Y22-178_Attachment_B_-_Proposal_Worksheet.docx

ATTACHMENT B

RFP #Y22-178

PROPOSAL WORKSHEET

GENERAL INFORMATION

Complete all questions in full and return the completed worksheet with your response. Respond as briefly as possible to each question, and answer only the question asked. When appropriate, a simple yes or no answer will suffice. Please respond to the questions within the worksheet format – DO NOT ALTER THE WORKSHEET FORMAT.

1. GENERAL INFORMATION

A. Provide the following information about your Company:

Company Name

Service Center Location

Primary Contact for RFP

Contact Person Address

E-mail Address

Telephone

Fax

B. References

Please provide the following information regarding the public sector clients your company currently serves: List five (5) clients for which you currently provide administrative services. Please include at least four (4) clients over 5,000 Eligible Employee (EEs).

Current Clients Large Clients (Public Groups Preferred) Group Size (EEs) Please include at least four over 5,000 EEs Product(s) FSA, COBRA, Retiree

C. Background

1. Provide a brief history of your company and describe your ownership and organizational structure. Please include any recent acquisitions, sales or mergers in the last two (2) years.

2. Where is the physical location of your processing unit for each of the benefits requested, and what are the hours of operation:

A. FSAs

B. COBRA

C. Retiree Billing D. Direct Billing Services A.

6. Has your company experienced any HIPAA or HITECH breaches in the last three (3) years? If yes, please describe.

7. Confirm that your company has information systems in place to perform the services requested including security and back up procedures. Briefly describe.

8. Please provide your 2020 or most current SSAE18 SOC1 and SOC2 reports under Tab 2 of your proposal. Please confirm.

9. Briefly describe actions your company is taking to maintain compliance with Federal and State guidelines.

10. Briefly describe your internal and external claims review process.

11. Does your company have any pending legal actions, disciplinary actions, restrictions or pending reviews by any client, former client, Federal, or State authorities in the past five (5) years for any actions pertaining to the services proposed herein? If yes, please explain.

D. List the personnel your company will assign to administer services proposed.

Account Service Rep.

Implementation Manager

2. TECHNICAL RESPONSE

A. SERVICES

Please Confirm the following Services or list any Deviations in your Response.

1. Confirm that your company can provide debit card usage for ALL of the following:

a. Medical FSA

b. Limited Purpose FSA

c. Dependent Care FSA.

a.

4. Indicate your current debit card vendor.

5. Please provide percentage of claims that are automatically adjudicated via debit cards.

6. Please describe your procedure for recovering and reporting debit card funds not substantiated.

7. Indicate how eligibility information for new hires is processed, the process for receiving employee changes and the reconciliation of eligibility for FSAs

8. What is the turnaround time for funding employee dependent care FSA accounts upon receipt of funds payroll deductions from the County?

9. Describe your process for claims submission.

10. Describe the process and frequency of reimbursement checks.

11. Confirm your company’s ability to administer the additional “grace” and run out periods for FSAs.

12. How are FSAs maintained for employees who elect to continue depositing money into the account as part of their COBRA election?

13. What are the safeguards for claims processed for terminated employees with an account balance?

14. Describe your process and timeline for handling denied claims appeals.

15. Define what information you require for claims processing for medical claims and verification for claims reimbursements.

16. Confirm FSA reimbursements shall be processed immediately and distributed to the participants bank account via ACH or check within 48 hours. In no circumstances shall the proposer hold the participants reimbursement in a non-qualified account.

17. Define what information you require and verification needed for claims processing for dependent care claims. Specifically address how often you require verification of daycare providers.

18. Confirm that your company will provide assistance with the development of employee education materials and plan document provisions including updates and revisions as a result of any federal or state mandate changes affecting benefits under employee benefits administrative services.

19. Confirm that your company will provide administrative guidance on changes in FSA, COBRA, ACA/FTE and/or Retiree administration federal and state laws.

20. Confirm that your company will retain records pursuant to current regulations.

21. Confirm that your company will provide annual enrollment assistance, including an on-site representative to attend all benefit fairs over a maximum of 6 days.

22. Confirm that your company will provide a fillable claim form in PDF format that are easily accessible to enrollees either on the County’s intranet, or on the company’s website and that claims can be submitted through the following methods:

a. Fax

b. via website or portal

c. via mobile app

d. other options a.

26. Confirm you have provided a sample claim form in Tab 2.

27. Confirm that the County has the ability to update enrollment information via electronic filing and access to Client Portal.

28. Please describe how County funds (payroll deductions) are held. Are they pooled (co-mingled with other client funds) or held separately for County claims, who owns the account?

