UnitedHealthCare (stacked).pdf

State of Nebraska | RFP 120084 O5 - Table of Contents

R E Q U E S T F O R P R O P O S A L F O R S E R V I C E S C O N T R A C T :

State of Nebraska State Purchasing Bureau

Solicitation Number: RFP 120084 O5

D U E O N : D E C E M B E R 1 9 , 20 24

I S S U E D O N : N O V E M B E R 20 , 2 02 4

State of Nebraska | RFP 120084 O5 - Table of Contents

Section 1 Cover Letter

Section 2 Contractual Agreement Form

Section 3 Technical Approach A. Attachment A – Vendor Requirements Matrix

Section 4 Cost Proposal

A. State of Nebraska UHIC Disability Financial Proposals B. 120084 O5 Cost Proposal

Section 5 Section II – Terms and Conditions

Section 6 Section III – Vendor Duties

Section 7 Section IV – Payment

Section 8 Section V – Project Description and Scope of Work

Section 9 Section VI – Solicitation Response Instructions (References

Redacted)

Section 10 Acknowledgement of Addenda A. 120084 O5 Addendum One Questions and Answers

Section 11 Additional Attachments

A. RFP 120084 O5 Deviations B. Statement of Confidentiality C. Account Team Bios (Redacted) D. Sample Disability Policy E. State of Nebraska - STD Certificate of Coverage F. State of Nebraska – LTD Certificate of Coverage G. Form 10-K H. Subcontractor Listing for State of Nebraska (Redacted) I. UHIC Certificate of Authority J. Sample STD Member Welcome Brochure K. Sample LTD member Welcome Brochure

State of Nebraska | RFP 120084 O5 Cover Letter

December 18, 2024

Connie Heinrichs / Brook Taylor, Buyer State Purchasing Bureau 1526 K Street Suite 130 Lincoln, NE 68508

Re: The State of Nebraska RFP 120084 O5

Dear Ms. Heinrichs and Ms. Taylor, On behalf of UnitedHealthcare, I am pleased to submit our response to The State of Nebraska’s RFP for disability benefits. Today’s successful organizations understand that a high quality, cost-effective benefit package can be a key factor in attracting and retaining the best talent available. We are committed to providing the benefits package with the highest possible value to The State of Nebraska and its employees.

Our disability portfolio includes a wide range of short- and long-term disability benefit options, enhanced by flexible plan designs and value-added services. We also offer an advantage our competitors cannot match:

the security and vast financial and technological resources of our ultimate parent organization, UnitedHealth Group Incorporated, the top-ranking company in the insurance and managed care sector on Fortune’s 2023 “World’s Most Admired Companies” list. This is the 14th straight year UnitedHealth Group ranked No. 1 overall in its sector.

A disability lasting three months or longer will strike roughly three in 10 workers. Many American families couldn’t go one month, let alone two or three years, without the support of a regular income. We offer short-and long-term disability options that can provide a steady flow of income to help maintain a consistent standard of living in the case of a disability.

Employees can find life’s challenges stressful and overwhelming. Untreated personal problems can affect the workplace in costly ways, including poor performance, increased turnover, absenteeism, accidents and greater use of medical benefits. To reduce these problems and provide employees with the support they need, we offer a member assistance program as part of our long-term disability product at no additional premium cost.

Our innovative Bridge2Health wellness program is designed to positively impact overall employee health – and the health of your organization– by empowering members with information, resources and support so they can make better decisions that may lead to better outcomes. The key differentiators of our program are early intervention and our ability to provide medical, disability and behavioral health case management coordinated by a single case manager under one roof.

Most conditions that drive high medical costs are the same ones causing employee disability absences. When employees have disability and health plans from UnitedHealthcare, we’re able to access their medical and disability claim data to take a holistic, whole-person approach and:

• Initiate earlier intervention for high-cost-potential cases

• Increase engagement in condition-specific support programs

State of Nebraska | RFP 120084 O5 Cover Letter

• Connect claims, absence and care specialists to simplify the employee’s experience and shorten the claim process.

Combining disability and health plans delivers more, including:

• Medical cost savings, which may be achieved by uniting your UnitedHealthcare plans

• Linked plan data, which can help identify concerns and be used to provide clinical guidance and support for employees with a health risk or complex condition

• Simpler administration with 1 dedicated account team, 1 implementation process (eligibility, claims and billing) and 1 self-service administration website

We have more than 25 years of experience designing short-term and long-term disability insurance plans built to deliver more than just income protection. Plans help your employees return to work safely and may improve productivity while helping you manage costs.

You’ll benefit from: • Personal service and support • Flexible plan and funding options • Smarter approaches to wellness and productivity

Thank you for your consideration of our proposal. I welcome the opportunity to discuss it with you and answer any questions you may have.

Sincerely, Jelena Edwards Strategic Client Executive UnitedHealthcare Public Sector 1600 McConnor Pkwy, Mail Route IL043-1000, Schaumburg, IL 60173

(w) 224-231-1221 (m) 847-409-1917 jelena_edwards@uhc.com

Attachment A

Vendor Requirements Matrix

CONTRACT ADMINISTRATION

1.

Provide documentation that bidder is licensed to conduct business in the State of Nebraska and be responsible for administering the State’s STD plan and LTD plan in accordance with all applicable laws, regulations, IRS requirements, and State of Nebraska requirements.

