RFP_31786-00192_Amendment_2.docx

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Voluntary, Fully-Insured Vision Insurance Plan - UPDATED
Solicitation number
RFP 31786-00192
Issued by
Tennessee

About this file

This is Amendment #2 to Request for Proposals #31786-00192 issued by the Tennessee Department of Finance & Administration, Benefits Administration for a fully-insured, voluntary vision insurance plan. The RFP seeks proposals to provide vision coverage for eligible state employees, local education and local government employees, retirees, and dependents across Tennessee's 83 counties and nationally. The plan will offer two benefit options: Basic Vision and Expanded Vision with specified frame and contact lens allowances. Respondents must hold a current Tennessee Certificate of Authority and demonstrate at least six years of experience providing group vision insurance to at least five employer accounts with at least one account serving 10,000 members. The pre-response conference is scheduled for August 21, 2026. Written questions and comments are due September 4, 2026, with a second round deadline of October 6, 2026. Technical evaluation completion is targeted for December 17, 2026, cost proposal opening on December 18, 2026, negotiations January 6-8, 2027, and Notice of Intent to Award on January 28, 2027, with a protest period ending February 4, 2027. The contract becomes effective March 1, 2027, with the first ten months designated for implementation activities and the benefit period running January 1, 2028, through December 31, 2032. Responses are due by 2:00 p.m. on November 6, 2026.

The enrolled population as of June 2026 totals approximately 175,000 members across all coverage types, with monthly paid claims projected between $550,000 and $1.088 million. All implementation activities, claims processing, call center operations, member communications, online enrollment services, and comprehensive reporting must be included in the proposed premium rates with no separate administrative fees. Evaluation criteria allocate up to 10 points for general qualifications and experience, 20 points for technical qualifications and experience, 30 points for network analysis, and 40 points for cost proposals, with award made to the responsive and responsible respondent offering the best combination of attributes. The current vendor is EyeMed Vision. This amendment updates the RFP schedule of events, adds new appendices including vision premium rates and vision enrollment data, revises multiple sections of the pro forma contract addressing information systems security, hold harmless provisions, HIPAA compliance, insurance requirements, and IT security requirements, and responds to 57 questions and comments submitted by prospective respondents.

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Other files

File Type Posted
RFP_31786-00192_Appendix_7_5%20Enrollment_by_Coverage_2023_June_2026_REVISED.xlsx XLSX spreadsheet
RFP_31786-00192_Appendix_7_16_Vision_Enrollment_Including_Zip_and_Status-1.xlsx XLSX spreadsheet
RFP_31786-00192_Appendix_7_15_Vision_Premium_Rates.xlsx XLSX spreadsheet
RFP_31786-00192_Vision_Release_2.docx DOCX document
RFP_31786-00192_Amendment_One.docx DOCX document
RFP_31786-00192_Appendix_7.12_Expanded_Plan_Certificate_Eff.%201-1-26_.docx DOCX document
RFP_31786-00192_Appendix_7.4_Eligibility_and_Enrollment_Counts_by_Zip_Code.xlsx XLSX spreadsheet
RFP_31786-00192_Appendix_7.6_Benefits_Administration_834_Guidance_Manual.docx DOCX document
RFP_31786-00192_Appendix_7.2_Quest_Analytics_Access_Report_Instructions.docx DOCX document
RFP_31786-00192_Appendix_7.3_Sample_Quest_Analytics_Analysis_Report.docx DOCX document
RFP_31786-00192_Appendix_7.13_Plan_Benefit_Changes.xlsx XLSX spreadsheet
RFP_31786-00192_Appendix_7.5_Enrollment_by_Coverage_2023%E2%80%93June_2026.xlsx XLSX spreadsheet
RFP_31786-00192_Appendix_7.1_Premium_Collections2023-June2026.xlsx XLSX spreadsheet
RFP_31786-00192_Appendix_7.11_Basic_Plan_Certificate_Eff.%201-1-26_.docx DOCX document
RFP_31786-00192_Appendix_7.7_Basic_Plan_Vision_Utilization_by_Year2023-June2026.xlsx XLSX spreadsheet
RFP_31786-00192_Appendix_7.14_Written_QuestionsComments_Template.xlsx XLSX spreadsheet
RFP_31786-00192_Appendix_7.9_HIPAA_Business_Associate_Assessment.xlsx XLSX spreadsheet
31786-00192%20Digital%20Submission%20Instructions.docx DOCX document
RFP_31786-00192_Appendix_7.8_Expanded_Plan_Vision_Utilization_by_Year_2023%20June%202026.xlsx XLSX spreadsheet
RFP%2031786-00192%20Attachment%206.3%20Cost%20Proposal.xlsx XLSX spreadsheet
RFP_31786-00192_Appendix_7.10_Census_of_Enrolled_as_of_June_2026.xlsx XLSX spreadsheet
RFP%2031786-00192%20Vision.docx DOCX document
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Text version

STATE OF TENNESSEE

DEPARTMENT OF FINANCE & ADMINISTRATION, BENEFITS ADMINISTRATION

REQUEST FOR PROPOSALS #31786-00192

AMENDMENT #TWO

FOR VOLUNTARY, FULLY-INSURED VISION INSURANCE PLAN

DATE: September 25, 2026

RFP #31786-0086 IS AMENDED AS FOLLOWS:

1. This RFP Schedule of Events updates and confirms scheduled RFP dates. Any event, time, or date containing revised or new text is highlighted.

