T3093 SHBP RFP 6-8-18~1.docx

Bid Solicitation

Vendor’s {Bidder’s} Electronic Question Due Date (Refer to Bid Solicitation Section 1.3.1 for more information.)

Mandatory Pre-Quote Submission Conference (Refer to Bid Solicitation Section 1.3.5 for more information.)

Mandatory/Optional Site Visit (Refer to Bid Solicitation Section 1.3.4 for more information.)

Not applicable

Quote Submission Date (Refer to Bid Solicitation Section 1.3.2 for more information.)

Dates are subject to change. All times contained in the Bid Solicitation refer to Eastern Time. All changes will be reflected in Bid Amendments to the Bid Solicitation posted on the Division of Purchase and Property website and on www.njstart.gov.

Small Business Set-Aside Status ☐ Not Applicable

☐ Entire Blanket P.O.

☐ Partial Blanket P.O.

☒ Subcontracting Only Category

☒ I ☐ IV

☒ II ☐ V

☒ III ☐ VI

Bid Solicitation Issued By Using Agency/Agencies

Date: 6/8/18

Table of Contents

INFORMATION FOR VENDORS {BIDDERS}

NOTICE: This Bid Solicitation is part of the NJSTART Procurement Program. The Vendor {Bidder} is advised to thoroughly read all sections, as many have been revised, and follow all instructions contained in this Bid Solicitation, including the instructions on the Bid Solicitation’s Offer and Acceptance Page and read through all Quick Reference Guides (QRGs) located on the NJSTART Vendor Support Page (http://www.state.nj.us/treasury/purchase/njstart/vendor.shtml), before preparing and submitting its Quote.

NJSTART terminology is used throughout this document. See Bid Solicitation Section 2.1 for a crosswalk of NJSTART terminology to legacy terminology.

PURPOSE AND INTENT

This Bid Solicitation is issued by the Procurement Bureau, Division of Purchase and Property (Division), Department of the Treasury on behalf of State Health Benefits Commission and the School Employees’ Health Benefits Commission (Commissions). The purpose of this Bid Solicitation is to solicit Quotes from qualified Vendors {Bidders} to provide fully insured Medicare Advantage Preferred Provider Organization (PPO) Plan and Medicare Advantage Health Maintenance Organization (HMO) Plans and other services as specified in this Bid Solicitation for the State Health Benefits Program (SHBP) and the School Employees’ Health Benefits Program (SEHBP).

Each plan type must include the benefit levels as outlined in Section 1.2.1 of the Bid Solicitation.

Public Law 2011, Chapter 78 (Chapter 78), created the State Health Benefits Plan Design Committee and the School Employees’ Health Benefits Plan Design Committee (the Plan Design Committees), which are responsible for reviewing the SHBP and SEHBP plan designs, respectively, and developing any changes therein that are determined to be cost effective and in the mutual best interests of the State, participating Local Employers, Employees, Retirees, and their Dependents.

Accordingly, the Plan Design Committees may make benefit design changes during the term of this Blanket P.O. that are not contemplated by this Bid Solicitation. The State expects that such changes could include, but are not limited to, changes in deductibles, copays, out-of-pocket (OOP) maximums, innovative programs, new plan options, and similar variables. In the event of any such change, appropriate changes to the Blanket P.O. and/or guaranteed insured premium rates and financial guarantees shall be made pursuant to Section 5.14.6 of the Bid Solicitation.

This Bid Solicitation is not requesting bids on the SHBP/SEHBP Prescription Drug Plan currently administered by Optum Rx under Purchase Order No 17-PROSV-00180 {State Contract T2679}, available for review on NJSTART.

The intent of this Bid Solicitation is to award Master Blanket Purchase Orders (Blanket P.O.s) to those responsible Vendors {Bidders} whose Quotes, conforming to this Bid Solicitation are most advantageous to the State, price and other factors considered. The State may award any and all price lines. The State, however, reserves the right to separately procure individual requirements that are the subject of the Blanket P.O. during the Blanket P.O. term, when deemed by the Director of the Division of Purchase and Property (Director) to be in the State’s best interest.

The State expects the Blanket P.O.s resulting from this Bid Solicitation to be:

A. Focused on the success of the SHBP/SEHBP by delivering a superior level of service and attention during the implementation process, and on an ongoing basis;

B. Cost effective by demonstrating an interest in the SHBP/SEHBP and quoting competitive premiums, practicing effective care management, and agreeing to be held accountable through performance and financial guarantees;

C. Quality-focused by demonstrating high levels of strong outcomes and Member satisfaction; and

D. Able to provide comprehensive network access to the vast majority of current Retirees enrolled in Medicare Advantage plans.

The State anticipates multiple scenarios for the Blanket P.O.

Note: The additional Education population (117,000 members) included in Scenarios 1B/1C, 2B/2C, and 3B/3C above is currently enrolled in self-insured Medicare Supplement PPO plans with Horizon BlueCross BlueShield. This Bid Solicitation does not guarantee that this group will move to Medicare Advantage plans, but requests guaranteed premium rates in the event that this population moves from Medicare Supplement to Medicare Advantage plans in 2019 or 2020. There is no guaranteed date that this group may convert to Medicare Advantage plans, and therefore the Vendor {Bidder} must provide financial quotes separately for the Scenarios noted above to allow the State maximum flexibility in Blanket P.O. award.

