THIRD PARTY ADMINISTRATOR SERVICES FOR THE CITY OF LOS ANGELES CIVILIAN BENEFITS PROGRAM

Transcription

1 REQUEST FOR PROPOSAL THIRD PARTY ADMINISTRATOR SERVICES City of Los Angeles Civilian Benefits Program Personnel Department - Employee Benefits Division Joint Labor-Management Benefits Committee DATE ISSUED: May 8, 2017 TITLE: THIRD PARTY ADMINISTRATOR SERVICES FOR THE CITY OF LOS ANGELES CIVILIAN BENEFITS PROGRAM CONTRACT TERM: Up to Five (5) Years PRE-PROPOSAL CONFERENCE: May 24, :00 p.m. 2:00 p.m. City Hall 200 North Spring Street, Room 805 Los Angeles, CA PROPOSAL DELIVERY ADDRESS: City of Los Angeles Attention: Jenny M. Yau City Hall 200 North Spring Street, Room 867 Los Angeles, CA DEADLINE FOR SUBMITTING PROPOSAL: June 30, 2017 at 3:00 p.m. Pacific Standard Time (PST). DEADLINE FOR OUTREACH TO SUBCONTRACTORS (pursuant to the City s Business Inclusion Program outreach requirements): June 15, 2017 at 11:59 p.m. PST. RFP ADMINISTRATOR: Jenny M. Yau, Civilian Benefits Program Director Phone: (213) jenny.mach@lacity.org 1

2 PART A TABLE OF CONTENTS Section 1: Introduction/Background Section 2: Plan Profile & Scope of Services Section 3: Proposal Questionnaire Section 4: Proposal Format and Submission Requirements Section 5: Evaluation of Proposals Section 6: General Terms & Conditions Attachments A to I Supplemental Information Attachment J Proposer Declaration Page PAGE NUMBER PART B City of Los Angeles General Contracting Requirements (Rev. 1/17) 2

3 SECTION 1 INTRODUCTION/BACKGROUND 1.0 INTRODUCTION The City of Los Angeles Personnel Department and Joint Labor-Management Benefits Committee (JLMBC) are seeking proposals for a Third Party Administrator for the City of Los Angeles Civilian Benefits Program ( LAwell Program ). The mission of this procurement is to identify the service provider which can best support the LAwell Program by efficiently and effectively administering the recordkeeping, administrative, and communications infrastructure in support of the LAwell Program, its oversight and support staff, and its members. It is the City s intent to approach this procurement from a member-based perspective focused first and foremost on addressing the support services, access to services, and communications efficacy that LAwell members are most concerned with and which directly impact their health and wellbeing. The City presently contracts with Mercer Benefits Administration to provide third-party administration of the LAwell Program, including the following: Recordkeeping and administration Eligibility management relative to contracted benefits service plan providers Call center communications Member website for self-service benefits elections and ongoing management Plan sponsor website for benefits administration and reporting Affordable Care Act eligibility, compliance, and tax reporting recordkeeping Segal Consulting ( Segal ) is the JLMBC s consulting firm providing plan administration consulting services relative to this procurement. 1.1 DEFINITION OF TERMS The following terms used in the RFP documents shall be defined as follows: Agreement or Contract will mean the contract to be entered into between the City and proposer(s). Benefits Program will mean the City of Los Angeles Civilian LAwell Employee Benefits Program. Bidder or Proposer will mean the entity that responds to the Request for Proposal. CIL will mean the City s Cash-in-Lieu monetary benefit for employees satisfying its requirements for opting out of health coverage. 3

4 City will mean the City of Los Angeles. COBRA means the Consolidated Omnibus Budget Reconciliation Act of 1985 as it relates to offers of continuation coverage to employees losing benefits coverage due to termination of employment or other reasons. Contractor will mean the individual, partnership, corporation or other entity to which a contract is awarded, and will be synonymous with the term vendor. Department will be considered synonymous with the City s Personnel Department. Flexible or Flex Credits will mean additional dollars provided by the City based on an employee s benefits elections and/or employee s job classification per the provisions of an MOU or the Los Angeles Administrative Code. LAwell Program will mean the City of Los Angeles benefits program for its Civilian and other eligible employees. JLMBC will mean the City of Los Angeles Joint Labor-Management Benefits Committee. MBC will mean the City s current Mercer Benefits Central website for member benefit elections. MOU will mean a Memorandum of Understanding, or collective bargaining agreement, to which an employee labor organization and the City of Los Angeles are both parties. New Hire will mean a newly hired City employee eligible for the Civilian LAwell Benefits Program. Non-Represented will mean an employee who is not represented by a City of Los Angeles employee bargaining unit. PEW will mean a Personal Enrollment Worksheet outlining an employee s benefit election options at time of new eligibility or pursuant to the annual Open Enrollment Process. Represented will mean an employee who is represented by a City of Los Angeles employee bargaining unit. RFP will mean this Request for Proposal for contracted services issued by the City of Los Angeles. Subsidy will mean monetary assistance provided by the City for an employee eligible for LAwell benefits applied toward the cost of benefits. TPA will mean the Civilian Benefits Program Third-Party-Administrator function that is the subject of this RFP. 1.2 CONTRACT TERM The term of any contract(s) awarded pursuant to this RFP shall be for a period of up to five years from the contract effective date as provided for by the final contract, subject to the termination provisions therein. 1.3 RFP CONTENTS The contents of this RFP are as follows: 4

5 PART A Request for Proposal, including the Introduction/Background, Plan Profile & Scope of Service, Proposal Questionnaire, Submission Requirements, Evaluation of Proposals, and General Terms and Conditions. PART B General Contracting Requirements and Attachments, which includes the City of Los Angeles Standard Provisions for City Contracts (Rev. 1/17) and other general contracting requirements that must be reviewed and completed by proposers as specified in order for a proposal to be deemed responsive. 1.4 RFP CONTACT INFORMATION The Personnel Department and JLMBC are committed to ensuring that all LAwell Benefits business transactions, including procurement processes, are based strictly on integrity, competence, merit, and benefit to LAwell members and their dependents. As a matter of policy and consistent with the City s ethics rules, JLMBC members and staff will not communicate with current or prospective vendors or their representatives, or any other person or organization, for the purpose or intent of having a particular vendor secure or maintain a contract or business with the LAwell Program, or otherwise realize financial gain from the LAwell Program, whether during or outside of a procurement process. In support of this, and to ensure the transparency and objectivity of this procurement process, all communications and questions regarding or related to the services included in this RFP should be directed as follows: PART A Contact Information All questions regarding this RFP PART A must be in writing and should be directed to the RFP Administrator as follows: Personnel Department, Employee Benefits Division Attention: Jenny M. Yau jenny.mach@lacity.org Phone: (213) PART B Contact Information All questions regarding this RFP PART B must be in writing and should be directed to the Personnel Department s Administrative Services Division staff as follows: Personnel Department, Administrative Services Division Attention: Sherry Cox sherry.cox@lacity.org Phone: (213)

6 Questions regarding certain General Contracting Requirements may also more appropriately be directed to the City department responsible for the particular requirement, as specified within the Part B materials. 1.5 GENERAL INFORMATION AND PRE-PROPOSAL CONFERENCE The City intends to award a contract, in a form approved by the City Attorney, to the selected proposer. Written proposals submitted to the City shall constitute a legally binding contract offer and shall remain open for twelve (12) months. It is requested that proposals be prepared simply and economically, avoiding the use of unnecessary promotional material. Proposal Timeline The following is the current timeline for the RFP process. The City reserves the right to adjust this schedule. Changes to the timeline, if any, will be posted online as an RFP Addendum. Target Dates Event May 8, 2017 May 16, 2017 May 22, 2017 May 24, 2017 May 31, 2017 June 7, 2017 June 14, 2017 June 21, 2017 June 30, 2017 Request for Proposal Released Deadline for receiving written questions for the Pre- Proposal Conference is 4:00 p.m. PST Deadline to register to participate in the Pre-Proposal Conference by telephone is 4:00 p.m. PST Pre-Proposal Conference at 1:00 p.m. PST City Hall 200 N. Spring Street, Room 805 Los Angeles, CA General Contracting Requirements Preliminary Submission Deadline by 3:00 p.m. PST Deadline for vendors to issue written solicitations to subcontractors via website. This step should be completed by 11:59 p.m. PST to avoid risk of late submission. City Review of General Contracting Document Due to Vendor by this Date Deadline for receiving written questions regarding the RFP is 4:00 p.m. PST RFP responses due by 3:00 p.m. PST City Hall 200 N. Spring Street, Room 867 Los Angeles, CA

7 June 16, 2017 July 1, 2017 July September, 2017 August, 2017 September, 2017 September - October, 2017 (tentative subject to revision) December 31, 2017 or upon contract agreement January 1, 2018 There is an online Business Inclusion Outreach requirement via website. All outreach must be completed by 6/15/17 at 11:59 PM Pacific Standard Time. No outreach will be allowed or considered on or after 6/16/17 12:00 AM. Business Inclusion Program (BIP) Summary Sheet Submission on Los Angeles Business Assistance Virtual Network (LABAVN) 4:30 p.m. PST RFP evaluations Determine qualified proposers that will move on to the performance testing phase Complete performance testing of qualified proposers City makes selection and begins contract negotiation with successful proposer Target date for executing contract Commencement of Services Pre-Proposal Conference A Pre-Proposal Conference will be held to provide information regarding the RFP requirements and answer questions from prospective proposers regarding this RFP. The Pre-Proposal Conference will also give proposers and potential subcontractors the opportunity to network. City staff will not provide assistance regarding a proposer s individual RFP response. The conference has been scheduled pursuant to the schedule noted in the Proposal Timeline. Potential proposers may participate by physically attending or by calling in to the conference. Participants will be asked to identify themselves by name and firm. If you intend to participate by telephone, pre-register by contacting the RFP Administrator by the deadline noted in the Proposal Timeline. The City will provide a call-in number at that time for those interested in participating by telephone. It is to your benefit to bring your own copy of the RFP, particularly the City s General Contracting requirements, to the conference. No copies will be provided at the conference. Questions Regarding the RFP To maximize the effectiveness of the conference, to the extent possible, proposers should provide questions in writing prior to the Pre-Proposal Conference in accordance 7

