effectively utilizing their benefits, relevant dental health topics as well as wellness related topics.

F. Conractor websites and mobile apps shall be responsive design for viewing on PC, MAC, phone, tablet, etc. Program must contain a mobile application or responsive design. Contractor shall utilize CalHR logo or graphics.

G. Contractor shall ensure compatibility of program with the state supported web browser (i.e., Internet Explorer, Microsoft Edge).

H) PROGRAM QUALITY

A. Contractor shall maintain a documented process for dental provider credentialing, selection, and monitoring. Upon request, Contractor shall provide details as to how it maintains quality in your providers and the services they offer.

B. Contractor shall record all calls to the 800# and have a written process for monitoring the quality of the interactions.

C. Contractor shall have a written process around complaint resolution.

D. Contractor shall facilitate and cooperate with a third-party audit at CalHR’s discretion.

I) CLAIMS ADJUDICATION

A. Contractor shall pay claims in accordance with agreed upon plan designs.

Timeliness of payments shall follow State-specific performance guarantees.

B. Contractor shall review current provider lists on an annual basis and investigate complaints and take action to improve customer service satisfaction.

C. Contractor shall establish and maintain criteria to determine if dental services are appropriate when provided by either a network or a non- network dentist.

D. Contractor shall provide a grievance resolution process to employee and family members.

J) IMPLEMENTATION AND TRANSITION

A. Contractor shall ensure that the customer service center is operational and able to accept and answer call from employees and retirees as of September 1, 2026.

B. Contractor shall, in collaboration with the State, develop customized communications materials for distribution both during open enrollment as well as in early December 2026 in anticipation of the January 1, 2027, effective date.

C. Coordinate with incumbent vendor on any files needed to support transition.

K) QUALITY OF TRAINING

A. Contractor shall deliver statewide training via Microsoft Teams or Zoom, webinars, and/or conference calls to department HR Coordinators and/or directly to employees on topics mutually agreed upon with CalHR.

B. Contractor will adjust or customize training (e.g., registration and platform capabilities) to meet the needs of the state and provide recorded online tutorials for employees.

L) DATA QUALITY AND PROGRAM EVALUATION

A. Contractor will assist in determining both data elements to be included in the reporting and provide metrics on program engagement and effectiveness.

B. Contractor shall provide monthly claims experience reports including paid premium, paid claims and enrollment. The format and content shall be mutually agreed upon by CalHR and Contractor.

C. Contractor shall provide ad-hoc reporting on an as needed basis and at the request of CalHR at no additional cost.

D. Contractor shall store and maintain historical data records in electronic format, accessible to CalHR for a period of seven years beyond the Agreement termination or expiration of the Agreement.

M) ELIGIBILITY REQUIREMENTS

A. CalHR shall have the sole responsibility for determining eligibility and setting eligibility requirements. Contractor agrees to support all current and future eligibility rules.

N) ENROLLMENT REQUIREMENTS

A. Contractor must be able to support the State’s unique enrollment process which is based on paper enrollment forms and future California State Payroll System.

B. Current Enrollment Process for Actives

(i) Employee enrolls via paper via STD Form 692 and submits to Department HR for processing

(ii) Department sends to the State Controller’s Office (SCO)

(iii) Vendor downloads enrollment files from SCO

1. Deduction file identifying deductions taken for the employee

2. Demographic file with census data for the employee only (see appendix for listing of fields)

3. For dependents, vendor retrieves scanned STD Form 692 from SCO weekly for dependent demographic data

a. Any changes to dependents are handled through scanned STD Form 692

b. Vendor is responsible for capturing and updating information from STD Form 692

(iv) Contractor agrees to combine Deduction and Demographic Files to create complete enrollment data file

1. Enrollment Form cutoff is the 10th of the month.

2. If form received on or prior to cutoff, member coverage is effective in the current month. Otherwise, member will be effective 1st of following month

(v) Vendor compares combined files to enrollment data in the system.

Reconciliation is done through “term by omission”. Exceptions are members reported on the Demographic file, and members who are effective 2 months prior to the processing month

C. Direct Pay Departments – California Exposition & State Fairs and California Fairs Services Authority

(i) Employees of the California Exposition & State Fairs and California Fairs Services Authority are not eligible to enroll online and must fill out an enrollment or by sending an email to the Contractor.

(ii) Employees must return the enrollment form to their departmental personnel office.

(iii) Personnel offices are responsible for verifying eligibility.

(iv) The personnel specialist shall email the form to contractor.

D. Current retiree Enrollment Process

(i) Retirement System (CalPERS)CalPERS Health Account Services (HAS) is responsible for processing all dental enrollment/change documents for retired state employees. It is the responsibility of each department to complete an STD. 692 for retiring employees and forward it to CalPERS for processing. In addition, employees may not change dental plans when they retire unless their dental plan is no longer available to them within a 50-mile service area.

E. California State Payroll System (CSPS)

(i) The CSPS Project is an initiative to modernize the current Uniform State Payroll System (USPS). This aligns with the SCO's organizational goal to "deliver core services and products more effectively through innovative business processes and technology solutions." The CSPS Project Team is responsible for providing leadership and oversight for the project's scope, schedule and resources to ensure the successful implementation of a modernized personnel and payroll system.

(ii) Contractor agrees to collaborate with CalHR during the implementation of CSPS and understands this will be a multi-year phased implementation.

During such time, Contractor agrees to continue the current enrollment method for Departments that have not yet transitioned while utilizing electronic eligibility files for Departments that transition to CSPS.

O) PREMIUM PAYMENT REQUIREMENTS RETIREES

A. Prepaid Plans No monthly premium; the State pays 100% of the premium for EE + eligible dependents

B. Indemnity & PPO Plans: A monthly premium cost share will be deducted from their retirement warrant [Note to bidder: The State Controller’s Office (SCO) issues the retirement warrants (payments) for CalPERS retirees.

While CalPERS is responsible for calculating and managing retirement benefits, the actual disbursement of monthly retirement payments (warrants or direct deposits) is handled by the SCO, which is the official agency that processes state payments in California.]

P) COBRA ADMINISTRATION

A. Contractor shall support COBRA Administration, including eligibility, premium billing, and sending COBRA Qualifying notices to qualified beneficiaries.

Q) CLAIMS FLUCTUATION RESERVE

A. Contractor agrees to develop and manage a claims fund reserve (CFR) which may also be known as a claims stabilization fund for the State programs it administers according to the following process flow:

(i) Contractor shall provide monthly updates to the CFR with statements due to the State designees by the end of the following month.

(ii) Within 180 days following the close of the agreement year, contractor shall conduct a final annual accounting of the program which will identify all claims incurred in the program year plus administrative expenses which shall equal expenses.

(iii) Contractor shall identify all premium paid in the program year plus any applicable interest earned on the CFR balanced maintained by contractor to equal total…