Student Health 2012/13 Request for Purchase Student Health Insurance Plan Proposal

Transcription

1 February 10, 2012 Student Health 2012/13 Request for Purchase Student Health Insurance Plan Proposal

2 Contents 1. Background General Information Proposal/Administration Requirements Plan Design Summaries Financial Proposal Questionnaire Appendix A: Data for Quotation Appendix B: Performance Guarantees Student Health Insurance Request for Purchase (2012/13) i

3 1 Background The purpose of this Request for Proposal (RFP) is to obtain competitive proposals for fully insured student health care coverage for institutions that are members of the North Dakota University System (). The North Dakota University System includes 11 campuses: two world-class research institutions, four outstanding regional universities and five vibrant community colleges. For more information, visit Each campus offers different learning and living experiences, and all share a commitment to excellence and personal and professional growth. Whether students are preparing to provide health care, teach math, manage businesses, conduct research or overhaul trucks, when they leave our campuses they are prepared to be the best in their fields. Our investment in technology and the connectedness of our campuses give University System students incredible access to instruction, no matter where they live. Through partnerships with business, industry and government agencies, the campuses provide training, conduct research and stimulate economic growth - brightening the future for all of us. Access. Excellence. Innovation. All are hallmarks of the North Dakota University System. Current RFP Process for Student Health Insurance Agreement Recommendation The current Student Health Insurance Agreement provides coverage through 08/15/2012. The Student Affairs Council unanimously adopted a recommendation at its July 14, 2011 meeting to rebid the coverage. The SBHE Budget, Audit and Finance Committee granted approval to rebid the student health insurance contract on November 9, The Sub- Committee has developed an RFP timeline which will identify a student health insurance program/vendor to be in place for Fall Sub-Committee group membership includes: Michelle Eslinger, Director, Student Health Services, UND Chair Chelsea Larson, Student Account Operations Manager, Student Account Services, UND Raymond Lagasse, Director, International Programs, UND Wayne Swisher, Interim Dean of the Graduate School, UND Alicia Kauffman, Associate Director, International Programs NDSU Peggy Lucke, Associate Vice President for Finance & Operations, UND Student Health Insurance Request for Purchase (2012/13) 2

4 Mark Lowe, Comptroller, DSU Stacey Winter, Purchasing Director, NDSU David Wittrock, Dean of the Graduate School, NDSU Olivia Spencer, Student Representative named by NDSA (Student, NDSU) Senior Staff oversight: Michel Hillman, Vice Chancellor for Academic & Student Affairs SBHE oversight: Duaine Espegard, Vice President for N.D. State Board of Higher Education The and the State Board of Higher Education (SBHE) support initiatives to increase regional collaboration and achieve outcomes that could not be realized by institutions and systems acting independently. All of the institutions participate in the solutions established by the. The combined enrollments for the eleven institutions total over 48,833 students (Headcount Enrollment, Fall 2011). The Sub-Committee is charged with exploring regional initiatives to improve higher education productivity for colleges and universities that face increasing costs for student health care. The committee consists of a wide cross section of experts in student health benefits from campuses across the The Sub-Committee is looking for the student health care initiative to provide its colleges and universities health insurance for their students with cost-savings that could only be achieved by working collaboratively. The believes that this sort of initiative will offer unique advantages and benefits to participating institutions that cannot be readily achieved through institutions seeking this on an individual basis. SBHE policy mandates that all international students (excluding those from Canada and Norway) must have health insurance coverage. In addition, some institutions may mandate coverage for graduate students and students in certain undergraduate programs. Pending full implementation of the Patient Protection and Affordable Care Act of 2010, health insurance coverage for other students is voluntary. This RFP is designed to solicit proposals for a plan that satisfies SBHE policy and individual institution requirements. According to SBHE Policy 505, international students not exempt or granted a waiver must participate in a plan approved by the chancellor. However, given that institutions have differing student health insurance needs, the selected plan must be designed with flexibility to meet those varying needs. Each institution will still dictate whether the plans are voluntary or mandatory for students other than international students, what the plan design will look like (although there will be limits on the options available) and how administration will occur. Current procedures that apply at all institutions provide that institutions shall collect plan premiums for international students for whom coverage is mandatory and submit payments to the insurance provider not later than the sixth week in each term. Institutions do not enroll or collect premiums for students for whom coverage is not mandatory. Although all eleven institutions are subject to SBHE policy requirements and participate in the RFP, please note that preference is to allow flexibility for each of these institutions and an opportunity to buy up or down on specific plan design options as driven by the demographics of their student constituency as warranted. Student Health Insurance Request for Purchase (2012/13) 3

5 The Sub-Committee will evaluate proposals received on the following criteria: Flexibility in providing a solution for this collective program Cost History, Current Cost, and Projected Cost guarantees Network access and provider contracts Provider disruption Accurate, timely claims administration Quality of customer service Competitive retention/expenses Flexible funding arrangements Reporting capabilities Expertise in student plans Ability to administer enrollment waivers INSTITUTIONAL ABBREVIATIONS BSC DCB DSU LRSC MaSU MiSU NDSCS NDSU UND Bismarck State College Bismarck, ND Dakota College at Bottineau Bottineau, ND Dickinson State University Dickinson, ND Lake Region State College Devils Lake, ND (prior to 1999, LRSC was aligned under UND and thus referred to as UND-LR) Mayville State University Mayville, ND Minot State University Minot, ND North Dakota State College of Science Wahpeton, ND North Dakota State University Fargo, ND University of North Dakota Student Health Insurance Request for Purchase (2012/13) 4

