SECHQ1-15-R-0001_Supplemental_Health_Benefits_Program.pdf

SECHQ1-15-R-0001 SUPPLEMENTAL HEALTH BENEFITS PROGRAM

United States Securities and Exchange Commission (SEC)

Office of Human Resources (OHR)

SUPPLEMENTAL HEALTH BENEFITS PROGRAM (SHBP)

Request for Proposal

SECHQ1-15-R-0001

U.S. Securities and Exchange Commission

Office of Human Resources (OHR)

Request for Proposals

SUPPLEMENTAL HEALTH BENEFITS PROGRAM (SHBP)

The U.S. Securities and Exchange Commission (SEC) has a requirement for a contractor to provide a

Supplemental Health Benefits Program (SHBP) for the Securities and Exchange Commission (SEC), consistent with the requirements of Title 26 of the Internal Revenue Code, Subtitle A, Chapter 1, Subchapter B, Part III, Section 125. The SHBP shall include 1) a dental plan and a vision plan that the

SEC will provide to all employees and their eligible dependents nationwide; and 2) a voluntary benefits package paid for entirely by the employee to include, at minimum, short-term and long-term disability insurance. Other voluntary benefits may include, for example, discounted group rates for auto insurance, homeowner’s and renter’s insurance, pre-paid legal services and identification theft insurance, and a program of employee discounts on products and services. The contractor shall be required to manage, market, and administer the SHBP in its entirety. It is the intention of the Government to award a single task order resulting from this RFP.

This Request for Proposal (RFP) is issued to all eligible contractors meeting the requirements of this RFP.

The Government requests submission of a Technical Proposal and Price Proposal in accordance with the instructions of this RFP.

(1) Contract Number: TBD

(2) Date of Solicitation: December 16 2014

(3) Statement of Work: See section C – Performance Work Statement

(4) Anticipated Contract Type: Firm-Fixed-Price

(5) Submission of Proposals:

All correspondence, questions, and proposal submissions regarding this Request for Proposal shall be directed to both of the Government’s Points of Contact (POC) identified below:

Daniel Taylor Takela Morris

Contract Specialist Contracting Officer

P: (202) 551-4041 P: (202) 551-7483 taylorda@sec.gov morrist@sec.gov

(6) Proposal Due Date:

Proposals must be submitted via email to Daniel Taylor (with a CC: to Takela Morris) no later than 12:00 EST on 15 January 2015.

mailto:taylorda@sec.gov mailto:morrist@sec.gov

TABLE OF CONTENTS

Sections &

Enclosures Content

A SOLICITATION/CONTRACT FORM

B SUPPLIES OR SERVICES AND PRICES/COSTS

C

DESCRIPTION/SPECIFICATIONS/

PERFORMANCE WORK STATEMENT

D PACKAGING AND MARKING

E INSPECTION AND ACCEPTANCE

F DELIVERIES OR PERFORMANCE

G CONTRACT ADMINISTRATION DATA

H SPECIAL CONTRACT REQUIRMENTS

I CONTRACT CLAUSES (AND PROVISIONS)

J LIST OF ATTACHMENTS

K

REPRESENTATIONS, CERTIFICATIONS, AND OTHER

STATEMENTS

L INSTRUCTIONS, CONDITIONS, AND NOTICES

M EVALUATION FACTORS FOR AWARD

SECTION A: SOLICITATION/CONTRACT FORM

STANDARD FORM 1449

PLACEHOLDER

SECTION B: SUPPLIES OR SERVICES AND PRICES/COSTS

IMPLEMENTATION PERIOD (CLIN 0001)

CLIN 0001 Implementation Period (Date of Award to 31 December 2015)

This contract includes an implementation period that will start upon contract award and end on 31

December 2015. The effective date of insurance shall commence on 1 January 2016, which begins the base period of contract performance. The implementation period shall include, but is not limited to, open season, submission of census data, finalizing data transfer procedures, and a kick-off meeting which will be held within five business days of contract award.

Implementation Fee $

BASE PERIOD (CLIN 0002-0005): 1 January 2016 to 31 December 2016

CLIN 0002 Base Period – Dental Insurance Plan

CATEGORY

MONTHLY

PREMIUM

NUMBER OF

PERSONNEL*

TOTAL PREMIUM

Self $ 1,350 $

Self and Spouse $ 600 $

Self and Children $ 370 $

Self, Spouse and Children $ 1,980 $ x 12 Months

Dental Plan Total $

CLIN 0003 Base Period – Vision Insurance Plan

CATEGORY

MONTHLY

PREMIUM

NUMBER OF

PERSONNEL*

TOTAL PREMIUM

Self $ 1,350 $

Self and Spouse $ 600 $

Self and Children $ 370 $

Self, Spouse and Children $ 1,980 $

Vision Plan Total $

CLIN 0004 Base Period – Medical Evacuation Insurance

MONTHLY PREMIUM MONTHS TOTAL PREMIUM

$ 12 $

CLIN 0005 Base Period – Administrative Services**

MONTHLY ADMINISTRATIVE

FEE

MONTHS

TOTAL ADMINISTRATIVE

FEE

Total Firm-Fixed-Price – Base Period $

*The number of persons likely to enroll in each plan is estimated. The contractor shall propose firm fixed unit prices for the dental and vision premiums, which will be invoiced monthly based on actual population and enrollment information. Population fluctuations may occur. Therefore, the contractor's proposed prices for dental and vision premiums shall remain firm throughout the term of the contract, allowing increases of no more than 20 percent from the estimated number of SEC employees (an additional 740 employees). If the SEC's population exceeds 20 percent, prices will be renegotiated.

