THE STATE OF FLORIDA, DEPARTMENT OF MANAGEMENT SERVICES, DIVISION OF STATE GROUP INSURANCE REQUEST FOR PROPOSAL GROUP VISION INSURANCE BENEFITS

Transcription

1 THE STATE OF FLORIDA, DEPARTMENT OF MANAGEMENT SERVICES, DIVISION OF STATE GROUP INSURANCE REQUEST FOR PROPOSAL GROUP VISION INSURANCE BENEFITS RFP : DMS 13/ ADDENDUM 1 The Department hereby formally provides written responses to questions received. Questions and Answers begin on the following page. FAILURE TO FILE A PROTEST WITHIN THE TIME PRESCRIBED IN SECTION (3), FLORIDA STATUTES, (as altered by section (3)(d)(4)), OR FAILURE TO POST THE BOND OR OTHER SECURITY REQUIRED BY LAW WITHIN THE TIME ALLOWED FOR FILING A BOND SHALL CONSTITUTE A WAIVER OF PROCEEDINGS UNDER CHAPTER 120, FLORIDA STATUTES.

2 Written Responses to Questions All written questions are reproduced in the same format as submitted by the Respondent. Question# ITN Section ITN Page# Question Answer 1 Is this coverage currently in force? Please confirm. Is there a consultant or broker that we should make note of? Substantially similar coverage is currently in force (materials and services plan). There is no consultant or agent. 2 The census does not seem complete. We would need DOB s, genders and zip codes. There is a column for zip codes but the numbers look odd. Seems there are employees from other states? Please clarify/confirm. A revised census file containing Protected Health Information will be accessible to those Vendors who submit Attachments 6 and 7 (Confidentiality and NDA and Intent to Submit a Proposal). The census includes employees eligible to enroll and COBRA enrollees as of January 1, 2014 and provides (1) date of birth, (2) gender, (3) home ZIP code, (4) plan name (if currently elected), (5) plan coverage tier (if currently elected) and (6) status (active or COBRA). To access the data, Vendors must submit Attachments 6 and 7 to the Department by 4:00 p.m. Eastern Daylight Time on Friday, March 28, Following the deadline, Vendors who submitted the attachments will simultaneously be provided a link to the file (using the address provided in Attachment 7) and any password(s) required to access the file. RFP : DMS 13/ Addendum 1 Page 2 of 14

3 3 Table of Contents- Attachments 2 of 24 In order to provide accurate pricing, please provide the following: 24 months of premium vs claims by month by plan (including enrollment) Exam and materials (frames and lenses) utilization percentages See Attachment 4 for claims experience. See Attachment 1 for current rates. See Attachment 2 for current certificate of coverage. Please provide the current rates for the State of Florida s vision plan. Please provide the in force certificate(s) of coverage from Humana 4 Attachment B- 3 Plan Design 5 Attachment B- 3 Plan Design 1 through 3 Please provide the total number of services (utilization) for 2013 for: Exams, Single Vision, Bifocal, Trifocal lenses, along with number of Contacts for both the materials only and full service plans. 1 through 3 How long has Humana been the State of Florida s vision carrier? See Attachment 4 for claims experience. Since January 1, Attachment B- 3 Plan Design 1 through 3 Have there been any plan changes in the last 2 years? 7 Attachment B- 3 Plan Design 1 through 3 Is it acceptable to offer a Retail Frame Allowance in lieu of a Wholesale Frame Allowance? RFP : DMS 13/ Addendum 1 Page 3 of 14

4 8 Attachment B- 3 Plan Design 9 Attachment B- 3 Plan Design 1 through 3 Does the state cover a vision exam in their current medical plan? 1 through 3 Please confirm that both the materials only and full service plans are both voluntary plans. Currently, preventive healthcare services are covered in accordance with the grade A and B recommendations of the US Preventive Services Task Force. Confirmed. 10 Attachment F- Census Data All Please provide a census that includes zip codes, gender, DOB and employees by tier, and plan (i.e. materials only and full service plan). See #2. 11 N/A N/A Is the County looking for a materials only plan quote? 12 N/A N/A Can we get experience/utilization data by plan/by month, with claims and enrollment information 12 months minimum/24 months preferred? 13 N/A N/A Can we get census enrollment for vision by rate tier and plan State and/or zip. Or current enrollment by rate tier and plan. 14 N/A N/A Can we get copies of carrier provided benefit summaries? See #3. See #2. See Attachment 3. RFP : DMS 13/ Addendum 1 Page 4 of 14

5 15 Attachment B Attachment B- 6 How many enrollment sites are there and what are the eligible lives counts at each location? As this relates to Benefit Fairs is there a proposed schedule? For the reporting performance guarantee, section c.) says the report that is due annually is due by December 31 of each year. Is this correct? The quarterly reports are due within 45 days of close of quarter. For annual reports the month needs to close before the vendor can prepare the report. Enrollment is conducted online or via telephone, not at benefit fairs. See Attachment 5 for tentative benefits fair schedule. Yes, this is correct. 17 How does the State of Florida currently communicate to the employee population preenrollment? Is information typically posted online and employees are directed to the website or is information mailed to the employee s home? 18 How does the State of Florida currently communicate to the employee population postenrollment? Is information typically posted online and employees are directed to the website or is information mailed to the employee s home? Information is generally provided via the MyBenefits website. A notice of information posted on the MyBenefits website is provided via direct mail. See #17. RFP : DMS 13/ Addendum 1 Page 5 of 14