6 Grand Forks, ND VSCU WSC Valley City State University Valley City, ND Williston State College Williston, ND (prior to 1999, WSC was aligned under UND and thus referred to as UND-W) Source: For purposes of this RFP, utilized Pages (Table 11 & Table12) Headcount Enrollments by State (using Canada & Other International Totals, Using Students Reported Home Address). NOTE: International Students are co-mingled in undergraduate, graduate, and professional student headcounts and thereby, already counted in Total Headcount figures reported in section that follows. A grand total of 2,241 International Students in the N.D.U.S. Student Health Insurance Request for Purchase (2012/13) 5

7 Detail on Institutions BSC DCB DSU Location Nature of University North Dakota Zip Codes: Public university One campus/ location North Dakota Zip Codes: Public university One campus/ location North Dakota Zip Codes: Public university One campus/ location 2011 Fall Enrollment Total Headcount 4,392 undergraduate students xxx graduate students 13 international students 4, undergraduate students xxx graduate students 36 international students 812 2,346 undergraduates students xxx graduate students 314 international students 2,346 Eligibility Mandatory / Hard Waiver For International Students Voluntary all others Coverage Effective Date Annual: August 15th August 14th Mandatory / Hard Waiver For International Students Voluntary all others Annual: August 15th August 14th Mandatory / Hard Waiver For International Students Voluntary all others Annual: August 15th August 14th LRSC MaSU MiSU Location Nature of University North Dakota Zip Codes: Public university One campus/ location North Dakota Zip Codes: Public university One campuses/ location North Dakota Zip Codes: Public university One campus/ location 2011 Fall Enrollment Total Headcount 2,056 undergraduate students xxx graduate students 20 international students 2, undergraduate students 21 graduate students 29 international students 970 3,367 undergraduates students 290 graduate students 332 international students 3,657 Eligibility Mandatory / Hard Waiver For International Students Voluntary all others Mandatory / Hard Waiver For International Students Voluntary all others Mandatory / Hard Waiver For International Students Voluntary all others Coverage Effective Date Annual: August 15th August 14th Annual: August 15th August 14th Annual: August 15th August 14th Student Health Insurance Request for Purchase (2012/13) 6

8 Detail on Institutions (continued) NDSCS NDSU UND Location Nature of University North Dakota Zip Codes: Public university One campus/ location North Dakota Zip Codes: Public university One campus/ location North Dakota Zip Codes: Public university One campus/ location 2011 Fall Enrollment Total Headcount 3,127 undergraduate students xxx graduate students 11 international students 3,127 11,911 undergraduate students 2,146 graduate students 853 international students 342 professional students 14,399 11,522 undergraduates students 2,673 graduate students 526 international students 502 professional students 14,697 Eligibility Mandatory / Hard Waiver For International Students Voluntary all others Mandatory / Hard Waiver For International Students Voluntary all others Mandatory / Hard Waiver For International Students Voluntary all others Coverage Effective Date Annual: August 15th August 14th Annual: August 15th August 14th Annual: August 15th August 14th VCSU WSC Location Nature of University North Dakota Zip Codes: Public university One campus/ location North Dakota Zip Codes: Public university One campus/ location 2011 Fall Enrollment Total Headcount 1,227 undergraduates students 157 graduate students 41 international students 1, undergraduates students xxx graduate students 66 international students 993 Eligibility Mandatory / Hard Waiver For International Students Voluntary all others Mandatory / Hard Waiver For International Students Voluntary all others Coverage Effective Date Annual: August 15th August 14th Annual: August 15th August 14th Student Health Insurance Request for Purchase (2012/13) 7

9 2 General Information Award or Rejection All qualified proposals will be evaluated and the award, if any, will be made on the basis of what the believes to be in its students best interests and its decision will be final. The chancellor has final approval authority. Notification will be made in writing. Proposal Deadline Your response must be received no later than 5:00 p.m., Wednesday, March 7, 2012 with (2) original, hard copies of your proposal and (1) electronic copy. Proposals should be sent to: As determined by N.D.U.S Stacey Winter Director, Purchasing (NDSU Dept 3150) North Dakota State University Old Main 17 P.O. Box 6050 Fargo, ND Phone: (701) Fax: (701) Student Health Insurance Request for Purchase (2012/13) 8

10 Project Timing The following schedule has been established for selecting a vendor: Activity Date Distribute bid specifications February 15, 2012 Proposal due March 7, 2012 Vendor Matrix Evaluation Criteria Finalists are selected Week of March 12, 2012 Conduct finalist interviews Week of March 26, 2012 Joint Student Affairs & Academic Affairs Meeting April 3 rd & 4 th, 2012 Final vendor selection is completed Week of April 9, 2012 Prepare findings and recommendations to to Approve May 10, 2012 Finalize brochure and contract May 15, 2012 Sign contract July 1, 2012 Effective date of contract August 15, 2012 The above timetable may be changed or modified by the Sub-Committee at its discretion. Vendors who cannot meet the timing requirements must immediately notify in writing. Binding Proposal Acknowledgment Each proposal must be signed by a duly authorized officer of the bidder and the completed proposal shall be without alterations. All representations made in your proposal will be binding. Student Health Insurance Request for Purchase (2012/13) 9