1. Please see the attached certificate of authority and annual financial report.

Response: Confirmed. As the incumbent carrier, we will continue to provide the short-term disability (STD) and long-term disability (LTD) in accordance with all laws and State of Nebraska requirements.

2.

Describe commitment to work cooperatively with the State of Nebraska and provide at least one day-to-day contact person for account management of the STD and LTD contract.

Response: We will continue to offer a designated, experienced account management team (AMT) to help you and your employees with your daily needs and long-term goals. Jelena Edwards, State of Nebraska’s current Strategic Account Executive (SAE) will continue to lead the team and is ultimately responsible for our relationship with you. She will continue to work closely with other members of the AMT to verify we are consistently meeting your business and financial objectives.

3.

Provide information regarding restrictions or benefit limitations for pre-existing conditions applied to any employee under the plan.

2. Response: The pre-existing condition limitation has been removed from the STD plan.

3.

Under the LTD plan, UnitedHealthcare will not cover any disability that begins during the first 12 months after the covered person’s effective date of insurance that is caused or contributed to by a pre-existing condition.

4.

■ Pre-existing condition means: any Sickness or Injury including Mental Illness, Substance

Abuse or Subjective Symptoms for which the Covered Person, within 3 months prior to his Effective Date of insurance:

- was diagnosed by or received Treatment from a legally qualified Physician; or

- had symptoms for which an ordinarily prudent person would have sought Treatment.

4.

Indicate Acceptance of the current enrollment files for the State’s employees.

Response: Confirmed. As the incumbent carrier, we will continue to administer the plan according to the information you provide in the ongoing eligibility files.

5.

Review all plans, draft plan abstracts, and confirm plan provisions with the State.

Response: Confirmed.

6.

Describe the draft, revision, and finalization of the policy and benefit summaries (Summary Plan Descriptions (SPD)/booklets) for review by the State by the 10th business day of February each calendar year for the July 1st plan year.

Response: We offer a certificate of coverage (COC) to fully insured customers which is typically provided within 20 business days of receipt of all necessary policyholder information.

Our group policy and COC have been filed and approved by the appropriate regulatory entities within the Department of Insurance (DOI). The group policy and COC contain the necessary mandated benefits and other provisions required by the DOI. We encourage our customers to use our filed and approved group policy and COC. Any deviation to the terms and conditions of these documents could potentially require a customer-specific filing with the DOI which would have to be approved prior to use.

We issue updates in the form of an amendment, as applicable. If there is a significant change such as a decrease or deletion of a benefit, we will prepare a new contract and COC.

7.

Provide SPDs in an electronic format for access via internet or intranet.

Response: Confirmed. We will continue to provide plan members and employers with access to benefit plan documents online, through our myuhcfp.com and www.uhcfinancialprotection.com websites.

We will also continue to send electronic COCs to you directly for posting to your intranet site.

8.

Deliver an Administration Manual containing all user guidelines on such matters as eligibility, reports, plan summaries and procedures 60 days prior to plan year.

Response: Confirmed. You can continue to access our administration guide and other helpful resources on our employer website, uhcfinancialprotection.com. The administration guide is a comprehensive manual that provides information on billing, claims and eligibility/enrollment. It also includes frequently used contact numbers and addresses and details on all of our financial protection products.

9.

Describe the State staff portal for eligibility updates, eligibility validation, uploading documentation, pulling management reports, etc.

Response: Our customer portal, eAdministration, will continue to help you manage eligibility, view and pay bills, run reports, access forms, download administrative guides and access the Employer Claims Portal. The portal is updated in real-time and is available 24 hours a day, seven days a week. Your authorized contacts will have access to a suite of resources for your STD and LTD plans.

Our portal provides easy access to:

■ e-Bill services: Enables you to update billing information, access a 12-month history of invoices/ payments and make electronic payments

■ Forms library: Provides access to claim, beneficiary, enrollment and medical underwriting forms

■ Report portal: Contains various claim and underwriting reports (reports may not be available for all group sizes)

■ Employer Claims Portal: Customers can initiate an online disability claim on behalf of the employee by uploading a claim form directly from the portal. Additionally, customers can complete the employer statement for an active claim, access an electronic repository of customer correspondence and view claim status and payment history for all active and closed disability claims.

10.

Describe the employee/claimant portal for monitoring claim status, communications, uploading documentation, etc.

Response: Our member website will continue to give members interactive tools for managing their financial protection products and claims. Built to provide the financial protection membership with digital solutions for the following:

■ Submit disability claims.

■ View limited claim status and paid benefit amounts.

▪ Note: Benefit amounts are not available pre-claim submission.

■ View up to seven years of historical claims data.

■ Review correspondence related to claims and evidence of insurability (EOI).

■ Submit EOI applications and check application status.

▪ Note: EOI is unavailable for employers in CA, OR, UT, NY, NJ, MA, NH, NM.

■ Beneficiary management.

■ Download documents and forms.

■ Simplified points of contact for Member Services.

▪ Including the ability to send inquiries via embedded webform.

11.

Communications (phone calls, emails) should be responded to within 24 hours. The customer service department shall provide telephone support to members via a toll-free number and maintain telephone technology for the hearing and visually impaired.

Describe your customer service process, including the hours of operation and methods of contact.

Response: Our standard is to return customer phone calls and emails within 24 business hours. If we are unable to completely resolve a request within that time frame, we acknowledge the call or email and share the next steps that will be taken with the customer.