8 with the deadline noted in the Proposal Timeline. This will enable the City to prepare responses in advance. All questions regarding the RFP should be submitted in writing and sent via to the RFP Administrator. Please identify the RFP title on the subject line of your message. All questions should identify the RFP section and page number, or the relevant General Contracting provision, for each question submitted. Additional questions may be accepted and addressed at the conference. However, certain responses may be deferred and posted online as addenda to the RFP at a later date. The City will make every effort to respond to all written questions as soon as practical. All questions and responses to questions, or any other changes to or interpretation of the RFP, will be posted online at Any such changes or interpretations shall become a part of this RFP and may be incorporated into any Contract awarded pursuant thereto. 1.6 GENERAL CONTRACTING REQUIREMENTS PRE-SUBMISSION OPTION AND SUBMISSION DEADLINES The City s General Contracting Requirements are included in Part B, which is attached hereto. Part B contains the Standard Provisions for City Contracts and a variety of documents and forms with which prospective City vendors must demonstrate compliance in order to be awarded a City contract. Within Part B is a list of requirements that must be fully met, including forms to be completed and submitted and details regarding certain processes which must be followed by prospective vendors as part of their RFP response. Failure to meet any of these requirements to the satisfaction of the City by the RFP Proposal Submission Deadline will result in disqualification of the vendor s proposal as being non-responsive. The City will provide vendors an opportunity to demonstrate responsiveness to the City s General Contracting Requirements at a date prior to the Proposal Submission Deadline. Vendors are not required to complete and submit their General Contracting Requirements forms/processes by the Preliminary Submission Deadline; however, it may be to their advantage to do so. If a vendor utilizes this option, City staff will identify whether the documents as submitted are or are not responsive to the City s requirements. If deemed non-responsive, the vendor will have time to demonstrate responsiveness with its proposal at the RFP Proposal Submission Deadline. Following the Proposal Submission Deadline, there will be no further opportunity for demonstrating responsiveness to the City s General Contracting Requirements. Failure to adequately demonstrate responsiveness to the City s General Contracting Requirements, or a rejection by the vendor of those requirements or the Standard Provisions for City Contracts, will result in disqualification of the proposal. The relevant dates with respect to this process are included in the Proposal Timeline. 1.7 RFP PROPOSAL SUBMISSION DEADLINE 8

9 Responses to this RFP must be submitted on paper and electronic copy must be received by the RFP Administrator by the Proposal Submission Deadline noted on page one of this RFP and the Proposal Timeline. Electronic portions, as specified further in this RFP, must be received no later than this date/time as well. Late responses will not be considered. The City reserves the right to extend the Proposal Submission Deadline should this be in the interest of the City. 1.8 CONSULTANT RESPONSE INFORMATION Responses to this RFP must also be submitted at the same time on paper and electronic copy to the consultant used by the City in the evaluation of responses to this RFP. Delivery should be provided to: Segal Consultants Attention: Michael Eck HR Technology & Automation Practice Leader 333 West 34 th Street New York, NY

10 SECTION 2 PLAN PROFILE & SCOPE OF SERVICES A. LAwell PROGRAM OVERVIEW The City of Los Angeles LAwell Benefits Program is offered to eligible full-time and halftime employees of the City of Los Angeles civilian employee population. The City offers its LAwell Civilian Benefits Program ( LAwell ) under Internal Revenue Code (IRC) Section 125. The LAwell Benefits Program includes approximately 24,800 City employees and their 33,000 dependents. In 2016 the LAwell Program spent approximately $297 million in combined employer and employee contributions to health insurance premiums to its medical service providers, along with an additional $41 million on combined premiums for other LAwell service providers (dental, life, disability, & accidental death and dismemberment, also known as AD&D). B. LAwell PROGRAM GOVERNANCE & CONTRACTING AUTHORITY The City s Joint Labor-Management Benefits Committee (JLMBC) and the Personnel Department's Employee Benefits Division administer the LAwell Program for active City civilian employees and their qualified dependents. The JLMBC is composed of five management and five labor representatives and makes recommendations to the General Manager Personnel Department for LAwell Benefits service provider selections. The General Manager Personnel Department is the contracting authority for LAwell Benefits service providers. In accordance with Los Angeles Administrative Code Section 10.5, the Personnel Department may enter into contracts with LAwell Benefits service providers for a period of up to five years. The JLMBC will be reviewing the findings of a designated review panel for this RFP in generating its recommendations to the General Manager Personnel Department. C. CORE MISSION The core mission of the LAwell Program is to promote employee health/wellness with competitive benefits at a reasonable level relative to the City's financial capacity. The core mission of the Third Party Administrator is to support the LAwell Program by efficiently and effectively administering the recordkeeping, administrative, and communications infrastructure in support of the LAwell Program, its oversight and support staff, and its members. 10

11 D. KEY SUCCESS METRICS The key metrics for evaluating success in meeting the core mission for the Third Party Administrator include the following: Reliability and Accuracy in Processing, Recordkeeping, and Data Exchange Responsiveness, Reliability, and Outstanding Customer Service in Call Center and Other Personalized Member Communications Responsiveness, Reliability, and Outstanding Customer Service in Interactions with City Staff Member Satisfaction E. LAwell PROGRAM DESIGN The LAwell Civilian Benefits Program presently offers employees a menu of medical, dental, vision, life, disability, employee assistance and tax-advantaged savings programs, detailed with incumbent service providers as follows: MEDICAL Kaiser Permanente - Statewide Staff- Model HMO Anthem Blue Cross - Statewide Narrow Network HMO, Statewide Full Network HMO, Regional HMO, National PPO DENTAL Delta Dental - Preventive Only, DHMO, PPO LIFE INSURANCE The Standard Insurance Company - Basic life, Supplemental life (1-5 times pay), Dependent life DISABILITY INSURANCE The Standard Insurance Company - Basic disability, Supplemental disability ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE The Standard Insurance Company - Voluntary AD&D. Dependent AD&D TAX-ADVANTAGED SAVINGS ACCOUNTS Wageworks - Flexible Spending, Dependent Care Reimbursement, Transportation Saving, Parking Saving EMPLOYEE ASSISTANCE PROGRAM Managed Health Network VISION PROGRAM EyeMed 11

12 F. SUMMARY DATA Indicative statistical data regarding the City s benefits eligible population and volume of activity required of the Third Party Administrator to manage is included within Attachment A. G. ELIGIBILITY Full-Time Employees The eligible population for the City s LAwell Program includes all civilian full-time employees who are contributing members of the City of Los Angeles City Employees Retirement System (LACERS) and who are compensated a minimum of 40 hours per pay period 1. In addition, eligible employees must also meet at least one of the following requirements: Eligible for membership within one of the employee representation units where the LAwell Program has been negotiated through a Memorandum of Understanding (MOU). A Non-Represented civilian employee. A Port Police Officer (MOU 27 or MOU 38) and a member of Tiers 5 or 6 of the Fire & Police Pension System. An elected official of the City of LA or a full-time member of the Board of Public Works. Half-Time Employees The eligible population includes all civilian half-time employees who are contributing members of LACERS and who are compensated a minimum of 20 hours per pay period. Employees in part-time, temporary, or seasonal positions who are not LACERS members are not generally eligible for LAwell Benefits unless provided for in the applicable MOU. Employee Family Member Eligibility LAwell members may also enroll eligible dependents including a spouse, domestic partner, biological or step child, child of a domestic partner, grandchildren for whom the member has legal custody, and grandchildren of children who are up to age 26, unmarried, and financially dependent on the member. H. THIRD PARTY ADMINISTRATION The City presently contracts with Mercer Human Resources Services, LLC to provide its third party administrator (TPA) services for the LAwell Civilian Benefits Program. The TPA is responsible for performing a wide range of services related to administering the LAwell Civilian Benefits Program. These services include but are not limited to the following: administering eligibility and benefit elections; participant and dependent enrollment, termination, and life event processing; recordkeeping employee and 1 Or alternate number of hours specified in a Memorandum of Understanding. 12

