Schedule B Pricing.xlsx
XLSX spreadsheet 30 KB Posted
- Solicitation number
- RFP-171-250000002307-2
- Issued by
- Grand Traverse County, Lansing City, Michigan
About this file
This document is a Schedule B Pricing worksheet for a Vision Insurance Administration Services Request for Proposal (RFP No. 250000002307) for the Michigan Public School Employees' Retirement System (MPSERS). The contract is for a four-year period from January 1, 2027, through December 31, 2030, covering an estimated 170,090 to 171,369 contracts and 263,898 to 265,883 total members. The solicitation allows bidders to submit proposals for self-funded, fully insured, or combined options, with pricing to be submitted in a modifiable format like Microsoft Excel.
The pricing document provides detailed tables for both self-funded and fully insured options, requiring bidders to complete specific yellow-highlighted cells with administration fees, premiums, and claims costs. Bidders must use provided enrollment and utilization data from Schedule P and complete a claims repricing worksheet in Schedule O. The pricing must include all potential costs, including one-time or set-up charges, and is subject to a 2% illustrative membership growth rate. The State of Michigan does not guarantee minimum or maximum service volumes, and the pricing will be used for proposal comparison purposes. Bidders are also required to complete a lens enhancements section detailing non-covered lens enhancement tiers and their business distribution percentages.
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Pricing Matrix
SCHEDULE B - PRICING
| STATE OF MICHIGAN |
| Request For Proposal No. 250000002307 |
| Vision Insurance Administration Services for Michigan Public School Employees’ Retirement System (MPSERS) |
| 1. The Bidder must provide a pricing schedule for the proposed Contract Activities identified in Schedule A using the tables below. Schedule P includes detailed enrollment and utilization data that Bidders may use to assist in the development of the pricing schedule. If Bidder is providing a Self-funded proposal, Bidder must complete TABLE 1. If Bidder is providing a Fully insured proposal, Bidder must complete TABLE 2. If Bidder is providing a Self-funded and Fully insured proposal, Bidder must complete TABLE 1 and TABLE 2. All Bidders must also complete Tab 2 - Lens Enhancements. Bidders must complete only areas shaded in yellow and must not alter data or formulas in cells that are not shaded yellow. |
| 2. Enter the administration fees and/or Fully insured premium for the rate types listed below. |
Bidder must also complete Schedule O Claims Repricing in order to complete all required fields on this Schedule B.
Enter estimated Claims Cost from Schedule O. Contractor must take the 1-Year Estimated Claims Cost from cell P64 of Schedule O to be entered on this worksheet in cells: D34, I34, N31 and S31.The estimated membership counts below will be used in the calculation and a 2% illustrative growth rate will be applied to the Claims Cost.
Enter the estimated Member Out-of-Pocket costs from the claims repricing. Contractor must use the the Estimated Member Out of Pocket Costs from cell O64 of Schedule O to be entered on this worksheet in cells D38, I38, N35, S35, D66, I66, N63, S63.
Only the light yellow boxes should be populated, and it is necessary that they only be populated with numeric values. For any comments, use the boxes below the tables to enter any explanation of claims that couldn't be repriced, caveats to the pricing quote, or other notes relevant to your pricing.