The State does not guarantee any actual minimum/maximum enrollment. The following population counts are close approximations:

A. Award Scenario 1 (One MA Vendor {Contractor}):

All current Medicare Advantage PPO and HMO plans are awarded to one Vendor {Contractor}:

1. Scenario 1A:

(i) All current MA PPO and HMO Members (82,000 Members) are awarded effective 1/1/2019;

2. Scenario 1B:

(i) All current MA PPO and HMO Members (82,000 Members) are awarded effective 1/1/2019; and

(ii) All Education Medicare Members currently enrolled in $10/$15 Horizon Medicare Supplement PPO plans (117,000 Members) are awarded effective 1/1/2019;

3. Scenario 1C:

(i) All current MA PPO and HMO Members (82,000 Members) are awarded effective 1/1/2019; and

(ii) All Education Medicare Members currently enrolled in $10/$15 Horizon Medicare Supplement PPO plans (117,000 Members) are awarded effective 1/1/2020;

B. Award Scenario 2 (Two MA Vendors {Contractors} – Separate PPO and HMO):

Vendor {Contractor} A is awarded current Medicare Advantage PPO plans and Vendor {Contractor} B is awarded current Medicare Advantage HMO plans:

1. Scenario 2A:

(i) Vendor {Contractor} A is awarded all current MA PPO Members (66,000 PPO Members) effective 1/1/2019; and

(ii) Vendor {Contractor} B is awarded all current HMO Members (16,000 HMO Members) effective 1/1/2019;

2. Scenario 2B:

(i) Vendor {Contractor} A is awarded all current MA PPO Members (66,000 PPO Members) effective 1/1/2019 and all Education Medicare Members currently enrolled in $10/$15 Horizon Medicare Supplement PPO plans (117,000 Members) effective 1/1/2019; and

(ii) Vendor {Contractor} B is awarded all current HMO Members (16,000 HMO Members) effective 1/1/2019;

3. Scenario 2C:

(i) Vendor {Contractor} A is awarded all current MA PPO Members (66,000 PPO Members) effective 1/1/2019 and all Education Medicare Members currently enrolled in $10/$15 Horizon Medicare Supplement PPO plans (117,000 Members) effective 1/1/2020; and

(ii) Contractor B is awarded all current HMO Members (16,000 HMO Members) effective 1/1/2019;

C. Award Scenario 3 (Two MA Vendors {Contractors}):

Vendor {Contractor} A is awarded current Horizon membership and Vendor {Contractor} B is awarded current Aetna membership as described below. Note: Retirees have the option to switch plans once per year and may choose to move between the two Vendors {Contractors}:

1. Scenario 3A:

(i) Vendor {Contractor} A is awarded all current Horizon MA PPO Members (58,000 PPO Members) effective 1/1/2019; and

(ii) Vendor {Contractor} B is awarded all current Aetna MA PPO and HMO Members (8,000 PPO Members and 16,000 HMO Members) effective 1/1/2019;

2. Scenario 3B:

(i) Vendor {Contractor} A is awarded all current Horizon MA PPO Members (58,000 PPO Members) and all Education Medicare Members currently enrolled in $10/$15 Horizon Medicare Supplement PPO plans (117,000 Members) effective 1/1/2019; and

(ii) Vendor {Contractor} B is awarded all current Aetna MA PPO and HMO Members (8,000 PPO Members and 16,000 HMO Members) effective 1/1/2019; and

3. Scenario 3C:

(i) Vendor {Contractor} A is awarded all current Horizon MA PPO Members (58,000 PPO Members) effective 1/1/2019 and awarded all Education Medicare Members currently enrolled in $10/$15 Horizon Medicare Supplement PPO plans (117,000 Members) effective 1/1/2020; and

(ii) Vendor {Contractor} B is awarded all current Aetna MA PPO and HMO Members (8,000 PPO Members and 16,000 HMO Members) effective 1/1/2019.

IMPORTANT NOTE: The current SHBP/SEHBP Self-Insured plans will be bid through a separate, standalone procurement process and are not covered by the scope of this Bid Solicitation, with the exception of the potential migration of the Education population noted in Scenarios 1B/1C, 2B/2C, and 3B/3C above.

The State of NJ Standard Terms and Conditions (SSTC) accompanying this Bid Solicitation will apply to all Blanket P.O.s made with the State of New Jersey. These terms are in addition to the terms and conditions set forth in this Bid Solicitation and should be read in conjunction with them unless the Bid Solicitation specifically indicates otherwise.

BACKGROUND

The State Health Benefits Program (SHBP) was created in 1961 by the NJ State Health Benefits Program Act, N.J.S.A. 52:14-17.25 et seq., (the Act) to provide health insurance coverage to State Employees. The State Health Benefits Commission (SHBC) is charged with establishing health benefits programs for State and qualified Local Government Employees, Retirees, and eligible dependents and promulgating regulations, as necessary, to administer the Act. The SHBC is comprised of representatives of the State Treasurer (Chairman), the Commissioner of the Department of Banking and Insurance, the Chairperson of the Civil Service Commission, a State Employees’ representative and a Local Government Employees’ representative, both chosen by the Public Employees’ Committee of the AFL-CIO. The SHBC has the authority to provide health benefits in accordance with the Act. The Division of Pensions and Benefits (DPB) administers the SHBP on behalf of the SHBC.