13 dependent eligibility data; dependent eligibility verification; providing a customized participant enrollment website for members to make benefits elections and report life event changes; providing a dedicated customer service call center Monday to Friday from 8 a.m. to 5 p.m, Pacific Standard Time to answer member questions and process benefits elections and changes; generating enrollment communication notices (e.g. annual and new hire Personal Enrollment Worksheets or PEWs outlining benefits options and related costs) and confirmation statements; communicating election and termination information to LAwell benefits service providers (health, dental, vision, life/disability/accidental death & dismemberment, tax-advantaged savings accounts) electronically on a bi-weekly basis; collecting elections for tax-advantaged savings accounts and calculating and transmitting to the City Controller s Office the per pay period deduction amount for the employee; coordinating the receipt of information from the LAwell life/disability/accidental death & dismemberment vendor and updating participant elections regarding approval, denial, or non-receipt of life or disability insurance Evidence of Insurability and Medical History Statement forms; computation and verification of employee deductions based on type of benefits plan and coverage level elected; transmitting employee deduction information to the City Controller s Office to upload into the City s payroll system (PaySR) on a bi-weekly basis; creating and verifying imputed income amounts for medical and dental plans and supplemental optional benefits (e.g. life, spouse life, and child life insurance, disability, and accidental death and dismemberment insurance); providing support for one Open Enrollment period annually including creation of annual PEWs for all eligible employees, creation and mail fulfillment of confirmation statements after the close of Open Enrollment, and processing of benefits elections (both active and passive enrollment); dual year coverage monitoring and processing support; generating COBRA reports and beneficiary and dependent verification letters; generating monthly invoices and back-up detail rosters to enable the City to make payments to LAwell benefits service providers via self-billing; producing a wide range of reports and data used by staff to monitor eligibility and coverage outcomes (e.g. Open Enrollment activity, call center statistics, demographic reports, family status change report, dual coverage report, direct billing report); and tracking and reporting of ACA eligible employees. Relative to the LAwell benefits service providers, the TPA provides recordkeeping of employee eligibility through a data exchange with the City s payroll system, as well as employee elections of providers, coverage tiers, dependents, life event changes, etc., as a result of either Open Enrollment (held in October of each year) or life event or employment status changes or new hire events which occur throughout the year. Data updates are provided to the health insurance carriers on a bi-weekly basis. ORGANIZATIONAL STRENGTH, PLAN SPONSOR & RECORDKEEPING SERVICES I. ORGANIZATIONAL QUALIFICATIONS & RELIABILITY (1) Organizational Background, Experience, Financial Strength & Continuity 13

14 The City will be evaluating each proposer s organizational experience, stability, financial strength, and experience in providing TPA services, and the degree to which an organization can be a long-term viable partner with the City in executing LAwell and benefits plan missions, goals, and strategies. (2) External Agency Ratings The City will be evaluating each proposer s rating agency status (if applicable) as part of assessing overall financial stability. (3) Client Experience The City will be reviewing the client experience of the proposer, including current governmental plan sponsors who are currently utilizing the provider s services, as well as recently terminated governmental plan sponsors. (4) Regulatory and Compliance Services The City will be assessing each proposer s status relative to any regulatory actions, complaints, administrative challenges, judicial actions, lawsuits, or other material events initiated by or against the vendor that may be relevant to the organization s reliability as a City of Los Angeles service partner, and as part of ensuring that administrative functions are conducted in accordance with applicable law and regulation. (5) Health Insurance Portability and Accountability Act (HIPAA) Compliance The City will be assessing each proposer s compliance with the Health Insurance Portability and Accountability Act (HIPAA). J. PLAN SPONSOR SERVICES (6) Plan Sponsor Functions The City is seeking a TPA partner that can provide to City staff the ongoing administration and support services that are required for the successful administration of the LAwell Civilian Benefits Program. This includes an effective account management team that is both proactive in ensuring that the recordkeeping system accurately executes all of its functions and is highly responsive and expeditious in resolving errors. Ongoing services include administering eligibility and termination rules, identifying, reporting on, and creating COBRA notices for terminated employees or those otherwise ineligible for City subsidies, processing life event changes, generating eligibility reporting and invoicing to the City s benefits service providers, maintaining beneficiary information, administering Open Enrollment and new hire enrollment, providing a call center and member self-service website, generating standard and ad-hoc reports, and participating in meetings as required throughout the year with City staff. 14

15 (7) Plan-Level Website & Access to Plan and Member Records The City provides day to day administrative support of the LAwell Civilian Benefits Program and requires access to real time and historical member benefits data. Employee data comes from the City s payroll system (PaySR) in a specific file format called a Demographic File. Please see Attachment B for the specific file layout information. The Demographic File is made available and transmitted to the Third Party Administrator biweekly based on the City s payroll calendar (see Attachment C). Elections and enrollment changes made within the Plan-Level or Member-Level website to member records must be translated into a specifically formatted payroll file containing deductions for coverage elections and then transmitted to the Office of the City Controller (Controller s Office) to upload into PaySR. Holding historical data of employee election choices (e.g. elections made as a result of either new hire, life event, or employment status changes which occur throughout the year and Open Enrollment (held in October of each year), adequate notes of actions, and details of chronological events within a Plan-level website is imperative for City staff to provide adequate customer service. The TPA is expected to hold and maintain this historical data for the duration of the contract and to transfer those records to the City or to a successor TPA upon termination of the contract in a mutually agreed upon format. To the extent that, due to practical obstacles, records cannot feasibly be transferred to the City or the successful TPA upon contract termination, the TPA must be willing to agree to mutually agreeable terms of retaining and making those records accessible beyond the contract termination date. The City also requires multiple system users with varying levels of system access in compliance with all laws and regulations to access and review confidential content contained within the Plan-level website. The City desires a system that is functional and expandable to the Plan s growing needs. The system should be very secure, but also adaptable to the City s needs and versatile. Each proposer will be evaluated for its ability to provide a comprehensive and versatile online system capable of providing the City with the ability to provide day to day administrative support. K. RECORDKEEPING SERVICES (8) Systems Architecture, Recordkeeping & Data Management Capabilities The City s Benefits Program structure provides certain benefits to all of its members on a uniform basis, and certain benefits on a categorical basis. The categories are primarily distinguished by the benefits negotiated in the City s various Memoranda of Understanding (MOUs). There are approximately 30 MOUs that are eligible to receive benefits from the LAwell program. Additional benefits design features apply to certain populations. The following table provides a high-level summary of the benefits design and rules architecture that must be administered by the TPA: 15

16 Health Dental Vision Life Disability AD&D EAP Tax- Advantaged Savings Accounts Kaiser HMO Anthem PPO Anthem Narrow Network Anthem Full Network Anthem Regional Network HMO (Vivity) Full-Time LAwell Plan (no premium contribution up to the Kaiser family premium) Full-Time LAwell Pay Plan (10% premium contribution) Delta Dental PPO Delta Dental HMO Delta Dental Preventive Delta Dental PPO City subsidy up to 85% of employee-only coverage Delta Dental HMO City subsidy up to cost of employee-only coverage EyeMed Vision Insurance LAwell Benefits Service Providers The Standard The Base Life Standard Insurance Base Disability The Standard Supplemental Life Insurance The Standard Child and Spouse Life Insurance The Standard Supplemental Disability Benefits Design Models (Full-Time Employees)* All members receive Citypaid $10,000 life insurance benefit All members receive Citypaid basic vision insurance. Coverage tier is based on the employee s medical plan election. Employees enrolled in Cash-in-Lieu are automatically enrolled in employeeonly level coverage for vision Based upon General Manager status or membership in certain MOUs, some employees are eligible to receive supplemental life insurance at 1x annual base pay at no additional cost (City paid benefit) All members receive Citysubsidized STD benefits of 50% of pay up to applicable maximum, for up to 2 years At employee cost (aftertax), employees may purchase supplemental coverage up to age 65 and 66 2/3% of pay, with cost varying by salary and age The Standard AD&D No base benefit At employee cost (pretax), coverage may be purchased in blocks of $50k up to $500k; employee and employee plus family options are available. Coverage options are offered at a flat rate cost regardless of employment status. Managed Health Network EAP Program Base benefit provided to all members WageWorks Healthcare Flexible Spending Account (HCFSA) WageWorks Dependent Care Spending Account (DCRA) WageWorks Transit Spending Account (TSA) WageWorks Parking Spending Account (PSA) All members may participate in any or all of these accounts; one administrative fee applies regardless of the number of accounts 16

17 For employees qualifying under the Cash-in- Lieu (CIL) Program, $100 per month is provided in lieu of benefits provided Delta Dental Preventive City provides $5 monthly credit At employee cost (pre-tax), employees can purchase supplemental life insurance coverage up to 5x annual base pay, with cost varying by salary and age. At employee cost, employees may purchase spouse life insurance (after-tax) from minimum $10,000 to maximum $100,000 of coverage and child life insurance (after-tax) of $5,000 per child. Both coverages are offered at a flat rate cost regardless of employment status. Approved family or medical leave and certain types of military leave provide continuation of health and dental subsidies Benefits Protection Plan provides continuation of health, dental, vision, and life insurance subsidies/benefits for those on an approved disability insurance claim *Employees compensated at least 40 hours per pay period or the number specified in their Memorandum of Understanding. Benefit Design Models (Half-Time Employees)** Half-Time LAwell Plan and LAwell Pay Plan City subsidy up to the employee only Kaiser premium subject to applicable MOU premiumsharing requirements Half-Time Delta Dental PPO: City subsidy up to 50% of employee-only coverage; Delta Dental HMO: City subsidy same as Full-Time employee; Delta Dental Preventive: City provides $2.50 monthly credit Same as Full-Time employee Half-Time receive Citypaid $5,000 life insurance benefit; supplemental, spouse, and child life insurance options same as Full-Time employee. Same as Full- Time employee No base benefit; may also purchase supplemental coverage similar to Full-Time employee Same as Full-Time employee Same as Full- Time employee Approved family or medical leave and certain types of military leave provide continuation of health and dental subsidies 17

