Schedule A - Final.docx

STATE OF MICHIGAN

Request For Proposal No. 180000001030 Vision Insurance Plan Administration for the Civil Service Commission

SCHEDULE A

STATEMENT OF WORK

CONTRACT ACTIVITIES

This schedule identifies the anticipated requirements of any Contract resulting from this RFP. The term “Contractor” in this document refers to a bidder responding to this RFP.

The Contractor must respond to each requirement or question, as requested, and explain how it will fulfill each requirement. Attach any supplemental information and appropriately reference within your response. When a “plan” is requested as part of the response, plan refers to the detailed process used/steps that will be taken to achieve this specific requirement. Responses must not be broad.

The Contractor must state their agreement to all requirements in Schedule A:

BACKGROUND

The Michigan Civil Service Commission (MCSC), Employee Benefits Division (EBD), administers benefits for eligible State employees, retirees, dependents and COBRA participants. MCSC, EBD serves as the Plan Sponsor for this Contract. There are approximately 45,294 active employees 55,734 retirees, 97,243 dependents, and 564 COBRA participants currently enrolled in the Vision Benefit Plan as of November 2017. A majority of the member population resides in Michigan with a portion residing in other states across the nation. The current plan is an Administrative Services Only (ASO) plan.

SCOPE

This is an RFP to solicit proposals from Bidders for administration of the Vision Benefit Plan for eligible State employees, retirees, dependents, and COBRA participants, on an ASO basis.

The MCSC seeks competitive bids to administer its Vision Benefit Plan to ensure that claim and administrative costs are the lowest possible without compromising the integrity of the plan and the evaluation process will assess which Bidders have the ability and technical capabilities to meet the State’s goals and objectives for their Vision Benefit Plan. The Contractor must provide all staffing, systems, and procedures required to perform the services described herein.

The Contract is to be effective May 10, 2018 through September 30, 2021. May 10, 2018 through September 30, 2018 is the implementation period and services are to begin without interruption on October 1, 2018. No payment will be made to the Contractor during the implementation period. The implementation period begins with Contract award date through the Plan Effective Date.

Any awarded Contract(s) between the State and any awarded Contractor(s) is a separate document, whose terms are limited by Standard Contract Terms.

1. REQUIREMENTS

A. General Requirements

1) The Contractor must provide a fully functional Vision Plan as defined by the MCSC, for Members which includes active State employees, retirees, dependents and COBRA participants.

Bidder Response to 1.A.1:

2) The Contractor must be a licensed Third-Party Administrator (TPA) in the State of Michigan or insurance company licensed to do business in Michigan, or must qualify in any other capacity as an entity that is properly licensed by statute to provide administrative services only and cost-plus arrangements, or to act as a TPA. See also Proposal Instructions Section 6 Mandatory Minimum Requirements in the Solicitation Instructions and Vendor Questions document.

Bidder Response to 1.A.2. Bidder to provide their statement of agreement and must attach details regarding any statutory cites that permit the Contractor to meet this requirement. Bidder Response:

3) The Contractor must partner with the Plan Sponsor to manage the Plan effectively and collaborate with the Plan Sponsor to ensure the future success and ability of the Plan to continue to offer competitive vision coverage.

Bidder Response to 1.A.3:

4) The Contractor must provide financial management, reporting, and analytical support as required by this contract and which meets or exceeds current industry standards.

Bidder Response to 1.A.4:

5) Ensure transparency for all Services provided on behalf of the Plan Sponsor.

Bidder Response to 1.A.5:

6) Comply with the State of Michigan’s Public Act 454 of 2004 (Social Security Number Privacy Act).

Bidder Response to 1.A.6:

7) The Contractor must provide exceptional customer service for both State of Michigan benefits personnel and members.

Bidder Response to 1.A.7:

8) The Contractor must provide services that meet or exceed current industry standards in the administration of Eligibility, Claims Processing, Member Servicing, and review and administration of Grievances and Appeals.

Bidder Response to 1.A.8. Bidder must describe how they measure, track and report on account service performance:

9) Contractor must provide support of strategic planning efforts and identifying areas of improvement upon request including, but not limited to, comparative analysis of Plan Sponsor’s membership to other like groups across Contractor’s book of business.

Bidder Response to 1.A.9:

10) The Contractor must provide all necessary administrative functions. This must include, but is not limited to:

a. Producing and distributing EBD-approved Vision Benefit Plan member communications at no additional cost to Plan Sponsor.

b. Processing claims in accordance with State of Michigan plan design

c. Providing monthly, quarterly, year-end, reporting as defined herein and ad-hoc reporting, upon Plan Sponsor’s request. See Section 4.3 Reporting.

Bidder Response to 1.A.10:

11) The Contractor must provide independent ratings of financial strength to the Plan Sponsor such as an A.M. Best Financial Strength Rating.