**The contractor shall propose a firm fixed monthly price for its administrative fees, which will be invoiced for the same amount monthly. This amount shall include all costs associated with administering and managing the contract, such as the on-site customer service representative, website hosting, reasonable profit charges, and all printing costs.

This is a firm fixed price contract with one base period and four option periods. The contract line items for dental and vision insurance will be reimbursed based on the SEC's actual number of personnel enrolled in the programs.

OPTION PERIOD 1 (CLIN 0006-0009): 1 January 2017 to 31 December 2017

CLIN 0006 Option Period 1 – Dental Insurance Plan

CATEGORY

MONTHLY

PREMIUM

NUMBER OF

PERSONNEL*

TOTAL PREMIUM

Self $ 1,450 $

Self and Spouse $ 625 $

Self and Children $ 400 $

Self, Spouse and Children $ 2,000 $

CLIN 0007 Option Period 1 – Vision Insurance Plan

MONTHLY

PREMIUM

NUMBER OF

PERSONNEL*

TOTAL PREMIUM

Self $ 1,450 $

Self and Spouse $ 625 $

Self and Children $ 400 $

Self, Spouse and Children $ 2,000 $

CLIN 0008 Option Period 1 – Medical Evacuation Insurance

CLIN 0009 Option Period 1 – Administrative Services**

FEE

MONTHS

TOTAL ADMINISTRATIVE

Total Firm-Fixed-Price – Option Period 1 $ population and enrollment information. Population fluctuations may occur. Therefore, the contractor's proposed prices for dental and vision premiums shall remain firm throughout the term of the contract, allowing increases of no more than 20 percent from the estimated number of SEC administering and managing the contract, such as the on-site customer service representative, website

This is a firm fixed price contract with one base period and four option periods.

OPTION PERIOD 2 (CLIN 0018-0013): 1 January 2018 to 31 December 2018

CLIN 0010 Option Period 2 – Dental Insurance Plan

MONTHLY

PREMIUM

NUMBER OF

PERSONNEL*

TOTAL PREMIUM

Self $ 1,475 $

Self and Spouse $ 650 $

Self and Children $ 425 $

Self, Spouse and Children $ 2,050 $

CLIN 0011 Option Period 2 – Vision Insurance Plan

MONTHLY

PREMIUM

NUMBER OF

PERSONNEL*

TOTAL PREMIUM

Self $ 1,475 $

Self and Spouse $ 650 $

Self and Children $ 425 $

Self, Spouse and Children $ 2,050 $

CLIN 0012 Option Period 2 – Medical Evacuation Insurance

CLIN 0013 Option Period 2 – Administrative Services**

FEE

MONTHS

TOTAL ADMINISTRATIVE

Total Firm-Fixed-Price – Option Period 2 $ population and enrollment information. Population fluctuations may occur. Therefore, the contractor's proposed prices for dental and vision premiums shall remain firm throughout the term of the contract, allowing increases of no more than 20 percent from the estimated number of SEC administering and managing the contract, such as the on-site customer service representative, website

OPTION PERIOD 3 (CLIN 0014-0017): 1 January 2019 to 31 December 2019

CLIN 0014 Option Period 3 – Dental Insurance Plan

CATEGORY

MONTHLY

PREMIUM

NUMBER OF

PERSONNEL*

TOTAL PREMIUM

Self $ 1,550 $

Self and Spouse $ 750 $

Self and Children $ 500 $

Self, Spouse and Children $ 2,200 $

CLIN 0015 Option Period 3 – Vision Insurance Plan

MONTHLY

PREMIUM

NUMBER OF

PERSONNEL*

TOTAL PREMIUM

Self $ 1,550 $

Self and Spouse $ 750 $

Self and Children $ 500 $

Self, Spouse and Children $ 2,200 $

CLIN 0016 Option Period 3 – Medical Evacuation Insurance

CLIN 0017 Option Period 3 – Administrative Services**

MONTHLY ADMINISTRATIVE MONTHS TOTAL ADMINISTRATIVE

FEE FEE

Total Firm-Fixed-Price – Option Period 3 $ population and enrollment information. Population fluctuations may occur. Therefore, the contractor's proposed prices for dental and vision premiums shall remain firm throughout the term of the contract, allowing increases of no more than 20 percent from the estimated number of SEC administering and managing the contract, such as the on-site customer service representative, website

OPTION PERIOD 4 (CLIN 0018-0021): 1 January 2020 to 31 December 2020

CLIN 0018 Option Period 4 – Dental Insurance Plan

CATEGORY

MONTHLY

PREMIUM

NUMBER OF

PERSONNEL*

TOTAL PREMIUM

Self $ 1,650 $

Self and Spouse $ 850 $

Self and Children $ 550 $

Self, Spouse and Children $ 2,300 $

CLIN 0019 Option Period 4 – Vision Insurance Plan

MONTHLY

PREMIUM

NUMBER OF

PERSONNEL*

TOTAL PREMIUM

Self $ 1,650 $

Self and Spouse $ 850 $

Self and Children $ 550 $

Self, Spouse and Children $ 2,300 $

CLIN 0020 Option Period 4 – Medical Evacuation Insurance

CLIN 0021 Option Period 4 – Administrative Services**

FEE

MONTHS

TOTAL ADMINISTRATIVE

Total Firm-Fixed-Price – Option Period 4 $ population and enrollment information. Population fluctuations may occur. Therefore, the contractor's proposed prices for dental and vision premiums shall remain firm throughout the term of the contract, allowing increases of no more than 20 percent from the estimated number of SEC administering and managing the contract, such as the on-site customer service representative, website

SECTION C: DESCRIPTION/SPECIFICATIONS/PERFORMANCE WORK STATEMENT

C.1 Background

OHR currently services approximately 4,300 SEC employees nationwide. A list of SEC locations is available on the SEC public website: www.sec.gov.