18 Benefits Protection Plan provides continuation of health, dental, vision, and life insurance subsidies/benefits for those on an approved disability insurance claim **Employees compensated at least 20 hours per pay period or the number specified in their Memorandum of Understanding. Benefits Design Models (Sworn Employees)*** May choose to enroll in LAwell health plans City subsidy and employee cost, if any is subject to applicable MOU premiumsharing requirements. Employees may also choose to enroll in LAwell CIL program. May choose to enroll in LAwell dental plans City subsidy and employee cost, if any is subject to applicable MOU premiumsharing requirements ***Employees who are members of MOUs 22, 23, 24, and 25. N/A N/A N/A N/A N/A All members may participate in any or all of these accounts; one administrative fee applies regardless of the number of accounts. Additionally, data interfaces are set up between the TPA, the City s payroll system, PaySR, and LAwell benefits service providers to communicate election and termination information, dependents, coverage tiers, and associated employee cost (i.e. payroll deduction) as a result of elections made due to either new hire, life event, or employment status changes which occur throughout the year and Open Enrollment (held in October of each year). The following table provides a high-level overview of the frequency and number of payroll feeds and carrier file transfers that are required of the TPA: Vendor Name File Type Frequency Kaiser Health plan eligibility file from TPA to vendor Bi-weekly/24 feeds per year Anthem Health plan eligibility file from TPA to vendor Bi-weekly/24 feeds per year Delta Dental Dental plan eligibility file from TPA to vendor Bi-weekly/24 feeds per year The Standard Life insurance eligibility file from TPA to vendor Bi-weekly/24 feeds per year The Standard Disability insurance eligibility file from TPA to vendor Bi-weekly/24 feeds per year Accidental death & dismemberment insurance The Standard eligibility file from TPA to vendor Bi-weekly/24 feeds per year WageWorks City Controller's Office City Controller's Office TPA Tax-advantaged savings accounts (HCFSA, DCRA, TSA, PSA) eligibility file from TPA to vendor Payroll file (subsidy amounts, employee deductions, imputed income) from TPA to vendor; see Attachment H for data layout specifications Demographic file communicating employee data and hours worked to determine benefits eligibility from Controller s Office to TPA; see Attachment B for data layout specifications Annual Open Enrollment payroll test and production file reflecting annual Open Enrollment election and changes for the entire covered population from TPA to City Controller s Office Bi-weekly/24 feeds per year Bi-weekly/24 feeds per year Bi-weekly/24 feeds per year Test Payroll File Early December Full Production File Mid to Late December 18

19 The TPA is expected to meet or exceed the current level of system function and access experienced by the City and is required to transmit file feeds as displayed in the table above. The TPA s recordkeeping and systems architecture must further be capable of being highly adaptive to the inherent complexity of the Benefits Program s design. In addition, the City s benefits rules, MOU provisions, and plan design construction are subject to frequent change. The City seeks a TPA partner that is adaptive and can participate in and help identify solutions to implementing changes on an ongoing basis in an efficient and cost-effective manner. The complexity of the City s Benefits Program requires a TPA partner that can invest the necessary level of systems, technical, and support resources to provide effective, accurate, and timely program administration. The City will be evaluating the software systems, information technology staffing resources, and future investment plans of each proposer. The City will further be evaluating capabilities to capture and generate reporting on a range of participant indicative data, both for the purpose of ongoing account administration but also for generating statistical reports on a variety of demographic data points that will assist the City in being able to target its goals and evaluate its success. (9) Electronic Documents, Imaging & Document Storage The City seeks a TPA capable of generating electronic documents and forms specific to an individual employee s profile information and benefits elections. The TPA is also responsible for cataloging and retaining other components of member data electronically. Electronic documents and forms include, but are not limited to, personalized benefits statements, confirmation statements, pre-filled enrollment or claim forms, etc. The City will be evaluating the TPA s ability to generate, process, and/or receive customized member specific documents. The City is seeking to expand the resources available for the Benefits Program to track, maintain, and make available to the City and to its members core documents which pertain to the member s ongoing management of his/her benefits, including dependent verification documentation. The City seeks a provider capable of imaging and maintaining electronic records of all member records, documents, and forms related to the administration of member accounts. Please note that the current TPA does not image or store electronic documents in the Plan-Level or Member-Level website. The TPA is expected to maintain this data in an electronic format for the duration of the contract and to transfer those records to the City or to a successor TPA upon termination of the contract in a mutually agreed upon format. To the extent that, due to practical obstacles, records cannot feasibly be transferred to the City or the successful TPA upon contract termination, the TPA must be willing to agree to mutually agreeable terms of retaining and making those records accessible beyond the contract termination date. 19

20 (10) Security Protocols, Disaster Recovery & Guarantees The TPA is responsible for maintaining the confidentiality and security of participant records relative to its administration of the service. Confidential Information includes participant data, records and personal information such as social security numbers, dates of birth, marital status, home addresses, transaction histories, and other information related to participation in the LAwell Civilian Benefits Program. The provider will need to execute, as part of its contract, a Confidentiality Agreement providing that all confidential information provided to the TPA by or on behalf of City and/or City Personnel, or accessed or reviewed by the TPA during the performance of the Contract, is and will remain the confidential property of the City. The TPA will be required to further agree not to provide or divulge confidential information to any other person or entity except as authorized in writing by the City. The TPA will also be responsible for protecting the confidentiality and maintaining the security of all confidential information in its possession by implementing and maintaining adequate and necessary security systems, along with policies and protocols, to provide the highest reasonable level of safety and security of the confidential information. In the event of a security or data breach, the TPA must have in place an emergency response plan. The TPA must, if there is a breach of its security system and confidential information is accessed or believed to have been accessed, include the information in Civil Code Section (d)(3) in the required notification of a breach and indemnify the City against any losses in connection with the data breach. In addition, the TPA will also be required to demonstrate its member protection and remediation plan, including but not limited to the purchase of credit protection services for impacted participants. Finally, the TPA is responsible for establishing contingency plans for emergencies, disasters, and disaster recovery. These plans should include redundant processing centers and plans for activating the necessary participant support services in the event a primary processing center is not available. These plans should also address backup systems and records in the event of damage or disaster impacting the storage and maintenance of the recordkeeping system and its records. THIRD PARTY ADMINISTRATOR SERVICES L. Ongoing & Open Enrollment Administration (11) New Hire Enrollment & Employment Status Changes Presently, the City s rules stipulate that a new employee becomes eligible for benefits coverage in the first two-week pay period for which the employee has been compensated for at least 40 hours (full-time employee) or 20 hours (half-time employee). Employees who meet this requirement are identified in the bi-weekly Demographic File (Attachment B) transmitted by the Controller s Office to the TPA. Currently, the TPA generates a Personal Enrollment Worksheet (PEW) that outlines the benefits options available to the new-hire based on his/her status (e.g. full-time or halftime employee and MOU). The PEW is provided to City staff, who then issues and mails 20

21 the related enrollment informational materials to the employee. The date of eligibility is presently administered as being on or around the employee s payday for the initial pay period of eligibility. The employee is provided with 60 days from the date of eligibility to make elections for coverage, including the ability to opt out of the health coverage and receive a $100 per-month Cash-in-Lieu (CIL) benefit ($50 per-month for half-time employees) if the alternate coverage meets the City s requirements. Benefits are effective as of the date the employee enrolls in a benefits program (e.g. health, dental, etc.). If an employee fails to make an election, (s)he will be defaulted to health and dental coverage as determined by the City (presently, the Anthem Narrow Network and DeltaCare DHMO Plan). The employee also receives Basic Life, Disability, and Vision coverage. A confirmation statement is then issued to the employee upon election of coverage or default into coverage. Presently, the confirmation statement is typically issued within two to four weeks of the election date. If an employee has added dependents, the member will have 60 days from the date on the confirmation statement to submit documentation of the dependent s relationship to the member. If the documentation is not provided, the dependent will be removed from coverage by the TPA and payroll deductions will be adjusted accordingly to reflect the associated benefits coverage level. A final confirmation statement reflecting this cancellation and associated employee payroll deductions per pay period will be generated and provided to the City for City staff to mail to the employee. To improve the member experience, the City will explore vendor capabilities with respect to issuing these communications directly to new-hires, removing City staff from the distribution process. This will involve not only establishing a regular ongoing cycle for normal distributions, but also being able to bypass any data/systems errors or expedite communications in certain situations as necessary. (12) Life Event, Dependent Verification & Ongoing Affidavit Processing The City s LAwell Civilian Benefits Program provides for members to make changes to their benefits elections upon experiencing certain qualifying life events within specified time periods as determined under applicable Federal law/regulation and in accordance with City policy. Please see pages five to six of the Eligibility, Making Changes & Supplemental Plan Information Guide (Attachment D) for additional information. Presently, members report a life event change through the TPA by calling the TPA s call center or accessing their online account on the member self-service web portal to report the life event. The TPA then generates and provides to the City for mail fulfillment a confirmation statement within two to four weeks. Similar to PEW processing, the confirmation statement is provided to City staff, who then issues and mails the confirmation statement and any additional forms (e.g. Evidence of Insurability and Medical History Statement forms) to the employee. The member then has 60 days to submit any applicable supporting documentation such as a marriage or birth certificate, divorce decree, or CIL or domestic partner affidavit to the City. If supporting 21