Bidder Response to 1.A.11. The Bidder must provide a copy of their independent ratings of financial strength with their proposal in the space below. In addition, Bidder’s independent ratings of financial strength will be evaluated for indicators of, and level of, vulnerability to default on financial commitments. Bidder Response:

12) The Contractor must demonstrate the total value in administrative fees and claims cost of the Contractor’s program.

Bidder Response to 1.A.12. The Bidder must reprice claims based on the proposed plan (See Schedule F). Pricing information must be entered into Schedule B. The claims repricing will be evaluated and considered as part of Schedule B, Pricing and total cost of ownership. Bidder Response:

13) The Contractor must smoothly transition administration of the Plan from the current administrator, if not the incumbent. There will be no fee to Plan Sponsor for Contract Implementation. See also Section 4.1 Project Plan/Implementation Plan.

Bidder Response to 1.A.13. Bidder Response:

B. Plan Design

1) The Contractor must administer the Plan in accordance with the Plan Design outlined in Schedule C.

Bidder Response to 1.B.1:

2) The Contractor must duplicate the current Plan Design. See also Proposal Instructions, Section 6 Mandatory Minimum Requirements in the Solicitation Instructions and Vendor Questions document.

Bidder Response to 1.B.2:

3) This Plan is a bargained benefit and is subject to change throughout the duration of this Contract, depending upon the results of future collective bargaining agreements. Historically, non-bargaining unit employees have received the same benefits as bargaining unit employees, but this is not guaranteed. Retiree benefits are also subject to change.

Bidder Response to 1.B.3:

a. The Contractor must be able to administer multiple plan designs based on bargained terms.

Bidder Response to 1.B.3.a:

b. The Contractor must implement Plan changes as requested by the Plan Sponsor or as required to comply with changes in law or regulation in a mutually agreed time frame, at no additional fee to the Plan Sponsor.

Bidder Response to 1.B.3.b:

C. Claims Processing

1) The Contractor must only pay claims for eligible participants.

Bidder Response to 1.C.1:

2) The Contractor must only charge against the Plan Sponsor’s account claim payments authorized under the Plan Sponsor’s Plan Design. If it is determined that claims have been improperly paid due to Contractor system rules or programming error(s), the Plan Sponsor will be reimbursed for the cost of improper payment and the member will not be billed.

Bidder Response to 1.C.2:

3) The Contractor must maintain confidentiality of all data collected by the Contractor, according to all applicable laws, rules and regulations. All data identifying specific enrollees or their dependents is to be treated and secured according to HIPAA privacy and security regulations. The Contractor’s system must comply with HIPAA. Contractor must provide Plan Sponsor with an annual attestation that it meets this requirement.

Bidder Response to 1.C.3:

4) The Contractor must capture and store all Claim data elements involved in the processing or payment of Claims.

Bidder Response to 1.C.4:

5) The Contractor must capture additional Claim data elements, if requested by the Plan Sponsor.

Bidder Response to 1.C.5:

6) The Contractor must have processes in place to detect fraud and abuse. Detected fraud or abuse must be reported to the Plan Sponsor immediately and remedied in conjunction with the monthly reporting schedule in Section 4.3 Reporting.

Bidder Response to 1.C.6:

7) The Contractor must have procedures for handling overpayments and recoveries in place. Any procedures impacting members must be mutually agreed upon.

Bidder Response to 1.C.7. The Bidder must provide their procedures for handling overpayment and recoveries:

8) The Contractor must perform Coordination of Benefits (COB) for claims administration when a member is covered by more than one vision plan.

Bidder Response to 1.C.8:

9) Data collected on behalf of the State is not to be distributed to any party without the written consent of the State and is not to be used by the Contractor for any purposes without express, written approval by the State.

Bidder Response to 1.C.9:

10) System rules or programming errors that result in improper payment of claims or payment of claims to ineligible participants will be considered financial errors.

Bidder Response to 1.C.10:

D. Provider Network

1) The Contractor must provide effective plan management for vision services and supplies by maintaining a broad national network of participating preferred community vision Providers where members reside. The network must offer convenient access to employees, retirees, dependents, and COBRA participants who reside throughout the country. See Schedule D – GeoAccess Data.

Bidder Response to 1.D.1:

2) The Contractor must have and use a valid process to credential, monitor, and re-credential Network Providers.

Bidder Response to 1.D.2. Bidder must explain their process to credential, monitor and re-credential Network Providers:

3) The Contractor must be able to add Providers to the Provider Network to meet network access requirements.

Bidder Response to 1.D.3:

4) The Contractor must have a process in place to audit network providers for compliance with contractual terms and ensure the accurate administration of the State Vision Plan.

Bidder Response to 1.D.4. Bidder must describe this process:

5) The Contractor must support Provider access to Protected Health Information (PHI) by means of a secured Internet portal.