11 3 Proposal/Administration Requirements Please review the following requirements. We have prepared the following information for your use. We will assume these conditions have been reviewed and accepted by an executive of your company unless specifically indicated at the end of this section. Administrative Requirements 1. The group contract holder is: 2. The effective date of the plan is as detailed in the background information for each school for the plan year, effective at 12:00A.M of the start date. 3. The contract will cover all eligible full-time, part-time, resident and international (on F-1, J- 1, and M-1 visas) students and their dependents (spouses, and children). In addition, this contract includes coverage for J-1 Visiting Scholars. Eligibility and coverage requirements will be determined by the 4. Confirm that your firm is an admitted carrier in each of the campus locations. 5. You are required to takeover all current eligible participants on a no-loss/no-gain basis (i.e. you agree that you will waive all pre-existing conditions exclusions and that all eligibles currently with coverage will not lose coverage when the new plan year begins). Any claims incurred prior to the effective date will be the liability of the current carrier. 6. Newly eligible dependents will be enrolled within 31 days of the qualifying event with a retroactive effective date. Student Health Insurance Request for Purchase (2012/13) 10

12 7. Please see Section 4 for summaries of the proposed plan design. In the event that you cannot match the current plan, you must replicate the plan design as closely as possible and provide (1) a detailed summary of your proposed plan design, AND (2) a detailed comparison that highlights differences between the current plan and your proposal. This comparison should include coverage items, limitations, and exclusions. Please be aware that preference will be given to plan designs that meet minimum compliance standards as it relates to essential health benefits. Essential health benefits need to keep premiums affordable and cost sharing provisions within reasonable limits. Standards to be referenced when determining compliance will include one, both, or a combination thereof: o The American College Health Association (ACHA) published standards for student health insurance and benefits programs in 2008 that call for: mandates for coverage, and benefits that include preventive health services, catastrophic illness or injury, prescription medications including psychotropic medications and the minimization or elimination of pre-existing condition exclusions/waiting periods. o Comparatively, the Affordable Care Act (ACA) describes essential health benefits as including at least these ten categories of services: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental/behavioral health and substance use disorder services; prescription drugs; rehabilitative services an devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care. Student health care plans may be subject to certain health care reform legislation. Given that the regulations change from year to year, selected lead vendor will be responsible to research and update the plan(s) annually to ensure that they are compliant with the new regulations. All benefits are subject to insurance laws, which can vary by state. 8. The reserves the right to audit from time to time, either directly or through its authorized agent(s), your compliance with the terms of the contract. The will further reserve the right to perform a chart audit or other appropriate review to assess the quality of any clinical or other services performed by you or your affiliated health care providers upon reasonable advance notice to you. Upon providing appropriate assurances as to compliance with applicable HIPAA and other relevant privacy standards, you will agree to provide the or its authorized agent(s) with medical records as well as any data needed to perform audits or other reviews. Student Health Insurance Request for Purchase (2012/13) 11

13 9. You will demonstrate adoption of arrangements to protect the and plan participants from incurring liability for payment of any premium which are your legal obligation, including but not limited to (i) sufficient insolvency and liability insurance, (ii) a contractual arrangement with medical providers affiliated with you that prohibits such providers from holding any participant liable for payment of any premium which are your obligation, and (iii) other protection from liability for participants as provided by applicable state or federal laws. 10. The shall not be liable for any part of any overpayment of plan benefits, judgment or settlement, including, but not limited to, attorneys fees, compensatory, and punitive damages, caused by or arising out of any acts or omissions of you, your employees or your agents. You will indemnify and hold harmless the for any of these or related expenses caused by or arising out of such acts or omissions, including attorneys fees. 11. To the extent applicable, you are and will remain duly licensed and in full compliance with all federal and statutory administrative requirements and mandates for each institution, and will notify the of any action or proceeding which could affect endorsed plan within ninety (90) days of the initiation of such action or proceeding. 12. You will act promptly in response to complaints made by participants and beneficiaries, maintain written records of such complaints, and make grievance appeal and ERISAcompliant procedures available where applicable when addressing such complaints. Upon providing appropriate assurances as to compliance with HIPAA and other relevant privacy standards, the shall have the right to inspect such written records during normal business hours upon notice to you. 13. You will agree to commit personnel resources once a month to physically be present on campuses to assist students with claim questions for the first year of the contract, as needed. 14. You or your subcontractors, agents, and employees, including health care providers affiliated with you, shall at all times be acting as independent contractors of the and not as their agents. Determination of the extent and nature of health care services to be provided to participants shall be made exclusively by you and your affiliated health care providers. 15. Your organization will draft, produce, and deliver to a centralized location within respective Student Affairs and/or Academic Affairs Division(s) customized enrollment information (e.g., student packets, benefit summaries, provider directories, etc.) for all eligible students for the line(s) of coverage you will administer. Your organization has the ability to complete a direct mailing to eligible students over the summer term if requested, and prior to anticipated start date of academic term(s) for respective campuses that enroll Graduate and/or Professional Students. staff should have the opportunity for editing and final editing. The cost of this must be included in your premium and drafts must be finalized by May 1 for the plan's next policy beginning date the first year. Subsequent years request that premium and drafts must be finalized by March 1 for the plan s next policy beginning date. Student Health Insurance Request for Purchase (2012/13) 12