The School Employees’ Health Benefits Program (SEHBP) was established in 2007 by the School Employees’ Health Benefits Program Act, N.J.S.A. 52:14-17.46 et seq., to provide health coverage to qualified Local Education Employees, Retirees, and eligible dependents. The School Employees’ Health Benefits Commission (SEHBC) is comprised of representatives of the State Treasurer, the Commissioner of the Department of Banking and Insurance, a member appointed by the Governor who is a New Jersey resident, a member representing the New Jersey School Boards’ Association, three members representing the New Jersey Education Association, a member representing the New Jersey State AFL-CIO, and a member appointed to be the chairperson.

The SHBC and SEHBC may be referred to herein, collectively, as the Commissions.

The DPB, specifically the Health Benefits Bureau and the Bureau of Policy and Planning, is responsible for the daily administrative activities of the SHBP and the SEHBP.

The SHBP/SEHBP covers State Employees and Retirees, as well as Employees and Retirees of Local Government and Education Employers who have elected to purchase coverage in the SHBP/SEHBP. Presently, the SHBP/SEHBP covers approximately 825,000 lives (including active, retired and COBRA individuals and their dependents). The Medicare Advantage population is approximately 85,000 lives of the 825,000 total lives (50,000 State lives, 25,000 Local Government lives, and 9,000 Education lives). Note: The non-Medicare Advantage plans, including all self-insured Medicare Supplement Plans, with the exception of the potential migration of the Education population noted in Scenarios 1B/1C, 2B/2C, and 3B/3C above, are NOT included within the scope of this bid and will be procured through a separate bid process.

This is a reprocurement of a portion of the services provided under the SHBP and SEHBP Plans under State Health Benefits Program & School Employees Health Benefits Program Plans, presently due to expire on December 31, 2018. Vendors {Bidders} interested in the current Blanket P.O. specifications and pricing information may review the current Blanket P.O. (T2846) at www.njstart.gov by following these steps:

Go to: www.njstart.gov Select “Contract & Bid Search” Select “Contracts/Blankets” Under “Contract/Blanket Description” type in (T2846), Click “Find It” The current Blanket P.O’s will appear under “Results”.

Vendors {Bidders} are cautioned that this new Bid Solicitation addresses current requirements.

overview of CURRENT MEDICAL PLAN DESIGNS

Public Law 2007, Chapter 103, approved June 28, 2007, requires a certain benefit level for certain Retiree Members.

There are a number of self-insured PPO, HMO, HDHP, and Tiered Network medical plans administered to SHBP/SEHBP Employees, Retirees, and their dependents.

IMPORTANT NOTE: The SHBP/SEHBP self-insured plans will be bid through a separate, standalone procurement process and are not covered by the scope of this Bid Solicitation with the exception of the potential migration of the Education population noted in Scenarios 1B/1C, 2B/2C, and 3B/3C above.

The current fully-insured Medicare Advantage levels of benefits and the administrators in place for Plan Year 2018 are described below. Please note that not all Plans are available to all Retiree groups.

Fully-Insured Medicare Advantage Plans - All Medicare-eligible Members in the SHBP and SEHBP enrolled with Aetna are in Medicare Advantage Plans – either the HMO, HMO1525, PPO10, or PPO15 plan. Additionally, effective January 1, 2017, the SHBC authorized a contract amendment with Horizon, which was supported by the SHBPDC, to provide coverage for all State and Local Government Medicare-eligible Members enrolled in the Horizon PPO10 and PPO15 plans to Medicare Advantage plans; these Members were previously enrolled (for Plan Year 2016 and previous years) in Medicare Supplement plans through Horizon.

A. Preferred Provider Organizations (PPOs). There are two National Open Access Medicare Advantage PPO Plans offered by each vendor for the State and Local Government populations: PPO10, and PPO15, The Local Education population has two plan design offerings offered through Aetna only: PPO10 and PPO15. All Medicare Advantage PPO Plans are fully insured.

B. Health Maintenance Organizations (HMOs). The Commissions currently contract to offer two Medicare Advantage HMO Plans through Aetna: Aetna Legacy HMO and Aetna HMO1525. All Medicare Advantage HMO Plans are fully insured.

Prescription Drug Plans. The State requires that all Retirees participating in SHBP/SEHBP Plans have access to prescription drug coverage. Retirees receive prescription drug coverage based on the SHBP/SEHBP medical plan that they have chosen. Prescription Drug Plan Design differs by medical plan. A Pharmacy Benefits Manager (PBM) administers all SHBP/SEHBP drug coverage, and all Medicare-eligible SHBP/SEHBP members are in an Employer Group Waiver Plan (EGWP). As noted above, this Bid Solicitation is not requesting bids for this prescription drug coverage.