The SEC provides and shall continue to provide health care benefits to eligible employees, spouses, and eligible dependents through the Office of Personnel Management’s (OPM) Federal Employees Health

Benefits (FEHB) program. Information about this program is available at www.opm.gov.

The SEC shall provide dental and vision care for all eligible SEC employees and their eligible dependents up to age 26. The Contractor will receive a biweekly electronic file from the SEC that contains updated employee information. The SEC will provide the Contractor with an email identifying new employees and other pertinent information to ensure new employees receive an enrollment letter regarding their supplemental health benefits.

The Contractor’s SHBP program enables SEC employees to select various supplemental benefits, some provided by the SEC and some paid for by the employee using a collection of manual and automated processes supported by three externally hosted web-based applications. The Contractor’s application coordinates the collection of premiums and payments to carriers. Employees will pay for any voluntary benefits through the Contractor’s systems or by payroll deduction.

SEC employees elect benefits from multiple providers through one website. The website provides web portals to access the Government-provided benefit options and links to applications for employee-paid supplemental benefit options. Employees visit two other websites individually to elect benefits offered by those providers.

The three externally hosted web-based applications provide the Contractor with information on the benefits that employees select. The Contractor’s system will take information from each insurance provider and provide an output report to the SEC OHR through a secured data pipe to support the SEC’s paying of benefits chosen by employees. OHR will use the report to setup payroll deductions (allotments) for the benefits paid for by employees. The only interface between the Contractor’s system and OHR’s system occurs when OHR receives a contractor’s system output report.

Three data pipes are used in the SHBP system. First is the existing data pipe between SEC and the

Department of the Interior (DOI), which provides employee census data to the SEC. Secondly, is a data pipe between the SEC and the Contractor to allow the Contractor to send a system output report to SEC as described above. The third data pipe between the SEC and the Contractor allows the SEC to pass DOI census data to the Contractor in a weekly feed.

Each carrier’s system contains employee personally identifiable information (PII). Employees will interact with each carrier’s portal. Therefore, all portals are subject to certification and accreditation

(C&A) testing for security purposes, the SEC Quality Control Test Center (QCTC) testing for accessibility purposes, and user acceptance testing (UAT) for functionality purposes.

C.2 Scope

The U.S. Securities and Exchange Commission’s (SEC) Office of Human Resources (OHR) oversees the provision of benefits to SEC employees. The Contractor shall provide SEC employees with a

Supplemental Health Benefits Package (SHBP) consistent with the requirements of Title 26 of the

Internal Revenue Code, Subtitle A, Chapter 1, Subchapter B, Part III, Section 125.

The SHBP shall at a minimum be comprised of the following items:

C.2.1 Dental Plan

The Contractor shall provide a comprehensive dental plan (e.g., at a minimum, as a standard plan:

Preferred Provider Organization (PPO) – 100% preventative, 80% basic; 60% major including dental implants; 60% orthodontia with $2,500 lifetime maximum; and $3,000 annual maximum dental limitation per employee) that SEC provides to eligible employees and their eligible dependents (spouse, domestic partner, minor child or adult child) at no cost unless it is upgraded to a Dental Buy Up plan.

The Contractor shall provide dental care from A rated insurance companies or better under either (1) an indemnity plan (i.e., premiums are paid to an insurance company which in turn pays the servicing medical professionals for the treatments they provide) or (2) a managed care plan (i.e., requires patients to select from a pool of providers). The managed care plan may be either a Preferred Provider Organization (PPO or Health Maintenance Organization (HMO).

Dental Plan Conditions and Limitations:

a. The plan shall provide coverage for dependents (spouse, domestic partner, minor or adult child) that is the same as the employee’s coverage. The annual per person reimbursement ceiling shall at a minimum be $3,000.

b. All services under the plan shall be under the direction or prescription of a qualified physician.

c. The plan shall cover all routine dental care and preventative tests, unless specifically excluded in the contract.

d. The plan shall provide full and immediate benefits for preexisting conditions.

e. The plan shall include coverage for adult orthodontia.

f. The Contractor shall ensure that all fees and charges are reasonable, customary, and necessary.

Dental Plan Exclusions:

a. Prescriptions for products available without a prescription;

b. Cosmetic surgery unless resulting from accident, illness, injury, or birth defect;

c. Fees for persons who are not licensed physicians or nurses; or services or supplies which have not been prescribed or approved by a licensed physician or nurse;

d. Reimbursement for expenses related to an illness or injury that is a result of an unlawful action by the patient, excess or illegal use of alcohol or drugs, or a self- inflicted wound;

e. Reimbursement for expenses incurred after an employee leaves the SEC; or

f. Incidents that are covered by the Federal Employees Compensation Act.

C.2.1.1 Dental Buy-Up Plan

The Contractor shall provide a buy-up plan that offers a more robust dental plan outside of the agency’s core plan (See page 13), at an additional cost for eligible SEC employees.