14 16. Claims reports, upon request, must be able to be broken out by multiple (but not more than 4) reporting levels for EACH plan; show utilization by age/sex, student/dependent status, and type of service; and show benefit category by claim amount. 17. You must be willing to provide 30 hours of ad hoc reporting each year at no additional charge. 18. You must have the capability to support several group numbers and various levels of benefits. 19. You will allow a grace period of at least 90 days for payment of premium. 20. You must agree to conduct quarterly account meetings with the 21. You will name one account executive and one service representative to be the central source of information and primary contact with the 22. You must be willing to conduct annual -specific customer satisfaction surveys. Such surveys will be pre-approved by the 23. Your network must include the specific facilities identified by each member institution 24. You must be willing to enter into performance guarantees with the as outlined in Appendix B. 25. You must notify the in writing at least sixty (60) days prior to any changes in network providers that will impact ten (10) or more students (e.g., elimination of hospital from network, reduction in number of contracted lab facilities). 26. You must be able to produce electronic provider directories on-line (and paper on a limited basis). The cost of producing and distributing provider directories to students must be included in your rates. 27. You must fully comply with the provisions outlined by the during implementation and once the plan is effective. 28. If required, you agree to assist with the implementation and/or transition of information from the prior or current vendors, including but not limited to pre-determination of benefits, deductibles, and plan and lifetime maximums. 29. Please provide hard copies of the following for the s review: (a) sample management reports (claims/utilization) (b) implementation plan and (c) sample customer call documentation screen with data fields and (d) sample EOB. Please denote compliance with request below. 30. The carrier must have an A.M. Best rating of A- or better. Rating: Date: Student Health Insurance Request for Purchase (2012/13) 13

15 Financial Requirements 31. All rates should include annual commissions of 1.5% and be guaranteed for a minimum of 12 months. 32. Annual renewals must be provided by January 10th of every year. 33. Quarterly and annual claims and utilization summary reports shall be delivered to the within 30 days following the end of the reporting period. 34. Include a $50,000 credit to be utilized for the purpose offsetting implementation costs for the selection and implementation if a new vendor is selected Student Health Insurance Request for Purchase (2012/13) 14

16 Acceptance of Requirements Lead vendor, on behalf of all sub-contractors, agrees to the provisions of the specifications: Without exception With exceptions described above Lead vendor: Location: Signature: Officer's Name: Title: Date: Student Health Insurance Request for Purchase (2012/13) 15

17 4 Plan Design and Plan Changes See Appendix A for summaries of the current plan design and historical plan changes. The following table summarizes the proposed plan design and options that would be made available to the participating institutions. Proposed SAMPLE Plan Design Plan Design In-Network Out-of-Network Policy Year Benefit Maximum Base Plan: Option 1: $100,000 per policy year Option 2: $200,000 per policy year Supplemental Buy-Up Plan: Option 3: $500,000 per policy year Option 4: $750,000 per policy year Option 5: $1,000,000 per policy year Out of Pocket Max (not incl. ded) Option 1: $2,500 Individual; $5,000 Family Option 2: $5,000 Individual; $10,000 Family Option 1: $5,000 Individual; $10,000 Family Option 2: $10,000 Individual; $20,000 Family Deductible Amounts Option 1: $100 Individual; $200 Family Option 2: $300 Individual; $600 Family Option 3: $500 Individual; $1,000 Family Option 1: $200 Individual; $400 Family Option 2: $600 Individual; $1,200 Family Option 3: $1,000 Individual; $2,000 Family Student Health Center 100%, no deductible Student health referral options Option 1: referral required Option 2: no referral required N/A Coinsurance 80% 60% Student Health Insurance Request for Purchase (2012/13) 16

18 Proposed SAMPLE Plan Design Plan Design In-Network Out-of-Network Office Visits (Deductible waived) Preventive $25 60% Primary Care $25 60% Specialist $25 60% Hospital Facility Inpatient 80% 60% Outpatient 80% 60% Hospital Physician Inpatient 80% 60% Outpatient 80% 60% Emergency Room $150 copay then 80% $150 copay then 60% Mental Health Inpatient 80%; max 30 days 60%; max 30 days Outpatient 80%; max 50 visits 60%; max 50 visits Substance Abuse Inpatient 80%; max 30 days 60%; max 30 days Outpatient 80%; max 50 visits 60%; max 50 visits Other Services 80%; Limitations for Consideration: 1. Physical Therapy: Max 60 visits/condition 2. Pre-existing condition: 6/6 3. Dental accident: $5,000 max 4. DME: $5,000 max Prescription Drugs Option 1: $5,000 maximum benefit per policy year Option 2: $2,500 maximum benefit per policy year Retail Copayments Generic $10 Formulary $30 Non-Formulary $50 Mail Order (Optional) Option 1: Not Offered Option 2: Offered at Copays: Generic $20 Formulary $60 Non-Formulary $100 60%; Limitations for Consideration: 1. Physical Therapy: Max 60 visits/condition 2. Pre-existing condition: 6/6 or none 3. Dental accident: $5,000 max 4. DME: $5,000 max N/A Student Health Insurance Request for Purchase (2012/13) 17

