University of Missouri

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1 Questionnaire: US Sales Contact Questionnaire General Information >> Sales Executive Personal Information Personal Information Professional Information Full Name: Title: Location Address: Phone Number: Address: General Information >> Account Manager / National Account Executive General Information >> Implementation Manager Full Name: Title: Location Address: Phone Number: Address: Number of Years with your Organization: Number of Years in Current Position: Number of Years Experience in Industry Total Number of Current Clients: Maximum Number of Clients this Account Manager may support: Average Size of Clients (e.g., 0-1,000 ; 1,000-4,999 ; 5,000-10,000 lives): Percent of Acct. Managers Time Available for our Client on an ongoing basis: Personal Information Professional Information Full Name: Title: Location: Number of Years with your Organization: Number of Years in Current Position Number of Years Experience in Industry: Average Size of Clients (e.g., 0-1,000 ; 1,000-4,999 ; 5,000-10,000 lives): Percent of Implementation Manager's Time Available for our Client's Implementation: General Information >> Proposed Rates Do the Proposed Rates include requested commission levels? on proposed rates t Included t Included Dental RFP 2018 TO BE COMPLETED ON AON ONLINE RFP TOOL 1

2 Questionnaire: Large Market Questionnaire General >> General Information Please provide the following information for the person to contact regarding this proposal. a) Contact Name b) Title c) Street Address d) City, State, ZIP e) Internet/ address f) Phone Number g) Fax Number Please provide the following information for the Account Executive assigned to the client account. Please provide the following information for the Account Manager (day to day) assigned to the client account. Are there any locations where you are not able to administer the dental plan designs as specified? Please describe the plan design differences and provide location[s]. a) Contact Name b) How many accounts does this person handle? c) Briefly describe this person's scope of responsibility. a) Contact Name b) Title c) Street Address d) City, State, ZIP e) Internet/ address f) Phone Number g) Fax Number h) Length of service with your organization i) How long has this individual held this position? j) How many accounts does this person handle? k) Percent of time dedicated to the client during implementation l) Percent of time dedicated to the client on an ongoing basis m) Briefly describe this person's scope of responsibility Please attach a description of any and all standard benefit exclusions. In general, how are treatments initiated prior to the effective date handled? Please describe your transition of care procedures in detail. Are any services outsourced or administered offshore? If so, provide name and location of company and which function is outsourced. Dental RFP 2018 TO BE COMPLETED ON AON ONLINE RFP TOOL 2

3 Questionnaire: Large Market Questionnaire General >> General Information List proposed services you intend to contract/subcontract to a third party. Include the contractor name(s), contractor location(s), contracting arrangements, and other special considerations that may be important to client's evaluation. a) If you will be using contractors, please confirm your organization will be the sole contracting agent with respect to any service agreement with the client and that your organization will be fully accountable for any and all contracted services. b) Do you have any leased networks? If yes, list location[s]. t applicable In general, how are treatments in progress prior to the effective date continued under the network? Please confirm that a detailed implementation timetable that ensures a smooth implementation/transition has been attached. How many other implementations with this client's effective date could be assigned to the same implementation coordinator assigned to this client? a) Please describe your transition of care procedures in detail. Address your willingness to participate in the enrollment meetings at no cost if needed at various sites during the open enrollment period. General >> Specifications Confirm your organization will allow the client to self bill? For self-funded plans, do you require use of a specific bank? If so, please provide information. Are you willing to fund a pre-implementation audit up to $25,000? How much of an implementation credit is your organization offering? If so, can you have your claims system coded by 30 days prior to the effective date? t applicable Dental RFP 2018 TO BE COMPLETED ON AON ONLINE RFP TOOL 3

