Posted RFP's

RFP 540062010 Group Health/Dental Insurance
* Claim Expenses and Utilization
*Health Certificate of Coverage
-AQNA Benefits Summary
-AHJU Benefits Summary 
-BA3A Benefits Summary
Dental Certificate of Coverage
Detailed Dental Information
* Please note any modifications to RFP 540062010: Web Link is now www.putnamschools.org/rfp
Addendum No 1 Opening Time (8/29/2019)
Addendum No 2 Additional Information Required (8/30/2019)

* Q: Can you provide me with the total eligible count
* A: Information found here
        We have 1,598 active employees. 

* Q: Please provide a complete employee census including, home zipcodes, enrollment and coverage tiers for
 each line to be quoted.

* A: Health Information Rev.1 
       Health Information Rev.2 (posted 9/9/2019)
        Dental Information Rev. 1
        Dental Information Rev. 2 (posted 9/9/2019)


* Q: Are you looking for only fully-insured quotes or are you also looking for partially self-funded?
* A: We are fully-insured group now. We are looking for fully-insured quote.

* Q: The census shows approx. 733 enrolled but the claims exhibit shows as of June 2019, 799 enrolled.
We would like to know which number is correct?
* A: We will be off on count due to using June totals and current census due to termination for August 31st and
 new hires benefits not starting till October 1st. We had about 100 terms/retirements and about 100 new hires
and we are still hiring.

Updated 9-5-2019

*Q: This is more of a clarification, but are the months of July and August low in premium because of the 10 pay periods
arrangement currently?
*A: Yes we are a 10 pay September to June no payment in July and August.

*Q: Please confirm the dental rates should be Net of Commission.
*A: Yes, Dental rates should include commission.

*Q: Please advise how many employees are benefit eligible for the dental coverage 
*A: We have 1598 employees and everyone is eligible. 

*Q: Please confirm we are to provide dental rates based on 12 months but the school district only wants
billing for 10 months?
*A: Yes 

 

*Q: Please confirm the dental rates provided in the RFP are based on a 10 month billing cycle vs 12.
*A: Yes

 

*Q: Please advise if there have been any dental benefit changes since inception with UHC and if so,
advise accordingly
*A: No, We have not made any plan changes.

 

*Q: Please advise if the employer contributes towards the cost of the dental plan and if so, how much toward
 the employee and dependents.
*A: Putnam County dose not contribute any money towards the cost of dental care coverage for employees.
How ever the insurance carrier picks up the balance due to error on their part in establishing rates.

 

*Q: On page 11 of the RFP #48 last paragraph states the following:

The signature on the Proposer’s Warrant(ies) must be that of an officer, partner or a sole practitioner of the
company making the proposal. The original proposal, and each copy submitted, should contain an original
 signature on the Proposer’s Warranty contained in each Proposal Form.

Should in fact each copy contain an original signature or just the binder that is marked original as indicated
 on page 4 #11 in the RFP?
*A: Yes, each copy need original signature.

 

*Q: On page 6 of the RFP under Evaluation Criterion, #4 indicates that you request information on Provider
Network, however it does not appear that this has been addressed within the proposal format/questions of
the RFP.
*A: Yes, We have done an Addendum NO 2  adding additional required information. Please see web site.

 

*Q: Please provide a High Cost Case report with details of conditions.
*A: Please see attachments.

Premium vs claims incurred including IBRN
Hospital
Claims expenses by size of payment
Provider and market

*Q: Please confirm that the Medical/Health rates should be Net of Commission.
*A: Yes, rates should be NET Commission,  but if you have your own broker. Please provide rates net of
commission and including commission.

Updated 9-8-2019
*Q: Should we just be responding to the topics/narratives on pages 21 and 22 of the  RFP (i.e. Sections 1-7)
 and prior pages are just instructional?
*A: Please respond to all information in the RFP

 *Q: Based on the Addendum posted which only provided employee data, please provide a current Census
 (in stacked format) of all employees and dependents, indicating:
a. Medical coverage (UHC Plan and Coverage Type – Employee Only, E&S, E&C, Family) i. If coverage was
declined, the reason why
b. Dental coverage (Plan type and coverage type – Employee Only, E&S, E&C, Family)
c. See attached template for required information
*A: N/A

*Q: Please provide your last 3 Renewal Proposals (on Carrier letterhead) for both Medical and Dental.
*A: N/A