22 documentation is not received by day 30, the City will send a physical postcard reminder to the employee notifying the employee of the upcoming deadline to submit the documentation, otherwise the dependent will be dropped from coverage on day 61 by the TPA and payroll deductions will be adjusted accordingly to reflect the associated benefits coverage level. No electronic documents are currently provided to the employee. Presently, the City collects supporting documentation via , fax, or physical hard copy. If received through , the documentation is printed. All supporting documentation is filed on-site with the City and then sent to an off-site records retention facility after a certain period of time has elapsed. Once the documentation is received and validated by the City, City staff enters a receipt date in the plan sponsor member site. The TPA does not collect supporting documentation and the City does not currently have the ability to upload these documents for electronic storage in the plan sponsor website. The LAwell Civilian Benefits Program also provides employees the ability to purchase additional life insurance of up to five times their annual salary. Generally, buy up options above three times the annual salary require proof of good health. Employees are required to complete and submit an Evidence of Insurability (EOI) form to the City s life insurance vendor. Additionally, purchasing supplemental disability insurance for the first time during Open Enrollment and future elections requires proof of good health. Employees are required to complete and submit a Medical History Statement to the City s disability insurance vendor. If any proof of good health is not submitted by March 1 of the calendar year following Open Enrollment or within 60 days of a member s enrollment as a new hire, the pending coverage amount of the buy up option will be removed from the employee s account by the TPA. The City and TPA do not collect EOI and Medical History Statement forms as they are provided directly by the employee to the City s insurance vendor. To create a streamlined and efficient process for dependent verification and proof of good health processing, the City will be evaluating vendor capabilities to provide record keeping services that meet or exceed the current level of service, including: 1) reviewing and validating supporting documentation; 2) imaging and storing supporting documentation electronically; 3) generating dependent verification letters and notices to the member directly via ; 4) providing members the ability to electronically submit EOI and Medical History Statement forms directly to the City s life and disability insurance vendor; and 5) providing clearly communicated and user-friendly reminders to members regarding outstanding dependent verification documentation, EOI, and Medical History Statement forms due via . This will improve efficiency, communications, and member outcomes by removing City staff from manually processing and filing supporting documentation, sending physical postcard reminders for documentation due, and establishing a regular ongoing cycle of review and validation of supporting documentation. 22

23 (13) Tax-Advantaged Spending Accounts Administration The LAwell Civilian Benefits Program currently provides four different tax-advantaged savings accounts 1) Healthcare Flexible Spending Account (HFSA), 2) Dependent Care Reimbursement Account (DCRA), 3) Transit Spending Account (TSA), and Parking Spending Account (PSA) to eligible employees. The HFSA and DCRA are restricted to annual Open Enrollment election processing, while the TSA and PSA provide for election, changes, and cancellations at any time during the year. Participants are permitted to contribute the following minimum and maximum amounts on a pre-tax basis in accordance with Federal law, for each type of account: HCFSA A minimum of $300 up to the maximum amount as established by Federal law/regulation. DCRA A minimum of $600 up to the maximum amount as established by Federal law/regulation, and consistent with limitations applying when the member is married and a spouse is working. TSA A minimum of $10 per payday up to $255 per month (as adjusted pursuant to Federal law/regulation). PSA A minimum of $10 per payday up to $255 per month (as adjusted pursuant to Federal law/regulation). Based on 2016 Open Enrollment information, the number of participants enrolled in the HCFSA and DCRA tax-advantaged savings account and average election amount is provided below: HCFSA Enrollment 1,808 Civilian; 465 Sworn; Total 2,273 HCFSA Average Election Amount per Participant $1,456 Civilian; $1,813 Sworn DCRA Enrollment 447 Civilian; 183 Sworn; Total 630 DCRA Average Election Amount per Participant $3,612 Civilian; $4,057 Sworn The TPA will be required to collect employee elections for each of these tax-advantaged savings accounts as an annual amount and then calculate the per pay period deduction based on the annual amount divided by the number of pay periods remaining after the day the election is made (per the City s bi-weekly payroll calendar provided as Attachment C). The per pay period deduction amount is then transmitted to the Controller s Office to upload into the City s payroll system on a biweekly basis. Currently, the TPA does not receive actual year-to-date payroll information from the City s payroll system after each payroll cycle to: 1) reconcile against the payroll deduction amounts it transmits to the City s tax-advantaged savings accounts vendor; 2) determine if a participant has not contributed enough to meet his or her elected goal amount; and 3) recalculate participant bi-weekly deduction amounts to ensure the participant meets his or her elected goal amount. 23

24 The City will be evaluating vendor capabilities to provide comprehensive taxadvantaged savings accounts administration including: 1) collecting and processing employee elections and coverage election changes; 2) calculating per pay period deductions based on the participant s elected goal amount accurately and transmitting this information timely to the Controller s Office and the City s tax-advantaged savings account vendor; 3) reconciling payroll deduction amounts against actual year-to-date payroll information received from the City to ensure the employee does not exceed the maximum contribution amount set by plan rules or Federal law/regulation; and 4) recalculating participant deduction amounts to ensure the goal amount is met. (14) Open Enrollment Administration The LAwell Civilian Benefits Program Open Enrollment period is held annually during the month of October. Benefits elections made during Open Enrollment are effective the following January 1. Qualified benefits eligible employees receive an Open Enrollment Guide (go to to review the 2017 Open Enrollment Guide) along with a Personalized Enrollment Worksheet (PEW). The Open Enrollment Guide and PEW (Attachment E) are mailed to all benefits eligible employees by the City in the last week of September prior to the start of Open Enrollment on October 1 and provides the following information: 1) personal information including date of birth, annual base pay, and zip code; 2) dependent information; 3) current benefits elections; 4) plan options and associated per pay period employee cost and buy-up options for supplemental life, disability, and accidental death and dismemberment insurance for the following year; and 5) specific benefits coverage applicable to certain employees per the provisions of their MOU (e.g. City-paid supplemental life insurance at one times annual salary for employees in certain MOUs). During the Open Enrollment period, employees are able to make changes to existing benefits elections and/or make new benefits elections (e.g. adding new dependents, enrolling into HCFSA and DCRA, purchasing supplemental life insurance) by logging into the TPA member web service portal presently known as Mercer Benefits Central (MBC). Through the MBC, employees are able to review their plan options and premiums, add elections to their shopping cart, and click a checkout feature to complete their enrollment. Employees are also able to make changes and/or enroll in new plans by calling the Benefits Service Center Monday through Friday from 8:00 am to 5:00 pm. If employees do not make an active enrollment, they are automatically re-enrolled into their benefits elections from the prior year (i.e. passive enrollment). Upon the close of the Open Enrollment period, a confirmation statement (see Attachment F) summarizing the employee s benefits elections and associated per pay period employee cost effective January 1 (i.e. pay period deduction) and beneficiary information is generated and mailed to the employee by the TPA. The confirmation statement is mailed to all employees whether they passively or actively enrolled during the Open Enrollment period. Please note that a separate confirmation statement is generated for sworn employees enrolling into CIL and/or tax-advantaged savings accounts (see Attachment G). The majority of these employees have health and dental coverage through their sworn association. 24

25 Employees adding dependents during the Open Enrollment period are required to submit supporting documentation such as a marriage or birth certificate or domestic partner affidavit directly to the City. Employees electing benefits coverage where proof of good health is required must submit an EOI and/or Medical History Statement to the City s LAwell insurance providers. Lastly, employees electing CIL are required to submit a CIL affidavit directly to the City. Presently, the member self-service web portal does not provide for employees to electronically submit these documents or for the City to provide confirmation or a notification or reminder to the employee of documentation due. If the employee does not submit dependent verification documentation or a CIL affidavit by the deadline established by the City (usually the second week in December), their dependents will be canceled from coverage, CIL will be canceled, and the employee will be defaulted back into their previous health plan option. After the document submission deadline, the TPA provides a list of employees whose dependents have been dropped from coverage and employees whose CIL has been canceled. Additionally, the TPA will provide a final confirmation statement reflecting these cancellations to the City for City staff to issue and mail to the employee. Additionally, the City provides for a silent two-week correction window after the close of the Open Enrollment period on October 31. During the correction window, employees are allowed to make additional changes to their benefits elections or correct any errors that are discovered. A separate confirmation statement is also generated by the TPA reflecting these changes and provided directly to the City for City staff to issue and mail to employees who have made corrections during the correction period. As part of this RFP, the City will be evaluating vendor capabilities to provide Open Enrollment administration which meets or exceeds the current level of service provided as described above including: 1) generating accurate PEWs detailing employee plan options and associated per pay period costs and mailing these PEWs to employees before the start of the Open Enrollment period; 2) providing an alternative method for delivery of PEWs and Open Enrollment Guide(s) that provides members the choice of opting into electronic document delivery; 3) generating accurate confirmation statements and mailing these statements timely to employees immediately after the close of the Open Enrollment and correction periods; 4) providing an alternative method for delivery of confirmation statements electronically via ; 5) ability to customize PEWs and confirmation statements and the amount of time required to program this type of customization during the Open Enrollment window; 6) provide for electronic submission of dependent verification documentation, EOIs, and Medical History Statements; 7) provide confirmation of documentation received and notifications and reminders to members of documentation due; and 8) generating accurate final confirmation statements reflecting cancellation in coverage for employees who did not submit supporting documentation and affidavits timely and providing an alternative method for delivery of these statements electronically via . Finally, Open Enrollment processing occurs on top of, and in addition to, regular ongoing determination of benefits eligibility due to new hire events and processing of election changes due to life event changes (also known as dual year processing). Presently, for employees who report life event changes in the months of September to 25