We provide nationwide customer service through a single toll-free number. Our customer service call center operates Monday through Friday from 7 a.m. to 7 p.m. CT. The call center is staffed with experienced representatives who can answer general benefits questions as well as address specific company-sponsored benefit plan information. Claim management personnel are also available Monday through Friday from 7 a.m. to 7 p.m. CT.

In addition, we offer a toll-free TTY/TDD service for the deaf and hearing-impaired populations. We are committed to making sure each member has access to customer service and quality care.

Our consumer-facing website was developed to be accessible to individuals with hearing, visual and sensory limitations. We adhere to the Americans with Disabilities Act (ADA) and Web Content Accessibility Guidelines (WCAG) and use the standards of both as a benchmark and are in compliance with Section 508.

12.

Describe the process for initial claim intake, validation of initial and continuing disability.

Response: Both LTD and STD claims may be submitted online, mailed or faxed. We also offer telephonic claim submission for STD where the employee may call us to report a claim. Once we receive a completed employee statement, employer statement and attending physician’s statement, the claim is considered complete and assigned for review. The filing date is the date all three documents are received.

If a claim transitions from STD to LTD, a separate form is not required. All correspondence is aggregated in a centralized system for our claim analysts and customer service representatives to view.

If an employee is not capable of submitting a claim (due to physical or mental restrictions), an employer representative may submit on behalf of the employee.

Once a claim is approved, we contact members by phone at medically appropriate intervals based on their condition. During these conversations, we discuss prognosis, treatment plans and opportunities for return to work. We also contact the attending physician to verify the present and expected restrictions, abilities and anticipated duration. The information is used to determine the appropriate time period for re-evaluation and possible extension.

If a claim is pended because we require additional information pertinent to the adjudication of the claim, we contact the member and ask that it is provided within 30 days. If the information is not received within that time frame, we will provide an additional 30-day notice and final, 15-day notice before rendering a decision based on available information. To the extent we are able, we will assist the member in obtaining the necessary documentation.

Members who reach a point of permanent and total disability, where all offsets are in place and changes are not anticipated, are contacted at least every 12 months, or as needed, to monitor their condition. If a claim specialist cannot reach a member after three attempts, we will attempt to contact another source (e.g., family member, physician, personal visit) to verify the member’s status. We will also check the Social Security death registry to confirm the member has not passed away. In the event checks are returned or have not been cashed, we will suspend payment until we are able to confirm the member’s location and status. If all efforts to locate and/or reach the member fail, we may suspend payment.

13.

Provide routine underwriting and actuarial services.

Response: Confirmed. We currently have 28 full-time underwriters on staff who focus on our financial protection products.

In addition, our actuarial department evaluates, implements and communicates changes regarding laws that may affect program costs. Actuarial services also include relevant pricing and reserving activities. All actuarial functions are overseen and directed by our chief actuary who is a Fellow of the Society of Actuaries.

14.

Make determinations with respect to submitted claims, including claim investigation and analysis prior to payment.

Response: Confirmed. Our processing unit handles STD and LTD claims, using a single platform that combines all claim administration elements, including benefit design, payment and history.

Upon claim receipt, an assigned disability claim specialist (DCS) reviews the information and calls the member within five business days.

The claim is clinically pre-screened by a nurse at the onset (with the exception of normal pregnancy and delivery). The nurse reviews for proper diagnosis and treatment plan, comorbidities, restrictions and limitations. They take note of current functional capacity, request required medical information and consult with our on-site clinical staff and the DCS as needed.

The nurse completes the medical review prior to final claim determination.

15.

Maintain claim files to support payment, denials and appeals. Documentation must be legally acceptable and readily accessible.

Response: Confirmed. We document written and verbal information in our claim system and save all data within the applicable claim file. Documents scanned and saved to the claim file include those received by mail (including the envelope) or fax (including stamped date, time and number of pages).

Due to HIPAA regulations, fully insured customers cannot audit claim files or associated working materials, as they must be kept in a secured and confidential environment. As an alternative, we provide customers with reports on timeliness and financial accuracy.

16.

Explain the medical review and integration with medical administrator for co-management of claim.

Response: As your medical carrier, medical review and integration for co-management of claims will be seamless. We handle claim payment and case management on the same system, and the components are fully integrated. Our disability claims processors combine each element, including benefit design, claim payment and claim history to create a cohesive case file. Multiple resources have access to the file at the same time and can conduct simultaneous reviews. The result is an enhanced claim management experience for our customers.

5.

6. All disability claims, with the exception of normal pregnancy and delivery, are clinically pre-screened when the original claim is assigned. A nurse reviews the claim for diagnosis and proper treatment plans, comorbid diagnoses, restrictions/limitations and current functional capacity.

Additionally, a disability claims specialist evaluates the claim to determine when consultation with our onsite clinical resources staff would be beneficial to the administration of the claim.

7.

If a claimant’s disability continues beyond the expected duration guidelines, we work with the claimant’s physician and our clinical team to identify any ongoing medically supported restrictions and limitations that may impact functional capacity. Depending on the specifics of the claim, the nurse may request additional information or clarification, recommend a formal file review or determine that a physician-to-physician call is set up. Our clinical staff works directly with our claims staff on consultation, file reviews and team discussions.

17.

Describe the process to evaluate and recommend Return to Work options and accommodations.