19 Exclusions The following table summarizes typical exclusions, and whether the would like those as exclusions, or would like to have those benefits covered under the plan. Exclusion SAMPLE Plan Pre-existing Exclusion 6/6 Medical evacuation and repatriation Covered Option 1: Medical evacuation minimum threshold at $10,000 and repatriation at $7,500 Option 2: Medical evacuation minimum threshold at $20,000 and repatriation at $15,000 Aerial navigation Excluded Elective Abortion Option 1: Covered up to $500 per policy year Option 2: Excluded Contraceptives Covered ADD Testing covered; treatment excluded Gender reassignment Covered up to $25,000 benefit per lifetime Prosthetics Covered Vision, hearing Excluded; provide discount programs only Infertility IC Sports Suicide, alcohol, addiction Congenital Defects Organ transplants Weight reduction Other Option 1: Vision, hearing (if available via 3 rd party) Option 2: Dental ( if available via 3 rd party) Testing covered; treatment excluded Option 1: Excluded Option 2: Covered up to $10,000 per policy year Option 1: Covered Option 2: Excluded Covered Covered Not covered Cover acne benefits/prescriptions, foot care; Exclude TMJ, hirsuitism, sinus surgery If you have other exclusions other than those listed above, and they cannot be removed from the contract, please list them in detail and include them as a separate attachment to your response. Deviations If any edits are made to the plan design provisions or exclusions noted above, please include a separate page explaining why you plan cannot administer that specific plan provision as requested Student Health Insurance Request for Purchase (2012/13) 18

20 5 Financial Proposal Eleven schools have provided their experience and current rates as provided in the appendix. These eleven schools are: Bismarck State College Dakota College at Bottineau Dickinson State University Lake Region State Colllege Mayville State University Minot State University North Dakota State College of Science North Dakota State University University of North Dakota Valley City State University Williston State College The first rate exhibit, Exhibit 1, requests one set of rates (blended) that would be charged to all eleven schools. The second rate quote exhibit, Exhibit 2, that follows must be completed for each of these eleven schools, as well as a manual rate for schools deciding to join endorsed plan for the 2012/2013 school year. Each of the eleven institutions should be rated on their own experience, with the exception of pooling, that you are recommending using in the underwriting methodology. For the manual rates for schools other than the eleven institutions that provided data, please provide your approach on development of rates. Student Health Insurance Request for Purchase (2012/13) 19

21 The following assumptions apply: Rates must be quoted on a firm basis for the effective dates listed in the Background section. The new carrier must work with incumbent vendor to coordinate continuation of care services. Include the cost of providing the following in your rates: A toll-free member services number Provider directories ID cards Standard data reports Local account service for each member Rates are guaranteed for a minimum of 12 months. Quotes should assume the plan design noted in Section Verify that all rates quoted are guaranteed for a minimum of 12 months. 2. Indicate if your plan agrees to multiple year rate guarantees. Explanation: *** Multi-year rate guarantees will be looked upon very favorably by the Minimum contractual obligation of three years with maximum of five years, with option of annual review and renewal anticipated. 3. Confirm that your quote is not contingent upon any minimum participation requirements. If so, please disclose. 4. Discuss any implementation credit or allowance that you are proposing: a. the amount b. how it can be used c. when and how it will be paid d. required paperwork 5. Provide any other quote stipulations not disclosed above. 6. Please indicate the pooling point used in your rating of the core eleven universities. Student Health Insurance Request for Purchase (2012/13) 20

22 Rate Quote Exhibit 1 (Blended Rate) Proposed Rates Base (Option 1) Design All Institutions Blended Annual Rates 2012/2013 Student Only $ Spouse $ Child or Children $ All Institutions Blended Annual Rates Student Spouse Child(ren) Per Policy Year Benefit Maximum Option 2: $500,000 Per Policy Year Benefit Maximum Option 3: $750,000 Per Policy Year Benefit Maximum Option 4: $1.000,000 Out-of-Pocket Maximum Option 2: $5,000/$10,000 in-network network (2 out of net work) Deductible Option 2: $300/$600 in-network (2 out of net work) Deductible Option 3: $500/$1,000 in-network (2 out of net work) Student Health Center Option 2: no referral required Mail Order Prescription Drugs Option 2: Offer mail order at 2 retail copayments $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Elective Abortion Option 2: Excluded $ $ $ IC Sports Option 2: Excluded $ $ $ Suicide, Alcohol addiction Option 2: Excluded $ $ $ Rate Quote Exhibit 2 (Separate Exhibit for Each Institution) Proposed Rates Base (Option 1) Design Institution Name Annual Rates 2011/2012 Student Only $ Spouse $ Child or Children $ Student Health Insurance Request for Purchase (2012/13) 21