C.2.2 Vision Plan

The Contractor shall provide a comprehensive vision core plan (e.g., at a minimum a standard plan which includes at a minimum 40% for contact lenses every 12 months; 2nd pair of glasses subsidized up to

$3,000 per year; exam with dilation with copays limited to $10 in network and $35 out-of-network; 45% off retail price of frames, up to $130 retail value with 20% off balance above $130; standard plastic lenses with copays limited to $35 for single vision and $90 for trifocal; lens coatings and options with copays limited to $12 for UV coating and $45 for progressive lenses) that SEC provides at no cost to eligible employees and their eligible dependents (spouse, domestic partner, minor child or adult child).

The Contractor shall provide vision care from “A” rated insurance companies or better under either (1) an indemnity plan or (2) a managed care plan. The managed care plan may be either a Preferred Provider

Organization (PPO or Health Maintenance Organization (HMO).

Vision Plan Conditions and Limitations:

a. The plan shall provide coverage for dependents (spouse, domestic partner, minor or adult child) that is the same as the employee’s coverage. The annual per person reimbursement ceiling shall be unlimited.

b. All services under the plan shall be under the direction or prescription of a qualified physician.

c. The plan shall cover all routine vision care and preventive tests, unless specifically excluded in the contract.

d. The plan shall provide full and immediate benefits for preexisting conditions.

e. The contractor shall ensure that all fees and charges are reasonable, customary, and necessary.

f. Contact lens coverage is a mandatory requirement.

Vision Plan Exclusions:

a. Prescriptions for products that are available without a prescription;

b. Cosmetic surgery unless resulting from an accident, illness, injury, or birth defect;

c. Fees for persons who are not licensed physicians or nurses; or services or supplies that have not been prescribed or approved by a licensed physician or nurse;

d. Reimbursement for expenses related to an illness or injury that is a result of an unlawful action by the patient, due to excessive or illegal use of alcohol or drugs, or a self- inflicted wound;

e. Reimbursement of expenses incurred after an employee leaves the SEC; or

f. Incidents that are covered by the Federal Employees Compensation Act.

C.2.2.1. Vision Buy-up Plan

The Contractor shall provide a buy-up plan that offers comprehensive vision benefits outside of the agency’s core plan (See page 14), at an additional cost for eligible SEC employees.

C.2.3 Medical Evacuation Insurance for International Trips

The Contractor shall provide Medical Evacuation Insurance to all SEC employees who travel overseas on official SEC and/or approved business by the SEC.

C.2.4 Voluntary Benefits Package

The Contractor shall provide a package of voluntary benefits from A rated companies or better at discounted group rates that includes at a minimum, short-term disability (STD) and long-term disability

(LTD) insurances, term life insurance, and critical care insurance for eligible SEC employees. The voluntary benefits program shall provide the variety and quality of benefits that promotes the maximum level of employee participation. The Contractor shall provide voluntary benefits from reputable companies that offer standard commercial pricing that is readily available through published price lists, websites, etc. All proposed discounted group rates on voluntary benefits will be incorporated into the contract. These benefits will be paid for entirely by the SEC employee.

The short-term and long-term disability plans shall have the following features, at a minimum:

a. After a benefit waiting period of seven (7) calendar days for STD and 90 calendar days for LTD, STD shall cover up to 13 weeks and LTD shall cover up to 2 years or Federal disability retirement, whichever comes first;

b. STD shall cover at a minimum, 60 percent of employee’s insured weekly pre-disability earnings reduced by deductible income. The maximum STD weekly benefit shall be $ 3,067.

c. LTD shall cover at a minimum 60 percent of employee’s insured monthly pre-disability earnings reduced by deductible income. The maximum LTD monthly benefit shall be $10,000.

C.2.5 Program Administration

The Contractor shall manage, market, and administer the SHBP. At the Agency’s discretion, the

Contractor may provide an on-site SHBP customer service representative who is knowledgeable on all of the content in the insurances and who will serve on a part-time or full-time basis to provide expert assistance to SEC eligible employees. The Contractor shall provide a toll free 24/7 customer service telephone number where SEC employees and their eligible dependents nationwide can obtain answers and have their problems/issues resolved. The Contractor shall provide a commercial off-the-shelf (COTS) or

Government off-the-shelf (GOTS) web-enabled (i.e., entries are made on a web browser and computations are reported through a web browser) application that provides employees with direct online access to their personal SHBP accounts to view personal benefits information, complete automated forms, and submit benefit transactions electronically.

The Contractor’s web application shall use an extranet delivery system that eliminates the need for the

SEC to create, staff, and maintain its own information technology (IT) infrastructure. All operations pertaining to the web application shall be performed “server side” without the use of “cookies,” downloads of code, or client-side software.

For verification purposes, the Contracting Office Representative (COR) shall receive all notices, brochures specific to SEC and any written documentation to be placed on SEC’s website prior to it being sent to employees. These notices will be reviewed and approved by the COR prior to distribution to SEC employees.

C.3 Business Requirements

C.3.1 Compliance

C.3.1.1 Section 508 Accessibility. The Contractor’s products and services shall comply with all applicable provisions of the standards issued by the Architectural and Transportation Barriers Compliance

Board (Access Board) to ensure the accessible use of Federal electronic and information technology.

C.3.1.2 HIPAA. The Contractor’s products and services shall comply with the Department of Health and

Human Services (HHS) Health Insurance Portability and Accountability Act (HIPAA) requirements. The

Contractor shall provide SEC employees with HIPAA certificates of coverage and SEC-specific HIPAA notices of privacy practices.

C.3.1.3 Affordable Care Act. The Contractor’s products and services shall comply with the Affordable

Care Act, to include dependent eligibility to age 26.