Bidder Response to 1.D.5. The Bidder must describe their protocol and system:

6) The Contractor must provide Pass-Through Pricing to Plan Sponsor. The Contractor must not charge Plan Sponsor or any Member any amount above that which is paid to the Provider under the terms of the contract between the Contractor and the Provider.

Bidder Response to 1.D.6:

7) The Contractor must perform a GeoAccess analysis. See also Schedule D.

Bidder Response to 1.D.7. Using the Member Locations by Zip Code and the Zip Code Definitions in Schedule D, the Bidder must perform a GeoAccess analysis using the Bidder’s proposed Provider Network. The Bidder must detail their provider access criteria in the Bidder Response below, and enter data in Tab 2 and 3 of Schedule D by including data for each of the following provider types:

1. Optometrists

1. Ophthalmologists

1. Retail Locations

8) The Contractor must identify the percentage of Members who will have access to a vision Provider in the Contractor’s network, based on the following criteria:

Definition of Urban, Suburban, and Rural:

Urban: > 3,000 population per square mile

Suburban: 1,000 - 3,000 population per square mile

Rural : < 1,000 population per square mile

Bidder Response to 1.D.8. Bidders must complete Tab 1 in Schedule D using the data above to identify the percentage of members who will have access to a vision Provider in the Contractor’s network:

9) The Contractor must perform a disruption analysis to determine the potential network access disruption that would result from a change in current administration. Refer to Schedule G for a list of Member count utilization by Network Provider.

Bidder Response to 1.D.9. The Bidder must complete the table in Schedule G, showing how many members are currently going to Network Providers who would not be covered by the Bidder’s proposed Provider Network:

10) Contractor must commit to improving Provider access in any areas where the access standard is not met.

Bidder Response to 1.D.10. The Bidder must explain how they will commit to improving Provider access in any areas where the access standard is not met:

11) The Contractor must make Provider directories available to members.

Bidder Response to 1.D.11. The Bidder must describe how Provider directories are made available to members:

E. Member Support

1. The Contractor must provide a Customer Service call center, where it will maintain staff dedicated to supporting the needs of the Plan Sponsor’s Members. The call center must be in the United States of America, but the Plan Sponsor prefers that the call center be located in Michigan. The Customer Service call center must, at a minimum include:

a. A single front-end toll-free dedicated telephone number with touch-tone routing (if necessary) for Customer Service staff to respond to Member requests for participating Provider locations, for questions on Claims and access, and complaints about Providers and Services.

Bidder Response to 1.E.1.a:

b. A customer service system scalable to future demand.

Bidder Response to 1.E.1.b:

c. An advanced telephone system that provides the Plan Sponsor with management tracking and reporting capabilities.

i. Methods for logging calls, recording call data and content; it is highly preferred that the recorded call be attached to the customer account.

ii. Methods to report metrics, standards and ad-hoc report generation.

iii. Methods to monitor calls for quality

Bidder Response to 1.E.1.c:

d. An interactive voice response (IVR) system with a user-friendly menu.

Bidder Response to 1.E.1.d:

e. Information on how to access Customer Service must be clearly communicated in all Plan specific booklets and newsletters and Identification Cards.

Bidder Response to 1.E.1.e:

f. The Contractor must attempt to resolve Member’s issues during the initial contact with the Member. For those issues not resolved immediately, Contractor must send Members a written response to their issues. This response must either resolve the outstanding issue(s) or inform the Member as to when resolution can be expected.

Bidder Response to 1.E.1.f:

2. The Contractor must provide web-based support to the Plan Sponsor and its Members. This must be a Plan-specific website dedicated solely to the Plan Sponsor and Members. The web-based system must include, but not be limited to, having the ability to:

a. Provide Members with secure access to information specific to their own Claims and enrollment.

Bidder Response to 1.E.2-a:

b. List Providers based on proximity to Member’s home address or zip code.

Bidder Response to 1.E.2.b:

c. Provide detailed Provider network information accessible to members on-line.

Bidder Response to 1.E.2.c:

d. Answer Member questions about the Plan (Q&A).

Bidder Response to 1.E.2.d:

e. Provide Members access to designated electronic Plan-specific documents on the Contractor’s Plan-specific website.

Bidder Response to 1.E.2.e:

f. Provide details of the services and functions that will be available to the Plan Sponsor and Members on the Internet and/or via mobile applications.

Bidder Response to 1.E.2.f:

3. The Contractor’s customer service team must respond to Claims, Inquiries, questions, and problems regarding operations from the Plan Sponsor and/or members.

Bidder Response to 1.E.3:

4. The Contractor’s Customer Service team must log and manage all incoming and outgoing member calls and correspondence.

Bidder Response to 1.E.4. The Bidder must describe how they plan to meet this requirement:

5. The Contractor must use the information captured in the communication tracking system to target improvement opportunities (e.g., reducing call volume, providing online capabilities, identifying issues, etc.).

