CALVERT COUNTY PUBLIC SCHOOLS. ITB: #CCPS-INSUR-MED-2017 DATE OF ISSUE: October 31, 2017 BIDDING INSTRUCTIONS FOR

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1 CALVERT COUNTY PUBLIC SCHOOLS DATE OF ISSUE: BIDDING INSTRUCTIONS FOR MEDICAL BENEFITS FOR EMPLOYEES OF CALVERT COUNTY PUBLIC SCHOOLS Contents: Section 1 - Instructions to Bidders page 2-3 Section 2 - Current and Requested Plan Information - page 4 Section 3 - Performance Standards pages 5-6 Sent via secure - Proposal Forms; Census; Plan Information Name of Firm Submitting Bid

2 SECTION 1 INSTRUCTIONS TO BIDDERS A. Background Calvert County Public Schools (CCPS) is soliciting proposals for a benefits plan administrator/insurer for the Medical plans offered to eligible employees, retirees, and dependents. There are approximately 2,400 employees and retirees covered for medical benefits. B. Geographic Accessibility Report You must provide a Geo Access Report for each Medical plan network you are quoting. Use the zip codes provided on the enclosed census file. Please produce the geo-access reports using all employees and retirees. To determine if an employee is covered by your service area, use a standard of 2 PCP s within 10 miles; for hospitals, one within 15 miles; for specialists, two within 15 miles. Under PCP s, please break out pediatricians as a separate category. C. Proposal Forms In order for your proposal to be considered, the Proposal Forms TM1-TM7 and PM1-PM6 provided must be completed and returned with your proposal based upon the coverage options you are quoting. D. Funding All plans are requested on a self insured basis with Stop Loss as outlined in Section 2. E. Questionnaire The enclosed questionnaires (Proposal Forms TM1 and PM1) must be completed and returned with your proposal. F. Census Data Census data are included in the enclosed files. G. Rate Guarantee/Notification All rates must be guaranteed for a minimum of one (1) year. Your proposal should note any additional rate guarantees you are willing to offer. Renewal terms must be provided by February 1 prior to the July renewal. H. Enrollment Assistance You must provide enrollment support to CCPS including employee communications, employee meetings, administration, and any other services CCPS deems appropriate. I. Run-out Claims Your proposal should assume that the current carrier will pay the run-out claims. J. Commissions Do not include commissions in your proposal costs. K. Network Directories Network directories must be provided on disk. Directories should be organized by County and submitted in Excel or Windows compatible format. L. Healthcare Reform (ACA) Assistance You must provide guidance and support to CCPS for provisions of the ACA including Summary of Benefits and Coverage, HPID, employee and other communications, administration, and any other services CCPS deems appropriate. 2

3 M. Claim Re-Pricing Instructions Data Provided: Twelve months (September 2016-August 2017) of paid claims is provided with claims line item detail to support a re-pricing analysis. The data is provided in an Excel spreadsheet format. The data includes the billed amount, copay, coinsurance and deductible amounts, but does not include paid amounts or any additional COB amounts. A random member ID was created, and all other member information was removed from the file except for the member zip code. Instructions: The claims data to be re-priced is included in the Medical Claims Detail spreadsheet PM 6A. For all line items of the spreadsheet, bidders must indicate if the provider is in-network, whether the claim was excluded from the re-pricing analysis and the re-priced allowed amount (re-priced amount paid). This detail information will be used to verify the total claims discounts proposed/guaranteed, a full disruption of the all providers used by Calvert County Public Schools and to verify the re-pricing summary information provided. If a claim is excluded from the re-pricing analysis, please provide an explanation in the Re-Pricing Summary Bid Form PM 6. The Re-pricing Summary on Price Proposal Form PM 6 provides a breakdown of the current summarized claims into the following categories: Inpatient Outpatient Physician (primary and specialty) Other (includes Lab, X-Ray, Diagnostic, Rx under medical, Ambulance, DME, injectibles, etc.) Excluded Claims totals (with summary explanation below the chart) must be provided on the Proposal Form PM 6. The total re-priced amounts and current amounts must equal. No records should be deleted from the claims detail spreadsheet provided. 3

