Schedule P TRR Report Template.xlsx
XLSX spreadsheet 17 KB Posted
- Attached to
- HMO Services for MPSERS
- Solicitation number
- RFP - 171 - 230000003226
- Issued by
- Ingham County, Lansing City, Michigan
About this file
This document is a template for the Schedule P TRR Report for RFP No. 230000003226. The RFP is to solicit proposals from contractors for HMO health coverage, including medical and prescription drug services, for the Medicare-Eligible Members and non-Medicare Eligible Members of the Michigan Public School Employees' Retirement System (MPSERS), administered by the Michigan Office of Retirement Services (ORS). The contract will have a term of one (1) year, with four (4) one-year options.
The RFP requires fully-insured offerings only, and the contractor must be able to provide and administer both a non-Medicare and a Medicare product inclusive of prescription drug coverage. The contract will cover Eligible Members who elect enrollment in an HMO, pursuant to the requirements listed in the RFP. The RFP is for services in Ingham County and the City of Lansing, Michigan.
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Other files
| File | Type | Posted |
|---|---|---|
| Schedule B Pricing.xlsx | XLSX spreadsheet | |
| Schedule I3 Non-Medicare Prescription Drug Summary of Benefits.pdf | ||
| Schedule J Dependent Coverage.pdf | ||
| Schedule M HMO Census Data REVISED.xlsx | XLSX spreadsheet | |
| Schedule F Definitions.docx | DOCX document | |
| Schedule I2 PPO Medicare Summary of Benefits.pdf | ||
| Schedule L Benefit Comparison and Actuarial Attestation.xlsx | XLSX spreadsheet | |
| Schedule Q RFI Report Template.xlsx | XLSX spreadsheet | |
| 230000003226 HMO Services RFP.docx | DOCX document | |
| 230000003226 Questions Answers.pdf | ||
| Schedule I4 Medicare Prescription Drug Summary of Benefits.pdf | ||
| Schedule K 834 Use Case and Example.docx | DOCX document | |
| Schedule N Section 2 Solutions Table.xlsx | XLSX spreadsheet | |
| Schedule G - Contractor Performance Evaluation Survey.doc | DOC document | |
| Schedule I1 PPO Non Medicare Summary of Benefits.pdf | ||
| Schedule R Payment Discrepancy Report Template.xlsx | XLSX spreadsheet | |
| Schedule H HMO Benefits Summary and Claims Paid Data.xlsx | XLSX spreadsheet |
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Text version
Sheet1
| Schedule P TRR Report Template |
| RFP No. 230000003226 |
hicn surname first_name middle_initial gender_code date_of_birth record_type contract_number state_code county_code transaction_status_flag disability_indicator hospice_indicator institutional_nh_c_hcbs_ind esrd_indicator transaction_reply_code transaction_code entitlement_type_code effective_date working_aged_indicator plan_benefit_package_id transaction_date ui_initiated_change_flag field_24 district_office_code prv_prt_d_cntrct_pbp_trp_tnsfr source_id prior_plan_benefit_package_id application_date ui_user_organization_designation out_of_area_flag segment_number part_c_beneficiary_premium part_d_beneficiary_premium election_type enrollment_source part_d_opt_out_flag premium_wthhld_option_parts_c_d number_of_uncovered_months creditable_coverage_flag employer_subsidy_override_flag processing_timestamp secondary_drug_insurance_flag secondary_rx_id secondary_rx_group eghp prt_d_low_inc_prem_subsdy_lvl low_income_co_pay_category low_income_period_effective_date part_d_late_enrllmnt_pnlty_amt part_d_lep_waived_amount part_d_lep_subsidy_amount low_inc_prt_d_prem_subsdy_amt part_d_rx_bin part_d_rx_pcn part_d_rx_group part_d_rx_id secondary_rx_bin secondary_rx_pcn de_minimis_differential_amount msp_status_flag low_income_period_end_date lis_source_code enrollee_type_flag_pbp_level application_date_indicator trc_short_name drc fa_demo_opt_out_flag sys_assigned_trnsctn_track_id plan_assgnd_trnsctn_trck_id plan_transaction_text_a plan_transaction_text_b end_date submitted_uncovered_mths hospice_provider
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