Bidder Response to 1.E.5. The Bidder must describe how they plan to meet this requirement:

6. The Contractor must record incoming and outgoing member calls and review for quality monitoring purposes.

Bidder Response to 1.E.6:

7. Call recordings must be retained for a minimum of one year from the date of the call. Calls related to an appeal or grievance must be preserved until final disposition of the appeal or grievance.

Bidder Response to 1.E.7:

F. Member Communications Materials and Meetings

1. Member Communication Materials

a. All communication materials must be provided in a web-ready format and reviewed and approved by EBD in advance of distribution. All communication materials presented to Plan Sponsor for approval must allow for 10 business days for review and editing. This applies to all information developed, provided, and/or distributed by Contractor to Members about the Plan including those placed on the Contractor’s Plan Sponsor-specific website including, but not limited to the following:

Bidder Response to 1.F.1.a:

1) The Contractor must create both a brief Plan Summary and a detailed Plan Booklet for members.

Bidder Response to 1.F.1.a.1:

2) The Contractor must provide reimbursement and claim forms which have been reviewed and approved by EBD. A separate claim form must be used for Specialty Safety and Computer Glasses in accordance with Plan Design.

Bidder Response to 1.F.1.a.2:

3) The Contractor must prepare and distribute, at its own cost, all communication materials, including but not limited to announcements, letters, notices, brochures, forms, postage, and other supplies and Services for distribution to Members.

Bidder Response to 1.F.1.a.3:

4) Customized Member communications must be provided, by the Contractor to Members, at no additional charge and are subject to the Plan Sponsor’s approval. This also includes co-branding materials with the name of Contractor and Plan Sponsor, where desired by Plan Sponsor.

Bidder Response to 1.F.1.a.4:

5) The Contractor must provide Explanation of Benefits (EOB) that detail charges, copays, outstanding benefit limits, and contact information for following up with questions or Appeal in easy-to-read language. Any denial of claims must have a detailed, understandable explanation of reason for denial.

Bidder Response to 1.F.1.a.5:

2. Communication Meetings:

a. Contractor must provide speakers at meetings designated by Plan Sponsor at no additional charge to the Plan Sponsor. Meeting requests may vary from year-to-year.

Bidder Response to 1.F.2.a:

b. In addition to Plan Sponsor designated meetings, the Contractor may receive requests for speakers from Member support organizations (i.e.: State Employees Retiree Association). All requests for in-state meetings must be channeled through the Plan Sponsor and accommodated upon request. If the Contractor is unable to accommodate an in-state meeting request, the Contractor must seek and obtain Plan Sponsor approval for excusal.

Bidder Response to 1.F.2.b:

3. Member Satisfaction:

a. The Contractor must send a Plan specific member satisfaction survey, that is mutually agreed upon between the Plan Sponsor and Contractor on an annual basis. The Contractor must report results of the survey to the Plan Sponsor as indicated in the Service Level Agreements (SLAs) in Section 1.I. All areas where Member satisfaction levels are low must be remedied by the Contractor within a timeframe acceptable to the Plan Sponsor. Sample sizes of responses must be sufficient to produce statistically valid results.

Bidder Response to 1.F.3.a:

4. The Contractor must supply an electronic Provider directory to the Plan Sponsor for placement on the Plan Sponsor’s website.

Bidder Response to 1.F.4:

G. Enrollment and Eligibility

1. Eligibility will include active State employees, retirees, dependents, and COBRA participants. The Plan Sponsor is responsible for transmitting eligibility and enrollment information for covered active employees, COBRA participants, and their Dependents. ORS is responsible for transmitting eligibility and enrollment information for the State Employee Retirement System (SERS), State Police Retirement System (SPRS), Judges Retirement System (JRS), and the Military Retirement System (MRS) members. ORS is also responsible for transmitting eligibility and enrollment information for some of the Defined Contribution former qualified participants. Payment of Administrative Fees to the Contractor is predicated on the enrollment records of the Plan Sponsor and ORS.

The Contractor must maintain a system for enrollment and eligibility and be prepared to accept, and coordinate, multiple data files from two separate State Agencies (MCSC and ORS), as indicated in Schedule E – HIPAA 834 File Layouts.

Bidder Response to 1.G.1:

2. The Contractor must provide the Plan Sponsor with secure online access to the Contractor’s enrollment and eligibility system in order to review and update member eligibility at or near real time.

Bidder Response to 1.G.2:

3. Data for active and COBRA members will be supplied through the Human Resource Management Network (HRMN). Eligibility information will be transferred, by the Plan Sponsor, via FTS (or another method selected by the State). The State sends an 834 HIPAA compliant “changes only” file on a weekly basis and a “full file” quarterly.

Eligibility information for members who are enrolled retirees will be transferred by ORS using FTS (or another method selected by the State). ORS sends an 834 formatted “changes only” file weekly and a “full file” semi-annually. Data for retirees and their dependents is supplied from the retirement account management system, Clarety.

The Contractor must maintain and update the enrollment system based on weekly eligibility files received by the State.