23 Impact on Annual Rates of Other Options Provide the impact on the annual rates quoted above, for the other possible options that the institutions would be able to elect. Each impact amount should be additive, so that institutions can pick and choose their desired benefits and add up the pieces for all possible combinations. Institution Name Annual Rates Student Spouse Child(ren) Per Policy Year Benefit Maximum Option 2: $500,000 Per Policy Year Benefit Maximum Option 3: $750,000 Per Policy Year Benefit Maximum Option 4: $1.000,000 Out-of-Pocket Maximum Option 2: $5,000/$10,000 in-network network (2 out of net work) Deductible Option 2: $300/$600 in-network (2 out of net work) Deductible Option 3: $500/$1,000 in-network (2 out of net work) Student Health Center Option 2: no referral required Mail Order Prescription Drugs Option 2: Offer mail order at 2 retail copayments $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Elective Abortion Option 2: Excluded $ $ $ IC Sports Option 2: Excluded $ $ $ Suicide, Alcohol addiction Option 2: Excluded $ $ $ Student Health Insurance Request for Purchase (2012/13) 22

24 Rate Development Base Plan Design for 2012/13 Please provide estimated annual dollar amounts used in your underwriting and rate development. Projected Claims a. Medical $ b. prescription drugs $ c. pooled claims Projected Reserves $ Incurred Claims $ Retention a. claims administration $ b. marketing expense/printing $ c. premium tax $ d. network access fees $ e. risk/profit $ f. pooling/reinsurance $ g. other (please specify) $ h. total retention $ Other Expenses (list and detail each one separately) $ Total Annual Cost $ Assumed number of students covered Institution Name Student Health Insurance Request for Purchase (2012/13) 23

25 Retention Guarantees by Size Please provide proposed retention levels based on the number of eligibles that the covers. Please confirm if these are multi-year guarantees. Retention <10,000 Students 10,000-15,000 Students 15,000-20,000 Students 20,000-25,000 Students a. claims administration % % % % b. marketing expense/printing % % % % c. premium tax % % % % d. network access fees % % % % e. risk/profit % % % % f. reinsurance % % % % g. other (please specify) % % % % h. total retention % % % % Multi-Year Guarantee? If yes, how many years? Alternative Rating Methodologies The is considering alternative rating methodologies to rate the eleven core institutions, utilizing some level of internal pooling of large claims among the eleven universities and / or utilizing some form of geographical rating methodologies. Internal Pooling Please complete the following rate grid for each institution assuming the large claims experience of each of the eleven core institutions is internally pooled together for claims between $75,000 and the pooling point used in your original rating calculation. Example: Carrier A utilizes a pooling / reinsurance point of $150,000. Any large claim experience in the eleven core institutions exceeding $75,000, but less than $150,000 is aggregated and converted into a fixed cost by dividing by the total enrollment of the group and applying this per capita cost back to each institution. All remaining claims above the pooling point would be subject to normal pooling charges. Student Health Insurance Request for Purchase (2012/13) 24

26 Proposed Rates Base (Option 1) Design with Internal Pooling Institution Name Annual Rates 2012/2013 Student Only $ Spouse $ Child or Children $ Demographic Rating Factors Please provide geographic factors for each of the eleven institutions that represent your expected cost differences between each institution, based solely on their geographic location. Factors should reflect relative unit cost and utilization differences expected for each geographic location, relative to a baseline university (please use North Dakota State University for the purpose of this exercise). North Dakota State University University of North Dakota Bismarck State College Minot State University University 4 next largest in headcount enrollment size University 5 and so on to include all 11 institutions 1.00 (relative factor) Student Health Insurance Request for Purchase (2012/13) 25

27 6 Questionnaire Program Structure 1. For each of the following services, please list the vendor(s) that will directly render the following services to the and for which you have priced the plan: a. Insurance coverage for U.S. covered benefit claims b. Insurance coverage for international (non-u.s.) covered benefit claims c. Claims administration d. Plan administration (eligibility, enrollment, billing, customer service, and account management) e. Provider network(s) f. Utilization and Care Management 2. Please indicate which vendor will assume local accountability and responsibility for plan coordination and account management. 3. Please confirm that the will reserve the right to substitute any of the above vendors for another mutually acceptable vendor if desired. Explain Student Health Insurance Request for Purchase (2012/13) 26

28 Provider Network / Access 1. Please provide the number of physicians and other key information outlined in Data for Quotation.xls, tab # of providers. Count each physician once based on their primary practice location in the three-digit ZIP code listed. 2. Do you foresee any significant changes in the provider network(s) offered to the for the plan year? 3. Are there any large physician groups in the network(s) that will expire in the next six months? List: 4. Are there any hospital contracts in the network(s) that will expire in the next six months? List: 5. Do the provider contracts (hospital, physician, special facilities, etc.) indicate the patient will not be financially liable in the event your health plan denies, delays or fails to pay covered expenses? 6. Please list any international countries in which you have developed networks or have favorable financial arrangements with providers. 7. What is your process and procedure for obtaining provider discounts rendered by international providers? 8. What is the average percentage of claim discounts obtained for international providers in 2010? Administration and Claims Payment Claims Processing 1. What is your current rate of automatic adjudication for claims processing? 2. What is your current rate of EDI claims receipts (count only those claims transmitted electronically, not claims converted to EDI by optical character recognition scanning)? 3. Assuming the existing enrollment, how many claim processors would be dedicated to the account? 4. How are fraudulent claims identified and recovered? 5. What is your procedure for recovery of overpayments from providers? From students? 6. What is your process and procedure for claims subrogation? What is the cost? % % Student Health Insurance Request for Purchase (2012/13) 27