Copies of the current Plan Documents – Summary Program Description (SPD) and Member Handbooks for all Plans – are available at the Division of Pensions and Benefits website at http://www.nj.gov/treasury/pensions/health-benefits.shtml.

HISTORY OF MEDICARE ADVANTAGE OPTIONS IN THE SHBP/SEHBP

Since 2009, any Medicare plans offered by Aetna to State, Local Government, and Local Education (SEL) Medicare Retirees were offered to retirees as Medicare Advantage plans. The plans were offered alongside Medicare Supplement plans administered by Horizon BCBS, with nearly identical Plan Designs. Retirees have a choice between enrolling in the Aetna Medicare Advantage plan or the Horizon Medicare Supplement Plan. Historically, approximately 10-15% of total Medicare Retirees were enrolled in the Aetna Medicare Advantage Plans, with the remainder enrolling the Horizon Medicare Supplement plans.

The State does not hold a traditional annual Open Enrollment for Retirees; however, Retirees are permitted to change plans once in a 12 month period.

In 2016, the SHBC (covering all State and Local Government Retirees) voted to implement Medicare Advantage plans through Horizon, in place of the $10 and $15 PPO Medicare Supplement plans that were administered by Horizon. Therefore, effective January 1, 2017, all State and Local Government Medicare Retirees enrolling in the $10 PPO or $15 PPO plan options had the choice of Horizon Medicare Advantage or Aetna Medicare Advantage. After this change, only 2,000 State and Local Government Medicare Members combined remain in Medicare Supplement plans. The Medicare retiree is permitted to switch annually into any SHBP plan design option, including the Medicare Advantage PPO or HMO plans.

The SEHBC (covering Education Retirees) did not choose to implement the Horizon Medicare Advantage Plans for 2017; however, as described in Scenarios 1B/1C, 2B/2C, and 3B/3C noted above, it is possible that this change may occur in the future for Education Medicare members. The Medicare Advantage plans in place for that group at the current time are the Aetna Medicare Advantage plans and the Horizon Medicare Supplement plans for all plan options. There are approximately 8,000 Education Medicare Members enrolled in the Aetna Medicare Advantage plans, and approximately 117,000 Education Medicare Members still enrolled in Medicare Supplement PPO or HMO plans through Horizon. Most current Retirees do not pay for the cost of their health benefits therefore, there is no financial incentive for the SEHBP Medicare Members to switch into the more cost-effective Medicare Advantage options. The successful Vendor(s) {Contractor(s)} will be permitted to send communication materials to these Medicare Supplement members regarding the benefits of enrolling in a Medicare Advantage plan provided all communications are pre-approved by the State.

Most current Medicare-eligible retirees are grandfathered from the contribution requirements enacted under P.L. 2011, Chapter 78 and do not contribute toward the cost of their health benefits. This is a significant factor in the static movement between the various plan options each year. The historical trends indicate that Members remain in the same plan option in which they were enrolled as an Active employee in the SHBP or SEHBP. However, following the enactment of Chapter 78, future retirees are required to pay a portion of the cost for their health benefits. It is anticipated that these retirees will seek the most cost effective plan option when enrolling in their Medicare retiree benefits.

Chapter 78 required that Employees and Retirees of the SHBP and SEHBP contribute toward the cost of their health benefits through a salary/retirement allowance-based contribution structure. Retiree rates and contribution scales can be found here: http://www.state.nj.us/treasury/pensions/hb-retired.shtml.

Retiree wellness program

Pursuant to Public Law 2007, Chapter 103, the State offers a wellness program as an option to a small number of State Retirees. Since April 2008, State Retirees who retired after July 1, 2007 with 25 or more years of service and who had been required to contribute 1.5% toward their Retiree health care coverage have been eligible for participation in the Retiree Wellness Program (RWP) to reduce this contribution. Eligible Retirees who participate in the RWP have their entire health premium contribution waived.

The Retiree Wellness Program (RWP) began operation as of July 1, 2008, and provides for early detection and intervention to address health risks, encourages the development of healthy lifestyles designed to promote wellness and prevent disease, provides reminders of critical tests and screenings necessary to monitor retiree health, and provides guidance to those now struggling with chronic disease.

Currently, there are 1,900 State Medicare Advantage Retirees eligible for this program. There are also approximately 5,000 current Actives and Retirees that are eligible to participate in the program as well; however, outside of those Members, the group is closed and will not add any additional eligible Members in the future.

In addition to submitting a pledge to renew their RWP eligibility annually, participating Retirees are required, each year, to complete a Health Assessment Test (HAT), have an annual medical check-up and submit the annual Physician Certification, obtain age and gender appropriate tests and screenings, and participate in disease management programs administered by the SHBP/SEHBP medical vendors.

The selected Medicare Advantage Vendor(s) {Contractor(s)} will administer the RWP and to provide innovative and strategic planning and support to help enhance the RWP.

Note: All anticipated charges associated with the administration of the Retiree Wellness Program must be factored into insured premium rates and cannot be billed separately.

KEY EVENTS

ELECTRONIC QUESTION AND ANSWER PERIOD

The Division will electronically accept questions and inquiries from all potential Vendors {Bidders} via the “Q&A” Tab of the Bid Solicitation in NJSTART.