Bidder Response to 1.G.3. The Bidder must describe their processing in regards to 834 “changes only” and “full” files, specifically in regard to eligibility:

4. The State requires use of its FTS (or another method selected by the State) for all file transmissions. Electronic transmission of identifiable data must be protected by passwords and a Secure File Transfer Protocol (SFTP) method.

Bidder Response to 1.G.4:

5. The Contractor must accept, load, store and maintain Member information. Any changes, additions, or terminations of Member enrollment information or changes or additions to Member demographic information must originate from the Plan Sponsor. The Contractor must not make any changes to Member information that would lead to Contractor and Plan Sponsor having different information for the same Member.

Bidder Response to 1.G.5:

6. The Contractor must be able to accept the Plan Sponsor’s electronic eligibility files in the file format indicated in the File Layouts, Schedule E.

Bidder Response to 1.G.6:

7. The Contractor must be able to process change transactions to maintain up-to-date information for eligibility certification.

Bidder Response to 1.G.7:

8. The eligibility files must be processed and Member eligibility and/or enrollment update completed, upon notification from the Plan Sponsor or its designee, with confirmation of changes submitted to the Plan Sponsor and number of records loaded.

Bidder Response to 1.G.8:

9. The Contractor must accept a full file on a quarterly basis (or other frequency designated by the State) for audit purposes. See Section 1.I for service level requirement regarding file timing.

Bidder Response to 1.G.9:

10. Upon written or verbal notification by authorized Plan Sponsor representatives, member eligibility and/or enrollment updates must be completed in real-time by the Contractor.

Bidder Response to 1.G.10:

11. The Contractor must have accessible and experienced information technology professionals to provide timely programming who are capable and authorized to implement system changes and produce reports.

Bidder Response to 1.G.11:

12. The Contractor must use a system similar to a Secure Sockets Layer (SSL) Message Center for all administrative communications concerning individual Members.

Bidder Response to 1.G.12:

13. The Contractor must maintain a Member’s enrollment in the Plan unless otherwise notified by Plan Sponsor, regardless of notifications from any other source.

Bidder Response to 1.G.13:

14. No participant will lose eligibility for benefits through pre-existing condition exclusions as a result of a change in carrier at transfer or during the duration of the Contract. The Plan Sponsor has the sole authority to determine the effective date of a Member, including retroactive adjustments.

Bidder Response to 1.G.14:

15. The Contractor is responsible for any changes, and any associated costs therein, to their systems or processes required to support the receipt and processing of Plan Sponsor’s enrollment and eligibility files. The Contractor must work with the Plan Sponsor to develop a timeline for implementation and testing of any system changes. The Contractor must maintain a testing environment for such purposes.

Bidder Response to 1.G.15:

a. The Contractor must allow Plan Sponsor, or Plan Sponsor's consultant, the right to review the internal testing completed for Plan Sponsor's vision Plan, if applicable, prior to the effective date of the plan on an annual basis.

Bidder Response to 1.G.15.a:

b. The Contractor must allow Plan Sponsor, or Plan Sponsor's consultant, the right to create and submit test claims for Plan Sponsor's vision plan, without limitations on the number of test claims, as part of a pre or post implementation audit on an annual basis.

Bidder Response to 1.G.15.b:

16. All records passed from the Plan Sponsor to the Contractor must be uploaded within one business day in the order required by the Plan Sponsor. The Contractor must have validation edits in place to ensure, for each data load, that all fields transmitted are properly uploaded, read, and populated in their system. Any records that do not pass Contractor’s validation tests must be reported to Plan Sponsor within two business days after the file has been uploaded. All discrepancy reporting must be in the format defined by the Plan Sponsor.

Bidder Response to 1.G.16. The Bidder must describe their validation and quality control processes:

H. Audits

1. The Plan Sponsor intends to periodically (at least once every two years) perform on-site audits of the Contractor. The Plan Sponsor’s current approach has been to audit two Plan Years at one time, conducted within 12 months of the end of the second year audited. The Plan Sponsor reserves the right to change this approach without prior notice.

Bidder Response to 1.H.1:

2. The Contractor must make records associated with the administration of the State’s Plans available to, and must cooperate with, such auditors and audits as the Plan Sponsor may designate.

Bidder Response to 1.H.2:

3. The Contractor agrees to not impose limitations on the number of claims to be audited and no additional charges to Plan Sponsor for audits, including, but not limited to, onsite pre-implementation audit, annual claims audit and annual benefit audit, etc.

Bidder Response to 1.H.3:

4. The Contractor must provide any requested data elements required to complete a benefit and claims audit 30 days from receipt of the data request by the Plan Sponsor’s auditor.

Bidder Response to 1.H.4:

5. The Contractor must provide their responses to the claims that require review within 30 days of receipt of claim inquires and/or exceptions from the Plan Sponsor’s auditor.