26 December and who do not make an active election to change benefits for the following calendar year either online through the MBC or through the call center, prior benefits elections will roll over to the new calendar year. The TPA will be required to maintain and provide support to simultaneous Open Enrollment administration activities and dual year processing. The City will be evaluating vendor capabilities to manage dual year processing and ensure benefits elections are carried forward without interruption or errors. M. PAYROLL PROCESSING (15) Data Transmission, Processing Changes & Auditing Functions The City utilizes a fully customized in-house payroll system known as PaySR. PaySR is supported primarily by the City s Controller s Office and Information Technology Agency. The TPA will be responsible for transmitting a payroll file in a format specified by the City (Attachment H) and coinciding with the City s payroll cycle to the Controller s Office to upload to PaySR biweekly. The payroll file includes: 1) deduction amounts and effective dates of employee benefits plan elections and changes; 2) employer contributions (City subsidy and flex credits) and employee contribution amounts to facilitate W-2 reporting; and 3) imputed income amounts for life insurance and taxable dependent benefits provided by the City. The City will be evaluating vendor capabilities of transmitting a payroll file containing the information outlined above to the Controller s Office as part of ongoing administration (payroll file includes changes made in an employee s benefits elections only on a biweekly basis coinciding with the City s payroll calendar) and at the beginning of each year (one payroll test file and one consolidated payroll production file for the entire covered population reflecting annual Open Enrollment elections and changes) timely and accurately, including the TPA s auditing functions for ensuring that employee deductions match their benefits elections, validating deductions biweekly with the City s payroll system, quality assurance standards, and ability to resolve payroll errors with minimal delay. (16) Direct Billing Process The LAwell Civilian Benefits Program requires that employees maintain a specific number of compensated hours per pay period (40 hours for full-time employees and 20 hours for half-time employees) to remain eligible for the employer subsidy paid towards LAwell program benefits. Employees not meeting this requirement, but who are still employed with the City, may continue receiving LAwell program benefits by paying for the full cost of their benefits through a direct billing process. The TPA will be required to assist in maintaining administration of benefits for employees making payment outside of the City payroll system, including providing a report of direct bill participants, charges, and terminations biweekly and assisting with cancelation and reinstatement of benefits. Additionally, the City will be evaluating vendor capabilities of providing a comprehensive direct billing system, including premium billing and payment collection, issuing billing 26

27 notices and payment reminders to employees, and monitoring and tracking billing and payment activity on a bi-weekly basis. (17) Eligibility & Premiums Reporting The TPA is responsible for sending election and termination information to the City s LAwell service providers (health, dental, vision, life/disability/ad&d, tax-advantaged savings accounts) electronically on a bi-weekly basis. Currently, the City s health plan carriers require transmission of a full eligibility file in EDI 834 format bi-weekly. In addition to transmitting eligibility files bi-weekly, the TPA will also be responsible for transmitting a full eligibility file to reflect all Open Enrollment elections annually. The TPA will review and process carrier eligibility error reports for each file transmission and coordinate with the carrier and the City to correct and resolve these errors on a timely basis. Currently, the City processes payment monthly to its LAwell service providers on a selfbill basis. The TPA will be responsible for the following to enable the City to self-bill: 1) providing monthly premium reports to the City and its LAwell service providers, including carrier backup reports, premium invoice, including tabs for each vendor and summary tab, adjustment reports, Cash-in-Lieu report, and EAP count report (Attachment I); 2) calculating premium billing amounts and retroactivity based on the billing rules identified by the City; and 3) processing of retroactive premium adjustments. The TPA will also be responsible for premium reconciliation by working with the City s LAwell service providers to resolve eligibility issues with minimal delay. The City will be evaluating vendor capabilities to: 1) transmit election and termination information timely and accurately to LAwell service providers; 2) provide eligibility and premiums reporting to enable the City to self-bill, and 3) provide eligibility and premiums reconciliation. The City will also be evaluating vendor quality assurance standards for ensuring that monthly premium reports are provided timely and accurately and eligibility and premiums error reports are resolved as soon as possible with minimal delay. N. OTHER PROCESSES (18) Specialized Processes The City currently manages certain benefits programs that require specialized processing due to the type of program and employee that is able to participate in the program. Please see below for a description of these programs, the specialized processing required, and the City s criteria for evaluation of administration of these programs as part of this RFP. Presently, the City s LAwell Civilian Benefits Program covers the City s civilian employees. However, sworn City employees may also choose to participate in the LAwell Civilian Benefits Program by enrolling into LAwell health and/or dental plans, Cash-in-Lieu, and/or tax-advantaged savings accounts. Sworn City employees choosing to participate in LAwell health and/or dental plans are 27

28 currently processed and manually tracked by City staff outside of the plan sponsor website. The City s TPA does not handle administration for this group of employees (about 15 sworn employees enrolled in a LAwell health plan and 70 sworn employees enrolled in a LAwell dental plan). Sworn City employees choosing to participate in LAwell tax-advantaged savings accounts are administered by the TPA. Sworn City employees may elect participation in these accounts during the Open Enrollment period or due to a life event change. As part of its evaluation, the City will be reviewing vendor capabilities to remove the manual processing and tracking of sworn employees enrolling in LAwell health and/or dental plans by City staff, tracking and reporting on these employees, identifying the types of confirmation statements that are generated and the method by which those confirmation statements are delivered to these employees, and providing tax-advantaged savings account administration for sworn employees. The City s Benefits Protection Plan (BPP) provides that employees who are on an approved disability leave may continue LAwell health, dental, vision, and basic life insurance for up to two years of disability. While an employee is covered by BPP, the City subsidy continues, so the employee only pays for the coverage cost they would have paid while an active City employee. Employees who are currently covered under BPP are required to pay their share of the cost through direct billing. The City must manually track these employees separately in its payroll system and subsequently send this information to the TPA. As part of its evaluation, the City will be reviewing vendor capabilities of tracking and reporting on these employees separately from the City s LAwell civilian population and generating and ing direct billing notices, payment reminders, and COBRA letters to BPP employees and their dependents. Employees who are members of the Engineers and Architects Association (MOUs 1, 19, 20, and 21) are eligible to participate in LAwell dental plans or EAA dental plans. Currently, there are approximately 60 EAA employees electing EAA dental coverage. During the City s annual Open Enrollment period from October 1 to 31, the City manually processes requests from City employees to cancel LAwell dental coverage and elect EAA dental coverage and vice versa. This information is then transmitted to the TPA to update the plan sponsor website to reflect the dental plan elected by the employee. As part of its evaluation, the City will be reviewing vendor capabilities to: 1) remove the manual processing and tracking of EAA employees electing or canceling EAA dental coverage; 2) provide employees the ability to elect EAA dental coverage online during Open Enrollment through the member self-service web portal; 3) identify the types of confirmation statements that are generated and the method by which those confirmation statements are delivered to these employees, and 4) provide tracking and reporting on these employees. Currently, the City processes disability and life insurance claims manually. Employees complete disability and life insurance claims paperwork and return it to the City for processing. Similar to life event, dependent verification, and ongoing affidavit processing, no electronic documents are provided or uploaded to the plan sponsor website for storage. As part of its evaluation, the City will be reviewing vendor capabilities to: 1) provide for electronic submission of disability 28

29 and life insurance claims; 2) record information such as the date and amount of a life insurance claim paid in the plan sponsor website; 3) provide electronic storage of additional supporting documentation; and 4) generate and claims forms, confirmation statements, and standard correspondence to employees. The City provides employees the opportunity to prepare and submit a written appeal if there is a disagreement over benefits eligibility, claims for refunds, or any other matter outside the plan rules. Currently, the City reviews and provides a determination on these appeals. Once the determination on the appeal is made, the written appeal is filed on-site and then sent to an off-site records retention facility after a period of time has elapsed. The plan sponsor website does not currently provide for the electronic storage of appeals and supporting documentation. Additionally, City notes and comments on the decision that is made cannot be recorded in the plan sponsor website. As part of its evaluation, the City will be reviewing vendor capabilities to provide for electronic submission and storage of employee appeals and the ability to record appeals information such as notes and comments for each employee. O. REPORTING CAPABILITIES (19) Standard Reporting Presently, the TPA provides the City with a number of standardized reports on a biweekly basis as outlined below. The City has minimal ability to self-generate standard reports and relies heavily on the TPA to accomplish this task. As part of its evaluation, the City will review vendor capabilities to generate and produce the standard reports described below as well as any additional reports that the vendor is able to generate for the City to streamline processing and create efficiency. The City will also evaluate vendor capabilities to allow the City to self-generate these reports on its own, whenever necessary. Lastly, the City requires that the TPA provide standard letters and statements such as beneficiary letters and confirmation statements. The City will evaluate each proposer s ability and confirmation to provide these documents. Standard Reports: Benefits Protection Plan (BPP) Employees with 2-Years Limit Report Identifies BPP employees that have been on disability for two years. The TPA is responsible for terminating the employee s benefits based on the two year date. BPP & Hours Report Identifies those employees that are currently in BPP but have more than zero hours worked. BPP Employees with Termed Benefits This report identifies BPP employees with terminated benefits. The City will review the report and notify the TPA if there are any changes. Carrier Billing (Premium Reporting) Detailed premium reports including adjustment details and detailed premium rosters that allows the City to self-bill (see additional detail in Section 17). 29

30 Chargeback Report A report summarizing the City subsidy and employee costs for benefits elections for four City departments Los Angeles World Airports, Los Angeles City Employee s Retirement System, Los Angeles Fire and Police Pensions, and Harbor Department. These four departments are responsible for reimbursing the City s General Fund for these costs. Death Report Identifies those employees or dependents that have passed away within a two week period. Demographic File Drop Report Identifies those employees who are showing as being active in the plan sponsor website but have dropped off of the bi-weekly Demographic File sent by the Controller s Office. All active employees should be transmitted on the Demographic File sent to the TPA. Direct Bill Report Every other Wednesday, the TPA should provide the City with a report identifying those employees in a direct bill status. There are seven different reports sent based upon the number of hours worked, employment status, and the employee s MOU. Employee Dual Coverage Report Identifies employees who are covering their spouse as a dependent but are also covered under their spouse s insurance. Either the City or the TPA must contact the employee to resolve the dual coverage. Dependent Dual Coverage Report Identifies dependents that are covered under both parent s insurance. Either the City or the TPA must contact the employee to resolve the dual coverage. Pending Family Status Change Report Identifies those employees who have initiated family status changes that are pending through the MBC or in the service center. The City will contact these employees to remind them to call the service center to complete their family status change. Move Report Identifies those employees who have experienced a move life event based on information that has been received via the Demographic File. The City will contact those employees if their change in zip code affects their current dental coverage so that the employee can make new selections. Please note that there is no zip code restriction on health plans. Multiple Life Event Report Identifies employees who have had multiple life events run within the same two week period that the report is run and both life events require verification documentation to be returned to the City. New Hire Report Identifies those employees who have come over on the Demographic File as new hires. This report is used by the City to determine if the employee is eligible to receive a new hire packet. No Documentation Received Report Identifies employees who have not returned the necessary documentation within the 60 day time period. If documentation is not received on the 61 st day, the TPA will cancel the employee s new benefits elections and adjust the employee s payroll deductions accordingly to reflect the associated benefits coverage level. No Documentation Received/30 Days Report Identifies those employees who have 30 more days to return the necessary verification documentation to the City before their new elections will be canceled if not received on the 61 st day. The City sends these employees a reminder postcard. 30