A. Questions should be directly tied to the Bid Solicitation and asked in consecutive order, from beginning to end, following the organization of the Bid Solicitation; and

B. Each question should begin by referencing the Bid Solicitation page number and section number to which it relates.

Vendors {Bidders} may refer to the QRG “Submit a Quote” for additional instruction. QRGs are located on the NJSTART Vendor Support Page.

A Vendor {Bidder} shall not contact the Using Agency and/or the Procurement Specialist directly, in person, by telephone or by e-mail, concerning this Bid Solicitation, prior to the final award of the Blanket P.O.

The cut-off date for electronic questions and inquiries relating to this Bid Solicitation is indicated on the Bid Solicitation cover sheet. In the event that questions are posed by Vendors {Bidders}, answers to such questions will be issued by Bid Amendment. Any Bid Amendment to this Bid Solicitation will become part of this Bid Solicitation and part of any Blanket P.O. awarded as a result of this Bid Solicitation. Bid Amendments {Addenda} to this Bid Solicitation, if any, will be posted as a File Attachment on the “Summary” page of the Bid Solicitation in NJSTART after the cut-off date. (See Bid Solicitation Section 1.4.1 for further information.)

EXCEPTIONS TO THE STATE OF NJ STANDARD TERMS AND CONDITIONS (SSTC)

Questions regarding the State of New Jersey Standard Terms and Conditions (SSTC) and exceptions to mandatory requirements must be posed during this Electronic Question and Answer period and shall contain the Vendor’s {Bidder’s} suggested changes and the reason(s) for the suggested changes.

SUBMISSION OF QUOTES

In order to be considered for award, the Quote must be received by the Procurement Bureau of the Division at the appropriate location by the required time.

Vendors {Bidders} shall submit a Quote either electronically through NJSTART or via hard copy.

QUOTES NOT RECEIVED PRIOR TO THE QUOTE OPENING DEADLINE SHALL BE REJECTED. THE DATE AND TIME OF THE QUOTE OPENING ARE INDICATED ON THE BID SOLICITATION COVER SHEET AND ON THE “SUMMARY” TAB OF THE BID SOLICITATION WEBPAGE WITHIN NJSTART.

IF THE QUOTE OPENING DEADLINE HAS BEEN REVISED, THE NEW QUOTE OPENING DEADLINE SHALL BE SHOWN ON THE POSTED BID AMENDMENT AND ON THE “SUMMARY” TAB OF THE BID SOLICITATION WEBPAGE WITHIN NJSTART.

Procedural inquiries concerning the use of NJSTART may be directed to njstart@treas.nj.gov and/or (609) 341-3500.

The State will not respond to substantive questions related to the Bid Solicitation or any other Blanket P.O. via this e-mail address or phone number. For inquiries related to substantive questions refer to Section 1.3.1 (Electronic Question and Answer Period).

VENDOR {BIDDER} SUPPORT

Vendors {Bidders} are strongly encouraged to visit the NJSTART Vendor Support Page, which contains Quick Reference Guides (QRGs), supporting videos, a glossary of NJSTART terms, and helpdesk contact information.

The Vendor {Bidder} should utilize the QRGs before attempting to submit its Quote using the NJSTART process. It is the Vendor’s {Bidder’s} responsibility to ensure that the NJSTART Quote and attachments have been properly submitted.

MANDATORY/OPTIONAL SITE VISIT

Not applicable to this procurement.

MANDATORY PRE-QUOTE CONFERENCE

The date and time of the Mandatory Pre-Quote Conference is indicated on the Bid Solicitation cover sheet. The location of the Mandatory Pre-Quote Conference will be as follows:

Department of the Treasury Division of Purchase and Property 33 West State Street 9th Floor Bid Room Trenton, NJ 08625-0295

Directions to this location are available on the web at: http://www.state.nj.us/treasury/pensions/drctns.htm.

A Quote from any Vendor {Bidder} that was not represented or failed to register properly at the Mandatory Pre-Quote Conference will be rejected.

Attendance at the Mandatory Pre-Quote Conference will be limited to four (4) attendees per bidding entity. An attendee may represent only one (1) potential bidding entity.

In addition, at the conference, each Vendor {Bidder} will be required to provide a signed copy of the Confidentiality/Non-Disclosure Agreement, signed by an officer or other authorized representative of the Vendor {Bidder}. The information will enable the Vendor {Bidder} to complete the financial aspects of its proposal. This is the only time that the data will be available. This Confidentiality/Non-Disclosure Agreement is required under HIPPA in order for the Vendor {Bidder} to receive confidential files outlined below:

A. Audit File Layout;

B. Current MA Member Census File;

C. Current Med Supp Member Census File;

D. Eligibility File Layout (HIPAA 834);

E. Daily Return File Transmission Layout (HIPAA 999);

F. Employer File Layout;

G. Descriptions of Coverage Groups;

H. Technical Data Elements;

I. Experience and Risk Score Data;

J. CMS MOR and MMR Reports for Current MA Members;

K. CMS MMR Part D Reports for Education $10/$15 PPO Med Supp Members;

L. Provider Disruption Workbook (note: this workbook contains data for current MA Members only);

M. Medicare Advantage Plan Designs; and N. Medicare Advantage EOCs for Plan Year 2018.

The purpose of the Mandatory Pre-Quote Conference is to provide a structured and formal opportunity for the State to accept questions from Vendors {Bidders} regarding this Bid Solicitation. In the event that questions are posed by Vendors {Bidders}, answers to such questions will be issued by Bid Amendment. Any Bid Amendment to this Bid Solicitation will become part of this Bid Solicitation and part of any Blanket P.O. awarded as a result of this Bid Solicitation.