8. Response: Once an employee returns to work in a residual capacity, we make sure both the employee and employer stay abreast of the status of disability benefits. The employee is required to submit earnings documentation for review and calculation by our certified public accountant prior to the release of benefits. We provide written communications to the employee that explain the return-to-work process and earnings loss percentage required to continue to be eligible for benefits.

9.

10. If an employee is released to full or part-time duty with restrictions, and the employer is not able to accommodate the restrictions without modifying the job duties or worksite, we engage our clinical and vocational resources to discuss potential return-to-work opportunities. Accommodations can range from modifying or eliminating a job duty to adjusting a work schedule or purchasing specialized, ergonomic equipment.

11.

12. ■ If modifications for the employee’s duties are required to support part-time return to work, they continue for as long as medically supported or as long as the employer can support them.

■ If either a physical modification to the worksite or adaptive equipment is needed, a worksite modification benefit may be accessed to assist with the associated expense. This benefit is available to a covered person on a one-time basis for up to the maximum benefit amount (generally $5,000).

18.

Describe bidder’s transition from STD to LTD, when applicable.

13. Response: The transition from STD to LTD can be both physically and emotionally difficult for members. Offering both STD and LTD from UnitedHealthcare, we can offer a seamless transition to help ease that burden.

14.

15. As an employee on STD approaches the end of his or her benefit, the STD claim specialist notifies the LTD claim specialist of the upcoming transition. The LTD specialist conducts a thorough review of the case and requests the information necessary to render a decision before the employee’s STD period ends.

16.

17. The LTD specialist works closely with the employer, employee and attending physician to verify everything is received within 45 days of receiving a complete claim. The employee is informed of the new benefit and change in payment cycle: from weekly STD payment to monthly LTD payment.

18.

Because our claim process is fully integrated, there is consistency in how we manage claims and share data. The employee’s information is readily available to all claim specialists, which prevents us from having to request the same information twice. The LTD claim specialist is in constant contact with the employee throughout the transition and beyond. Our due diligence and expert coordination create a smooth transition for you and your employee.

19.

Describe bidder’s fraud monitoring and detection.

19. Response: Insurance fraud is a very real threat—one that can cost customers thousands of dollars.

That’s why we built fraud identification processes directly into our claims management practices.

We use external vendors to complete background investigations, member visits and surveillance to aid in fraud detection.

20.

21. During the initial review and ongoing management of a disability claim, we may use surveillance to obtain additional information (e.g., work activity) or confirm a member’s functional capacity. The need for surveillance is determined on a case-by-case basis, with the primary reason to clarify suspicious claim inconsistencies.

22.

23. In the event we suspect fraudulent activity has occurred, we refer the claim to our special investigations unit vendor. The vendor will complete an independent investigation and advise us on the appropriate next steps.

24.

We also provide annual fraud training to our claim staff and report all potential fraud to the proper state authorities. We have found these fraud prevention measures substantially limit the ability for a member to successfully submit a fraudulent claim.

20.

Provide ongoing assistance in administration, claim adjudication, and general problem solving. Periodic account servicing meetings will be held with the account manager and claims support group.

Response: Confirmed. Your current AMT plays an important role in delivering on our promise to maximize the investment you are making in health care. Jelena Edwards, your Strategic Account Executive (SAE), Clifton Sumrall, your Field Account Manager (FAM), and Natasha Banks, your designated Financial Protection Client Experience Manager (CEM), will continue to meet with you bi-weekly (or more frequent if needed) to discuss your utilization and claims experience and provide support in administration, claims adjudication and general problem solving.

Through regular performance assessments, we make certain our plans are consistently meeting your business and financial objectives, and we will continue to partner with you to propose solutions as your needs evolve.

Your AMT will continue to be your point of contact for questions about administration, claims, underwriting, contracts, eligibility, billing and reporting, and will work to make sure that all of your needs are met.

21.

Refrain from issuing any external communications material that mentions the State's benefit plans without written approval from the State. To include, but not limited to, newsletters and publications to agents, brokers and consultants.

Response: Occasionally, we may provide information related to our administration of a customer's benefit plan and other programs to a customer's participants. We agree to give our customers advance notice of certain information that will be provided to participants. Customers may choose not to participate in certain mailings of marketing materials or have other promotional communications sent to participants.

This ability to opt out of certain mailings or promotional communications would not extend to communications supporting the usual activities of providing service to participants, including:

◼ Enrollment and welcome materials ◼ Explanation of benefits documents ◼ Activation messaging on our member website, myuhc.com ◼ Other necessary service-related or legally required communications

22.

Design and submit for approval electronically, the EOI forms with the State's logo for use by plan participants to enroll, and change their coverages, in accordance with plan provisions.

Response: We will continue to use the standard EOI form that is in place today.

23.

When customized printing is requested by the State, present a complete draft and subsequent proof to the State for sign-off. The vendor must ensure that logo placement and color requirements are met. Vendor will be responsible for costs of printing booklets, certificates, or SPDs as required.

Response: We will continue to provide the current enrollment communication materials electronically at no additional cost.

We offer configurable open enrollment documents that our account management team can customize with State of Nebraska’s specific plan details to help your employees learn more about their options. We may be able to accommodate other customization requests, depending on the level of complexity and communications item, as some language cannot be changed due to legislative and compliance requirements.

We will also continue to send electronic COCs to you directly for posting to your intranet site.