31 Rehires and Reinstate Report Identifies employees who have been rehired or reinstated to City service based on the Demographic File. The City reviews the report and gives instruction to the TPA on the effective date of the reinstatement or rehire to determine benefits eligibility. Reject Report Identifies employees who were not able to be loaded in the plan sponsor website due to various issues with their data on the Demographic File. The City investigates these employees and ensures that the information is corrected before the next Demographic File is sent. Status 07 or Benefits Ineligible Report Identifies intermittent/part-time employees who are not eligible for benefits under the LAwell Civilian Benefits Program but who are showing active with benefits. The City reviews this report and informs the TPA when benefits should be terminated. Status 09 Report Identifies employees who have been terminated from City service (e.g. retirement, resignation, etc.). The City reviews this report and confirms if the employee has been terminated from City service. COBRA letters are then generated for these employees. Term Dependent Age 26 Report Identifies dependents who have reached the age of 26. The TPA is responsible for removing the dependent from coverage; the effective date of the coverage termination is the birth date of the dependent. 65/70 Report Identifies employees who are or will be 65 or 70 in the current month but have not yet experienced age reduced benefits. The TPA is responsible for reducing these employees life insurance amounts based on the first of the month that the employee turns age 65 or 70. Standard Letters and Statements: Beneficiary Letters Letters generated for employees who have made changes to their beneficiaries within the two week payroll processing calendar. These letters contain employee and new beneficiary information. COBRA Sheets Identifies employees and dependents whose health and/or dental coverage has been terminated in the previous two weeks. Confirmation Statements Letters showing changes an employee has made to their benefits elections in the previous two weeks. The letters are presently sent to the City and mailed to the employee s address on file by City staff. Personal Enrollment Worksheets (PEWs) Letters generated for new hires and rehires who are eligible for benefits. The PEWs contain employee information specific to the employee, benefits options available to the employee, and associated cost. The PEWs are sent to the City and presently mailed to the employee s address on file by City staff. (20) Open Enrollment Reporting Similar to standard reporting, the TPA provides the City with annual Open Enrollment reports during Open Enrollment and following the close of Open Enrollment. The City has no ability to self-generate standard Open Enrollment reports. As part of its evaluation, the City will be reviewing vendor capabilities for generating reports 31

32 summarizing Open Enrollment activity both during Open Enrollment and following the close of Open Enrollment, including any additional reports that the vendor is able to generate for the City to best capture and summarize Open Enrollment activity. The City will also evaluate vendor capabilities to allow the City to self-generate Open Enrollment reports on its own, whenever necessary and to customize Open Enrollment reports to meet the City s reporting needs. (21) Customized Reporting The City will be evaluating vendor capabilities for generating customized reports as requested by the City in a timely and accurate manner. P. LEGAL COMPLIANCE (22) Legal and Special Administrative Services The City will be evaluating the TPA s plan sponsor regulatory interpretive and oversight services and ability to provide legal analysis and interpretations of laws, regulations, and other matters pertaining to employee benefit plan information. (23) COBRA and CalCOBRA Administration Currently, City staff administers Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) notification and enrollment requirements. This includes receiving a list of terminated employees from the TPA, with the City then confirming that the employee has been terminated in its payroll system, mailing out COBRA notices and election forms to the employee and/or dependents, collecting the election form from the employee and/or dependents, and sending the appropriate plan information and enrollment forms to the employee and/or dependents. The City will be evaluating the capabilities of each proposer in providing comprehensive COBRA administration, including generating COBRA notices for terminated employees and/or dependents, delivering these notices via mail or electronically directly to the employee and/or dependents, processing COBRA enrollment election forms, and communicating enrollments and terminations directly to the City s LAwell health plan carriers. This will involve removing City staff from manual COBRA administration and establishing a regular ongoing cycle of processing and distribution of COBRA notices and election forms. (24) Affordable Care Act (ACA) Compliance As part of its compliance requirements with the ACA, the City worked with its current TPA to develop a payroll/benefits analytics program called the Employer Shared Responsibility (ESR) tracking tool. The ESR tracking tool exchanges information between the City s payroll system and the TPA recordkeeping system and is designed to track hours, make eligibility determinations based on the look back and stability period determined by the City, predict future enrollment volume, and conduct trend analysis. The City utilizes the ESR tracking tool to: 1) identify those City employees who 32

33 are not currently eligible for a City health subsidy under the LAwell Civilian Benefits Program but who qualify for health-care eligibility under the ACA and 2) provide annual summary data required to meet the tax reporting requirements of the ACA. The ESR tracking tool provides monthly and annual reports indicating employees who are trending as ACA-eligible based on the look back and stability period and makes final ACA eligibility determinations for the existing workforce and new hires. Additionally, the TPA provides the City with a separate reporting solution known as a Minimum Essential Coverage (MEC) report. The MEC report provides enrollment information of employees and covered individuals such as employees spouses and dependents who were covered by minimum essential coverage. The MEC enables the City to meet its obligation under the ACA requiring certain employers and insurance carriers to report on offers of health insurance coverage made to full-time employees during the calendar year. The City utilizes both the ESR tool and MEC report to coordinate the preparation of Form 1095-C for civilian and sworn employees and Form 1095-B for some sworn members and their dependents who participate in a self-insured plan. As the City does not administer the health plans provided to sworn employees, the City is required to facilitate and coordinate the exchange of health coverage information between the City and sworn associations to complete Form 1095-C for sworn employees. For the 2015 and 2016 calendar years, the City utilized an external tax reporting vendor to translate the ESR and MEC information provided by the TPA and sworn associations into the data required to populate and produce Forms 1095-C and 1095-B. The third party tax reporting vendor was also responsible for tax forms mail fulfillment. Under the assumption that the current ACA employer mandate and reporting requirements continue to be in effect on a go-forward basis, in order to refine and streamline its ACA tax reporting responsibilities, the City is seeking to partner with its TPA to develop a comprehensive ACA tracking hours and MEC coverage reporting solution, IRS tax forms completion, and tax forms mail fulfillment services. As such, the City will be evaluating vendor capabilities of providing comprehensive employee monitoring and tax reporting services to enable the City to comply with its ACA obligations or any similar health care regulation passed by the State or Federal government during the full term of the agreement. (25) Centers of Medicare and Medicaid Services (CMS) Data Match Occasionally, the City is required to report to CMS information regarding health plan coverage information for former or current City employees to identify potential dual Medicare and City plan coverage. Currently, the City works with its TPA to gather the information necessary to complete a CMS data match. This process is often lengthy and requires a significant amount of staff time to reconcile the information provided by the TPA. To improve the City s ability to respond to CMS, the City will explore vendor capabilities with respect to completing data match questionnaires from CMS on behalf of the City, thereby removing City staff from this process. 33

34 MEMBER SERVICES AND COMMUNICATIONS Q. PARTICIPANT WEBSITE AND OTHER TECHNOLOGY/MEDIA (26) Member-Level Website Core Template Structure, Functions & Security The City s LAwell Civilian Benefits Program is highly focused on providing the highest levels of customer service and responsiveness to its members. Part of that involves working with its TPA to communicate clearly and effectively via its website and other communication venues/materials. The City will look for processes that the TPA has in place to prevent recordkeeping and communication errors which lead to participant complaints; the processes used by the TPA in managing situations wherein a communication or recordkeeping error has occurred; and processes used by the TPA to ensure quality control relative to its communications to members, particularly in prioritizing effective communication relative to recordkeeping systems limitations, workflow processes, and disclosure requirements. Members currently utilize the MBC member website to: 1) access member-specific benefits information, 2) make benefits elections during Open Enrollment or due to a New Hire event, and 3) report life event changes and make associated benefits election changes. The portal is available 24 hours a day, seven days a week with registered user access and system troubleshooting options with security access (see following screen shot). 34

35 The City s objective for its TPA is to create a member-level website that is user-friendly, responsive and accessible over multiple electronic devices, and fully secure. The website must also incorporate flexibility and customizable features and options which provide the opportunity to evolve its benefits program design and features. The website must be ADA compliant. Members typically access the current portal only during Open Enrollment. The City would like to consider ways to expand the resources available on the website to help promote active member engagement with their benefits throughout the calendar year. These resources include, but are not limited to, access to historical data, enhanced educational information, personalized communication, access to other benefits information that is not part of the LAwell Civilian Benefits Program, etc. The City will evaluate each proposer s member level website and evaluate its capabilities and usability to accommodate the LAwell Civilian Benefits Program design and features. (27) Website News/Messaging/Interactive Capabilities The City s current MBC website has functionality to post general information news pieces after an employee has logged into his/her account on the member portal. The City is interested in enhancing pre-login content, interactive media, direct customized s, reminder notifications ( and account based), and other customizable content. The City will evaluate each proposer s capabilities in providing information through its online and other electronic media resources including, but not limited to, the Member-Level website. (28) Website Customization Capabilities & Resources The City will review the TPA s capabilities for customizing the website consistent with the City s ongoing needs to refine and evolve its capabilities to create an effective and user-friendly member experience. (29) Planned Enhancements The City will evaluate the TPA s "web vision," including the foundation, principals and philosophy that guide the standard site and form the foundation for future evolution, and enhancements planned over the next 3-5 years. Access to, and delivery of, benefits information is expected to remain current with industry standards. The City will evaluate each proposers planned online enhancements. (30) Media Technology: Video, Mobile Apps & Other Media The City is interested in reviewing other communications media technology that vendors may offer such as videos, mobile applications, social media tools, etc. The City is additionally interested in mass capability, with options to send communications to segments of the population. 35