| 3. The pricing schedule should be submitted in a modifiable format (e.g.. Microsoft Word or Excel); however, you may also submit an additional pricing schedule in a non-modifiable format (e.g., PDF). Failure to complete the pricing schedule as requested may result in disqualification of your proposal. |
| 4. Price proposals must include all costs, including but not limited to, any one-time or set-up charges, fees, and potential costs that Contractor may charge the State (e.g., shipping and handling, per piece pricing, and palletizing). |
| 5. By submitting its proposal, the Contractor certifies that the prices were arrived at independently, and without consultation, communication, or agreement with any other Contractor. |
| 6. The Contract will be for a four-year period with service commencing January 1, 2027, and ending December 31, 2030. For Annual-Rate Pricing, the price quoted each year must be firm for the period January 1 of that year through December 31 of that year. For Fixed-Rate Pricing, the price must be firm for the period of January 1, 2027 through December 31, 2030. Prices are to be quoted on a flat monthly fee for all services specified by this Contract. |
| Membership Assumptions: | ||||
| The estimated Membership assumptions are listed below .These are only estimates based on the best available data, and are subject to change throughout the year and contract term. | ||||
| Plan Year 1 | Plan Year 2 | Plan Year 3 | Plan Year 4 | |
| Total Contracts: | 170,090 | 170,516 | 170,942 | 171,369 |
| Total Members: | 263,898 | 264,558 | 265,220 | 265,883 |
| TABLE 1: Self-Funded Option | |||||||||||||||
| Annual Rate Pricing | Fixed Rate Pricing | ||||||||||||||
| Contract Pricing - Annual Rate | Member Pricing - Annual Rate | Contract Pricing- Fixed Rate | Member Pricing- Fixed Rate | ||||||||||||
| Year | Estimated Contract Count | Rate (Per Contract Per Month Administration Fee) | Annual Total | Year | Estimated Member Count | Rate (Per Member Per Month Administration Fee) | Annual Total | Term | Estimated Contract Count | Rate (Per Contract Per Month Administration Fee) | Annual Total | Term | Estimated Member Count | Rate (Per Member Per Month Administration Fee) | Annual Total |
| 2027 | 170,090 | $ - 0 | 2027 | 263,898 | $ - 0 | 2027-2030 | 170,729 | $ - 0 | 2027-2030 | 264,890 | $ - 0 | ||||
| 2028 | 170,516 | $ - 0 | 2028 | 264,558 | $ - 0 | 4-Year total | $ - 0 | 4-Year total | $ - 0 | ||||||
| 2029 | 170,942 | $ - 0 | 2029 | 265,220 | $ - 0 | ||||||||||
| 2030 | 171,369 | $ - 0 | 2030 | 265,883 | $ - 0 | 1-Year Estimated Claims Cost (Copy value from Schedule O, TAB 1, Cell P64) | 1-Year Estimated Claims Cost (Copy value from Schedule O, TAB 1, Cell P64) | ||||||||
| 4-Year total | $ - 0 | 4-Year total | $ - 0 | Estimated 4-Year Claims Cost | $ - 0 | Estimated 4-Year Claims Cost | $ - 0 |
| 1-Year Estimated Claims Cost (Copy value from Schedule O, TAB 1, Cell P64 ) | $ - 0 | 1-Year Estimated Claims Cost (Copy value from Schedule O, TAB 1, Cell P64) | Estimated Total System Cost | $ - 0 | Estimated Total System Cost | $ - 0 | |
| Estimated 4-Year Claims Cost | $ - 0 | Estimated 4-Year Claims Cost | $ - 0 | Estimated Member Out-of-Pocket Claims Costs (Copy value from Schedule O, TAB 1, Cell O64) | Estimated Member Out-of-Pocket Claims Costs (Copy value from Schedule O, TAB 1, Cell O64) | ||
| Notes: |
(1) The State of Michigan does not guarantee a minimum or maximum volume of services, claims and conversions.
(2) For purposes of proposal comparison, estimates in the tables above and Schedule O Claims Pricing Worksheet will be utilized.
| Estimated Total System Cost | $ - 0 | Estimated Total System Cost | $ - 0 |
| Estimated Member Out-of-Pocket Claims Costs (Copy value from Schedule O, TAB 1, Cell O64) | Estimated Member Out-of-Pocket Claims Costs (Copy value from Schedule O, TAB 1, Cell O64) | ||
| Notes: |
(1) The State of Michigan does not guarantee a minimum or maximum volume of services, claims and conversions.
(2) For purposes of proposal comparison, estimates in the tables above and Schedule O Claims Pricing Worksheet will be utilized.
| Enter Self-funded, annual rate Pricing Proposal notes here, including any discussion of claims that couldn't be repriced, caveats, etc.: | Enter Self-funded, fixed rate Pricing Proposal notes here, including any discussion of claims that couldn't be repriced, caveats, etc.: |
| Bidder Response: | Bidder Response: |
List any additional products or services (if any) that would be available to Members at no cost to Plan Sponsor with a Self-funded Plan.