We look forward to discussing options and associated costs at finalist notification.

24.

Handles problems and complaints initially and pursues all other inquiries in a timely fashion and advises State of NE of escalated issues and recurring patterns.

Response: Confirmed. We value our members’ opinions and strive to resolve questions at the first telephone call. Processes have been put in place at our member service center to document, address and quickly and effectively resolve member inquiries. As a result, our first-call resolution rate is currently 90%.

We document all inquiries in our automated, online system. The system tracks issues that cannot be resolved during the first call. Complaints received directly from the employee or employer will be responded to within 48 hours. Customer service managers and executive leaders monitor the turnaround time frames of open issues daily using reports generated by the inquiry system.

Any claim specialist feedback or procedural updates that may result from a specific complaint will be addressed on a case-by-case basis. Depending upon the facts of the complaint, it may be necessary to solicit input from one or more internal resources to provide additional facts and/or clarify existing internal processes. These resources include, but are not limited to the underwriting, billing, sales, management and/or legal areas.

In addition, Your AMT will communicate proactively, clearly and frequently to address any issues and concerns. They are a group of professionals dedicated to answering common day-to-day customer benefit questions and issue resolution. These individuals research and independently resolve questions and issues, or partner with other functional areas for resolution.

25.

Develops enrollment materials. Provide an example of an employee enrollment kit.

Response: We will continue to offer a variety of communications materials to fit your population’s unique needs. All materials are available in electronic format at no additional cost and includes the following:

■ Welcome/enrollment fliers to help your employees better understand their plan(s)

■ Benefit overviews to educate employees on additional options that may be available to them

■ Videos to explain all our financial protection products, inclusive of STD and LTD plans.

■ Benefit summaries that give an overview of the plans offered

Please refer to the sample welcome brochures included as attachments with our RFP response.

IMPLEMENTATION

26.

Provide a detailed timeline and implementation plan including deadlines set forth in this RFP including State resources and personnel required.

Response: Not applicable. As the current carrier for your STD and LTD plans, we would not need an implementation plan.

27.

No statement of health or medical evidence will be imposed upon the initial group of covered employees.

Response: Confirmed.

28.

Provide coverage to all present participants enrolled on the program effective date. No active employees or disabled employees shall lose coverage as a result of a change in the vendor.

Response: Confirmed. As the incumbent carrier, we will continue to cover those participants enrolled in the plans today.

29.

Any "actively at work" requirements will be waived for current covered employees.

Response: As the incumbent carrier, we will continue to cover those employees currently enrolled in the plans today.

30.

Identify any programs, systems, or administrative opportunities that your organization can provide during the implementation process that would be beneficial to the State.

Response: As the incumbent carrier, your STD and LTD plans are already implemented into our systems and no implementation is needed.

REPORTING

31.

Describe monthly, quarterly, semi-annual, and annual reporting to include but not limited to: Utilization, approvals/denials of coverage, etc.

Response: We will continue to offer a variety of reporting options that provide valuable information to you. Our standard disability reports include:

■ Benefits paid

■ Claims by division

■ Claim totals

Open, pending, closed and paid claim reports (without diagnosis) are also available. Due to privacy regulations, we report aggregate claims, not individual.

The following reports are also available on an ad hoc basis upon request:

■ Claim incident

■ Data analyzer

■ Disability top ranking diagnostic

■ Key indicators

■ List time trends

■ New claims submitted trends

■ Payments and deductions

■ Monthly paid claims experience report with loss ratio by line of coverage

■ Waiver of premium

■ Portability

Authorized users may access reports online at any time through our customer portal, eAdministration. Data is updated nightly, so customers choose the frequency that works best for them.

32.

Provide a year-end financial accounting for the program within 60 days of the contract anniversary date.

Response: While we do not routinely provide a year-end reconciliation report, we can provide a bill-versus-paid report upon request.

33.

Maintain an internal audit program and provide the State with a copy of the most recent internal audit report upon request.

Response: Confirmed. To make sure we process claims efficiently and accurately, we use the following internal quality audits:

■ Statistical review: Assess financial and procedural accuracy of claim processing and satisfy internal and external reporting needs

■ Processor review: Conduct baseline audits to measure the quality of individual processors

■ New hire trainee certification review: Quickly identify training gaps and training opportunities

■ End-to-end audit: Address current quality assessment gaps; verify supporting systems and data are loaded correctly; validate accuracy of supporting data

Through these quality review measures, we maintain the highest caliber of claims produced for our members.

Due to HIPAA regulations, fully insured customers cannot audit claim files or associated working materials, as they must be kept in a secured and confidential environment. As an alternative, we provide customers with reports on timeliness and financial accuracy.

PERFORMANCE GUARANTEES

34.

Explain bidder’s formal performance guarantee program and provide a copy.

Response: We have included our standard performance guarantees and have provided a copy as an attachment with our RFP response.

BILLING

35.

Provide a description of premium billing procedures.

25. Response: We will continue the self-bill arrangement in place today for State of Nebraska.

26.

27. You will continue to manage your own eligibility and calculate your own premium payments. A summary of enrollment must be submitted online prior to monthly premium payment containing the total count and volume of enrollment by product.

28.

29. We send invoices showing products and rates but not premium calculations. You can either update the invoice manually and send to our office or request access to our e-Bill portal and update online.

30.