PRE-QUOTE DOCUMENT REVIEW

The following are publicly available documents that a Vendor {Bidder} needs to review in order to prepare and submit accurate and comprehensive Quotes:

Retiree Wellness Program- http://www.nj.gov/treasury/pensions/shbp-wellness-program.shtml.

ADDITIONAL INFORMATION

BID AMENDMENTS: Revisions to this BID SOLICITATION

In the event that it becomes necessary to clarify or revise this Bid Solicitation, such clarification or revision will be by Bid Amendment. Any Bid Amendment to this Bid Solicitation will become part of this Bid Solicitation and part of any Blanket P.O. awarded as a result of this Bid Solicitation.

There are no designated dates for release of Bid Amendments. Those Vendors {Bidders} who are on the bid holder list either through commodity code registration in NJSTART or by acknowledging the bid in NJSTART should receive notification of any Bid Amendment(s). If a Vendor {Bidder} is not on the bid holder list to receive notifications related to a Bid Solicitation, Bid Amendments are still viewable on the “Summary” page of the Bid Solicitation in NJSTART.

BID AMENDMENTS WILL BE ISSUED AS FILE ATTACHMENTS, AND ARE VIEWABLE ON THE “SUMMARY” PAGE OF THE BID SOLICITATION IN NJSTART. Vendors {Bidders} may refer to the QRG “Submit a Quote” for additional instructions. QRGs are located on the NJSTART Vendor Support Page.

It is the sole responsibility of the Vendor {Bidder} to be knowledgeable of all Bid Amendments related to this procurement. An interested Vendor {Bidder} should check the NJSTART “Open Bids” Tab on a daily basis to ensure review of the most updated information.

VENDOR {BIDDER} Responsibility

The Vendor {Bidder} assumes sole responsibility for the complete effort required in submitting a Quote in response to this Bid Solicitation. No special consideration will be given after Quotes are opened because of a Vendor’s {Bidder’s} failure to be knowledgeable as to all of the requirements of this Bid Solicitation.

COST LIABILITY

The State assumes no responsibility and bears no liability for costs incurred by a Vendor {Bidder} in the preparation and submittal of a Quote in response to this Bid Solicitation.

CONTENTS OF QUOTE

Quotes can be released to the public pursuant to N.J.A.C. 17:12-1.2(b) and (c), or under the New Jersey Open Public Records Act (OPRA), N.J.S.A. 47:1A-1.1 et seq., or the common law right to know.

After the opening of sealed Quotes, including Quotes submitted through the NJSTART electronic process, all information submitted by a Vendor {Bidder} in response to a Bid Solicitation is considered public information notwithstanding any disclaimers to the contrary submitted by a Vendor {Bidder}. Proprietary and confidential information may be exempt from public disclosure by OPRA and/or the common law. When the Bid Solicitation contains a negotiation component, the Quote will not be subject to public disclosure until a notice of intent to award a Blanket P.O. is announced.

As part of its Quote, a Vendor {Bidder} may designate any data or materials it asserts are exempt from public disclosure under OPRA and/or the common law, explaining the basis for such assertion. The location in the Quote of any such designation should be clearly stated in a cover letter.

The State reserves the right to make the determination as to what is proprietary or confidential, and will advise the Vendor {Bidder} accordingly. Any proprietary and/or confidential information in a Quote will be redacted by the State. The State will not honor any attempt by a Vendor {Bidder} to designate its entire Quote and/or prices as proprietary, confidential and/or to claim copyright protection for its entire Quote. Copyright law does not prohibit access to a record which is otherwise available under OPRA. In the event of any challenge to the Vendor’s {Bidder’s} assertion of confidentiality with which the State does not concur, the Vendor {Bidder} shall be solely responsible for defending its designation, but in doing so, all costs and expenses associated therewith shall be the responsibility of the Vendor {Bidder}. The State assumes no such responsibility or liability.

A Vendor {Bidder} shall not designate any price lists and/or catalogs submitted as exempt from public disclosure as the same must be accessible to State Using Agencies and Cooperative Purchasing Program participants (if the Bid Solicitation has been extended to these participants) and thus must be made public to allow all eligible purchasing entities access to the pricing information.

ANNOUNCEMENT OF QUOTE INFORMATION

On the date and time Quotes are due under the Bid Solicitation, all information concerning the Quotes submitted may be publicly announced and shall be available for inspection and copying except as noted below:

A. Information appropriately designated as proprietary and/or confidential shall not be available for inspection and copying; and B. Where negotiation is contemplated, only the names and addresses of the Vendors {Bidders} submitting Quotes will be announced, and the contents of the Quotes shall not be available for inspection and copying until the Notice of Intent to Award is issued by the Director.