Bidder Response to 1.H.5:

6. If necessary, the Contractor and the State will meet to review each audit report after issuance. The Contractor must respond to each audit report in writing within 30 days from receipt of the report, unless a shorter response time is specified in the report. The Contractor and the State must develop, agree upon and monitor an action plan to address and resolve any deficiencies, concerns, and/or recommendations in the audit report.

Bidder Response to 1.H.6:

7. If the audit demonstrates any errors in the documents provided to the State, then the amount in error must be reflected as a credit or debit on the next invoice and in subsequent invoices until the amount is paid or refunded in full. However, a credit or debit may not be carried for more than four (4) invoices. If a balance remains after four (4) invoices, then the remaining amount will be due as a payment or refund within 45 days of the last quarterly invoice that the balance appeared on or termination of the Contract, whichever is earlier. See also Section 36 of Standard Contract Terms

Bidder Response to 1.H.7:

8. In addition to other available remedies, if the difference between the payment received and the correct payment amount is greater than 10.00%, then the Contractor must pay all of the costs of the audit.

Bidder Response to 1.H.8:

9. The Contractor must allow full, onsite auditability.

Bidder Response to 1.H.9:

10. The Contractor must not offset audit recovery overpayments by any potential underpayments identified by the audit.

Bidder Response to 1.H.10:

11. The Contractor must not hold a Member, a Provider or the Plan Sponsor financially responsible for the Contractor’s errors that are identified in an audit. If a pattern of payment errors is identified for a particular Provider, the Contractor must assume the cost of auditing that Provider.

Bidder Response to 1.H.11:

12. The Contractor must agree to pass through to Plan Sponsor 100% recovery of audit recoveries and overpayments.

Bidder Response to 1.H.12:

I. Performance Guarantees / Service Level Agreements (SLAs)

1. The Contractor must ensure that the SLAs are measurable using the Contractor’s standard management information systems. Every SLA must have a report provided that is deemed adequate by the Plan Sponsor to verify the SLA has been met. SLAs without a corresponding report will be deemed unmet and subject to the penalty. The Plan Sponsor reserves the right to independently verify the Contractor’s assessment of its performance, either by State employee or third party review. Disagreements regarding SLAs will be subject to Dispute Resolution under Standard Contract Terms.

Bidder Response to 1.I.1:

2. Within 45 Days after the end of each calendar quarter, the Contractor must provide the Plan Sponsor with a report assessing the Contractor’s performance under each SLA for the Plan Sponsor, and provide payment for any applicable penalties to the Plan Sponsor quarterly or, by mutual agreement annually via invoice credit. Any metric that is reported must be accompanied by supporting documentation upon request of the Plan Sponsor. The following SLAs relate to on-going Services and will apply throughout the duration of the Contract, including any optional renewal periods (if exercised).

Bidder Response to 1.I.2:

3. SLA Reports: Any metric that is reported must be accompanied by supporting documentation upon request of the Plan Sponsor and retained by Contractor for a mutually agreed-upon timeframe. See Schedule I for reporting layout requirements. A different format may be mutually agreed-upon by the Plan Sponsor and Contractor.

Bidder Response to 1.I.3:

4. SLAs are for all Services provided under this Contract for the Plan Sponsor as detailed in the table below:

Bidder must enter company name here

Version 1 Revised Date: 7/28/2017

100% of new Contract Holders’ ID Cards must be mailed within 10 days of Contractor receiving eligibility record. Performance must be substantiated by documentation providing proof of receipt date and mailing date.

B. Accuracy:

ID Cards must have an accuracy rate of 99.00% or higher.

Accuracy must be measured by sampling ID card production to ensure 99.00% accuracy of information

Failure to reach 80.00% will result in an additional 1.00% penalty of Contractor’s annual Administration Fee.

A. Monthly and Quarterly Reports:

Contractor must provide complete monthly and quarterly reports within 45 Days of the end of the month and quarter, as outlined in Schedule A Section 4.3 Reporting. Each report must be timely received in order to meet the quarterly SLA.

B. Annual Reports:

Contractor must provide complete annual reports within 90 days of Plan year end, as outlined in Schedule A Section 4.3 Reporting.

J. Technology and Support

1. The Contractor must keep back-up computer data files maintained in connection with this Contract in a place of safekeeping satisfactory to the State. All computer data files of the Plan Sponsor, as maintained by Contractor, must at all times remain the property of the State notwithstanding the fact that such records may be stored upon or within one or more computer or data retention systems owned, operated or leased by Contractor. The State, or its representatives, must, at all reasonable times, have access to the records. To the extent that any such records are to be maintained upon a computer system or any other data retention system which is not owned by the Contractor, the Contractor must provide the State with assurances from the owner of such computer facilities, satisfactory to the State, of continued availability and security of such records at all times.