29. Confirm your ability to waive any imprest balance pre-funding requirements.

30. Describe the requirements and options available for initial and ongoing funding of the FSA accounts. Include reference to prefunding of the debit card and Medical Availability.

31. If claims exceed deposits describe the steps your company will take to cover claims costs.

32. Describe your company’s non-discrimination testing process for public sector groups.

33. Confirm your company’s ability to conduct COBRA and Direct Bill premium calculations, billing to enrollees and management of ongoing premium election process.

34. Confirm your company’s ability to:

a. mail initial COBRA notice to new enrollees under the plan

b. send COBRA enrollment materials within a specified timeframe

c. administer notice of coverage termination and conversion rights a.

37. Describe the notification process for COBRA participants nearing the end of their eligibility period.

38. Describe the process for notifying employees and/or dependents of COBRA rights when they have a second qualifying event.

39. Indicate the review process used for certifying extended COBRA coverage.

40. Confirm your company’s ability to directly interface with carriers regarding enrollments, terminations and premium payments, electronically, on a monthly basis for COBRA and Retiree services according to the County’s billing and payment requirements.

41. Confirm that your company will submit premium remittance to the carrier and to the County has appliable within 30 days of the close of the month.

42. Briefly, describe your company’s notification and premium payment process to insurance carriers/contractors.

43. Describe the procedure your company follows when a qualified beneficiary submits a premium payment for more or less than the required amount.

44. Describe the procedure your company follows when a qualified beneficiary submits a delinquent premium payment after the 30 day grace period. How do you document the return of the check? At what point do you send a termination notice to the carriers?

45. Describe your process to maintain and audit dependent eligibility for retirees

46. Confirm that your company has enclosed sample form/letters you use for COBRA administration.

47. Confirm that your company will not charge more than a 2% surcharge for participants on extended COBRA for disability.

48. Describe the banking, fund accounting and transfer procedure you propose to use for managing collected COBRA and Retiree premiums, and payment to carriers

49. Confirm your company’s ability to coordinate with the Florida Retirement System allowing for FRS deduction of premium payments and annual FRS reporting for premiums paid?

50. Confirm your company’s ability to allow for automatic bank account deductions for COBRA and Direct Bill premiums.

51. Do you maintain historical COBRA and Retiree enrollment and payment information? If so, how long do you maintain this history?

52. Confirm the ability to have one contract for the Benefit Administrative Services, with separate billing and eligibility maintained for each agency for FSA Administration Services. FSA Admin. Services are paid by each agency, while the Benefit Continuation fees for all agencies are paid by the Board of County Commissioners.

53. Confirm that your Company will not impose minimum participation requirement on agencies

54. Confirm that you agree to work with the County and its affiliated agencies to receive eligibility electronically and/or via paper in the format provided by the County and affiliated agencies for flexible spending account enrollment.

55. Confirm that you have appropriate measures designed to ensure the security of employee or retiree information; protect against anticipated threats or hazards to the security of such information; and protect against unauthorized access to or use of such information.

56. Confirm that you shall comply with the County’s Security and Encryption Standards as presented in Attachment D and that all sensitive data stored on or transferred by any of the Proposer’s systems shall be encrypted using the approved encryption algorithms and allowed key lengths as defined in the standards.

57. Confirm that you will accept the use of the County’s enrollment forms.

58. Confirm you currently provide and will provide online electronic enrollment (annual open enrollments as well as mid year qualifying events) for similar sized organizations for COBRA, and Direct Bill participants.

59. Confirm that debit cards will be received and funds will be posted to retuning participant’s cards no later than January 1, of each year.

60. Confirm that you will accept FSA enrollment information through an electronic file provided by the County and/or affiliated agencies.

61. Confirm that you will accept COBRA and Direct Billing eligibility through an electronic file.

62. Confirm that you will accept initial retiree elections through an electronic file or via paper enrollment that is sent over through a secure portal.

63. Confirm that you will provide Medicare Supplement Coverage enrollment services direct to retirees, including coordination of enrollment with Medicare Supplement and PDP carrier(s).

64. Confirm your ability to submit all premiums for the County’s self-insured medical plans collected from COBRA, and direct bill participants directly to the County.

65. Confirm your ability to directly interface with County carriers on COBRA, and direct bill enrollments, terminations, and make premium payments directly to insurance carriers for fully- insured products on a monthly basis via an eligibility data transfer process.

66. Does your company have the ability to administer a combination account (limited purpose FSA to medical FSA) for employees enrolled in a high deductible health plan?

B. CUSTOMER SERVICE

Please Confirm the following Services or list any Deviations in your Response.

1. Confirm that your company will provide customer service (inbound and outbound) using various methods (email, phone, online) for all participants, ensuring that staff are appropriately trained in the Business rules of the Orange County account.