C.3.2 Security

C.3.2.1 The Contractor’s work, site, personnel, and service shall adhere to the security requirements defined in the documents referenced in the section titled, “Federal Requirements and SEC Regulations.”

The Contractor shall provide SEC with the access and information necessary to assess the ability of the subscribed service as operated by the Contractor under this contract to meet these requirements. The

Contractor shall resolve security, audit-related Plan of Action and Milestones (POA&M) items within a reasonable timeframe and as agreed upon with the COR, alternate COR, or OIT representative.

C.3.2.2 The Contractor shall provide for real-time intrusion detection and active security monitoring of the service’s Internet site. The security mechanisms built into the service shall meet or exceed current best practices for electronic commerce.

C.3.2.3 The service shall protect all communications between remote SEC users and the Contractor’s systems that are conducted over the Internet or other public networks. The service shall initiate and control a secured session with a remote user’s system and shall maintain a secure interface until the session ends.

C.3.2.4 The Contractor shall establish and maintain individual user accounts to provide access to service.

C.3.2.5 The Contractor shall maintain security logs and access audits for the service’s Internet site and shall make them available to the SEC. The Contractor shall provide the SEC with access and information necessary to conduct periodic security audits on service to ensure proper safeguards are being maintained and potential security threats are minimized.

C.3.2.6 The Contractor shall ensure employees in its organization timely fill out required SEC forms accurately and completely. The contractor’s employees must pass or have a favorable security clearance determination in order to work on the contract with the SEC. If a sub-contractor is hired, the Contracting

Officer (CO) must be notified. The CO must be provided the reason for using a sub-contractor and must further approve use of the sub-contractor. The Contractor must ensure that the sub-contractor’s employee’s timely fill out required SEC forms accurately and completely. The sub-contractor’s employees must pass or have a favorable security clearance determination in order to work on the contract with the SEC.

C.3.3 Eligible Program Participants

C.3.3.1 Schedule C Appointments. Employees with Schedule C appointments shall be eligible regardless of the term of their appointments. (Schedule C Appointments defined as Employees in the excepted service who are subject to change at the discretion of a new Administration are commonly referred to as

"Schedule C" employees. Schedule C positions are excepted from the competitive service because they have policy-determining responsibilities or require the incumbent to serve in a confidential relationship to a key official. Most Schedule C positions are at the GS-15 level and below. Appointments to Schedule C positions require advance approval from the White House Office of Presidential Personnel and OPM, but appointments may be made without competition. OPM does not review the qualifications of a Schedule C appointee -- final authority on this matter rests with the appointing official.)

C.3.3.2 Re-Employed Annuitants. Re-employed Annuitants are employees who retired under

CSRS/FERS, and are now reemployed in an appointive or elective position with the Federal Government, or reemployed in an appointive or elective position with the District of Columbia (when the annuitant was first employed subject to CSRS by the District of Columbia before October 1, 1987. Employees who are under a re-employment appointment are eligible to participate in SEC’s SHBP.

C.3.3.3 Appointments Exceeding One Year. The following individuals with appointments exceeding one

(1) year shall be eligible for participation in the SHBP:

1. All full-time and part-time SEC employees:

a. The SEC defines full-time employees as employees whose scheduled work hours are 40 hours or more per week, or 80 hours biweekly, per pay period.

b. The SEC defines part-time employees as employees whose scheduled work hours are 16-32 hours per week, or 32-64 hours biweekly, per pay period.

c. For STD and LTD insurance eligibility, “part-time employees” are employees whose scheduled work hours are 40-64 bi-weekly, hours per pay period.

d. Presidential Appointees

e. Presidential Management Fellows

2. The following individuals are eligible to participate in the SEC’s SHBP:

a. The legal spouse and dependents of eligible employee;

b. The same sex spouse or domestic partner and dependents of eligible employees as defined by the SEC’s Equal Employment Opportunity definition of same sex spouse and domestic partner.

c. Eligible employees’ children, legally adopted children, children under their legal guardianship, and stepchildren.

Minor children are eligible to participate in SHBP until the end of the calendar year in which they reach the age of 26 years old, in accordance with the Affordable Care Act when the employee remains eligible and is employed by the SEC;

Adult children are eligible to participate in SHBP until the end of the calendar year in which they turn 26 years old, when the employee remains eligible and is employed by the

SEC.

Age limits do not apply to a child who is disabled by a mental or physical handicap to the extent the child is unable to earn a living and is economically dependent on the eligible employee. Such children shall be eligible for coverage beyond 26 years of age, for as long as the incapacity lasts when the employee remains eligible and is employed by the

SEC. The Contractor shall collect and retain evidence of the child’s incapacity from the eligible employee.

C.3.3.4 Appointments for One Year or Less. SEC employees on temporary appointments, seasonal schedules who will be working on a schedule of less than six months per year, and intermittent employees who are expected to work 130 hours per month or more for at least 90 days will be eligible to enroll in an

FEHB plan. These newly eligible employees will receive the same government contribution as full-time permanent employees. Those temporary employees working for 12 consecutive months who are already eligible to enroll in the FEHB Program and who are expected to work for 130 hours per month for at least

90 days will now be eligible to receive a full employer contribution toward the FEHB premium.

C.3.4 SHBP Required Benefits

The SHBP program shall include a comprehensive dental plan, a vision plan, and a package of voluntary benefits that includes a dental buy-up plan, a vision buy-up plan, short-term and long-term disability insurance, term life insurance, and critical care insurances at a minimum. The dental and vision plans shall provide, at a minimum, the requirements indicated in the above section, C.2 Scope.