29 7. Regarding claims retention/electronic entry, are claims: Scanned using optical character recognition (OCR), which creates an electronic claim? Imaged for retention and viewing purposes by claims and customer service staff? Microfilmed for retention and retrieval purposes (if used before claim is processed)? Stored in paper files based on member history or date processed? 8. Specify the claims processing center that will serve the 9. What are the hours of operations CST Open Close Monday Tuesday Wednesday Thursday Friday Weekends Holidays Member Service 1. You will provide a dedicated member service number to the 2. How many member service staff (telephone representatives) would be dedicated to the account? 3. What were your FY 2009 and 2010 results in the following areas for the proposed claims/customer service center: Turnaround time of claims processed within 14 calendar days Percent of calls answered by a live voice within 30 seconds % % % % Percent of issues resolved on the first call % % Percent of telephone calls abandoned % % Financial accuracy of claims processing % % Incidence accuracy of claims processing % % Overall accuracy of claims processing % % Student Health Insurance Request for Purchase (2012/13) 28

30 4. Specify the call service center that will serve the 5. What are the hours of operations CST Open Close Monday Tuesday Wednesday Thursday Friday Weekends Holidays 6. Where will the calls be routed for contingency situations such as power outages, natural disasters, etc.? What is the routing process? General Administration 1. Please describe in detail your process for electronic or on-line administration of the enrollment waiver if each institution in the decides to outsource this either partially of fully. Include a description of the following: Audit capability Privacy and security Cost 2. Which typical benefit limits are tracked automatically? Deductibles Out-of-pocket maximums Lifetime maximums 3. What limitations exist for tracking lifetime maximums? 4. Your plan will accept and load historical experience as it relates to maximum amounts, where applicable? 5. Are there any restrictions, limitations, or additional costs associated with the claims and plan performance audits? If so, explain. 6. Confirm your organization s ability to pay covered claims from International SOS and international providers. Student Health Insurance Request for Purchase (2012/13) 29

31 7. Confirm you will provide added value advisory services: Educational programs Interface with legal, financial and other consultants Financial and benefit design modeling HIPAA compliance issues and other regulatory issues 8. Is there a tracking system to monitor the types, frequency, progress and resolution of complaints and grievances? Also, is there a system to measure changes made in procedures, system edits, etc.? Please describe. 9. Who is responsible for following up and resolving student complaints? What systems support this function? 10. Due to the nature of student health plan, please describe your willingness to accommodate special needs for the following enrollment issues for each institution in the endorsed plan. a. Early or late enrollees: b. Mid-semester additions/cancellations: c. Late waivers: d. Retroactive enrollment adjustments: 11. Describe your standard coverage policy for mid-semester cancellations (i.e. coverage continues through the period paid, coverage ends on student s ineligibility date, partial refunds are made on the student s behalf, etc.) 12. Describe options for how premiums will be submitted to you Eligibility 1. Describe how and where you will receive and download the eligibility information from each institution in the endorsed plan. 2. Confirm your organization s ability to certify eligibility online. 3. Are your eligibility and claims processing systems integrated? Web-based Services 1. Your website allows each institution in the to verify, change, add, and delete student/dependent eligibility. 2. Your website allows each institution in the to change member addresses. 3. Your website allows each institution in the endorsed plan to communicate on-line through with the administrator s claim, customer service and management teams. Student Health Insurance Request for Purchase (2012/13) 30

32 4. Your website allows each institution in the endorsed plan to process premium and billing statements. 5. Please provide a Web link to a demo of these capabilities. Web address: Log in: Password: Web-based Services for Students 1. Your website allows students through a hyperlink to access provider information to identify and locate providers. 2. Students may receive electronic communications regarding plan coverage/activity to their personal address. 3. Students may check status of their most recent 10 claims. 4. Students may verify the status of applicable copays, deductibles and coinsurance levels. 5. Students may communicate on-line via with the customer service team. 6. Students may request new ID cards on-line. 7. Students may print or request forms on-line. 8. Students may review a summary of their benefit information on-line. 9. Provide a Web link for a demo of these capabilities. Web address: Log in: Password: 10. Will you be able to provide the with a custom own webpage for institutions? Plan Reporting and Auditing 1. You will provide at least quarterly claims and enrollment and annual utilization reports. 2. Quarterly reports should be delivered no later than the 15th of the proceeding month. Quarterly reports should be delivered within 30 calendar days of the end of the quarter. Annual reports should be provided within 60 calendar days of the end of the year. 3. Reports that are provided are completely accurate and the information included is validated before release. Student Health Insurance Request for Purchase (2012/13) 31