2. Confirm that your company maintains appropriate staffing levels to serve participants in the respective programs at all times.

3. Confirm that covered persons will have year-round access to toll free customer services from 8:00 a.m to 8:00 p.m, Eastern Time, Monday through Friday. This customer service function shall be available, at the Proposer’s expense, during the Annual Enrollment period preceding the effective date of the Contract.

4. Confirm that your company will have a telephone system and staff capacity adequate to respond to covered persons within 24 hours.

5. Confirm that your company will be able to record and maintain information regarding service-related or other complaints reported by covered employees, retirees and/or employee representatives.

6. Confirm that your company can provide customer notifications regarding account balance, pending reimbursements and recent plan updates using various methods of communication (email alerts, text messages).

7. Confirm that your company can administer semi-annual customer service surveys and provide summary reports to the County.

3. ADMINISTRATION SUPPORT

A. ACCOUNT MANAGEMENT

Please confirm the following Services or list any Deviations in your Response.

1. Confirm that your company will provide advanced notification of any business mergers, along with complete disclosure of impact to current administration.

2. Confirm that your company will designate an account manager who is able to make decisions, or report to a person who can make decisions, concerning process changes as required to manage this account.

3. Confirm that your company will notify the County of any changes in account management or contact persons. Any change in the assigned account manager shall be approved by the County

4. Confirm that your company will maintain an up-to-date understanding and knowledge of the County’s account.

5. Describe employer tracking services that include statistical information on FSAs, COBRA enrollments, Direct Billing transactions and past due premiums. Please provide sample or access to demo site. Provide Link for evaluation.

6. Describe online enrollment capabilities for COBRA and Direct Bill participants and provide access to a demo site for the County’s review.

7. Confirm that your company currently provides account management reports and premium remittance reports to clients such as Orange County Government on a monthly basis. Please provide sample reports per service under Tab 2.

8. Please provide the format of your reports (e.g. PDF, Excel) by type.

9. Confirm that an Account Manager will be available to meet telephonically on a monthly basis, in person semi-annually or annually, and as deemed necessary by the County. .

B. COMMUNICATION AND MARKETING

1. Confirm your company’s ability to coordinate all communication and marketing activities related to Benefit Administrative Services.

2. Confirm that your Company will be responsible for all costs of producing, printing, and mailing/distributing adequate quantities of marketing and administrative supplies as designated by the County. The format and content of all materials used for the County account shall be satisfactory to the County.

3. Confirm and describe your company’s ability to provide electronic communications, upon approval by the County, directly to enrolled members.

4. Confirm the County can, prior to and during annual enrollment, develop general marketing and informational materials. The Company may use Company-specific informational materials, if deemed appropriate by the County, upon the County’s review.

5. Provide sample copies (under Tab 2) of your FSA, COBRA, Retiree and education materials, claim forms, explanation of payments/billing statements and claims denial letter. Indicate whether these can be customized for Orange County.

C. IMPLEMENTATION PROCESS

1. Describe your plan to seamlessly transition FSA, COBRA and Direct Billing information from another company, INCLUDING IMPLEMENTATION TIMELINES FOR THE COUNTY.

2. Identify the implementation and ongoing service team(s) who will be assigned to the County’s account, including staff expertise, knowledge, background, and training in the specific services proposed.

3. Confirm that your company shall accept enrollment and eligibility files from County’s payroll systems, in the County’s file format, at least 90 days prior to effective date

4. Confirm that your company shall provide a testing environment to review online services 30 days prior to start of Plan Year.

5. Describe your termination of service procedures. Include information on what will be provided to the County and the handling of run out and grace period claims. Please include any costs for termination services

6. Describe your company’s procedure for change in County vendors/carriers. Please include any costs for data set up and transfers/

7. Confirm that your company will interface with the County’s carriers, performing test and initial set up requirements prior to the County’s operational period.

4. PLAN COSTS AND GUARANTEES

Please provide your proposed fees in the format requested below.

A. FSA Enrollment

B. Please present your guaranteed rate quotes for each of the five years requested. RATES SHALL BE QUOTED ON A PER FSA PARTICIPANT PER MONTH BASIS.

There is should only be a Per Participant fee, even if the participant is enrolled in both a Medical FSA (Limited or Medical) and Dependent Care FSA.

FSA (Medical, Limited Purpose and Dependent Care) Administration

Per Mth Per Participant Per Mth Per Participant Per Mth Per Participant Per Mth Per Participant Per Mth

Under 1,000

1,000 +

Please indicate (x) below the FSA Services you are proposing and provide details of any additional fees associated with the service provided. Any additional fees shall be listed in this section.