PRICE ALTERATION IN QUOTES

Any price changes including hand written revisions or "white-outs" must be initialed. Failure to initial price changes shall preclude a Blanket P.O. award from being made to the Vendor {Bidder}.

QUOTE ERRORS

In accordance with N.J.A.C. 17:12-2.11 “Proposal errors,” a Vendor {Bidder} may withdraw its Quote as described below.

QUOTE WITHDRAWAL PRIOR TO QUOTE OPENING

NJSTART: A Vendor {Bidder} may withdraw its Quote submission in NJSTART prior to the Quote opening; however, Vendors {Bidders} should note that while withdrawn NJSTART Quotes remain viewable by the Vendor {Bidder} on its Vendor Profile Homepage, they are removed from the Division’s view and cannot be considered for Blanket P.O. award. The Vendor {Bidder} may submit a revised Quote as long as the Quote is received prior to the announced date and time for Quote submission. Vendors {Bidders} may refer to the QRG “Submit a Quote” for additional instruction. QRGs are located on the NJSTART Vendor Support Page.

Hard Copy: A Vendor {Bidder} may request that its hard copy Quote be withdrawn prior to the Quote opening. Such request must be made, in writing, to the Supervisor of the Proposal Review Unit at the address provided in Section 1.4.7.2 below. The Vendor {Bidder} may submit a revised Quote as long as the Quote is received prior to the announced date and time for Quote submission and at the place specified.

QUOTE WITHDRAWAL AFTER QUOTE OPENING, BUT PRIOR TO BLANKET P.O. AWARD

NJSTART and Hard Copy: If, after the Quote opening, but before Blanket P.O. award, a Vendor {Bidder} discovers an error in its Quote, the Vendor {Bidder} may make a written request to the Supervisor of the Proposal Review Unit to withdraw its Quote from consideration for award. If the Vendor’s {Bidder’s} request to withdraw is made in good faith, and the State will not be significantly prejudiced by granting the withdrawal of the Quote beyond the loss of the benefit of the bargain to the State of the withdrawing Vendor’s {Bidder’s} offer, the request shall be granted. Evidence of the Vendor’s {Bidder’s} good faith in making this request can be demonstrated by one (1) or more of the following factors: A mistake is so significant that to enforce the Blanket P.O. resulting from the Quote would be unconscionable; that the mistake relates to a material feature or term of the Blanket P.O.; and that the mistake occurred notwithstanding the Vendor’s {Bidder’s} exercise of reasonable care. After Quote opening, while pursuant to the provisions of this section a Vendor {Bidder} may request to withdraw its Quote and the Director may in his/her discretion allow said Vendor {Bidder} to withdraw it, the Division also may take notice of repeated or unusual requests to withdraw by a Vendor {Bidder} and take those prior requests to withdraw into consideration when evaluating the Vendor’s {Bidder’s} future Quotes.

All Quote withdrawal requests must include the Bid Solicitation identification number and the final Quote submission date and be sent to the following address:

Department of the Treasury Division of Purchase and Property PO Box 230 33 West State Street – 9th Floor Trenton, New Jersey 08625-0039 Attention: Supervisor, Proposal Review Unit

If during a Quote evaluation process, an obvious pricing error made by a potential Blanket P.O. awardee is found, the Director or his/her designee shall issue written notice to the Vendor {Bidder}. The Vendor {Bidder} will have up to five (5) business days after receipt of the notice to confirm its pricing. If the Vendor {Bidder} fails to respond, its Quote shall be considered withdrawn, and no further consideration shall be given to it.

JOINT VENTURE

If a Joint Venture is submitting a Quote, the agreement between the parties relating to such Joint Venture should be submitted with the Joint Venture’s Quote. Authorized signatories from each party comprising the Joint Venture must sign the Offer and Acceptance Page. Each party to the Joint Venture must individually comply with all the forms and certification requirements in Sections 4.4.1 and 4.4.2 of this Bid Solicitation.

RECIPROCITY FOR JURISDICTIONAL VENDOR {BIDDER} PREFERENCE

In accordance with N.J.S.A. 52:32-1.4 and N.J.A.C. 17:12-2.13, the State of New Jersey will invoke reciprocal action against an out-of-State Vendor {Bidder} whose state or locality maintains a preference practice for its in-state Vendors {Bidders}. The State of New Jersey will use the annual surveys compiled by the Council of State Governments, National Association of State Procurement Officials, or the National Institute of Governmental Purchasing or a State’s statutes and regulations to identify States having preference laws, regulations, or practices and to invoke reciprocal actions. The State of New Jersey may obtain additional information as it deems appropriate to supplement the stated survey information.

A Vendor {Bidder} may submit information related to preference practices enacted for a State, Local Government, or Local Education entity outside the State of New Jersey. This information may be submitted in writing as part of the Quote response, including name of the locality having the preference practice, as well as identification of the county and state, and should include a copy of the appropriate documentation, i.e., resolution, regulation, law, notice to Vendor {Bidder}, etc. It is the responsibility of the Vendor {Bidder} to provide documentation with the Quote or submit it to the Director within five (5) business days after the deadline for Quote submission. Written evidence for a specific procurement that is not provided to the Director within five (5) business days of the public Quote submission date may not be considered in the evaluation of that procurement, but may be retained and considered in the evaluation of subsequent procurements.

