RFP,_TUHSD_00188,_Dental_and_Vision_RFP_Background_and_SOW_2027(6004342.1).pdf

6004342v1/00188.001 1

BACKGROUND

Nestled in the Greater Phoenix area, the Tempe Union High School District is located in Tempe, Arizona and services approximately 11,000 students in six comprehensive high schools. The District encompasses 162 square miles and serves the City of Tempe, the Town of Guadalupe, the Gila River Indian Community, the Ahwatukee Foothills areas of Phoenix and parts of Chandler.

For purposes of determining final rates, all proposals should be submitted net of commissions. Segal is compensated through a consulting fee.

The District currently offers its employees a choice of two voluntary dental plans, a pre-paid DHMO offered by Cigna, DPPO plan offered by Delta Dental and a voluntary vision plan offered by Davis Vision. For the purpose of this bid, the District wants you to match the current plan designs as closely as possible. If your plan designs preclude you from matching the existing schedule of benefits, quote a plan that best matches the current plans and note the deviations on the appropriate form.

ELIGIBILITY

The following provides a summary of the categories of employees and dependents eligible for benefits.

You are eligible to elect employee benefits if you are:

An active hourly employee regularly scheduled to work a minimum of 30 hours of service per week Benefits are effective the 1st of the month after 30 days in a benefit eligible position.

Legal dependents include:

lawful spouse; and children up to age 26.

PROJECT SCOPE

It is the intention of the District to continue to offer the current plan designs for the July 1, 2027 through June 30, 2032 plan year for:

Voluntary PPO Dental Voluntary DHMO Dental Voluntary Vision

The following components should be included in your response to this section of the RFP:

1. ACCOUNT MANAGEMENT

• Provide a designated Account Manager and Account Management Team

2. CUSTOMER SERVICE

• Provide a designated call and claim unit with toll free telephone access.

• Provide customer service to answer inquiries on claims, eligibility, provider network, services, coverage, or other inquiries from participants Monday through Friday from 8:00 AM to 6:00 PM (AZ time)

• Provide prompt response to all telephone inquiries from plan participants and providers of service.

6004342v1/00188.001 2

3. OPEN ENROLLMENT SUPPORT

• Attend four (4) days of Annual Open Enrollment Meetings in Tempe, Arizona during normal business hours.

4. COMMUNICATION/EDUCATION SUPPORT

• Provide bilingual communication/educational materials

5. BOOKLETS AND IDENTIFICATION CARDS

• Coordinate and mail ID cards and Benefit Schedule/Plan Booklets to participants’ homes, (as applicable).

6. CLAIMS ADMINISTRATION

• Provide claims forms (as applicable)

• Determine benefits payable under the Plan, pursuant to the terms and conditions of the District’s Benefit Plan booklets

• Receive claims and process payments of benefits in accordance with the plan designs for all claims incurred (as applicable)

• Correspond with participants and providers if additional information is necessary to complete the processing of claims

• Coordinate benefits payable under the Plan and with other benefit plans, if applicable

• Provide notice to the Participants regarding the reason(s) for denial of benefits (which are denied) and provide for the review of such denied claims

• Provide notice to Participants in the form of an explanation of benefits for claims transactions (as applicable)

7. PROVIDER NETWORK

• Maintain a panel of participating providers to provide services to eligible plan participants.

8. ELIGIBILITY/ENROLLMENT ADMINISTRATION/NOTICES

• Administer eligibility based on the District’s eligibility criteria

• Provide enrollment materials

9. REPORTING REQUIREMENTS

Provide timely management reports or internet access to monitor financial and service level performance. Such reports must include the following information, as applicable based on type of coverage being provided:

DENTAL PPO

Monthly

• Enrollment (subscriber/member) by coverage tier and status (Active/COBRA)

• Premiums paid

• Claims paid by status (Active/COBRA) and in-network vs out-of-network.

Annually

• Utilization Report

• Lag Report

6004342v1/00188.001 3

DENTAL HMO

Annually

• Enrollment and Premiums Paid

• Utilization Report

VISION

Monthly

• Enrollment (subscriber/member) by coverage tier and status (Active/COBRA)

• Premiums paid

• Claims paid by status (Active/COBRA) and in-network vs out-of-network.

Annually

• Utilization Report

• Lag Report

SUPPORT PROCUREMENT REPORTING

• Historical monthly reports (36 months) containing claims cost by number of subscribers and number of members

• Changes in benefit plans by policy year

• Premium receipts identified by Active and COBRA by month (36 months)

10. SECURED INTERNET ACCESS

• Access to Enrollment/Eligibility Administration Portal for Employer

• Access to Claims Administration Portal for Employee to track dental history, estimate dental costs, compare dental service providers for quality and price, search for providers and print/request personal ID cards

• Employer and/or Designated Consultant access to Claims Data Reporting Portal

VOLUNTARY DENTAL

The District offers employees the choice between a prepaid DHMO and DPPO dental plan on a voluntary basis. The employees pay 100 percent of the cost toward employee coverage and dependent coverage.

Currently, Cigna is the DHMO provider and Delta Dental of AZ is the DPPO provider.

If quoting a stand-alone DPPO or DHMO program, your organization must be willing to be offered alongside another voluntary dental plan (i.e., DPPO or DHMO). This RFP is requesting quotes for voluntary DHMO and DPPO dental programs.

DHMO (PRE-PAID)

The current DHMO dental schedule of benefits is attached as Attachment B1. Shown below is a five-year rate history of the DHMO plan (enrollment experience is available in Attachment B2):

DHMO Dental – Rate History

07/01/2022- 06/30/2026 07/01/2026-06/30/2027

Employee $8.59 $9.45

Employee + One $15.03 $16.53

Employee + Family $22.19 $24.41

6004342v1/00188.001 4

DPPO

The current DPPO plan design is provided in Attachment B3.

Shown below is a five-year rate history (enrollment and claims experience is available in Attachment B4).

DPPO Dental – Rate History

07/01/2022- 06/30/2025

07/01/2025- 06/30/2027

Employee $35.44 $37.21

Employee + One $70.16 $73.67

Employee + Family $92.68 $97.31

VOLUNTARY VISION

The current Vision plan is provided by Davis Vision. The vision plan summary is provided as Attachment B6.

Shown below is a five-year rate history (enrollment, claims count and premiums are available in Attachment B5).

Vision – Rate History 07/01/2022- 06/30/2027

Employee $4.78

Employee + One $9.08

Employee + Family $13.96

Please contact Khin Tan at ktan@segalco.com with a carbon copy (cc) to Rachel Calisi at rcalisi@segalco.com for the attachments and exhibits not contained in this document.

Since some of this information contains confidential data, you will be required to have a current (within last 5 years) executed Confidentiality Agreement or bid-related NDA on file with Segal to receive the documents which will be sent to you via secure email service. If you do not have a current executed Confidentiality Agreement or NDA on file with Segal, you will be sent the necessary form for completion and submission before the data will be released.