C.3.5 SHBP Management and Administration

C.3.5.1 SHBP Single Point of Contact. The contractor shall provide all education, planning, estimating, programming, project management, supervision, and inspection of work. The Contractor shall provide a single point of contact for every aspect of the SHBP.

C.3.5.2 SHBP Client Support

C.3.5.2.1 SHBP On-Site Customer Service Representative. Depending on the demand of the work, the

Contractor shall provide a qualified part-time (PTE) or full-time equivalent (FTE) on-site SHBP customer service representative at the SEC’s Washington, DC location.

At a minimum, the Customer Service Representative shall provide the following services:

a. Verify eligibility for benefits, research information not provided in SEC files, and certify spousal, domestic partner, and dependent eligibility; answer employee questions about eligibility;

b. Assist SEC employees with enrollment in and coordination of benefits;

c. Assist insured employees with employee claims administration, research claim disallowance, and resolve errors;

d. Field customer service calls;

e. Distribute information about benefit availability;

f. Perform activities and tasks as required to support the administration of the SHBP program, including, but not limited to process documentation and SHBP-related special activities. These

SHBP-related special activities shall be mutually agreed upon between Contractor and SEC;

g. Conduct orientation of new employees; and

h. Prepare draft notices, marketing materials and other written documentation regarding the SHBP requirements, offerings, open season, carriers, rates, etc.

C.3.5.2.2 SHBP Communication / Marketing / Education. The Contractor shall educate SEC employees about available benefits and opportunities to enroll, and inform them of benefit changes. At the request of

SEC, the Contractor may be asked to travel to regional offices as well as Headquarters to educate employees about the SHBP program.

The Contractor shall host visual pictures, videoconferences, webinars, tutorials that can be used to market the benefits under the program. Visual pictures, videoconferences, etc., should include SEC employees and/or have SEC input.

C.3.5.2.3 SHBP Client Advocacy / Support. The Contractor shall act as a mediator and escalate any problems that may arise between benefit carriers and the SEC or between benefit carriers and the SEC employees.

C.3.5.3 SHBP Benefits Statement

The Contractor shall provide each insured SEC employee with a periodic statement (both paper and electronic form) that captures the employee’s SHBP dental and vision enrollment, voluntary benefit elections, and a description of the coverage. The statement shall specify benefit usage and the cost incurred by the employee and insurance plans for the reporting period in accordance with industry standards. Additionally, at the end of each calendar year, the contractor shall provide each insured SEC employee with an annual benefits statement that captures all activity and costs associated with the employee and dependents’ dental and vision appointments.

C.3.5.4 SHBP COBRA Administration

The Contractor shall administer COBRA coverage for all SHBP-related benefits for departing SEC employees. At a minimum, the Contractor shall provide COBRA initial rights notification, coverage election, change, and termination processing, coverage period tracking, including multiple qualifying events, coverage continuation and conversion notices, and billing and payment processing.

C.3.5.5 Management Plan

The Contractor shall provide the COR with a management plan that includes at a minimum:

a. A marketing/education/communication plan;

b. An implementation plan;

c. An administration plan; and

d. A quality assurance plan.

The plan must meet the COR and alternate COR’s expectations. At minimum, the management plan shall include:

a. The lines of responsibility, authority, and communication by which the program will be managed.

The plan shall include an organization chart that depicts key management and supervisory positions and shows how the positions relate to and will impact the day-to-day performance of services under the contract. The plan shall include an organizational chart that identifies the title of each position and is accompanied by a description of the functions, responsibilities, qualifications, and authority of each position on the chart;

b. The system of management controls covering the performance of the contractor’s employees and the subcontractor’s personnel employed under this contract;

c. Plans for communicating with the SEC and its employees including an Administrative

Communications Plan that documents the contractor and subcontractor’s provider communication, and associated schedules for direct communication to SEC employees regarding enrollment, claims, coverage adjustments, and other administrative communication;

d. Plans for marketing SHBP products and services to SEC employees;

e. Plans for ensuring SEC employees know how to use available tools to communicate with SHBP administrators and to complete transactions related to SHBP products;

f. Plans for data management and to ensure the SEC has access to all SHBP data;

g. Identification of the contractor’s assumptions, limitations and special conditions for process exceptions within the contractor’s systems; and

h. Written procedures the contractor will use to ensure quality and cost control. The Quality

Assurance Plan (QAP) shall specify how the contractor plans to manage and ensure sufficient quality control in meeting the terms of the contract.

The QAP shall include the following, at a minimum:

a. A plan for conducting quality control inspections;

b. A plan for ensuring the timeliness and accuracy of personnel data;

c. A sample of internal written inspection report formats or reports;

d. A description of internal distribution procedures for such reports;

e. Time frames/response times for correcting identified deficiencies;

f. A description of the follow-up procedures to be employed to ensure identified deficiencies are corrected; and

g. A copy of any written quality control procedures. If no written quality control procedures exist, the Contractor shall include a statement to that effect.

The Contractor shall incorporate feedback from the COR or alternate COR and submit a revised plan to the COR for review and approval. The approved management plan shall be incorporated into this contract as a modification.

C.3.5.6 SHBP Reporting

C.3.5.6.1 Reporting Plan. The Contractor shall provide the COR with a Reporting Plan that documents the system reports and reporting options available from the Contractor and the subcontractors/providers.