31. Billing invoices are usually available 15 days prior to the due date. If we have not received your payment, by the time we prepare the next billing statement, we automatically include the previous month’s outstanding balance. An automated past due notice is also sent.

32.

If we have not received payment after 45 days, coverage may be subject to termination.

36.

Explain how bidder will maintain a process for the correction of under and over payments.

Response: When preparing invoices, we review all adjustments and payments received to verify that each month’s invoice accurately reflects the amount due. This includes reviewing the previous month’s payment and validating the current month’s premium.

37.

Withhold Medicare taxes from the disabled employee’s disability benefits and remit them to the federal government.

Response: We are responsible for withholding and submitting the employee’s portion of Social Security (FICA) and Medicare taxes to the IRS under our employer identification number (EIN).

Upon the employee’s request, we can withhold state and federal income tax; however, we do not withhold local or municipal tax.

38.

Remit the State’s portion of Medicare tax (from a State Medicare matching Fund) to the federal government.

Response: We generally transfer employer tax liability back to the employer, which includes the deposit of the employer share of FICA, SUTA, FUTA and W-2 reporting, unless the employer contracts with us for W-2 reporting or W-2 and FICA match reporting. Unemployment tax responsibility remains with the employer.

Renewal for

State of Nebraska

Issued on: December 13, 2024

Legal Entity

Eligibility

Minimum Hours Requirement

Benefit Qualification

Definition of Disability

Elimination Period-Accident

Elimination Period-Sickness

Benefits Begin

First Day Hospital

Recurrent Disability

Coverage Type

Maternity

Volume Basis

Benefits Payable

Benefit Type

Benefit Percentage

Maximum Weekly Benefit

Minimum Weekly Benefit

Social Security Integration

Maximum Benefit Duration

Limitations and Exclusions

Pre-existing Conditions Exclusion

Evidence of Insurability

Annual Enrollment Period

General Exclusions

Additional Benefits

Lump Sum Survivor Benefit

Rehabilitation Services

Telephonic Claim Intake

Employer FICA Match

For all eligible military firefighters hired prior to 7/1/15 = 50 hours per week

For all eligible military firefighters hired on or after 7/1/15 =

53 hours per week

For all eligble employees, excluding military firefighters =

20 hours per week

Not Included - See Assumptions for one-time exception

UnitedHealthcare STD Renewal for State of Nebraska

Effective Date: 07/01/2025 | Policy Number: 00306147

Short Term Disability Insurance

Basic Annual Earnings Definition

Class 1

Custom

Core

Primary

United Healthcare Insurance Company

Total Covered Benefit

All Active Full Time Employees, Regular Part Time

Employees, and Temporary Employees with Assignments of 6 months or Longer.

The average weekly earnings received from the Covered

Person’s Employer for the three-month period ending just prior to the date of Disability. Pre-Disability Weekly

Earnings do not include commissions, bonuses, overtime pay, and other extra compensation.

Residual

0 days

Benefits begin the day after completion of the Elimination

Period or the exhaustion of any available sick or donated leave – whichever is later

7 days

Excluded

14 days

Non-Occupational

Treated like any other illness

26 weeks

Employees who have an Extended Illness Leave Bank are required to use this bank first, but in no event will the total amount of extended illness leave, plus Short Term

Disability, exceed 26 weeks

None

Required for late entrants

Benefit Percent

60.0%

$1,731

$25

Family

Included

Included

Not Included

Standard

Lesser of $3,000 or 3 weeks Gross

0000801-03 - 12/13/2024

Assumed Enrollment and Rates

Number of Employees

Volume of Insurance

Rate Basis

Current

Monthly Rate $0.774

$0.762

$0.774

$0.643

$0.690

$0.681

$0.777

$0.951

$1.199

$1.378

Monthly Premium TBD

Annual Premium TBD

Employer Contribution

Current Participation

Minimum Participation Requirement

Employee Contribution Tax Basis

Broker Commissions

Rate Guarantee

$2,131,919

Age-banded per $10 of Total Covered Weekly Benefit

Renewal

Under 25 $0.330

25 - 29 $0.310

30 - 34 $0.330

35 - 39 $0.270

40 - 44 $0.290

45 - 49 $0.300

65+ $0.580

TBD

50 - 54 $0.330

55 - 59 $0.400

60 - 64 $0.500

36 Months

TBD

0%

18%

25%

Post-Tax

None

General Assumptions

STD Assumptions

- Rates assume standard administrative services including Claims & Data processing, Enrollment & Billing, Customer Service, Case Management, Provider Relations, and Reporting

UnitedHealthcare Assumptions for State of Nebraska

Effective Date: 07/01/2025 | Policy Number: 00306147

- We reserve the right to change rates and/or plan provisions if the number of lives or volume of insurance change by more than

10% before, on, or after the effective date listed above or if factors used to generate this quote such as group demographics or effective date are changed, found to be incomplete or incorrect.

- Rates assume no changes in legislation or regulation that affects the benefits payable, eligibility or contract.

- Assumed contract situs is Nebraska.

- This quote is based on our current filed and approved policies and rates. Please be advised, if awarded the business, the benefits and/or rates in this proposal may need to be altered specific to any insured employee who resides in the State of New

Mexico as required by changes to New Mexico law (13.10.34, et al).

- Employees must be U.S. citizens or residents regularly working and living in the U.S. Coverage for U.S. citizens working outside of the U.S. must be approved in writing by us. Approval depends on locale and length of assignment.

