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 is a Mandatory Requirements Form (Schedule C) for an HMO Services Request for Proposal (RFP No. 190000002803) issued for the Michigan Public School Employees' Retirement System (MPSERS). The form establishes mandatory certifications that bidders must complete and sign to remain eligible for proposal consideration. Bidders must agree to provide HMO services exactly as outlined in Schedule A (Statement of Work) and in accordance with the specified Plan Design. Completion and signature of this form by an authorized company representative is a prerequisite for proposal acceptance; failure to respond results in automatic disqualification.
Bidders must meet specific operational requirements to qualify, including current HMO licensure in Michigan with National Council for Quality Assurance (NCQA) accreditation, authorization to operate in all Michigan locations where they are currently approved by the Michigan Department of Insurance and Financial Services (DIFS), and capability to provide comprehensive benefits to members temporarily residing outside the service area. Pricing must not exceed the 2020 premium rates listed in Schedule B of the RFP. All certifications and representations made in the form are conditions precedent to contract award, and bidders acknowledge that compliance with these requirements and all RFP requirements is mandatory and ongoing.
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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 .