*Q: Please provide the Plan Documents or SBCs for both Medical and Dental. 
*A: Please see the following attachments
AQNA Benefits Summary
AHJU Benefits Summary
BA3A Benefits Summary
High Dental COC
Low Dental COC

 
*Q: Per RFP item #33 (on Page 8) – Claims and Enrollment Reporting, please provide: 
a. A list of all monthly claims and enrollment reports currently received from UHC
b. Sample copies of each report
c. A description of any additional reports your team would like to receive

*A:  Please see attachment.
Premiums vs Claims incurred including IBNR Claim expenses by size of payment Provider and Market Hospital
 Health Information Rev.2 
Dental Information Rev. 2
Putnam County School District Dental BCR 012018-062019

 

 

*Q: What percentage of your monthly Rx rebates are being returned to you (versus retained by the Carrier
and/or PBM)? Are these rebate distribution amounts currently being reported to you on a monthly basis?
*A: N/A

 

*Q: What type of access/transparency do you have to your current medical and Rx costs, in terms of monthly
 or quarterly reporting? Which of these types of reports do you currently receive and review from your
broker/TPA on a regular basis:

a. Gaps in Care
b. Predictive Modeling
c. Top 20 Rx costs and discounts
d. Top 20 Hospital Procedures and percentage of Medicare paid per provider
e. Hospital Billing Audits/Savings – errors found and corrected prior to payment.

 *A: Please see attachments.
Premiums vs Claims incurred including IBNR Claim expenses by size of payment Provider and Market Hospital

*Q: When is the last time you benchmarked your top 20 Rx costs against a Fiduciary PBM’s costs?
*A:  N/A

*Q: What is the effective date for each of the insurance plans?
*A: The effective date will be January 1, 2020.

 
*Q:  How many COBRA employees are included in these services? 
*A: We have 6 enrolled in Cobra.

 

*Q: Is your current broker providing the same services as listed in this RFP’s Scope of Services? If not,
what are the additional services?
*A: Yes

 

*Q:  If new brokers are identified by the Medical and/or Dental Carriers and accepted by the Board,
how does that impact the current responsibilities of the incumbent Consultant/Broker – Alexander and
 Company?
*A: The new broker will replace current health and dental broker.

 

*Q:  What is the satisfaction level of the incumbent Consultant/Broker, and are they meeting the full needs
 of the District? If not, which areas would the District like to see improvement?
*A: Skip

  

*Q: Is ACA compliance reporting/IRS forms (9400 and 9500) included in the Scope of Services? Are these
fees and costs billed separately?
*A: N/A

 

*Q: Are you currently using any type of web-ba
sed or online enrollment system? a. If so, what system is currently in place, and how is the cost covered?
*A: We will keep our current website.

 

*Q: What percentage of your employees use this online enrollment (versus paper forms)?
*A: All enrollment is done on the current website.

 

*Q: How frequently do you hold formal new hire sessions? What is average number of employees per session?
*A: We have new hire meetings in the months of July and August.  We have anywhere from 10 to 60 new hires
 per meeting.

 

Q: Please describe your current enrollment process and timeframes?

a. Number or employee meetings
b. Mandatory or voluntary attendance
c. Locations
d. Employee Communications i. Videos
ii. Emails
iii. Posters
iv. Incentives

*A:  Open enrollment is the month of October or November.  Meetings are at each school or department.
They are Mandatory. Emails and posters are sent out.

 

*Q:  Are there any percentage of the fees at risk to performance (annual savings, etc.?) a. If not – is this type
of performance-based pricing of interest? 
*A: Not currently.

 

*Q: Full plan certificates for each plan.
*A: Please see High dental COC and Low dental COC attached.
High Dental COC Low Dental COC

 

*Q: How are out of network claims reimbursed?
*A: Please see High dental COC and Low dental COC attached
High Dental COC Low Dental COC

 

*Q: What is the employer contribution percentage for each plan?
*A: Putnam does not contribute to dental.  It is self paid by employee.

 

*Q: Excel census with dental tier and plan elections.
*A: Please see attachment
 Dental Information Rev. 2

 

*Q:Recent bill
*A: Not available

 

*Q: Claims data from UHC back to 1/1/2017 split out by plan with paid claims, premium, and lives. 
*A: Please see attached 
Putnam County School District Dental BCR 012018-062019

 

*Q: Any rate or plan changes since 1/1/2017 with UHC?  *A: NO rate or plan change since 2017.