Bidder Response to 1.J.1. Bidder must provide the method and system that will be used to maintain the back-up computer data files:

2. The Contractor must comply with Schedule J Safeguard Requirements of Confidential Data.

Bidder Response to 1.J.2:

3. The Contractor must maintain and keep a documented disaster recovery plan that will be made available to the State or Plan Sponsor upon request (See also Schedule J, Section N).

Bidder Response to 1.J.3. Bidder must provide their disaster recovery plan:

4. Within 24 hours of request by the State, the Contractor must provide the State access to all back-up source materials reports, books, records, computer programs and all other information and documentation relating to the Plan, as reasonably required so that the State and/or its designated officers, agents and accounts, can conduct a financial examination and/or audit of the plans.

Bidder Response to 1.J.4:

5. All State data must be stored, maintained and managed within the contiguous 48 states.

Bidder Response to 1.J.5:

K. SSAE No. 16

1. The Contractor must have either a Type II Statement of Auditing Standards (“SAS”) 70 or a Statement on Standards for Attestation Engagements (SSAE) No. 16, conducted annually.

Bidder Response to 1.K.1. Bidder to provide a copy of their most recent SSAE-16 or SAS-70 audit results with their proposal:

2. If the Contractor’s current SSAE-16 or SAS-70 has qualifications, the Contractor must provide the Plan Sponsor with the corrective action plan, in a timeframe mutually agreed upon by the Contractor and the Plan Sponsor, and provide regular updates until issues have been corrected.

Bidder Response to 1.K.2:

3. The Contractor must supply the Plan Sponsor with an annual electronic copy of the results of this audit within 45 Days of completion of the report.

Bidder Response to 1.K.3:

4. The Contractor must provide, to the Plan Sponsor, additional information pertaining to internal controls, upon request.

Bidder Response to 1.K.4:

5. The Contractor must provide the Plan Sponsor with a corrective action plan on all actionable items within 30 days from delivery of the report to the Plan Sponsor (or as mutually agreed upon between Contractor and Plan Sponsor) and provide regular updates on those items until they are resolved.

Bidder Response to 1.K.5:

L. Training The Contractor must provide on-site training, documentation and training materials, covering provider network, systems, access, overall product offering, etc. to the Plan Sponsor, Call Center or ORS, depending on Plan Sponsor’s need at the time and at no cost to the Plan Sponsor.

Bidder Response to 1.L. The Contractor must explain its training capabilities and any training that is included in its proposal. Bidder Response:

2. Acceptance

2. Acceptance, Inspection and Testing The State will use the following criteria to determine acceptance of the Contract Activities provided under this SOW: see Standard Contract Terms, Section 16.

3. Staffing

3.1. Contractor Representative

A. The Contractor’s appointed Senior Account Manager (SAM) will serve as the Contractor Representative. This representative must be specifically assigned to State of Michigan accounts, and is responsible for responding to State inquiries regarding the Contract Activities.

Bidder Response to 3.1.A. Name, Phone and Email Address of Bidder’s proposed Contractor Representative:

B. The Contractor must notify the Contract Administrator and Program Manager at least 30 calendar days before removing or assigning a new Contractor Representative.

Bidder Response to 3.1.B:

3.2 Customer Service Toll-Free Number

The Contractor must specify its toll-free number for the State to make contact with the Contractor Representative. The Contractor Representative must be available for calls during the hours of 8 am to 5 pm EST.

Bidder Response to 3.2:

3.3. Technical Support, Repairs and Maintenance

The Contractor must specify its toll-free number for the State to make contact with the Contractor for technical support, repairs and maintenance. The Contractor must be available for calls and service during the hours of 8 am to 5 pm EST.

Bidder Response to 3.3:

3.4 Work Hours

The Contractor must provide Contract Activities during the State’s normal working hours Monday – Friday, 7:00 a.m. to 6:00 p.m. EST, and possible night and weekend hours depending on the requirements of the project.

Bidder Response to 3.4:

3.5. Key Personnel

A. The Contractor must appoint individuals who will be directly responsible for the day-to-day operations of the Contract (“Key Personnel”). Key Personnel must be specifically assigned to the State account, be knowledgeable on the contractual requirements, and respond to State inquires within 24 hours.

Bidder Response to 3.5.A:

B. The Contractor must identify proposed staff who will be involved with the Contract and those who will be designated as Key Personnel in the table below . The Contractor must provide the following information within the table including but not limited to:

· Describing in detail their roles and responsibilities, including any special skills needed. Descriptions of roles should be functional and not just by title. A job description must be included in your response for each role.

· Identifying where staff will be physically located during Contract performance.

· Identifying any part-time personnel.