The plan shall identify the standard reports, their purpose and schedule, and any ad hoc reporting capabilities available under the contract. The plan shall also identify any additional custom reporting capabilities available including the customization and pricing criteria for such reports. The Contractor shall incorporate feedback from the COR and shall provide the COR with a final plan for review and approval. The Contractor shall implement the approved plan.

C.3.5.6.2 Required Reports. Required reports are in the List of Deliverables.

C.3.5.6.3 SHBP Enrollment Process. The Contractor shall work with the SEC to establish an overall enrollment strategy that includes the following at a minimum:

C.3.5.7 Initial Enrollment

C.3.5.7.1 All eligible SEC employees shall be automatically enrolled in the dental and vision plans on plan inception. Eligible employees shall have at least 60 days thereafter to enroll their eligible dependents in the plans. During this period, eligible employees shall have the opportunity to decline coverage.

C.3.5.7.2 The minimum initial period of enrollment for any employee or dependent in the dental and vision plans shall be one year, except for separation from the SEC including resignation, retirement, dismissal, or death. Enrollment for less than one year shall be accepted by the contractor under the following circumstances: newly hired employees, change in marital status, birth, adoption, or assumption of guardianship of a child. These employees shall be given the opportunity to participate in the SHBP program within 60 calendar days of the qualifying life event.

C.3.5.7.3 Initial enrollment in voluntary insurance programs shall be controlled by the Contractor and/or carrier. Non-insurance voluntary benefits shall be available to all employees at all times unless there is an additional liability associated with utilization.

C.3.5.7.4 Open Season Enrollment Changes. The SHBP program shall include an annual open enrollment period during which current employees may enroll in the program, select from the various SHBP insurance options, or change services. The open enrollment period shall match and parallel the open enrollment period established by the OPM FEHB program. Any new program changes to SHBP benefits shall be made available to SEC employees on January 1 of each year. The Contractor shall gather, record, and transfer all current SHBP enrollment data into their systems/server during the open enrollment period.

The SHBP shall include an annual “open season” period during which employees may enroll in the program or change services. SEC employees shall be able to access new and changed benefits beginning the first full pay period in January of each year. In addition, the program shall enroll newly hired employees throughout the year.

C.3.6 Claim Handling

C.3.6.1 SHBP Dental and Vision Claim Handling Process. The SEC does not control or monitor the claims processing for voluntary benefits under the SHBP. The Contractor shall establish procedures for handling insurance claims as follows:

C.3.6.1.1 Employee Claim File Maintenance. The Contractor shall maintain dental and vision insurance files for each eligible employee that include, at a minimum, receipts and proof of paid claims, requests for claim reimbursements, and an accounting of paid benefits.

C.3.6.1.2 Claim Forms. The Contractor shall provide the insured with the necessary claim forms for each type of benefit that can be claimed under the contract. These forms shall specify a list of documents that must be appended to each claim and otherwise provide instructions for claim filing.

C.3.6.1.3 Claim Submission and Settlement. The Contractor shall provide SEC employees with the ability to submit all claims directly to the Contractor either in paper form through the mail or electronically through the web-enabled application. The Contractor shall date stamp and screen all claims submitted on the date of receipt. If there are any missing documents or information that causes the claim to be disallowed and not payable, the Contractor shall notify the SEC employee in writing (electronic media is acceptable). The Contractor shall settle all properly submitted claims within two weeks after receiving the claim.

C.3.6.1.4 Claim Reports. The Contractor shall provide the individual claimant with a report that includes the name of the claimant, the date the claim was received, a brief description of the claim, the amount claimed, and the amount approved for reimbursement.

C.3.7 Implementation Schedule

C.3.7.1 Initial Implementation Schedule. During the implementation period, the Contractor shall perform services that include, but are not limited to, open season, submission of census data, finalizing file layout(s) and data transfer procedures, and a kick-off meeting that will be held within one week of the contract award. The Contractor shall prepare an implementation schedule that describes in detail the start and finish times of each task, and the milestones, dependencies, risks, and resources required to support the implementation project. The Contractor shall submit a draft project implementation schedule for evaluation. After the contract award, the Contractor shall incorporate feedback from the COR and deliver a final implementation schedule to the COR for review and approval. The approved final schedule shall be incorporated into the contract as a modification.

C.3.7.2 Pre-deployment Implementation Schedule Review. The contractor shall work with the COR to review and update the contractor’s implementation schedule to accommodate changes required by the

SEC. The contractor shall provide the COR with the new or updated document for review; the contractor shall also incorporate feedback from the COR and shall provide the COR with a final document for review and approval. The final updated implementation plan shall be incorporated into the contract as a modification. The contractor shall implement the approved implementation schedule.

C.3.7.3 Certification of Eligibility. The contractor shall extract benefit eligibility information for SEC employees and dependents from the personnel data supplied by the SEC. The contractor shall certify the benefit eligibility of dependents when this information is not available from the personnel data. The contractor shall certify the benefit eligibility of domestic partners from information provided by the relevant employee.

C.3.7.4 Pre-deployment Implementation Schedule Review. The Contractor shall work with the COR to review and update the Contractor’s implementation schedule to accommodate changes required by the

SEC. The Contractor shall provide the COR with the new or updated document for review; the Contractor shall incorporate feedback from the COR and shall provide the COR with a final document for review and approval. The final updated implementation plan shall be incorporated into the contract as a modification.

The Contractor shall implement the approved implementation schedule.