6 19 Attachment A Section The vendor recognizes that, as set forth in RFP Section 3.6.1, the Department will not accept redlines or modifications of the draft contract during the Evaluation Phase of the RFP process. Vendor requests clarification with respect to whether it can submit a stand-alone exceptions/deviations page at this time. Additionally, if a stand-alone exceptions/deviations page is not acceptable to the Department during the Evaluation Phase, will the Department be willing to entertain minor modifications to the draft contract in the event that Vendor reaches the finalist stage of the RFP process? Vendors may not submit exceptions/deviations. See Section 5.6 of the RFP regarding execution of the contract and modifications. 20 What is the current and requested employer contribution? 21 Please provide 3 years of premium, lives, and claims, preferably on a month to month basis by plan option. 22 Please provide rate history and any plan changes over the last 3 years. None. See #3. Information is not available by plan option. No plan changes. Premium rates (Attachment 1) have remained constant since RFP : DMS 13/ Addendum 1 Page 6 of 14

7 23 Please provide a census for participating employees including date of birth, status (active/cobra), plan option currently enrolled, and current tier. If this is not possible please provide the % of participating lives by status and those over 65. See #2. 24 Attachment A Section Our member website (as do all carrier websites) allows access to State of Florida data such as member eligibility, plan design, etc. and that data can be accessed from anywhere in the world. In order to prevent sharing of data as expressed in 3.2.5, please elaborate as to what data, what mediums, transmission modes, and access methods are prohibited by this provision? Section of the draft contract prohibits access to and transmission of data that is confidential or is personal health information. 25 Attachment A 6 Can the state please confirm that all references to subcontractors within the RFP are refers to subcontractors hired solely to the service and administer the State s contract? Subcontractor refers only to Vendor s Subcontractors and agents that deliver Services required by this Contract. Health care providers that have contracted with Vendor to participate in Vendor s provider networks shall not be deemed a Subcontractor under this Contract for any purpose. RFP : DMS 13/ Addendum 1 Page 7 of 14

8 26 N/A N/A Please provide utilization data shown by month & for 2 years or more: 1.) Claims $ s 2.) Claim Counts 3.) Premium $ s 4.) Enrolled Employee Counts 5.) Member Counts 6.) single/bi/tri claim counts 7.) contact lens claim counts 8.) exam claim counts 9.) materials only claim counts 10.) exam only claim counts 11.) comprehensive (exam & materials combined) claim counts 27 N/A N/A Can you please provide the Humana summary plan design documents (usually a marketing tool distributed to the enrolled members describing their plan and benefits in a summary format)? 28 N/A N/A Can you please provide the Humana member prices/costs per lens option for the current plan? 29 N/A N/A Please confirm that rates proposed should be Net of any Commissions? See #3. The additional requested information is not available or does not exist. See #14. Under the current plans, lenses are covered once every 12 months (i) in network at 100% after $10 copay; or (ii) out of network with an allowance of $40. Proposed rates will represent 100% of the premium to be received by the Vendor. RFP : DMS 13/ Addendum 1 Page 8 of 14

9 30 Plan Design Section I: Introduction; Subsection 1.2 Overview and Page 2 of 3 of the RFP General Information document Please clarify how many plan designs are to be offered and the benefit requirements for each. The RFP states that there are two options a materials only plan and a materials and service plan. However, only one plan design is included in the RFP materials. Please provide plan designs for both plans. The state currently offers a materials only plan and a materials and service plan. The materials and services plan described in the RFP documents will be the only plan offered. 31 Section I: Introduction Page 4 of 24 Are Retirees offered the same benefits as Full-Time Eligible Employees? If yes, does the current carrier administer direct billing for Retirees? Please confirm number of retirees currently covered by enrollment tier. 32 Section I: Introduction Page 4 of 24 Is it expected that the vision carrier provide COBRA Administration for the vision product? Or does The State handle this for all its lines through a third party vendor? Please confirm the number of COBRA subscribers by enrollment tier. Program administration is conducted by a third party as described in Section 1.2 of the RFP. For enrollment information regarding COBRA subscribers, see #2. 33 Do the current vision rates include any consultant/broker commission? Current rates do not include a specified amount for commission. RFP : DMS 13/ Addendum 1 Page 9 of 14