- Employers assumed primary business is classified as 9111 SIC Code.

- Rates may change at the next renewal in accordance with the terms of the policy.

A one-time exception for an Open Enrollment for the Voluntary STD has been approved for 7/1/25.

An Employees who is not currently insured may elect coverage with no proof of good health.

Notes

1. The enrollment should be completed, and the final census submitted by 7/31/25

2. The actively at work requirement will apply.

Our contract is for non-occupational coverage only and does not replace statutory mandated coverage..

The Policy will not cover a disability if it is due to: intentionally self-inflicted injuries, commission or attempted commission of a felony, participation in a riot, war, act of war of armed conflict between organized military forces or while the covered person is incarcerated or under house arrest.

The above exclusion is intended for illustrative purposes only. State specific exclusions and language may apply. Please refer to your Certificate of Coverage for detailed information.

- Policy Form UHI-DI-POL-NE 2023

Premium is calculated using Total Covered Weekly Benefit.

In the event of a disability, the claimant must remain a permanent resident of the United States and must be continuously under the care of a Physician as defined in our policy.

Our quote assumes the employer participates in Social Security and provides Workers Compensation for all eligible employees.

Benefit may be subject to Other Income Benefit Offsets outlined in policy.

Renewal for

State of Nebraska

Issued on: December 13, 2024

Legal Entity

Eligibility

Minimum Hours Requirement

Benefit Qualification

Definition of Disability

Own Occupation Period

Earnings Test

Requires Loss of Earnings/Duties

Elimination Period

Accumulation of Elimination Period

Recurrent Disability

Benefits Payable

Benefit Percentage

Maximum Monthly Benefit

Minimum Monthly Benefit

Guaranteed Issue Benefit

Social Security Integration

Maximum Benefit Duration

Limitations and Exclusions

Pre-existing Conditions Exclusion

Annual Enrollment Period

Evidence of Insurability

Mental and Nervous Limitation

Substance Abuse Limitation

Subjective Symptoms Limitation

General Exclusions

Additional Features

Work Incentive Benefit

Survivor Income Benefit

Rehabilitation

Transplant Benefit

Employer FICA Match

Member Assistance Program

3 months Gross

Voluntary

Elimination Period waived for Disability resulting from organ donation. Limited pay up to 12 months.

Included without Reimbursement

Included

12 months

$100

$7,500

Family

Reducing Benefit Duration w/SSNRA

3/12

Not included - See Assumption section for one-time exception for an Open Enrollment

Required for late entrants

24 months (per disability)

24 months (per disability)

No Limit

Standard

$7,500

United Healthcare Insurance Company

All active full-time Employees, regular part-time Employees, and temporary Employees with assignments of 6 months or longer

The average monthly earnings received from the Covered

Person’s Employer for the 12-month period ending just prior to the date of Disability. Pre-Disability Monthly Earnings includes commissions, averaged over the lesser of the most recent 24-month period or the Covered Person’s period of employment. It does not include bonuses, overtime pay, and other extra compensation.

Residual

24 months (2 year) own occupation

80% Own Occupation / 80% Any Occupation

Loss of Earnings and Duties

The later of:

the exhaustion of any available sick or donated leave; or

180 days

30 Days

6 months

60%

UnitedHealthcare LTD Renewal for State of Nebraska

Effective Date: 07/01/2025 | Policy Number: 00306147

Long Term Disability Insurance

Basic Annual Earnings Definition

Class 1

Custom

Voluntary

Core

Primary

For all eligible military firefighters hired prior to 7/1/15 = 50 hours per week

For all eligible military firefighters hired on or after 7/1/15 =

53 hours per week

For all eligble employees, excluding military firefighters = 20 hours per week

Assumed Enrollment and Rates

Number of Employees

Monthly Covered Payroll (MCP)

Rate Basis

Current

Monthly Rate $0.050

$0.080

$0.120

$0.140

$0.170

$0.240

$0.360

$0.430

$0.450

$0.470

$0.500

Monthly Premium TBD

Annual Premium TBD

Employer Contribution

Current Participation

Minimum Participation Requirement

Employee Contribution Tax Basis

Broker Commissions

Rate Guarantee

Additional LTD Benefits

Portability

Spouse and Elder Care Expense Benefit

Child Care Expense Benefit

Accelerated Benefit Included, 12 months life expectancy

$500 per family member, not to exceed $1,000

$350 per Child, not to exceed $1,000

0%

36 Months

Included

Post-Tax

65 - 69 $0.423

TBD

70* $0.450

TBD

0%

34%

25%

50 - 54 $0.324

55 - 59 $0.387

60 - 64 $0.405

35 - 39 $0.126

40 - 44 $0.153

45 - 49 $0.216

Under 25 $0.045

25 - 29 $0.072

30 - 34 $0.108

TBD

TBD

Age-banded per $100 of monthly covered payroll

Renewal

General Assumptions

LTD Assumptions

The Policy will not cover a disability if it is due to: intentionally self-inflicted injuries, commission or attempted commission of a felony, participation in a riot, war, act of war of armed conflict between organized military forces or while the covered person is incarcerated or under house arrest.

The above exclusion is intended for illustrative purposes only. State specific exclusions and language may apply. Please refer to your Certificate of Coverage for detailed information.

Premium is calculated using Total Monthly Covered Payroll.