EVENT
TIME

(central time zone)

DATE

1. RFP Issued

August 14, 2026

2. Disability Accommodation Request Deadline
2:00 p.m.
August 20, 2026
3. Pre-response Conference
10:00 a.m.
August 21, 2026
4. Notice of Intent to Respond Deadline
2:00 p.m.
August 24, 2026

5. Written “Questions & Comments” Deadline *NOTE: Submit written questions and comments on Appendix 7.14 the written questions and comments template.

2:00 p.m.

September 4, 2026

6. State Response to Written “Questions & Comments”

September 29, 2026

7. Round 2 Written “Questions & Comments” Deadline *NOTE: Respondents may submit no more than five (5) questions to the State in the 2nd round of Written Questions and Comments.

October 6, 2026

8. State Response to Written “Questions & Comments” Round 2

October 23, 2026

9. Response Deadline
2:00 p.m.
November 6, 2026

10. State Completion of Technical Response Evaluations

December 17, 2026

11. State Opening & Scoring of Cost Proposals
2:00 p.m.
December 18, 2026
12. Negotiations
4:30 p.m.
January 6-8, 2027

13. State Notice of Intent to Award Released and RFP Files Opened for Public Inspection

2:00 p.m.

January 28, 2027

13. End of Protest Period

February 4, 2027

14. State sends contract to Contractor for signature

February 5, 2027

15. Contractor Signature Deadline
2:00 p.m.
February 12, 2027

2. State responses to questions and comments in the table below amend and clarify this RFP.

Any restatement of RFP text in the Question/Comment column shall NOT be construed as a change in the actual wording of the RFP document.

Question
Section (if applicable)
Question
State Response
Could you please provide the current premiums for both the Base and Expanded plans? I was unable to locate this information within the RFP.
The State has added new RFP 31786-00192 Appendix 7.15 Vision Premium Rates with historical and current premium rates. See amendment Item #8.
Please confirm whether the negotiation dates listed in Section 2, Schedule of Events, should be January 6-8, 2027 rather than January 6-8, 2026.
Confirmed. See amendment item #1.
Please confirm whether the duplicate numbering in the Schedule of Events is intentional, as both “Negotiations” and “State Notice of Intent to Award Released and RFP Files Opened for Public Inspection” are listed as Event 12.
The duplicate number was not intentional. See amendment item #1.
Please clarify the intended meaning of Section 1.1.2, which states that the maximum liability for the resulting contract “will exceed one dollar ($1.00).” How will maximum liability be calculated for this fully insured arrangement?
The maximum liability will be determined based on the premium rates proposed by the winning Respondent and the projected enrollment figures for the contract period.
Please confirm the expected contract effective date for implementation activities and identify the key implementation milestones prior to the January 1, 2028 benefit effective date.
Refer to pro forma contract section B, which states the following: “This Contract shall be effective on March 1, 2027 (“Effective Date”) and extend for a period of seventy (70) months after the Effective Date (“Term”). The first ten months (March 2027-December 2027) are for implementation activities. The sixty (60) months of January 1, 2028, through December 31, 2032, are the Benefits dates. The State shall have no obligation for goods or services provided by the Contractor prior to the Effective Date or after the Benefits dates.

Key contract deliverables/milestones are outlined in Section A.18 of the pro forma contract.

Please clarify whether all implementation activities required prior to January 1, 2028 are expected to be included in the proposed premium rates/cost proposal, or whether any separate implementation compensation will be available.
Yes. All implementation activities are to be incorporated into the proposed premium rates
Please clarify the process for automatically transferring current enrollees to the new contractor effective January 1, 2028, including expected data transfer timing, required notices, eligibility reconciliation responsibilities, and responsibility for transition-related errors.
See sections A.12. and A.13. of the pro forma contract detailing system and enrollment processing requirements. The first full population enrollment file is typically provided in November prior to the start of the plan year.
Please confirm whether the core services described in Section 1.1, including claims processing, call center services, employee outreach and communications, referrals, online services, enrollment file processing, state insurance filings, and reporting, must all be included in the fully insured premium rates with no separate administrative fees.
Yes Additionally, all services specified in the pro forma contract must be included in the proposed premium rates. The State will not pay any separate administrative fees.
Please clarify how respondents should account for all costs, assumptions, optional services, taxes, fees, commissions, implementation costs, and other cost components when the Cost Proposal instructions require all costs to be included but prohibit respondents from recording any additional rates, amounts, or information outside Attachment 6.3.
All costs must be fully incorporated into the proposed premium rates. The State does not pay sales tax.
Please clarify the required process for customer references submitted under Attachment 6.4, including whether references must submit directly to the State, whether respondents may confirm receipt, and how late, incomplete, or nonresponsive reference submissions will be handled.
As stated in the reference questionnaire, customer references must submit their completed questionnaires directly to the Solicitation Coordinator. The Solicitation Coordinator will confirm receipt. The State will not accept late submissions. Any incomplete references will be provided to the evaluation team and scored accordingly.
Please clarify the required Quest Analytics network analysis methodology, including accepted file formats, provider matching methodology, distance/access standards, treatment of leased or affiliate networks, and whether respondents may supplement the analysis with additional network access information.
Please refer to Appendix 7.2, Quest Analytics Access Report Instructions for detailed requirements including data format, analysis requirements, data standards, report specifications, and access standards. Respondents should not provide supplemental network information.
Please clarify whether any confidential or proprietary information submitted in the response may be protected from public disclosure after the Notice of Intent to Award, and if so, what process respondents should follow to request confidential treatment.
As stated in RFP section 4.8, All materials submitted to the State in response to this RFP shall become the property of the State of Tennessee. Respondents are cautioned not to provide any materials in response to this RFP that are trade secrets, as defined under Tenn. Code Ann. § 47-25-1702 and any other applicable law. By submitting a response to this RFP, the respondent acknowledges and agrees that the State shall have no liability whatsoever for disclosure of a trade secret under the Uniform Trade Secrets Act, as provided at Tenn. Code Ann. § 47-25-1701-1709, or under any other applicable law. Selection or rejection of a response does not affect this right. By submitting a response, a Respondent acknowledges and accepts that the full response contents and associated documents will become open to public inspection in accordance with the laws of the State of Tennessee
Please clarify how vendors, affiliates, leased networks, fulfillment partners, call centers, or other third parties should be disclosed as subcontractors, and whether any such relationships require prior State approval before contract execution.
Respondents should provide information regarding subcontractors and all required information when they answer RFP Question B.12.