10 34 Attachment B- 4: Administrative Service Requirements Page 8 of 30, Section III. Support Services AR #7 The RFP specifically notes that all Benefit Fairs must be staffed with carrier employees and no subcontractors or contracted employees may be used. Does this refer to Benefit Fairs only or does it also apply to Open Enrollment meetings (if different)? This refers to Benefit Fairs only. 35 Attachment B- 4: Administrative Service Requirements Page 8 of 30, Section III. Support Services AR #7 How many Benefit Fairs and/or Open Enrollment meetings are conducted for The State of Florida? Are any conducted outside of Florida, considering the Census indicates employees are located outside of FL? There are Open Enrollment Benefit Fairs annually. None are conducted outside of Florida. 36 Attachment B- 6: Performance Guarantees Page 1 of 6, #3 Please provide a list/count of typical enrollment/benefit fairs (number of fairs/meetings, locations, and date range). Are benefit fairs and enrollment meetings the same thing? Typically Open Enrollment Benefit fairs are held annually in the fall. See #15 for typical locations. All references to enrollment meetings are replaced with benefit fairs within PG Attachment B- 4: Administrative Service Requirements Page 8 of 30, Section III. Support Services AR #7 Benefit Fairs: Please provide the average annual proportionate share of facility fees for the vision provider only. Costs vary depending on the number and type of venues, as well as the number of participating vendors. In 2013 for venues contracted by the Department, the average cost was $430 per vendor. Universities set their own registration fees. RFP : DMS 13/ Addendum 1 Page 10 of 14

11 38 Census File N/A Is the vision census eligible employees only or is it combined with dependents that are also enrolled in coverage? Eligible employees only. 39 Attachment B Technical Proposal Section B-3 (Plan Design) Section E. Elective Contact Lenses. Says, "The elective contact lenses benefit must include the cost of the contact lenses and may include the cost of extended exams to fit contact lenses and any follow up exams." Does the current Humana benefit include the cost of extended exams to fit contact lenses and any follow up exams within the $150 Elective Contact Lenses allowance? If not covered in the allowance but covered separately, is the cost of extended exams to fit contact lenses and any follow up exams currently under the Humana plan covered up to any $-amount and then overage charged to the member at any %-amount? If covered separately please disclose the covered up to $-amount and %- amount charged to the member for overage. The current plan contact lens benefit includes the cost of evaluation and fitting fees within a $100 allowance. RFP : DMS 13/ Addendum 1 Page 11 of 14

12 40 Attachment B Technical Proposal Section B-3 (Plan Design) Section F shows the Plan Design in a grid and under the section titled "Miscellaneous Benefits" it indicates that Anti- Reflective Lenses are covered up to a $50 allowance. Does the plan cover the cost of Anti- Reflective Lenses up to $50 retail value, or does the plan require a member copayment/charge of $50 when purchasing Anti- Reflective Lenses? Plan covers an antireflective lens benefit, up to $50 retail value. Any cost over $50 is the member s responsibility. 41 Attachment C Financial Proposal I. Monthly Premium Please disclose for the existing Humana coverage the current and renewal premium rates by tier? See Attachment 1 for current rates. There are no remaining renewals. 42 Attachment G Reference Check Template I. Can you please fill out this sheet from the State of Florida's perspective to share with proposing vendors? 43 Attachment A Draft Contract Page 11 of Warranty of Security A. Background Screening The contract states The Vendor is responsible for any and all costs and expenses in obtaining and maintaining the criminal background screening information for each person described above. Can this section be modified to read The Vendor or its Subcontractors shall be responsible. RFP : DMS 13/ Addendum 1 Page 12 of 14

13 44 Attachment A Draft Contract Page 12 of Warranty of Security 2. Self- Disclosure Can The Vendor and it Subcontractors require either self-reporting or conduct monthly background checks through FACIS Fraud and Abuse Control Information System (fraud related checks)? 45 Attachment A Draft Contract Page 20 of 50 Performance Bond The current vision contract has a performance bond of $150,000. Is that same bond that has been in place since 2009 expected to increase to $2,000,000 eff. 1/1/15? The reference within Section 7.2 to $2,000,000 is replaced with $650, Attachment B- 1: Minimum Requirements Page 1 of 1 Minimum Requirements - #2 If network access is based on state employees home addresses, does the census only include employee zip codes (not retirees zip codes)? The updated census includes home ZIP codes for eligible active employees and COBRA subscribers. See Attachment Attachment B- 1: Minimum Requirements Page 1 of 1 Minimum Requirements - #5 Please clarify minimum of 25,000 members. Does the 25,000 minimum requirements pertain to enrolled employees? Members refers to enrolled employees and their covered dependents. 48 Attachment B- 3: Plan Design Page 1 of 3 Employees are currently provided two plan options materials only and exam and materials. Will the State continue offering two plan options for employees? 49 Attachment F Census Data Census The census has a count of 203,319 by zip code. Does the census include retirees? A revised census has been provided. See #46. RFP : DMS 13/ Addendum 1 Page 13 of 14

14 Attachments Attachment 1: Rate Table Attachment 2: Certificate of Coverage Attachment 3: Summary of Benefits Attachment 4: Claims/Utilization Experience Attachment 5: 2014 Tentative OE Fair Schedule Attachment 6: Confidentiality and Non-disclosure Agreement Attachment 7: Notice of Intent to Submit a Proposal RFP : DMS 13/ Addendum 1 Page 14 of 14