Complete administration of Medical, Limited Purpose and Dependent Care Flexible Spending Accounts

Enrollment material describing the benefits of FSA participation

Section 125 Compliant Plan Document preparation

Regulatory Updates and Plan Amendments

Customer service telephonic and web page support for all FSA participants

Direct deposit of FSA reimbursements

Debit card option for participants

FSA information via website or telephone

Accounting services including check writing, funding requests, reconciliation

Management reports, including ad hoc report requests

Electronic data exchange in the County’s approved format (set-up and ongoing)

Carrier set-up fees

Change in file layout

Eligibility reconciliation

Records retention

Banking Options

Non-discrimination testing

C. Please present your guaranteed rate quotes for each of the three years requested. RATES SHALL BE QUOTED ON A PER COBRA PARTICIPANT PER MONTH BASIS.

COBRA Administration

Per Mth

Per Mth

Per Mth

Per Mth

Per Mth Annual Total

Please indicate (x) below the COBRA Services you are proposing and provide details of any additional fees associated with the service provided. Any additional fees shall be listed in this section.

Process COBRA elections within specified timeframes

Mail initial COBRA notices to new enrollees under the plan

Mail COBRA enrollment packets within specified timeframes. Enrollment packets should include information on enrollment and required plan notices

Mail Qualifying Event Notices to eligible employees and dependents

Premium calculation, billing to enrollees, and management of ongoing premium collection process

Pro rate monthly premium per effective date given by the County

Late notices and termination notices

Customer service for all COBRA participants

Directly interface enrollments, changes, and terminations to insurance carriers

Retain records pursuant to current regulations

Administrative guidance on changes in COBRA laws

Eligibility reconciliation with carriers

Liability for services rendered

D. Please present your guaranteed rate quotes for each of the three years requested. RATES SHALL BE QUOTED ON A PER RETIREE PARTICIPANT PER MONTH BASIS.

Retiree Billing Services

Per Mth Per Participant Per Mth Per Participant Per Mth Per Participant Per Mth Per Participant

Please indicate (x) below the Retiree Services you are proposing and provide details of any additional fees associated with the service provided. Any additional fees shall be listed in this section.

Premium calculation and billing to enrollees and management of ongoing premium collection process

Mail open enrollment packets within specified timeframes. Enrollment packets should include information on enrollment and required plan notices.

Pro rate monthly premium per effective date given by the County

Management of ongoing premium collection process

Coordination with FRS

Notice and premium payment to insurance carriers monthly

Premium reconciliation

Customer service for all Retiree participants

Eligibility reconciliation with carriers

Retain records

Directly interface enrollments, changes and terminations to insurance carriers

Coordination of enrollment with Medicare Supplemental Carrier

Coordination of enrollment with PDP carrier

E. Please present your guaranteed rate quotes for each of the three years requested. RATES SHALL BE QUOTED ON A PER DIRECT BILLING PARTICIPANT PER MONTH BASIS.

Direct Billing Services

Per Mth Per Participant Per Mth Per Participant Per Mth Per Participant Per Mth Per Participant

Please indicate (x) below the Direct Billing services you are proposing and provide details of any additional fees associated with the service provided. Any additional fees shall be listed in this section.

Premium calculation and billing to enrollees and management of ongoing premium collection process

Mail open enrollment packets within specified timeframes. Enrollment packets should include information on enrollment and required plan notices

Pro rate monthly premium per effective date given by the County

Management of ongoing premium collection process

Notice and premium payment to the County monthly

Premium reconciliation

Customer service for all participants

Eligibility reconciliation with the County

Retain records

F. You may provide additional pricing information for the Options below.

Per Mth Per Participant Per Mth Per Participant Per Mth Per Participant Per Mth Per Participant

Per Mth Per Participant Per Mth Per Participant Per Mth Per Participant Per Mth Per Participant

G. List the Performance Guarantees your Company has included in your premiums.

1. Implementation

2. Premium Remittance & Reports

a. Reconciliation of payments received and coverage effective dates

b. Collecting the appropriate premium based on participants coverage and age.

c. Following the County’s eligibility rules including rules for termination.

3. Customer Service

a. Average Speed of Answer

b. Abandonment Rate

c. Response to participant inquiry

d. Resolution of participant inquiry

4. Customer Satisfaction

8. Account Management

a. Annual Performance Survey

b. Notification prior to account management staff changes

9. Turnaround for end of year forfeitures

1. Confirm your company will provide performance guarantees to the County and shall offer a minimum 1.5% of the annual administrative fees as compensation for performance guarantees not met. Liquidated damages are a minimum of 1.5% of the annual administrative fees.

As an officer of the Company, I certify that the information contained in our proposal worksheet is accurate, and our Company will be bound by the contents of our proposal.

Signature: _____________________________ Date: ___________________

Name: ________________________________ Title: _____________________