*Q: Please provide the following information for the above referenced RFP Detailed Dental Benefits Summaries Dental Certificate Of Coverage 24 Months Dental Claims Experience Employer Contributions for Dental Dental-Out of Network Reimbursement ( ie. U&C or In-network Fee Schedule) *A: Please see attachment  Dental High Dental Low Dental Client Experience
*Q: Will the School District fund any portion of the EE/Dependent deductibles, if so dollar amount funded?
*A: No, Putnam County Schools will not pay any money toward deductible for any plans for health or dental.
*Q: What is the School District contribution toward the monthly cost of coverage for EE/Dependents costs for both Medical and Dental? *A: Putnam County Schools gives all employees’ $450.00 amount and MOU of $75.00 for active employees a total of $525.00.
*Q: This is more of clarification, but are the months of July and August low in premium because of the 10 pay periods arrangement currently? *A: Yes we are a 10 pay September to June no payment in July and August.
*Q: Please confirm if the dental rates currently include commissions? If so, please advise what the commissions is to quote. *A: Yes, Dental rate are currently commission.   
*Q: Or are the dental rates net of commissions?   *A: Dental rate currently include commission we have a broker
*Q: Please provide the details of the current bundling discount with UHC? *A: We received a 1% discount on dental.
*Q: We just wanted to check if there was an Employee Assistance Program in place because it mention on pages 15 and 21, 4.1.B for member engagement tools. *A: We DO NOT have a Employee Assistance Program ( EAP) in our group health plan. We are asking if your plan will have EAP
*Q: Should we just be responding to the topics/narratives on pages 21 and 22 of the  RFP (i.e. Sections 1-7) and prior pages are just instructional? *A: Please respond to all information in the RFP.
*Q: Please provide a High Cost Case report with details of conditions *A: Please see attachment.
*Q: Please provide additional premium details on July and August 2018 collected revenue on the dental experience report.  The two summer months appear to be billed $1 PSPM ($795 & $796) and it is noted in the RFP tenthly billing is used. *A: We are a 10 month payment group. We pay September to June. NO payment for July and August.

