Schedule C - Mandatory Requirements Form.doc
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- Attached to
- HMO Services for MPSERS
- Solicitation number
- RFP-171-190000002803-2
- Issued by
- Michigan
About this file
This document is a Schedule C Mandatory Requirements Form for an HMO Services Request for Proposal (RFP No. 190000002803) issued by the Michigan Public School Employees' Retirement System (MPSERS). The form requires bidders to certify compliance with specific mandatory requirements for providing health maintenance organization (HMO) services, including providing comprehensive benefits in all currently approved service areas, offering coverage for members temporarily residing outside the service area, and maintaining 2020 premium rates as specified in the RFP's Schedule B - Pricing.
The mandatory requirements stipulate that bidders must be HMO-licensed in Michigan and accredited by the National Council for Quality Assurance (NCQA), with coverage authorized under their HMO license. Bidders must agree to provide services exactly as outlined in the Statement of Work and adhere to the specified Plan Design. The form serves as a critical certification document that requires an authorized representative's signature, with non-compliance or failure to complete the form potentially resulting in proposal disqualification. The document emphasizes the bidder's commitment to meeting all specified service and regulatory requirements for the MPSERS health insurance contract.
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Text version
SCHEDULE C
HMO Services for MPSERS
Mandatory Requirements Form RFP No. 190000002803 The bottom of this page of must be signed by the Bidder’s authorized representative. Failure to respond to this form will result disqualification of the Bidder’s proposal.
As a legally authorized representative of , I hereby certify that the following statements are true:
1. Bidder agrees to provide services exactly as written in Schedule A – Statement of Work of the Request for Proposal and in strict accordance with the Plan Design.
2. Bidder is a HMO licensed in the State of Michigan and accredited by the National Council for Quality Assurance (NCQA), a national organization that evaluates HMO quality. The coverage offered to Members must be authorized under the Bidder’s HMO license.
3. Bidder agrees to provide services in all locations that they are currently approved by the Michigan Department of Insurance and Financial Services (DIFS) to service.
4. Bidder agrees to provide comprehensive benefits to members when they temporarily reside outside of the service area.
5. Bidder agrees to provide all services at or below the 2020 premium rates as listed in Schedule B - Pricing of the Request for Proposal.
I make the above certifications and assurances as a required element of this Request for Proposal (RFP) to which it is attached, understanding that the truthfulness of the facts affirmed here and the continuing compliance with these requirements and all requirements of the RFP are conditions precedent to the award.
Company Name of Bidder
Signature of Bidder’s Authorized Representative
Title of Bidder Authorized Representative
File details come from the government source that posted it. Updated .