As stated in RFP section 4.4.3 Subcontractors identified within a response to this RFP will be deemed as approved by the State unless the State expressly disapproves one or more of the proposed subcontractors prior to signing the Contract.

Please clarify which “required state insurance filings” are included in the contractor’s responsibilities, including whether this refers to Tennessee Department of Commerce and Insurance filings, SERFF filings, policy forms, certificates, rates, or filings in other jurisdictions.
Refer to pro forma contract section D.32 for insurance requirements. Additionally, see pro forma contract section A.16. To clarify the Contractor shall be responsible for Tennessee Department of Commerce and Insurance fillings, SERFF filings, policy forms, certificates, rates, filings in other jurisdictions and other regulatory documents and/or forms required by applicable federal and/or state laws.
Please confirm whether respondents may take exceptions, propose clarifying assumptions, or identify implementation dependencies without causing the response to be deemed nonresponsive, given the RFP’s restrictions on alternate terms, qualifications, or additional information.
RFP section 3.3.1 states that a response must not include alternate contract terms and conditions. If a response contains such terms and conditions, the State, at its sole discretion, may determine the response to be a non-responsive counteroffer and reject it. Any remaining exceptions or clarifying assumptions should be brought to the attention of the State during Round 2 of Written Questions and Comments.
Please clarify whether the State will provide updated enrollment, utilization, premium, and census data closer to the response deadline or prior to negotiations, and whether respondents may rely on such updated data for final pricingz.
The State will not provide updated enrollment, utilization, premium and census data for the time period after June 2026.

Would the State be open to the strategy of offering an additional more affordable vision option for materials only to complement the "single vision contract"?

The state is only seeking proposals for the services and requirements outlined in the pro forma contract.

Would the state be willing to offer a dual option plan design, using 2 different networks?
No, plan benefits must be provided as required in pro forma contract Attachment F. Multiple existing networks may be utilized to deliver these plan benefits.
Is COBRA Administration expected to be provided by the carrier, or do you currently partner with a COBRA vendor? If you do, please provide the name of the vendor.
COBRA Administration (eligibility and enrollment) is handled by the State and is passed on to the carrier on the weekly enrollment file with all enrollment information.
Will a current provider report be provided in order to run a disruption analysis?
No.
Is it possible to get a excel file with the following fields: ~ Date of Birth ~Gender ~ zip code ~ Plan (Basic/Enhanced) ~ Tier ~ Status (Active/Retiree/COBRA/COBRA Disabled)
See new Appendix 7.16 - Vision Enrollment Including year of birth, first three of zip code and Status. See amendment item #8.
Our interpretation of the term “subcontractor” as used throughout the State’s requirements and ProForma contract, are those third-party vendors that are entered into exclusively to perform services related to the State of Tennessee’s Vision insurance coverages. Does the State agree with this definition?
No. A subcontractor is any third-party vendor engaged to deliver the services required in the pro forma contract.
23
Appendix 7.1
Is there a breakout or key code to determine the Fund Code on the passthru sheet?
Fund Code & Description

51010 State Retirees 52000 Local Education Retirees 53000 Local Government Retirees 55000 State Active Employees 56000 Local Education Active Employees 58000 Local Government Active Employees

