RFP 6100062977 Cost Submittal.xlsx
XLSX spreadsheet 23 KB Posted
- Attached to
- RFP 6100062977-Flexible Spending Account
- Solicitation number
- OA-RFP005778
- Issued by
- Pennsylvania
About this file
This document is a Cost Submittal Instructions and Worksheet for RFP 6100062977, issued by the Commonwealth of Pennsylvania for a Flexible Spending Account (FSA) Third-Party Administration contract. The solicitation seeks a vendor to manage Medical and Dependent Care Reimbursement Accounts for an estimated 7,500 to 7,900 participants over a five-year contract period. The procurement requires comprehensive administrative services for FSA implementation and management, with vendors required to submit detailed cost proposals using the provided Excel workbook.
The cost submission is structured as an all-inclusive monthly rate per participant, covering implementation, administration, personnel, travel, equipment, supplies, and indirect costs associated with FSA services. Vendors must propose a per-participant monthly rate for each contract year, with claims to be billed at actual cost. The evaluation will be based on the five-year grand total cost, with offerors instructed to complete only yellow-highlighted cells in the cost breakdown worksheet. Strict formatting requirements are specified, including prohibitions against deleting rows or columns, with potential bidders advised to contact the issuing officer for any modifications needed.
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Other files
| File | Type | Posted |
|---|---|---|
| Appendix A - Plan 125 Document Medical FSA_DCAP.pdf | ||
| Appendix B - Personnel Listing and Experience by Position.xlsx | XLSX spreadsheet | |
| Appendix E - Service Level Agreements.xlsx | XLSX spreadsheet | |
| 1318784-event.pdf | ||
| Appendix D - Accessibility Requirement for Supplier-Built Websites or Apps_022025.pdf | ||
| 2027 Technical Submittal.docx | DOCX document | |
| Appendix C - Contract Terms and Conditions.docx | DOCX document | |
| Appendix F - PDAA Assessment.pdf |
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Text version
Cost Submittal Instructions
| COST SUBMITTAL - INSTRUCTIONS RFP # 6100062977 |
| GENERAL INSTRUCTIONS FOR COMPLETING THIS WORKBOOK |
| The Cost Submittal Worksheets contained in this workbook shall constitute as the Cost Submittal for RFP 6100062977. Calculation results within the cost submittal worksheets are intended for evaluation purposes only. The number of participants are estimated and should not be considered representative of the actual plan participants. |
All attached worksheets must be completed in their entirety. Data may only be entered in the cells highlighted in
YELLOW .
DO NOT DELETE ANY ROWS OR COLUMNS. IF ADDITIONAL ROWS ARE NEEDED, PLEASE CONTACT THE ISSUING OFFICER FOR INSTRUCTIONS.
Except as otherwise provided in the RFP, all costs must be inclusive of any overhead, travel, subsistence, supplies and other expenses. Such items may not be billed separately.
| COST SUBMITTAL Tab: |
| 1. Select the Cost Submittal Summary Tab at the bottom of this page. |
| 2. Complete the top portion of the form to include all contact information. |
NOTE: The information you supply here must match information you provided to Vendor Registration.
| 3. Offerors are to complete all yellow-shaded cells. This tab requires no entry of cost data. All data entered on the Cost Breakdown Tab will automatically populate to the Cost Submittal Summary section. |
| 4. The Cost Submittal Summary will be evaluated based on the Five (5) Year Total Contract Cost. |
| COST BREAKDOWN Tab: |
| 1. Select the Cost Breakdown Tab at the bottom of this page. |
| 2. Administrative Fee for FSA Reimbursement Accounts. Administrative Fee for the Flexible Spending Account (FSA) Plan Participants is an all inclusive rate including, but not limited to, costs associated with the implementation and administration of the Medical and Dependent Care FSA's as described in the Technical Submittal as well as personnel, travel, equipment, supplies and other costs (including indirect costs) incurred to provide these services. |
For each Contract year, under the Rate per Participant per Month column (Yellow-shaded cells), Offeror must propose on the basis of a per Participant per Month, the monthly rate that it will charge the Commonwealth for each participant for the administration of the FSA, with claims to be billed at actual cost. This calculation will automatically appear under the Extended Cost Per Month column for each year. Each years subtotal will be combined for the Total Cost. Both the yearly Subtotals and the Total Cost will automatically populate in the Cost Submittal Summary Tab.
The Cost Submittal Summary will be evaluated based on the Five (5) Year Grand Total Cost.
RFP 6100062977
Cost Submittal
Cost Submittal Summary
| COST SUBMITTAL SUMMARY WORKSHEET RFP # 6100062977 | |
| OFFEROR NAME | CONTACT PERSON |
OFFEROR ADDRESS EMAIL ADDRESS
PHONE NUMBER FAX NUMBER
VENDOR NUMBER FEDERAL ID OR SSN
| COST SUBMITTAL SUMMARY | |||||
| Administrative Fees for FSA Reimbursement Accounts | |||||
| YEAR 1 | YEAR 2 | YEAR 3 | YEAR 4 | YEAR 5 | GRAND TOTAL COST |
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
Cost Breakdown Worksheet
| COST BREAKDOWN WORKSHEET RFP #6100062977 |
| Offeror Name: |
| Except as otherwise provided in the RFP, all costs must be inclusive of any overhead, any travel, subsistence, supplies and other expenses. Such items may not be billed separately. | |||||||||||||||
| Estimated # of Participants | YEAR 1 | Estimated # of Participants | YEAR 2 | Estimated # of Participants | YEAR 3 | Estimated # of Participants | YEAR 4 | Estimated # of Participants | YEAR 5 | ||||||
| Rate per Participant per Month | Extended Cost Per Month | Rate per Participant per Month | Extended Cost Per Month | Rate per Participant per Month | Extended Cost Per Month | Rate per Participant per Month | Extended Cost Per Month | Rate per Participant per Month | Extended Cost Per Month |
| Administrative Fees for FSA Reimbursement Accounts | 7500 | $0.00 | 7600 | $0.00 | 7700 | $0.00 | 7800 | $0.00 | 7900 | $0.00 | |||
| SUBTOTAL | |||||||||||||
| Extended Cost Per Month x 12 Months | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
TOTAL COST: $0.00
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