QUOTE ACCEPTANCES AND REJECTIONS

N.J.A.C. 17:12-2.7(d), the Director’s right to waive minor irregularities or omissions in a Quote and N.J.A.C. 17:12-2.2 which defines causes for Quote rejection, apply to all Quotes.

ELECTRONIC SIGNATURES

Vendors {Bidders} submitting Quotes through NJSTART may sign the forms listed in Section 4.4.1 (Forms, Registrations and Certifications Required with Quote) and Section 4.4.2 (Forms, Registrations and Certifications Required Before Blanket P.O. Award and That Should Be Submitted with the Quote) of this Bid Solicitation electronically by typing the name of the authorized signatory in the “Signature” block as an alternative to downloading, physically signing the form, scanning the form, and uploading the form to NJSTART.

Vendors {Bidders} submitting Quotes in hard copy format, must provide forms with original, physical signatures, otherwise its Quote may be deemed non-responsive.

DEFINITIONS

CROSSWALK

GENERAL DEFINITIONS

The following definitions will be part of any Blanket P.O. awarded or order placed as a result of this Bid Solicitation.

All-Inclusive Hourly Rate – An hourly rate comprised of all direct and indirect costs including, but not limited to: labor costs, overhead, fee or profit, clerical support, travel expenses, per diem, safety equipment, materials, supplies, managerial support and all documents, forms, and reproductions thereof. This rate also includes portal-to-portal expenses as well as per diem expenses such as food.

Best and Final Offer or BAFO – Pricing timely submitted by a Vendor {Bidder} upon invitation by the Bureau after Quote opening, with or without prior discussion or negotiation.

Bid or Bid Solicitation – This series of documents, which establish the bidding and Blanket P.O. requirements and solicits Quotes to meet the needs of the Using Agencies as identified herein, and includes the Bid Solicitation, State of NJ Standard Terms and Conditions (SSTC), State-Supplied Price Sheet, attachments, and Bid Amendments.

Bid Amendment – Written clarification or revision to this Bid Solicitation issued by the Bureau. Bid Amendments, if any, will be issued prior to Quote opening.

Business Day – Any weekday, excluding Saturdays, Sundays, State legal holidays, and State-mandated closings unless otherwise indicated.

Calendar Day – Any day, including Saturdays, Sundays, State legal holidays, and State-mandated closings unless otherwise indicated.

Change Order – An amendment, alteration, or modification of the terms of a Blanket P.O. between the State and the Vendor(s) {Contractor(s)}. A Change Order is not effective until it is signed and approved in writing by the Director or Deputy Director, Division of Purchase and Property.

Cooperative Purchasing Program – The Division’s intrastate program that provides procurement-related assistance to New Jersey local governmental entities and boards of education, State and county colleges and other public entities having statutory authority to utilize select State Blanket P.O.s issued by the Division, pursuant to the provisions of N.J.S.A. 52:25-16.1 et seq.

Days After Receipt of Order (ARO) – The number of calendar days ‘After Receipt of Order’ in which the Using Agency will receive the ordered materials and/or services.

Director – Director, Division of Purchase and Property, Department of the Treasury, who by statutory authority is the Chief Contracting Officer for the State of New Jersey.

Discount – The standard price reduction applied by the Vendor {Bidder} to all items.

Division – The Division of Purchase and Property.

Evaluation Committee – A committee established or Division staff member assigned by the Director to review and evaluate Quotes submitted in response to this Bid Solicitation and recommend a Blanket P.O. award to the Director.

Firm Fixed Price – A price that is all-inclusive of direct cost and indirect costs, including, but not limited to, direct labor costs, overhead, fee or profit, clerical support, equipment, materials, supplies, managerial (administrative) support, all documents, reports, forms, travel, reproduction and any other costs.

Joint Venture – A business undertaking by two (2) or more entities to share risk and responsibility for a specific project.

Master Blanket Purchase Order (Blanket P.O.) – The Blanket P.O. consists of the State of NJ Standard Terms and Conditions (SSTC), the Bid Solicitation, the responsive Quote submitted by a responsible Vendor {Bidder} as accepted by the State, the notice of award, any Best and Final Offer, any subsequent written document memorializing the agreement, any modifications to any of these documents approved by the State and any attachments, Bid Amendment or other supporting documents, or post-award documents including Change Orders agreed to by the State and the Vendor {Contractor}, in writing.

May – Denotes that which is permissible or recommended, not mandatory.

Must – Denotes that which is a mandatory requirement.

No Bid – The Vendor {Bidder} is not submitting a price Quote for an item on a price line.

No Charge – The Vendor {Bidder} will supply an item on a price line free of charge.

Primary Form – An electronic form contained within a Vendor’s {Bidder’s} NJSTART profile designated by the Vendor {Bidder} as the primary or principal version of the required form.

Procurement Bureau (Bureau) – The Division unit responsible for the preparation,…