24
Appendix 7.1
Please confirm that by passthru, this represents premiums paid, and that the plan has been 100% employee paid during the duration of the experience.
The state confirms that the passthru report represents premiums paid and that it has always been employee/retiree paid premiums.
25
Appendix 7.5
Is there a breakout that can be provided on the report showing Active vs. Retiree vs. COBRA vs. COBRA disabled? Or can you provide an average annual breakout count for the groups?
Please see updated Appendix 7.5 Enrollment by Coverage 2023 – June 2026 REVISED for an updated monthly count that includes COBRA. Column “Group” differentiates among the breakouts.
26
Appendix 7.7 and 7.8
Is it possible to get monthly claim counts, or yearly total claim counts for each of the plans, for each of the experience periods?
No, the state is unable to provide claim counts.
27
Appendix 7.10
Please confirm if that the counts include current COBRA, Retirees and COBRA Disabled.
Appendix 7.10 includes all members, including active employees, retirees, their dependents, and COBRA.
28
Appendix 7.10
Please confirm if the totals within the file include only employee, or if they include all dependents as well? The lives appear off when comparing files between Appendix 7.10 vs 7.4 vs the lives shown on experience reports 7.7 and 7.8.
All totals in Appendix 7.10 (183,296), Appendix 7.7 & 7.8 (183,805) and Appendix 7.4 (183,296) include active employees, retirees and their dependents. Differences can occur as a result of timing in reporting.
29
RFP 31786-00192 Vision Sect 1.1
Please confirm how long the current rates have been in place since 1/1/2023
The current premium rates have been in place since January 1, 2023.
30
RFP 31786-00192 Vision Sect 1.1
Can you provide if the COBRA Disabled Rates were derived from the carrier, of if the surcharge was implemented by the State?
COBRA rates and COBRA disability rates are not derived from the carrier, but follow the rules set out by the U.S. Department of Labor
31
RFP Section 3.2
Please confirm that bidders have the option to submit bid responses via the online portal you provided OR via email, and that BOTH methods are not required.
Confirmed. Respondents may submit responses by either the digital submission process or email. Submission through both methods is not required.
32
RFP Section 4.8
Are bidders allowed to provide both an unredacted as well as a redacted copy for public release outlining confidential/proprietary information?
No, the State will not accept a redacted copy. As stated in RFP section 4.8, All materials submitted to the State in response to this RFP shall become the property of the State of Tennessee. Respondents are cautioned not to provide any materials in response to this RFP that are trade secrets, as defined under Tenn. Code Ann. § 47-25-1702 and any other applicable law. By submitting a response to this RFP, the respondent acknowledges and agrees that the State shall have no liability whatsoever for disclosure of a trade secret under the Uniform Trade Secrets Act, as provided at Tenn. Code Ann. § 47-25-1701-1709, or under any other applicable law. Selection or rejection of a response does not affect this right. By submitting a response, a Respondent acknowledges and accepts that the full response contents and associated documents will become open to public inspection in accordance with the laws of the State of Tennessee
33
RFP Section A Mandatory Requirement Items, A.1
This provision states we must sign the Statement of Certifications and Assurances as is with no qualifications or clarifications. If bidders have any redlines or clarifications to the proposed contract terms, will those be taken into consideration (re: item 6 on this form) even if we sign outright?
Any redlines or requests for clarification must be submitted during Round 1 or Round 2 of the Written Questions and Comments. These rounds will close prior to the proposal due date and before Respondents are required to sign the Statement of Certifications and Assurances.
34
A.5 (h)
Is the State agreeable to the following edit:

The Contractor’s call management system shall record and index all calls, except when a caller requests that the call not be recorded, such that the Contractor can easily retrieve recordings of individual calls based on the Edison ID of the caller, phone number of the caller, the caller’s name, and narrow results by the date/time of the call and/or the staff member who handled the call. The Contractor shall be able to provide a full recording of each call upon the State’s request. The Contractor shall archive the recordings for one ten years from the date of each call.

The State does not agree to this revision.

35
A.12 (h)
With respect to A.12(h) Information Systems (page 67), is the State agreeable to the following edit:

"Entire Agreement. The Group Contract is are complete and contains the entire understanding between the Parties relating to its subject matter, including all the terms and conditions of the Parties’ agreement. The Group Contract supersedes any and all prior understandings, representations, negotiations, and agreements between the Parties, whether written or oral.

Prior to implementing any major modifications to or replacement of the Contractor’s core information systems functionality and/or associated operating environment, the Contractor shall notify the State In Writing of the change or modification within a reasonable amount of time (commensurate with the nature and effect of the change or modification) if the change or modification; (a) would affect the Contractor’s ability to perform one or more of its obligations under this Contract; (b) would be visible to State system users and Members; (c) might have the effect of putting the Contractor in noncompliance with the provisions or substantive intent of this Contract; or

(d) would materially reduce the coverage amounts payable or services provided to the average Member. If directed by the State, the Contractor shall discuss the proposed change with the State prior to implementing the change. Subsequent to this discussion, the State may require the Contractor to demonstrate or attest to the readiness of the impacted systems prior to the effective date of the actual modification or replacement, if practicable."

The State does not agree to this revision.

36
A.12(i)(2)
With respect to A.12(i)(2) Information Systems (pages 67-68), is the State agreeable to the following edit: Upon sixty (60) days’ written notice and at a mutually agreed time, the Contractor shall make system information available to duly authorized representatives of the State and other federal and state agencies to evaluate, through review of such information, independent third-party assessments, or other means, the quality, appropriateness and timeliness of services performed; provided that (i) such evaluation shall not include direct access to or inspection of the Contractor’s information systems; (ii) the Contractor may withhold access to any information if, in the Contractor’s sole judgment, such access could compromise the security of the Contractor’s information systems or the confidentiality of third-party information; (iii) any third party engaged by the State to conduct such an inspection shall be mutually agreed upon by the parties, shall not be a competitor of the Contractor, and shall conduct such inspection pursuant to a separate written agreement governing its scope and confidentiality; and (iv) the State’s rights under this subsection shall be exercised no more frequently than once per calendar year
The State does not agree to this revision.
37
A.12(i)(6)
With respect to A.12(i)(6) Information Systems(page 68), is the State agreeable to the following edit: The Contractor shall provide for the physical safeguarding of its data processing facilities and the systems and information housed therein. The Contractor shall provide the State with access to data facilities upon no less than sixty (60) days’ advance written notice and at a mutually agreed time, no more frequently than once per calendar year, subject to the Contractor’s security and escort procedures and coordinated by Contractor personnel; the Contractor may suspend such access if, in the Contractor’s sole judgment, continued access could jeopardize the security, privacy, or integrity of information of the Contractor’s other customers or affect the performance of the Contractor’s systems. The physical security provisions shall be in effect for the life of this Contract
The State does not agree to this revision.
38
A.12(i)(9)
With respect to A.12(i)(9) Information Systems (page 69), is the State agreeable to the following edit: The Contractor shall put in place procedures, measures, and technical security designed to prohibit unauthorized access to the regions of the data communications network inside of the Contractor’s Span of Control, aligned with NIST 800-53.
The State does not agree to this revision, but the State has revised the language. See amendment item #3.
39
A.12(i)(10)
With respect to A.12(i)(10) Information Systems (page 69), is the State agreeable to the following edit: 1)The Contractor shall conduct a security risk assessment at least annually and communicate a summary of the results to the State in compliance with Contract Attachment C.22, subject to execution of a mutually acceptable confidentiality agreement between the parties. The first report shall be provided by the date specified in Contract Section A.18 and annually thereafter (refer also to Contract Attachment C.22). The risk assessment summary shall also be made available to appropriate State and Federal agencies, provided that Contractor shall have the right to withhold access to any and all information if, in Contractor’s sole judgment, such access could compromise the security of Contractor’s information systems or the confidentiality of third-party information. At a minimum the assessment summary shall contain the following: identification of loss risk events/vulnerabilities; analysis of the probability of loss risk and frequency of events; estimation of the impact of said events; identification and discussion of options for mitigating identified risks; cost-benefit analysis of options; recommended options and action plan for their implementation. The assessment shall be conducted in accordance with the following: requirements for administrative, physical, and technical safeguards to protect health data (45 CFR[HC1.1]