*Q: Please provide the dental claim experience separated by utilization (par vs non-par). *A: Please explain what par vs non-par means? *Q: We would like to get some clarification regarding the dental census provided…
 The census provided includes for “deduction desc” and is not clear as to which plan the employee selected.  It appears the low plan is “ST” or standard, and the high plan is “P” or premium.  However, there a quite a few that do have that designation.  Can we request another census that clearly indicates the plan the employee has?  We will need age, gender, zip, dental plan (standard or premium), and tier of coverage for each employee covered. *A: Please see attachment.
*Q: Please confirm that the Medical/Health rates should be Net of Commission. *A: Yes, rates should be Net Commission, but if you have your own broker. Please provide rates net of commission and including commission.
*Q: Employer Contribution for dental: *A: Putnam County School District does not make a contribution to dental coverage it is self paid by employee.
*Q: Please provide a dental rate history for both dental plans since inception with UHC *A: No, changes made.
*Q: Will the School District fund any portion of the EE/Dependent deductibles, if so dollar amount funded?
*A: No, Putnam County Schools will not pay any money toward deductible for any plans for health or dental.
*Q: What is the School Districts contribution toward the monthly cost of coverage for EE/Dependents costs for both Medical and Dental? *A: Putnam County Schools gives all employees $450.00 amount and MOU of $75.00 for active employees a total of $525.00.
*Q: What are the employer contributions to dental coverage? *A: Putnam County does not contribute any money towards the cost of dental care coverage for employees.  However the insurance carrier picks up the balance due to error on their part in establishing rates.
*Q: Should our group respond to Sections 1-7 (pgs.12-20), in addition to the questionnaire on pgs 21-22? *A:Please respond to all information in the RFP.
*Q: Should all of the bid forms, 1 original and 10 copies, contain a "Wet signature"? *A: Yes, each copy needs original signature. 
*Q: Is there a current Employee Assistance program in place?  If so, please provide any policies and plans that are in place. *A: We DO NOT have an Employee Assistance Program (EAP) in our group health plan. We are asking if your plans will have EAP. 
*Q: Please provide the full dental certificates for both high and low dental plans Please advise how out of network is reimbursed on the dental plans?  Fee schedule or U&C and %? Please provide a dental census to include:  DOB, Gender, Zip Code, Active, Retiree, Cobra, Dental High or Low Plan and Tier of coverage Please provide updated dental claim experience separated by plan (high and low) for the most recent 24 months to include enrolled, premium and claims by month Please provide a member report including a count of subscriber and all dependent members (spouse and all children) by month for the past 12 months *A: Please see attachment High Dental COC Low Dental COC RFP Dental Information rev 2 Putnam County School District Dental BCR 012018 - 062019
*Q: Please provide the benefit summaries and COB’s for each medical plan listed in the RFP  Please provide a census (in Excel document) of all full time employees, regardless of enrollment status including, date of birth home zip codes, enrollment by plan and coverage tiers for medical and dental plans to be quoted. Please include retirees and COBRA participants on the census for both Medical and Dental *A: Please see attachment. RFP Health Information Rev 2 AQNA Benefits Summary AHJU Benefits Summary BA3A Benefits Summary
*Q: Please provide monthly premium vs. claims (Medical/Rx) reports from January 2017 thru most current month available. Please provide paid high cost claims for the same time period as the premium vs. claims *A: Please see attachment. Premiums vs Claims incurred including IBNR Claim expenses by size of payment provider and market hospital
*Q: Can you provide monthly claims and lives, split by dental plan? *A: Please see attachment. Health/Dental Enrollment Count Putnam County School District Dental BCR 012018-062019
*Q: What is the current participation level in dental coverage? *A: Please see attachment. Client Experience and Utilization for dental
*Q: Could you provide detailed benefit summaries for both dental plans? Can you provide a census that indicates Dental Plan Selection? Can you provide monthly claims and lives, split by dental plan? Please provide a dental top utilized procedure report. What is the current participation level in dental coverage? *A: Please see attachment. High Dental COC Low Dental COC RFP Dental Information rev 2 Putnam County School District Dental BCR 012018 - 062019
*Q: Large Loss with diagnosis report *A: Please see attachment UHC Large Loss with Diagnosis Report
Updated 9/10/2019
*Q: Please confirm the “Proposer’s Warranty” is the form listed on Pg 23 of the RFP *A: The information on pg 23 is self explanatory. 
*Q: What is your dental fee/commission? *A: The commission for dental is 7%.
*Q: Confirm with you the true total eligible lives count? Initially it was entered as an estimate of 1620 and unless I am missing it, I am not seeing any documentation showing that. The initial census we got which only lists medical enrollment is 966 lives.  I was hoping the new census would clear this up but it only provided a listing of members enrolled not including all eligible.  Since this is voluntary dental we need to get a good idea of what the participation is. *A: Please see attachment RFP All Employee Census
*Q: Is there more information about the “rollover provision” for each dental plan? There is not an amount listed in the CCOC’s. Also, is there a known out of network reimbursement level for each plan? *A: Please see attachment. Dental Putnam School District UHC DE Sold Benefit
*Q: Are you able to provide a large claim report with diagnoses? *A: Please see attachment. UHC Large Loss with Diagnosis Report
*Q: Please provide a provider claims listing to include the top 50 dental provider by claims paid. *A: Please see attachment UHC Dental Top Provider by paid amount

*Q: Is there more information about the “rollover provision” for each dental plan?
There is not an amount listed in the CCOC’s
  
*A: For the CMM annual rollover
If you have a $750.00  limit and don’t use more than  $250.00  you get $125.00  roll and if you use a in network
 dentist you get another $100.00
If you have a $1000.00 limit and don’t use more than  $500.00  you get $250.00  rollover and $100.00 if you
use a INN dentist.
If you have a $1500.00  plan limit and don’t use more than $750.00  you get $400.00  and another $100.00  for
 using a INN dentist.

Updated 9/12/2019
*Q:  Will the existing contract for the incumbent Consultant/Broker be released for competitive solicitation 
in 2019 or 2020?
*A: January 1, 2020 for dental and health  and consultant/broker will be fall of 2020. 

*Q: Please provide an electronic claims file for the past 12 months including date of service, procedure code, provider information to include location, TIN, address & zip code, network status (in vs out), submitted charge and allowed charge. *A: Not Available
*Q: Please provide a provider claims listing to include the top 50 dental providers by claims paid. *A: Please see attachment UHC Dental Top Provider by paid amount
*Q: Clarification provided for the question below: Please provide the dental claim experience separated by utilization (participating vs non-participating providers) Participating = In Network Non-Participating = Out-of-Network *A:Please see attachment UHC Dental Top Provider by paid amount


 

 


RFP 540312012 Contracted Site Work