33 4. Additional custom reporting is available given reasonable time and cost to implement. 5. Please list all standard reports that are available at no additional charge. Appeals 1. How do you monitor and track appeals and complaints, payment issues or case management issues (student, provider, business or supplier)? Please describe the differences, if any, in the process for case management and/or payment. Contact Information 1. You will allow the to mutually agree to the assignment of the following key account service positions: account executive, account service manager, research consultant, and eligibility consultant. 2. Please complete the following for the proposed account team: Account Executive Contact Name: Address: City/State/Zip: Phone: Fax: Address: Member Services Supervisor Name: Address: City/State/Zip: Phone: Fax: Address: Student Health Insurance Request for Purchase (2012/13) 32

34 Claims Supervisor Name: Address: City/State/Zip: Phone: Fax: Address: Implementation Contact Name: Address: City/State/Zip: Phone: Fax: Address: Underwriting Contact Name: Address: City/State/Zip: Phone: Fax: Address: Student Health Insurance Request for Purchase (2012/13) 33

35 References 1. Provide references for three current accounts comparable in size to the Client Length of Relationship Number of Participants Services Provided Contact Name Contact Phone Number 2. Provide references for two accounts comparable in size to the that have terminated for reasons other than merger or acquisition. Client Length of Relationship Year Terminated Number of Participants Services Provided Contact Name Contact Phone Number Student Health Insurance Request for Purchase (2012/13) 34

36 Care/Health Management 1. Please complete the following exhibit regarding your disease management capabilities. Describe how you would integrate with the Student Health Center of each school (if available). Programs offered Length of time program has been in place Is the program internally managed or outsourced? ROI for the program in 2009/2010 Asthma / Diabetes / Is the program included in the base admin fee? Maternity/Well- Baby Neonatal Intensive Care / / HIV/AIDS / Depression / Other: / 2. Do you provide large case management programs? Explanation: 3. How do you identify claimants for large case management? 4. How is case management conducted? 5. Are the case managers in regular contact with the treating physician? Medical Cost Proposal 1. Do the provider reimbursement arrangements vary by network location? Specify the exact name of your network which you are proposing. Explanation: 2. Please provide the following medical trend information for your PPO Book of Business trend Book-of-Business % 2009 trend 2010 trend % % Student Health Insurance Request for Purchase (2012/13) 35

37 2011 projected trend % 3. In the upcoming year, do you anticipate any significant changes in your physician reimbursement policy? Specify: 4. In the upcoming year, do you anticipate any significant changes in your inpatient hospital reimbursement policy? Specify: 5. In the upcoming year, do you anticipate any significant changes in your outpatient hospital reimbursement policy? Specify: 6. In the upcoming year, do you anticipate any significant changes in your lab services reimbursement policy? Specify: 7. Do you use different trend rates for student plans? If so, how does the student health trend differ, on average, from your group business trend? 8. Do you use a different desired loss ratio for student plans? If so, how does the student health loss ratio, on average, from your group business trend? Student Health Insurance Request for Purchase (2012/13) 36

38 Appendix A Provided Data for Quotation The included file Data for Quotation.xls includes the following information: Rate History Tab rate history includes a three year rate history for the eleven institutions providing data Dataset will be provided to by Vaaler, Inc. /Student Assurance Services as the currently endorsed vendor no later than 12:00 p.m. CT on February 13, Provider Question for Carriers Tab #of providers is provided for your completion per instructions in Provider / Network Access question on page 27. Experience Tabs for each school have been included and show the available data which details: Enrollment Paid Claims Large Claims for two 12-month periods Plan Design For your reference, we have attached current plan designs for each of the eleven institutions current 2011/2012 policy year as well as historical policy years. Student Health Insurance Request for Purchase (2012/13) 37

39 Performance Guarantees As part of the 2012/2013 implementation, the is requesting your organization to commit a minimum of 2% of annual premium towards meeting the performance standards outlined below. In some instances goals and/or financial standards have been predetermined. Your score will increase or decrease based on whether you match, exceed or do not meet the stated standard. In the column called Proposed Standard state your performance objective and measurement criteria. In the last column indicate the dollar amount or percent of 2012/2013 annual premium committed to meeting the performance goal. On a separate page, indicate how you will measure and document achievement of the proposed standards. Provide samples of all reports that will be used in the measurement process. Performance Area & Minimum Standard Proposed Standard Percentage of Premium 1. Claims processing turn around time: % 90% of claims processed within 14 calendar days; 98% of claims processed within 30 calendar days. 2. Financial accuracy of claims processed: % 99.0% or higher. Financial accuracy is determined by dividing the amount of paid benefit dollars processed accurately by the total paid benefit dollars reviewed, based on the absolute value of overpayments and underpayments. 3. Procedural accuracy of claims processed: % 95.0% or higher. Claims processing accuracy is determined by dividing the number of claims processed without an error of any kind (financial, procedural, coding, data entry) by the number of claims reviewed. 4. Payment Incidence Accuracy: % 97.0% or higher. Payment incidence accuracy is determined by dividing the number of claims processed without a payment error by the number of claims reviewed. 5. Customer service speed to answer: % 80% or more of incoming calls answered in 30 seconds or less. 6. Customer service call abandonment rate: % Less than 3%. 7. Correspondence: % 90% of written inquiries acknowledged w/in 5 working days; 99% resolved w/in 60 calendar days. 8. Satisfaction with account management. % 9. Satisfaction with implementation. % 10. Member satisfaction with plan. % Student Health Insurance Request for Purchase (2012/13) 38