§§164.304 – 318); rules for conducting risk analysis and risk management activities (45 CFR §164.308); requirements for security awareness training (45 CFR §164.308(a)(5)); requirements for entities to have security incident identification, response, mitigation and documentation procedures (45 CFR§164.308(a)(6)).

The State does not agree to this revision.

40
A.13 (f)(2)
Is the State agreeable to the following edit:

Contractor shall submit complete and accurate data to the State’s DSS contractor by the fifteenth twenty-fifth of each month. Complete and accurate data is defined to be data that:

The State does not agree to this revision.

41
A.14 (a)
With respect to A.14(a) Audit Authority (pages 72-73), is the State agreeable to the following edit: Upon sixty (60) (30)days written notice and the establishment of applicable third-party confidentiality agreement(s), if any, reasonably required by the Contractor, the State and/or its representative shall have the right to examine and audit Contractor services and pricing to ensure compliance with all applicable requirements. For the purpose of this requirement, the term, "Contractor," shall include its parent organization, affiliates, and subcontractor subsidiaries, who provide services under this Contract. These requirements are separate and distinct from the audit requirements set forth in D.11 and E.4.
The state does not agree to this revision.
42
A.14(f)
With respect to A.14(d) Audit Authority, is the State agreeable to the following:

The Contractor shall, at its own cost, provide the State and/or its representative with prompt and reasonable access to any data, data extracts, documents, access to systems, and other information necessary to ensure Contractor compliance with all requirements of this Contract. Such access shall be limited to information directly related to services performed under this Contract and subject to applicable federal and state privacy, security, and confidentiality requirements. Access to Contractor systems shall be provided in a manner determined by Contractor to protect system security, proprietary information, trade secrets, and information relating to other customers, including through supervised access, read-only access, reports, data extracts, or demonstrations, as appropriate.

The state does not agree to this revision.

43
A.14(k)
With respect to A.14(k) Audit Authority(page 77), is the State agreeable to the following edit: The Contractor shall maintain an internal quality assurance plan. The Contractor shall provide by the date specified in Contract Section A.18 a summary of its internal quality assurance plan, indicating areas addressed, established criteria and standards, and methods employed to evaluate results. The plan should address, at a minimum, the Contractor’s methodology for conducting internal Claims and operational audits, including audits to determine Claims payment and processing accuracy and Claims payment turnaround. The Contractor shall notify the State In Writing at least thirty (30) calendar days in advance of any significant changes to its internal quality assurance plan. The State reserves the authority to review changes, if any, and require conduct good faith discussions with Contractor regarding additional changes, where appropriate.
The state does not agree to this revision.
44
A.15 (a)
With respect to A.15 (a), is the State agreeable to the following edit: The Contractor shall submit reports to the State electronically, in theJSON or another machine-readable format specified by the State, and shall be of the type and at the frequency indicated in Contract Attachment C. The State reserves the right to modify reporting requirements as deemed necessary to monitor the Plan. The State will provide the Contractor with at least ninety (90) days’ notice prior to implementation of a report modification or a new report. The Contractor shall comply with the State’s modifications to the reporting requirements by the end of the ninety
The State does not agree to this revision.
45
A.15(d)
At the State’s request In Writing, the Contractor shall provide the State access to its internal client reporting system, including program and fiscal information regarding Members served, services rendered, and the ability for said personnel to develop and retrieve reports. The Contractor shall provide training in and documentation on the use of this mechanism no later than date specified in Contract Section A.18. The Contractor shall provide access to this reporting functionality to a minimum of two (2) State employees no later than the date specified in Contract Section A.18. Additional or replacement users may be added at any time at the State’s request. If agreed upon by the State In Writing, the Contractor must provide the State with an individual dedicated to developing, retrieving, and providing reports in the timeframe requested by the State.
The State does not agree to this revision.
46
A.15 (e)
With respect to A.15 (e), is the State agreeable to the following edit: e All records, data, and other information acquired by the Contractor from the State under this Contract shall be treated as confidential and shall remain the sole property of the State. Except as required by law, regulation, or court order, or as required by the Contractor’s record retention policies, the Contractor shall return such information to the State upon receipt of the State’s request In Writing following termination or expiration of this Contract, and shall not use such information for purposes outside the scope of this Contract without the State’s express approval.
The State does not agree to this revision. There is not a section A.15 (e) in the pro forma contract.
47
A.15 (f)
With respect to A.15 (f), is the State agreeable to the following edit: f. The Contractor shall participate in the State’s risk assessment process no more frequently than once per calendar year, and the Contractor’s responses shall be subject to execution of a mutually acceptable confidentiality agreement between the parties.
The State does not agree to this revision. There is not a section A.15 (f) in the pro forma contract.
48
A.15 (g)
With respect to A.15 (g), is the State agreeable to the following edit: g. In the event of a security incident or breach affecting State Data, the Contractor shall engage an independent third party to review the incident and shall report to the State a summary of the findings, the root cause, and the relevant remediation efforts. Such report shall be provided in lieu of any post-incident audit or review of the Contractor’s systems or facilities conducted by the State or its representatives.
The State does not agree to this revision. There is not a section A.15 (g) in the pro forma contract.
49
D.20(b)
With respect to D.20 HIPAA Compliance (page 86), is the State agreeable to the following edit: In the event of any suit or claim, the Parties shall give each other immediate prompt notice and provide all necessary assistance to respond. The failure of the State to give notice shall only relieve the Contractor of its obligations under this Section to the extent that the Contractor can demonstrate actual prejudice arising from the failure to give notice. This Section shall not grant the Contractor, through its attorneys, the right to represent the State in any legal matter, as the right to represent the State is governed by Tenn. Code Ann. § 8-6-106.
This language is found in D.19, not D.20.b. The State agrees to revise the language. See amendment item #4.
50
D. 20 (d)
With respect to D.20(d) HIPAA Compliance(page 87), is the State agreeable to the following edit: The Contractor will indemnify the State and hold it harmless for any violation by the Contractor or its subcontractors of the Privacy Rules. Contractor is responsible for its costs of containing and remedying any breach under the Breach Notification Rule in accordance with applicable privacy laws, and may reimburse the State for reasonable documented costs incurred in responding to and mitigating damages caused by such breach, including legally required notice and remediation, provided that both parties coordinate their response to avoid duplicative actions. Contractor will also provide or pay for credit monitoring for affected individuals for one year or more if required by law. This includes the costs of responding to a breach of protected health information, the costs of responding to a government enforcement action related to the breach, and any fines, penalties, or damages paid by the State because of the violation.
The State agrees with the revision. See amendment item #5.
51
D.32 Insurance, a(2) Commercial General Liability (“CGL”) Insurance
Is the State agreeable to the following edit:

The Contractor shall maintain single limits not less than one million dollars ($1,000,000) per occurrence. If a general aggregate limit applies, either the general aggregate limit shall apply separately to this policy or location of occurrence or the general aggregate limit shall be twice the required occurrence limit.

The State agrees to make the requested revision. See amendment item #9.

52
D.37(a)(5)
With respect to D.37(a)(5) Information Technology Security Requirements (State Data, Audit, and Other Requirements)(page 94), is the State agreeable to the following edit: (1) The Contractor must annually perform Penetration Tests and Vulnerability Assessments against its Processing Environment per the NIST 800-115 definition. “Processing Environment” shall mean the combination of software and hardware on which the Application runs. “Application” shall mean the computer code that supports and accomplishes the State’s requirements as set forth in this Contract. “Penetration Tests” shall be in the form of attacks on the Contractor’s computer system, with the purpose of discovering security weaknesses which have the potential to gain access to the Processing Environment’s features and data. The “Vulnerability Assessment” shall be designed and executed to define, identify, and classify the security holes (vulnerabilities) in the Processing Environment. Upon written request from the State no more frequently than once per year, the Contractor shall provide the State with an attestation.The Contractor shall allow the State, at its option, to perform Penetration Tests and Vulnerability Assessments on the Processing Environment. The Contractor shall provide a letter of attestation on its processing environment that penetration tests and vulnerability assessments have has been performed within the last twelve (12) months by an independent third party and that taken corrective action has been taken to evaluate and address any findings.
The State does not agree to the revision, but the State has revised the language. See amendment item #6.
53
D.37(a)(6)
With respect to D.37(a)(6) Information Technology Security Requirements (State Data, Audit, and Other Requirements)(page 95),(page 94-95), is the State agreeable to the following edit: If a breach has been confirmed, the Contractor shall engage an independent a fully un-modified third party to conduct a forensic review and shall share with forensics report must be supplied to the State and through the STS SIRT a summary of the forensic review, including the root cause, and plan for actions for

remediation and restoration. Contractor shall take all necessary measures to halt any further Unauthorized Disclosures.

The State does not agree to these revisions.