A new pre-existing condition limitation period will apply on the date of any increase in coverage.

In the event of a disability, the claimant must remain a permanent resident of the United States and must be continuously under the care of a Physician as defined in our policy.

Our quote assumes the employer participates in Social Security and provides Workers Compensation for all eligible employees.

Benefit may be subject to Other Income Benefit Offsets outlined in policy.

A one-time exception for an Open Enrollment for the Voluntary LTD has been approved for the 7/1/25 renewal.

An Employees who is not currently insured may elect coverage with no proof of good health

Notes

1. The enrollment should be completed, and the final census submitted by 7/31/25.

2. The 3/12 Pre-existing Condition exclusion will apply.

3. The actively at work requirement will apply.

- Policy Form UHI-DI-POL-NE 2023

UnitedHealthcare Assumptions for State of Nebraska

Effective Date: 07/01/2025 | Policy Number: 00306147

- We reserve the right to change rates and/or plan provisions if the number of lives or volume of insurance change by more than

10% before, on, or after the effective date listed above or if factors used to generate this quote such as group demographics or effective date are changed, found to be incomplete or incorrect.

- Rates assume no changes in legislation or regulation that affects the benefits payable, eligibility or contract.

- Rates assume standard administrative services including Claims & Data processing, Enrollment & Billing, Customer Service, Case Management, Provider Relations, and Reporting

- Assumed contract situs is Nebraska

- This quote is based on our current filed and approved policies and rates. Please be advised, if awarded the business, the benefits and/or rates in this proposal may need to be altered specific to any insured employee who resides in the State of New

Mexico as required by changes to New Mexico law (13.10.34, et al).

- Employees must be U.S. citizens or residents regularly working and living in the U.S. Coverage for U.S. citizens working outside of the U.S. must be approved in writing by us. Approval depends on locale and length of assignment.

- Employers assumed primary business is classified as 9111 SIC Code.

- Rates may change at the next renewal in accordance with the terms of the policy.

SHORT TERM DISABILITY INSURANCE,

1ST DAY ACCIDENT, 8TH DAY ILLNESS

Initial Period Year One

Initial Period Year Two

Optional Renewal

One

Optional Renewal

Two *

Optional Renewal Three *

Rate per $10 of Weekly Benefit ** Under 25 0.330$ 0.330$ 0.330$ 0.343$ 0.357$

25-29 0.310$ 0.310$ 0.310$ 0.322$ 0.335$ 30-34 0.330$ 0.330$ 0.330$ 0.343$ 0.357$ 35-39 0.270$ 0.270$ 0.270$ 0.281$ 0.292$ 40-44 0.290$ 0.290$ 0.290$ 0.302$ 0.314$ 45-49 0.300$ 0.300$ 0.300$ 0.312$ 0.324$ 50-54 0.330$ 0.330$ 0.330$ 0.343$ 0.357$ 55-59 0.400$ 0.400$ 0.400$ 0.416$ 0.433$ 60-64 0.500$ 0.500$ 0.500$ 0.520$ 0.541$ 65-69 0.580$ 0.580$ 0.580$ 0.603$ 0.627$

70 & Over 0.580$ 0.580$ 0.580$ 0.603$ 0.627$

LONG TERM DISABILITY INSURANCE,

6 MONTH ELIMINATION PERIOD

Initial Period Year One

Initial Period Year Two

Optional Renewal

One

Optional Renewal

Two*

Optional Renewal Three *

Rate per $100 of Monthly Covered Payroll ** Under 25 0.045$ 0.045$ 0.045$ 0.047$ 0.049$

25-29 0.072$ 0.072$ 0.072$ 0.075$ 0.078$ 30-34 0.108$ 0.108$ 0.108$ 0.112$ 0.117$ 35-39 0.126$ 0.126$ 0.126$ 0.131$ 0.136$ 40-44 0.153$ 0.153$ 0.153$ 0.159$ 0.165$ 45-49 0.216$ 0.216$ 0.216$ 0.225$ 0.234$ 50-54 0.324$ 0.324$ 0.324$ 0.337$ 0.350$ 55-59 0.387$ 0.387$ 0.387$ 0.402$ 0.419$ 60-64 0.405$ 0.405$ 0.405$ 0.421$ 0.438$ 65-69 0.423$ 0.423$ 0.423$ 0.440$ 0.458$

70 & Over 0.450$ 0.450$ 0.450$ 0.468$ 0.487$

* The rates for Renewal Two and Renewal Three will not exceed the age-banded rates in the above table

COST PROPOSAL

RFP 120084 O5

STD AND LTD INSURANCE PLAN OPTIONS

Prices submitted on the cost sheet, once accepted by the State, shall remain fixed for the first two (2) years of the contract. Any request for a price increase subsequent to the first two (2) years of the contract shall not exceed four percent (4 %) of the price proposed for the period. Increases shall not be cumulative and will only apply to that period of the contract. The request for a price increase must be submitted in writing to the State Purchasing Bureau a minimum of 120 days prior to the end of the current contract period. Documentation may be required by the State to support the price increase.

Each monthly premium amount proposed should be evenly divisible by "2" with no rounding to accommodate two even deductions per month through our payroll system. Any premium amount not divisible by “2” will be reduced to the nearest lower amount that is divisible by “2” for scoring. By submitting this proposal, Bidder accepts this lower amount if a contract is awarded.

This is the rate an employee will pay for…