36 An important value for the City is ensuring that the TPA is able to communicate a highlevel, simple and coherent framework for participants to conceptualize the most fundamental tasks and features of the member s benefits selection and management process. The City strives to be innovative and effective, and seeks a TPA that has the resources, institutional commitment, creativity, facility, responsiveness, and innovative mind-set to support the City s ambitious communications objectives. R. PARTICIPANT CALL CENTER & REPRESENTATIVES (31) Call Center Location, Hours & Languages The TPA will be responsible for providing a call center team of dedicated representatives who are fully trained and capable of answering questions and providing detailed information about the City s benefits, which can vary depending on each employee s MOU membership, employment type, working status, etc. The current call center is available five (5) days a week, Monday through Friday, from 8:00 am to 5:00 pm Pacific Standard Time and is accessible through a toll free 800 number or through online chat. During the Open Enrollment period, which takes place during the entire month of October, the hours of operation are extended to a 12-hour period during the last few days of the Open Enrollment period. Spanish language speakers are also available during regular and extended hours. The City desires to enhance and improve the efficiency of its call center. Proposers will be evaluated on their capabilities in providing a call center that is capable of handling a high call volume and is versatile to meet the operational needs of a diverse population. (32) Staffing & Training The LAwell Civilian Benefits Program is governed by applicable law/regulation, multiple Memorandums of Understanding, and other governing documents. The call center representatives must be capable of competently and proficiently mastering this complexity in order to effectively assist the membership. The TPA will be required to provide adequate training and utilize ongoing quality control mechanisms to ensure that call center staff provide the highest level of competent service. The City requires dedicated call center staff resources that can become familiar with the unique aspects of the City s program and will evaluate each firm s abilities and options in providing sufficient resources. (33) Metrics & Standards, Case Management, Call Monitoring & Reporting Capabilities, & Call Center Customization Capabilities & Resources Currently, the TPA provides for a call monitoring and tracking system known as Siebel separate from the plan sponsor website. Call center representatives document all calls and City staff utilizes Siebel to review the representatives summary of the call and any additional notes. City staff is also able to record their own notes regarding a case in Siebel. If a case requires an action be made to correct eligibility information or member 36

37 data, City staff must use a secondary website to submit an e-room request to the TPA to make the change in the plan sponsor website. As such, City staff currently uses three separate systems Siebel to review and record member call information, eroom to request the TPA to correct member data, and the plan sponsor website to review the member s official record. As part of its evaluation, the City will review vendor capabilities for providing a single, integrated system for managing member data and call information. The City will also assess vendor capabilities to foster call center accountability through proposed response standards, including measuring responsiveness and timely resolution of member issues, metrics, call monitoring, and other tools. The TPA will be required to provide regular reporting on its results. S. PARTICIPANT CALL CENTER (AUTOMATED) (34) Structure, Script, Time & Languages The TPA will be responsible for providing an automated call system that is available to provide benefits information and access to member specific information 24 hours a day, seven days a week. The City desires an automated system that can provide generic benefits information, such as health plan options and contact information, to individuals calling at any time into the system. The City also desires an automated system that can allow for City employees to log in to their account through the phone and process member transactions or request verification of information on their account. The current automated system does not provide for this functionality. (35) , Fax & Mail Capabilities The City wishes to partner with a TPA that can provide services to assist in automated communication processes for member transactions, such as mailing or ing a confirmation receipt after a member changes information on his/her account. Proposers will be evaluated on their ability to provide mass mailing, specialized mailing, and other automated or manual fulfillment services. T. MEMBER SATISFACTION (36) Complaint Resolution & Website, Participant & Automated Call Center Member Satisfaction The City seeks to provide the highest level of customer service to its members and requires that member complaints be addressed promptly and in a responsive, professional, and customer-friendly manner. The TPA will be required to maintain a system of monitoring and tracking complaints and improving its processes as warranted based on recurring or systemic service issues. The City will evaluate each proposer's protocols and disciplines in effective complaint management. 37

38 The City s LAwell Civilian Benefits Program is highly focused on providing the highest levels of customer service and responsiveness, and will evaluate each firm s method of determining and maintaining member satisfaction with the self-service website, participant, and automated call center. U. MEMBER COMMUNICATIONS & COUNSELING SERVICES (37) Communications Philosophy & Resources The LAwell Civilian Benefits Program seeks a TPA that has the resources, institutional commitment, creativity, facility, responsiveness, and innovative mind-set to support the City s evolving communications objectives. The City's Plan is looking for ways to expand the intellectual resources devoted to its communications efforts, and looks to its TPA as providing a primary opportunity for partnership in this endeavor. The City will assess whether proposers would have the resources for, pursuant to this contract, establishing a Senior Communications Development staff resource that would be available to work closely with the City and exercise a leadership role in producing innovative, outcomesbased communications educational content, materials, and initiatives, and coordinate the execution of communication functions involving the City s benefit service providers. This resource would be separate and distinct from any resources required for the management and oversight of ongoing communications production efforts (e.g. for newsletters, quarterly statements, marketing material updates, etc.). (38) Enrollment Guide The City produces a printed enrollment guide book (guide) detailing benefits options and associated costs for all eligible civilian employees, as described in the Open Enrollment Administration section of this RFP. The printed guide information is posted electronically on the MBC website with personalized information post-login on each member account and is also available as a generic PDF on the site. In addition to the standard guide, the City currently produces two alternate versions: 1) a New Hire guide for civilian new hires which is used generally from mid-december to September, and 2) a Sworn guide which is intended for distribution to a select number of sworn employees (estimated around 500) during Open Enrollment. 38

39 Civilian Open Enrollment Guide Civilian New Hire Guide Sworn Open Enrollment Guide The three guides are currently fully developed by City staff and communications consulting resources, and utilize City publishing resources for mail fulfillment. The guides serve as the primary and principal communication piece produced by the City that reaches all of its members. In connection with its objectives for improving its communications resources, the City will assess vendor capabilities to develop, maintain, and refine its primary communication materials, including and most especially its enrollment guides. (39) Enrollment Worksheets & Confirmation Statements The TPA currently produces a Personal Enrollment Worksheet (PEW), as described in the Open Enrollment Administration section of this RFP, at one time each year for all eligible employees during Open Enrollment, and also every two weeks (payroll cycle) throughout the year for New Hire eligible employees. The PEWs contain detailed benefits election options and corresponding cost information for the employee specific to the individual s MOU, employment status, and salary. The PEWs are created from payroll information transmitted via the Demographic File (Attachment B) by the Controller s Office to the TPA biweekly. Based on the information provided in the Demographic File, the employee s employment status (e.g. full-time or half-time) and MOU provide different benefits options and varying employee costs, with some (not all) of those costs determined as a percentage of the employee s salary. Eligibility for these benefits options is determined by the hours worked and employment status. Eligibility can change from pay period to pay period and New Hire employees receiving a PEW an offer of coverage are given 60 days to make an election. The offer of coverage is at least two weeks old when the offer package is mailed via United States Postal Service to the employee. Once an election is made, a confirmation statement is generated biweekly on a pay period schedule and mailed by City staff to the employee. The confirmation statement identifies and confirms elections choices made (or defaulted option if no election was made) by the employee and outlines the supporting documents required for certain benefits choices, including the deadline to submit these documents to retain the benefits elections. Employee benefits elections are canceled by the TPA and payroll deductions 39

40 will be adjusted accordingly to reflect the associated benefits coverage level if the proper supporting documentation is not received. See below examples of a PEW and confirmation statement. Personal Enrollment Worksheet (6 pages) Confirmation Statement (4 pages) The City will be assessing each vendor s ability to enhance and customize the content of the Personal Enrollment Worksheet and Confirmation Statements to ensure that benefits information, options, expectations, deadlines, and consequences are clearly communicated. This will necessarily require flexibility on the part of the TPA in designing where certain content is located, how prominently certain pieces of information are displayed, and other factors which contribute to communications efficacy. (40) Onsite Member Advocate & Local Counseling Services The City maintains a public counter in its Benefits Office located in Room 867 of Los Angeles City Hall and provides in-person service hours Monday to Friday, 8:00 am to 4:00 pm Pacific Standard Time. City staff and health plan representatives are available at the public counter to answer questions and assist members in understanding their benefits options, assist with accessing services, and resolve member issues. In order to expand its customer service resources, the City will be assessing vendor capabilities to provide onsite benefits management member advocate services. A member advocate would assist members and City staff in navigating the TPA s resources, resolving issues that may arise in administration of the TPA s website and recordkeeping system, and/or address issues relating to employee status, eligibility, benefits coverage, and related issues. (41) Fees & Charges FEES & GUARANTEES The City values proposals that include reasonable, cost-effective, and competitive fees to perform the services described in this RFP. All proposers must submit a 40