54
D.37(a)(8)
With respect to D.37(a)(8) Information Technology Security Requirements (State Data, Audit, and Other Requirements)(page 95), is the State agreeable to the following edit: Upon termination of this Contract and in consultation with the State, the Contractor shall destroy, and ensure all subcontractors shall destroy, all State Data it holds (including any copies such as backups) in accordance with the current version of National Institute of Standards and Technology (“NIST”) Special Publication 800-88, except to the extent retention is required by applicable law, regulation, court order, or the Contractor’s record retention policies. The Contractor shall provide a written confirmation of destruction to the State within ten (10) business days after destruction. Any State Data retained pursuant to this provision shall continue to be subject to the confidentiality and security requirements of this Contract. The Contractor shall provide a written confirmation of destruction to the State within ten (10) business days after destruction.
The State does not agree with this revision, but the State has revised the language. See amendment item #7.
55
D.37(d)
With respect to D.37(d) Information Technology Security Requirements (State Data, Audit, and Other Requirements)(pages 96-97), is the State agreeable to the following edit: Upon at least sixty (60) days’ prior written notice and at any reasonable time, the Contractor agrees to allow the Comptroller of the Treasury, or the Comptroller’s duly appointed representatives, to perform information technology control reviews of the Contractor’s policies, procedures, and documentation related to the Contractor’s information technology hosting and processing environment used by the Contractor to provide services under this Contract; provided that the Contractor shall have the right to withhold access to any and all information if, in the Contractor’s sole judgment, such access could compromise the security of the Contractor’s information systems or the confidentiality of third-party information. The review may evaluate whether the Contractor has implemented appropriate privacy and security controls consistent with NIST Special Publication 800-53, including controls generally classified as general controls and application controls. The review may also assess whether those controls are designed and operating effectively and whether the Contractor is complying with applicable policies, laws, and regulations. Such reviews shall be conducted no more frequently than once per calendar year.
The State does not agree to this revision.
56
E.1
With respect to E.1 Conflicting Terms and Conditions (page 97), is the State agreeable to the following edit: Conflicting Terms and Conditions. Should any of these special terms and conditions conflict with any other terms and conditions of this Contract, the Group Contract governs. the special terms and conditions shall be subordinate to the Contract’s other terms and conditions.
The State does not agree to these revisions.
57
E.4
With respect to E.4 Artificial Intelligence (AI) Use and Compliance Requirements (pages 98-99), is the State agreeable to the following edit: The Contractor agrees that any product, service, or solution incorporating Artificial Intelligence (AI), including Generative AI (GenAI), procured under this Agreement shall comply fully with the State of Tennessee’s Enterprise Artificial Intelligence

Policy (Policy 200-POL-007), available at:https://www.tn.gov/content/dam/tn/finance/artificialintelligence/Enterprise_Artificial_Intelligence_Policy.pdf. a. Data Privacy and Security Contractor shall not use, access, store, transmit, or process any State Data—including but not limited to confidential, privileged, personally identifiable information (PII), protected health information (PHI), Payment Card Industry (PCI) data, criminal justice information (CJIS), federal tax information (FTI), Centers for Medicare & Medicaid Services (CMS) data, Social Security Administration (SSA) data, Family Education Rights & Privacy Act (FERPA) data, or internal communications—through any AI tools or platforms unless:

(1) The AI tool is explicitly approved in writing by the State.

(2) The tool is operated within a secure State-controlled or approved environment.

a. Data Privacy and Security Contractor shall notify the State annually of any AI used in connection with the products and Services. To the extent the State objects to the usage of any AI used by Contractor, the State shall have the right to terminate its agreement with Contractor. Such termination will not be considered a termination for cause. Contractor shall not use identifiable State Data to train, fine-tune, or otherwise improve AI models, unless expressly authorized in writing by the State.

c. Transparency and Accountability

In accordance with applicable laws, Contractor shall clearly disclose when AI tools are used in providing services or generating content on behalf of the State. Contractor is responsible for the accuracy, reliability, and appropriateness of all AI-generated outputs.

e. Ongoing Compliance and Risk Mitigation

Contractor shall ensure continued compliance with evolving State and federal regulations related to AI. The State reserves the right, no more than once per calendar year and on at least thirty (30) days written notice, to review AI usage under this Contract at any time, provided, however, [REDACTED] reserves the right to terminate any such review if it believes, in its sole discretion, that such review jeopardizes the security or privacy of any other customer of MetLife.

f. Contractor shall further indemnify and hold harmless the State in accordance with the Hold Harmless section of this Agreement for any unauthorized disclosure, misuse, or compromise of State Data resulting from Contractor’s negligent acts or omissions, or willful misconduct, in connection with AI-related processing that violates this Contract or State policy.

The State does not agree to these revisions.

58
E.6
With respect to E.6 - Liquidated Damages (page 99) is the State agreeable to the following edit: If the Contractor fails to fully meet any of the performance guarantees outlined in Contract Attachment B to the satisfaction of the State (“Liquidated Damages Event”), the State may assess damages on Contractor (“Liquidated Damages”). The State shall notify the Contractor of amounts to be assessed as Liquidated Damages. The Parties agree that due to the complicated nature of the Contractor’s obligations under this Contract it would be difficult to specifically designate a monetary amount for Contractor’s failure to fulfill its obligations regarding the Liquidated Damages Event as these amounts are likely to be uncertain and not easily proven. Contractor has carefully reviewed the Liquidated Damages contained in Attachment B and agrees that these amounts represent a reasonable relationship between the amount and what might reasonably be expected in the event of a Liquidated Damages Event, as outlined in Contract Attachment B and are a reasonable estimate of the damages that would occur from a Liquidated Damages Event. The Parties agree that the Liquidated Damages represent solely the damages and injuries sustained by the State in losing the benefit of the bargain with Contractor and do not include any injury or damage sustained by a third party. The Contractor agrees that the Liquidated Damages are the exclusive remedy for such performance guarantees and are in addition to any amounts Contractor may owe the State pursuant to the indemnity provision or any other sections of this Contract. The State is not obligated to assess Liquidated Damages before availing itself of any other remedy for actions that fall beyond the scope of such guarantees as outlined under the Liquidated Damages provision. The State may choose to discontinue Liquidated Damages and avail itself of any other remedy available under this Contract or at law or equity.
The State does not agree to these revisions.
59
Attachment C
Is the State agreeable to the following edit:

2. Monthly reports shall be submitted by the 15 25th of the following month;

The State does not agree to these revisions.

60
Attachment C (3)
Is the State agreeable to the following edit:

3) Paid Vision Loss Ratio Report, submitted quarterly (quarter-only and year-to-date).