Bidder Response:
| TABLE 2: Fully-Insured Option | |||||||||||||||
| Annual Rate Pricing | Fixed Rate Pricing | ||||||||||||||
| Contract Pricing - Annual Rate | Member Pricing - Annual Rate | Contract Pricing - Fixed Rate | Member Pricing - Fixed Rate | ||||||||||||
| Year | Estimated Contract Count | Rate (Per Contract Per Month Fully Insured Premium) | Annual Total | Year | Estimated Member Count | Rate (Per Member Per Month Fully Insured Premium) | Annual Total | Term | Estimated Contract Count | Rate (Per Contract Per Month Fully Insured Premium) | Annual Total | Term | Estimated Member Count | Rate (Per Member Per Month Fully Insured Premium) | Annual Total |
| 2027 | 170,090 | $ - 0 | $ - 0 | 2027 | 263,898 | 2027-2030 | 170,729 | $ - 0 | 2027-2030 | 264,890 | $ - 0 | ||||
| 2028 | 170,516 | $ - 0 | 2028 | 264,558 | Estimated 4-Year Total System Cost | $ - 0 | Estimated 4-Year Total System Cost | $ - 0 | |||||||
| 2029 | 170,942 | $ - 0 | 2029 | 265,220 | |||||||||||
| 2030 | 171,369 | $ - 0 | 2030 | 265,883 | Estimated Member Out-of-Pocket Claims Costs (Copy value from Schedule O, TAB 2, Cell O64) | Estimated Member Out-of-Pocket Claims Costs (Copy value from Schedule O, Tab 2, Cell O64) | |||||||||
| Estimated 4-Year Total System Cost | $ - 0 | Estimated 4-Year Total System Cost | $ - 0 | Notes: |
(1) The State of Michigan does not guarantee a minimum or maximum volume of services, claims and conversions.
(2) For purposes of proposal comparison, estimates in the tables above and Schedule O Claims Pricing Worksheet will be utilized. Also see above Note 1.
| Estimated Member Out-of-Pocket Claims Costs (Copy value from Schedule O, TAB 2, Cell O64) | Estimated Member Out-of-Pocket Claims Costs (Copy value from Schedule O, TAB 2, Cell O64) |
| Notes: |
(1) The State of Michigan does not guarantee a minimum or maximum volume of services, claims and conversions.
(2) For purposes of proposal comparison, estimates in the tables above and Schedule O Claims Pricing Worksheet will be utilized.
| Enter Fully-insured, annual rate Pricing Proposal notes here, including any discussion of claims that couldn't be repriced, caveats, etc.: | Enter Fully-insured, fixed rate Pricing Proposal notes here, including any discussion of claims that couldn't be repriced, caveats, etc.: |
| Bidder response: | Bidder response: |
| List any additional products or services (if any) that would be available to Members at no cost to Plan Sponsor for a Fully-Insured Plan. |
| Bidder Response: |
Lens Enhancements
| SCHEDULE B |
| Non-Covered Lens Enhancements |
| STATE OF MICHIGAN |
| Request For Proposal No. 250000002307 |
| Vision Insurance Administration Services for Michigan Public School Employees’ Retirement System (MPSERS) |
| Instructions |
| Bidder to enter response in yellow highlighted cells. |
| Tier refers to the tier of the non-covered lens enhancements. These are typically known as Standard, Tier 1, Tier 2, etc. Bidder must enter Bidder's current tier names in the Tier column. Add rows as needed. |
| Book of business distribution is the percentage amount of each tier for the non-covered lens enhancements. |
| Only fill in the tiers that are applicable to Bidder's specific response. |
| Anti-Reflective Coating | |
| Tier | Book of Business Distribution |
| Progressive Lenses | |
| Tier | Book of Business Distribution |
File details come from the government source that posted it. Updated .