C.3.7.5 Non-Pay Status. The Contractor shall establish an alternative method to collect premiums from employees to pay for employee-paid benefits in the event they are in a non-pay status for two or more consecutive pay-periods. The alternative method shall not incorporate direct-draft from an employee’s bank account. The process for the alternative pay method shall be described in the Management Plan.

Technical details, such as business rules and file format specifications shall be described in the “Data, Billing and Allotment Specification.”

C.3.8 System Requirements.

C.3.8.1 Service Quality and Accessibility. The Contractor’s web-enabled service shall accommodate concurrent access without degrading the quality or accessibility of the service. The service shall have sufficient capacity to meet all functional and performance requirements specified in this performance work statement. The service shall provide SEC personnel with an intuitive click and key-stroke user interface using standard Internet browsers. The service shall support the current version level of the browsers. The system shall provide immediate online acceptance or rejection of user responses.

C.3.8.2 Data Definition and Transmittal

C.3.8.2.1 The Contractor shall work with SEC’s IT representatives to identify, define, and document the

Contractor’s data specifications for SEC-provided data, as well as the data interfaces, file formats, and schedule requirements for data transfer between the SEC and the Contractor’s system(s). The Contractor shall work with the SEC to establish data formats, processes, and procedures that will ensure the efficiency of system set-up and data integrity, and will support ongoing system administration.

C.3.8.2.2 The Contractor shall consolidate and organize artifacts documenting the detailed results of data definition and transmittal specification agreements to the “Data, Billing and Allotment Specification.”

The Contractor shall deliver the “Data, Billing and Allotment Specification” to the COR for review. The

Contractor shall incorporate feedback from the COR and deliver a revised Data, Billing and Allotment

Specification to the COR for review and approval.

C.3.8.2.3 Personnel Information Data Integration. The Contractor shall incorporate initial personnel information from the SEC into its files before the SHBP goes live for SEC employees. The Contractor shall receive and incorporate an encrypted feed of updated personnel information provided by the SEC on a bi-weekly basis into its files within 5 days after receiving the updated file. The Contractor shall maintain the currency, accuracy, and consistency of the data in its system so that claims are not wrongfully denied.

The Contractor shall maintain benefit transaction information current for all participating SEC employees and their dependents. SEC employees shall have access to updated benefit transaction information in their personal accounts within 2 weeks after the transaction occurs.

C.3.8.2.4 Performance Standard. The Contractor shall maintain an error rate of less than 1% in processing: (1) personnel data into its system(s) from the SEC feed (census data); 2) the content of payroll deduction data transferred to the SEC from the Contractor’s system(s); and 3) billing and allotment data transmitted from the SEC to the Contractor.

C.3.8.2.5 Standard Automated Forms. The service shall provide standard forms and connections that allow employees to perform benefit transactions electronically. SEC users shall be able to complete, save, submit, and print the forms online.

C.3.8.2.6 Electronic Transactions. The Contractor’s system shall (1) process open and non-open season transactions from employee input; 2) produce a summary view of pending transactions for employees; 3) cancel a transaction based on employee input; and (4) provide confirmation of completed / successful transactions. The service shall allow for an electronic confirmation / approval.

C.3.8.2.7 HELP System. The Contractor’s service shall provide a HELP system from every screen and form at the field or topic level, as well as online links to additional resources or detailed data descriptions.

The HELP system shall include (1) explanations of all the tools and functions of the service; (2) definitions and explanations of terminology; and (3) SEC-specific help information that the COR or alternate COR may provide from time to time for inclusion in the system.

C.3.9 Website Hosting

C.3.9.1 The Contractor shall host, install, and configure its service’s website.

C.3.9.2 Training. The Contractor shall provide a series of group training sessions that explain at a minimum how to use the web application, how to add dependents, and how to file claims and monitor claim processing. The Contractor shall provide a user guide to all SEC employees that highlight procedures for using the service.

C.3.9.3 Data Handling Requirements

C.3.9.3.1 Database Administration. The Contractor shall provide ongoing database administration. The service shall maintain an optimized database, ensuring that there is no contention between processes that could materially impact user interfaces and the processing of data. The Contractor shall administer changes to the content database and table structure.

C.3.9.4 Application Updates

C.3.9.4.1 The Contractor shall manage and maintain the applications supporting the service to which the

SEC subscribes. The Contractor shall provide updates to the service to incorporate changes to laws, rules, and regulations. The Contractor shall update the online HELP system to keep it current with the production system.

C.3.9.4.2 The Contractor shall provide application maintenance notices to the COR or alternate COR within 10 days after a change occurs. The Contractor shall notify the COR or alternate COR in advance of changes anticipated to have user-visible impact.

C.3.9.5 Archiving

C.3.9.5.1 The Contractor shall periodically archive all SEC data associated with the service components including (1) all benefit transaction documents; (2) a list of all benefit transactions and cancellations; and

(3) all documents necessary to audit and reconstruct benefit actions. The Contractor shall store the data in

Extensible Markup Language (XML)-formatted images on compact disk (CD).

C.3.9.6 Backup and Recovery

C.3.9.6.1 The Contractor shall provide an integrated backup strategy for its system that includes (1) daily incremental backups; and (2) weekly, monthly, and yearly full system backups. The Contractor shall retain weekly system backup media for 10 weeks; monthly system backup media for 12 months; and yearly system backup media for 3 years. The Contractor shall store system backup media off-site in an environmentally controlled, secure location approximately 30 miles from the Contractor’s production site.

C.3.9.6.2 The Contractor shall provide the COR or alternate COR with recovery processes and procedures including (1) database recovery and file recovery from…