*Vision Loss Ratio – Contractor shall quarterly and annually calculate its Vision Loss Ratio (VLR) and submit such calculation and supporting data to the State. VLR shall be calculated as Paid Claims + IBNR Changes divided by Premium Collected for Subscribers.

The state does not agree to these revisions.

61
Attachment D, 14. Claims Data Submission
Contractor shall submit complete and accurate data to the State’s DSS contractor by the fifteenth (15th) twenty-fifth (25th) business day after the end of each month as required in Contract Section A.13.f.(2).
The State does not agree to these revisions.

3. Delete Pro Forma Contract Section A.12.i in its entirety and insert the following in its place.

i. System and Information Security and Access Management Requirements

1. The Contractor’s systems shall employ an access management function that restricts access to varying hierarchical levels of system functionality and information. The access management function shall:

· Restrict access to information on a “least privilege” basis, e.g., users permitted inquiry privileges only shall not be permitted to modify information;

· Restrict access to specific system functions and information based on an individual user profile, including inquiry only capabilities and the ability to create, change or delete certain data (global access to all functions shall be restricted to specified staff jointly agreed to by the State and the Contractor);

· Restrict unsuccessful attempts to access system functions to five (5), with a system function that automatically prevents further access attempts and records these occurrences.

2. The Contractor shall make system information available to duly authorized representatives of the State and other federal and state agencies to evaluate, through inspections or other means, the quality, appropriateness and timeliness of services performed.

3. The Contractor’s systems shall contain controls to maintain information integrity. These controls shall be in place at all appropriate points of processing.

4. Audit trails shall be incorporated into all systems to allow information on source data files and documents to be traced through the processing stages to the point where the information is finally recorded. The audit trails shall:

4. Contain a unique log-on or terminal ID, the date, and time of any create/modify/delete action and, if applicable, the ID of the system job that effected the action;

· Have the date and identification “stamp” displayed on any on-line inquiry;

· Have the ability to trace data from the final place of recording back to its source data file and/or document; and

· Facilitate batch audits as well as auditing of individual records.

5. The Contractor’s systems shall have inherent functionality that prevents the alteration of finalized records.

6. The Contractor shall provide the State with access to data facilities upon request.

7. The Contractor shall restrict perimeter access to equipment sites, processing areas, and storage areas through a card key or other comparable system, as well as provide accountability control to record access attempts, including attempts of unauthorized access.

8. The Contractor shall include physical security features designed to safeguard processor site(s) through required provision of fire-retardant capabilities, as well as smoke and electrical alarms, monitored by security personnel.

9. The Contractor shall implement administrative, physical, and technical safeguards designed to prevent unauthorized access to the portions of the data communications network within the Contractor’s Span of Control. Such safeguards shall be aligned with the applicable controls in the then-current edition of NIST SP 800-53, as appropriate to the services, systems, and information covered by this Contract.

10. The Contractor shall conduct a security risk assessment at least annually and communicate the results to the State in compliance with Contract Attachment C.22. The first report shall be provided by the date specified in Contract Section A.18 and annually thereafter (refer also to Contract Attachment C.22). The risk assessment shall also be made available to appropriate State and Federal agencies. At a minimum the assessment shall contain the following: identification of loss risk events/vulnerabilities; analysis of the probability of loss risk and frequency of events; estimation of the impact of said events; identification and discussion of options for mitigating identified risks; cost-benefit analysis of options; recommended options and action plan for their implementation.

11. Upon the State’s request, the Contractor shall provide designated State employees with access and applicable update authority to the Contractor’s employer portal for enrollment and reporting purposes by the date specified in Contract Section A.18. Additional users may be added at any time at the State’s request In Writing. The Contractor shall provide appropriate training and system documentation to State employees at the State’s request.

4. Delete Pro Forma Contract Section D.19 in its entirety and insert the following in its place.

D.19 Hold Harmless. The Contractor agrees to indemnify and hold harmless the State of Tennessee as well as its officers, agents, and employees from and against any and all claims, liabilities, losses, and causes of action which may arise, accrue, or result to any person, firm, corporation, or other entity which may be injured or damaged as a result of acts, omissions, or negligence on the part of the Contractor, its employees, or any person acting for or on its or their behalf relating to this Contract. The Contractor further agrees it shall be liable for the reasonable cost of attorneys’ fees, court costs, expert witness fees, and other litigation expenses for the State to enforce the terms of this Contract.

In the event of any suit or claim, the Parties shall give each other prompt notice and provide all necessary assistance to respond. The failure of the State to give notice shall only relieve the Contractor of its obligations under this Section to the extent that the Contractor can demonstrate actual prejudice arising from the failure to give notice. This Section shall not grant the Contractor, through its attorneys, the right to represent the State in any legal matter, as the right to represent the State is governed by Tenn. Code Ann. § 8-6-106.

5. Delete Pro Forma Contract Section D.20.d in its entirety and insert the following in its place.

d. The Contractor will indemnify the State and hold it harmless for any violation by the Contractor or its subcontractors of the Privacy Rules. Contractor is responsible for its costs of containing and remedying any breach under the Breach Notification Rule in accordance with applicable privacy laws, and may reimburse the State for reasonable documented costs incurred in responding to and mitigating damages caused by such breach, including legally required notice and remediation, provided that both parties coordinate their response to avoid duplicative actions. Contractor will also provide or pay for credit monitoring for affected individuals for one year or more if required by law.

6. Delete Pro Forma Contract Section D.37.a(5) in its entirety and insert the following in its place.

(5) The Contractor must annually perform Penetration Tests and Vulnerability Assessments against its Processing Environment per the NIST 800-115 definition.

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