4 SECTION 2 - CURRENT AND REQUESTED PLAN INFORMATION A. Current Plans Currently, CCPS offers a PPO plan and an HMO to eligible employees and retirees. There is also a grandfathered Traditional plan that is closed to new enrollees. Prescription Drug coverage is packaged with Medical coverage. Employees pay 10% of the single premium and 28% of the Parent/Child, Husband/Wife, and Family premiums. Retiree contributions generally vary by years of service. The Prescription Drug benefits are being bid under a separate ITB. However, Medical vendors that will also be responding to the Prescription Drug ITB #CCPS- INSUR-RX-2017 should provide medical pricing if they obtain both the Medical and Rx coverage. B. Requested Plan Design Duplicate current plan designs. Please also quote the following plan design options: Overlay your smaller, more heavily discounted (HMO) network on the PPO plan so that claims for members who access a provider who is in both networks will be processed at the lower allowed amount, with no impact to members who access providers who are only in the PPO network. C. Funding The current funding is self-insured with Specific Stop-loss at $300,000 for active employees and pre-medicare retirees and spouses (specific stop-loss premiums are not charged on the Medicare retiree group). The current funding arrangement is rate-based. The current carrier sets billing rates at the expected cost level. At the annual settlement, if costs (incurred claims plus fixed costs) are less than premium collected, CCPS receives a refund. If costs are higher than premiums, the current carrier can collect up to an additional 5% of premium. Any losses above this are carried forward. In years following losses, the carrier can collect up to 105% to recover loss carried forward amounts. If CCPS were to leave the current carrier in a loss carry forward position it would be responsible for reimbursing the carrier for the full loss carry forward at termination. This is what allows this arrangement to be considered self-insured. This is the preferred funding arrangement for CCPS. If you cannot quote such an arrangement, provide an ASO arrangement with as low an aggregate threshold as possible. In addition, provide alternate specific stop-loss quotes at $350,000 and $450,000. Potential new vendors should assume a 12/18 contract for stop-loss; the current carrier should assume continuation on a paid basis. Administrative Fees should be mature and include the cost to administer the runout at plan termination.. 4

5 SECTION 3 - PERFORMANCE STANDARDS The successful bidder(s) must be willing to agree substantially to the following performance standards and associated penalties for not meeting the standards. Not meeting one of the specified criteria within each category will result in 50% of the penalty being awarded to CCPS. Additional penalties within each category will be pro-rated over the remaining items using the outstanding penalty dollars. Unless specifically stated otherwise in your proposal, it will be assumed that your company agrees to these standards and penalties. Performance Standard Penalty 1. Implementation 5% of Fees Ensure accurate and up-to-date on-line provider directories at least one week prior to the enrollment period; note, enrollment period begins before employee meetings. Produce and mail ID cards at least 10 days prior to the effective date error free. It is the vendor s responsibility to work with CCPS to achieve error free distribution. Code benefits in claim system with 100% accuracy. Provide CCPS with a benefits and financial contract within two months of the plan effective date. Have a knowledgeable team available to attend all employee meetings. Representatives must be fluent on all plan offerings you are proposing. 2. Network Maintenance 3% of Fees Maintain a satisfactory number of open providers (hospitals and physicians) in all managed care locations (90% of providers identified during bid phase). If your network is not being maintained or that employees are not using the network (less than 85% of total claims are in network), the penalties will apply. Update website network bi-monthly (at a minimum). Report loss of provider and provider groups with membership greater than 50 employees within 10 days of notification of plan withdrawal 3. Customer Service 7% of Fees For time on hold criteria, use an abandonment rate not to exceed 5% Provide callback and/or written response to plan participants or CCPS designated administrator for unresolved issues within 24 hours. Provide callback and/or written response to CCPS administrator for Inquiries within 24 hours. 5

6 Claim processing (may be confirmed by outside audit) - dollar accuracy rate of 99% - procedural accuracy rate of 97% - turnaround time: 90% of clean claims paid in 14 calendar days. An EOB asking for more information is not included in meeting turnaround targets. Produce agreed upon reports at agreed upon dates/intervals. Duplicate errors on part of vendor - if CCPS documents a consistent pattern of mistakes or errors that go uncorrected for a substantial period of time (not to exceed two quarters), it will be determined you have not met this standard. Conduct annual member satisfaction survey and achieve overall Rating of 80% or better (survey format and rating methodology to be agreed upon by both parties). Survey results must be provided to CCPS within 45 days of completion date. Billing and enrollment (eligibility) - Initial: 99.5% loaded in system within five working days - Ongoing: 99.5% loaded in system within three working days Upon approval and signed performance guarantees, the Contractor is required to monitor and provide a written report, within 45 days of the close of the quarter, on all standards that were met and not met with backup information. The Contractor will pay penalties as an adjustment on the next administrative fee invoice 6