Bidder Response to 3.5.B:

Key Personnel Table

Senior Account Manager

Back-Up Senior Account Manager

C. The Contractor must assign not less than the following Key Personnel:

1. One SAM whose role and responsibilities must include:

a. Serving as the single point of accountability for all projects initiated between the Contractor and the Plan Sponsor for management of the Contractor’s Account Team;

b. Authority to make day-to-day decisions regarding service issues;

c. Ability within the Contractor’s organization to obtain the use of Contractor’s resources, both direct and indirect, as necessary;

d. Designating one back-up to the SAM, whose role and responsibilities must include involvement in account management and who is capable of performing the responsibilities of the SAM in the event that the SAM is unavailable. The Contractor’s SAM back-up must be familiar with all specific requirements of this Contract. This back-up role may be filled by another key-staff person.

Bidder Response to 3.5.C.1.a-d. Bidder must describe the degree of decision-making authority the designated executive account team, inclusive of the SAM, will have within Bidder’s organization to resolve operational problems and issues:

2. Key Personnel must be made available to the Plan Sponsor on a reasonably frequent basis (as determined or scheduled by Plan Sponsor or Program Manager, as designated by the State).

Bidder Response to 3.5.C.2:

D. The Contractor must provide current detailed chronological resumes for all Key Personnel identified in Section 3.4.D. Qualifications will be measured by education and experience, with particular reference to experience on projects similar to that described in the RFP.

Bidder Response to 3.5.D. Bidder must attach resumes for all proposed Key Personnel:

E. The State has the right to recommend and approve in writing the initial assignment, as well as any proposed reassignment or replacement, of any Key Personnel. Before assigning an individual to any Key Personnel position, Contractor will notify the State of the proposed assignment, introduce the individual to the State’s Project Manager, and provide the State with a resume and any other information about the individual reasonably requested by the State. The State reserves the right to interview the individual before granting written approval. In the event the State finds a proposed individual unacceptable, the State will provide a written explanation including reasonable detail outlining the reasons for the rejection. The State may require a 30-calendar day training period for replacement personnel.

Bidder Response to 3.5.E. Bidder must describe what percentage of Bidder’s accounts experienced turnover in account executives during calendar years 2016 and 2017:

F. Contractor will not remove any Key Personnel from their assigned roles on this Contract without the prior written consent of the State. The Contractor’s removal of Key Personnel without the prior written consent of the State is an unauthorized removal (“Unauthorized Removal”). An Unauthorized Removal does not include replacing Key Personnel for reasons beyond the reasonable control of Contractor, including illness, disability, leave of absence, personal emergency circumstances, resignation, or for cause termination of the Key Personnel’s employment. Any Unauthorized Removal may be considered by the State to be a material breach of this Contract, in respect of which the State may elect to terminate this Contract for cause under Termination for Cause in the Standard Terms. It is further acknowledged that an Unauthorized Removal will interfere with the timely and proper completion of this Contract, to the loss and damage of the State, and that it would be impracticable and extremely difficult to fix the actual damage sustained by the State as a result of any Unauthorized Removal. Therefore, Contractor and the State agree that in the case of any Unauthorized Removal in respect of which the State does not elect to exercise its rights under Termination for Cause, Contractor will issue to the State the corresponding credits set forth below (each, an “Unauthorized Removal Credit”):

(i) For the Unauthorized Removal of any Key Personnel designated in the applicable Statement of Work, the credit amount will be $25,000.00 per individual if Contractor identifies a replacement approved by the State and assigns the replacement to shadow the Key Personnel who is leaving for a period of at least 30 calendar days before the Key Personnel’s removal.

(ii) If Contractor fails to assign a replacement to shadow the removed Key Personnel for at least 30 calendar days, in addition to the $25,000.00 credit specified above, Contractor will credit the State $833.33 per calendar day for each day of the 30 calendar-day shadow period that the replacement Key Personnel does not shadow the removed Key Personnel, up to $25,000.00 maximum per individual. The total Unauthorized Removal Credits that may be assessed per Unauthorized Removal and failure to provide 30 calendar days of shadowing will not exceed $50,000.00 per individual.

Bidder Response to 3.5.F:

G. Contractor acknowledges and agrees that each of the Unauthorized Removal Credits assessed above: (i) is a reasonable estimate of and compensation for the anticipated or actual harm to the State that may arise from the Unauthorized Removal, which would be impossible or very difficult to accurately estimate; and (ii) may, at the State’s option, be credited or set off against any fees or other charges payable to Contractor under this Contract.

Bidder Response to 3.5.G:

3.6 Additional Staff:

A. Additional staff assignments are not considered key, but their roles are considered an integral complement to the roles, responsibilities, and abilities of the Contractor’s key-staff. These roles may include not only the staff roles listed below, but also may include other IT-System Technicians, Security Specialists, Accounting or Audit staff, Administrative support staff, etc. Contractor must include a detailed description of these additional roles in the table below.

1. Enrollment Service Specialist(s)

2. Customer Service Specialist(s)

3. Optometrist or Ophthalmologist

Bidder Response to 3.6.A:

Non-Key Staff Table

B. The Contractor must notify the Program Manager at least 10 business days before redeploying non-Key Personnel, who are dedicated primarily to the Project, to other projects.