4 Questionnaire: Large Market Questionnaire The General client >> may General wish to have Information its logo on various printed materials. The designated vendor must agree to this at no additional cost and must ensure that logo placement and color requirements are met. Confirm that if selected as a finalist the vendor must provide at least three references from clients similar in size, complexity, and demographic makeup of the client. General >> Eligibility Please confirm that you are able to administer benefits for both same-sex and opposite-sex domestic partners. If no, please explain. Your organization must be able to accept eligibility information from the client's selected third-party administrator. Describe your organization's disabled dependent verification process. Your organization agrees to allow for 90 calendar days for retroactive adjustments to coverage and recalculation of premiums for new hires, terminations, and status changes. The client will be granted online access to all eligibility and claims information, including edit access for eligibility. Administration >> HIPAA Is your organization compliant with the HIPAA Privacy Rule, Unsecured Protected Health Information Breach tification Rule, and Security Rule issued by the U.S. Department of Health and Human Services? Pursuant to the U.S. Department of Health and Human Services Standards for Privacy of Individually Identifiable Health Information (the 'HIPAA Privacy Rule'), will your organization require an individual's authorization before using or disclosing his/her protected health information for purposes other than treatment, payment, or health care operations, or as otherwise permitted or required by the HIPAA Privacy Rule? If your organization uses an authorization form, would your organization be willing to use a standard authorization form developed by University of Missouri for this purpose? Is your organization subject to state laws that, in your organization's opinion, require more stringent privacy policies and procedures for individually identifiable health information than those outlined in the HIPAA Privacy Rule issued by the U.S. Department of Health and Human Services? a) If 'yes', then is your organization compliant with such state law(s) not preempted by HIPAA? Dental RFP 2018 TO BE COMPLETED ON AON ONLINE RFP TOOL 4

5 Questionnaire: Large Market Questionnaire General >> General Information With respect to self-insured plan options, will your organization enter into a business associate contract and/or agreement with University of Missouri, as plan sponsor, to comply with the HIPAA Privacy Rule, Unsecured Protected Health Information Breach tification Rule, Security Rule, and the applicable requirements of the HIPAA Electronic Transaction and Code Set Standards? To the extent that your organization conducts all or part of an electronic HIPAA transaction covered by the HIPAA Electronic Transaction and Code Set Standards, does your organization conduct such transaction(s) in a manner that complies with applicable HHS standards, requirements and operating rules? With respect to self-insured options, will your organization notify University of Missouri, as plan sponsor, in the event of a breach of unsecured protected health information as required by the Unsecured Protected Health Information Breach tification Rule? With respect to self-insured options, if your organization uses subcontractors who create, receive, transmit, or maintain protected health information on your behalf, will your organization obtain satisfactory assurances in accordance with the HIPAA Privacy and Security Rules that the subcontractor will appropriately safeguard the protected health information? a) With respect to selfinsured options, if your organization uses subcontractors who conduct all or part of an electronic HIPAA transaction covered by the HIPAA Electronic Transaction and Code Set Standards, does your organization require that such subcontractor conduct such transaction(s) in a manner that complies with applicable HHS standards, requirements, and operating rules? Dental RFP 2018 TO BE COMPLETED ON AON ONLINE RFP TOOL 5

6 Questionnaire: Large Market Questionnaire General >> General Information Is your organization compliant with the HIPAA omnibus final rule (effective date of March 26, 2013; compliance date of September 23, 2013) that includes final modifications to the HIPAA Privacy Rule and Security Rule to implement the privacy and security provisions of the HITECH Act, a final Unsecured Protected Health Information Breach tification Rule, and, with respect to self-insured options, modifications to the HIPAA Privacy Rule and Security Rule that impact the HIPAA compliance obligations of business associates? Administration >> FSA Coordination Will your organization send out-of-pocket data to the client's FSA administrator? a) If yes, is there an additional fee to do so? Please include the additional fee in the comments box. You will provide weekly data extracts to the client's FSA/HRA administrator to substantiate debit card transactions, and you will be compliant with the client data layout requirements, which will be shared at a later date. Administration >> Legal Concerns The client expects that your organization will maintain adequate levels of corporate/general liability insurance. Please confirm and provide details on the levels of coverage your organization maintains. Please confirm that you carry a fiduciary bond as required by ERISA for any arrangements where you serve as a fiduciary. If you are unwilling to serve as fiduciary, please describe why you would be unwilling to make this representation. If the plan is fully insured, we assume your organization will act as fiduciary. If this is not correct, please explain who will have fiduciary responsibility. Are you willing to be designated as the claims and appeals fiduciary for the clients' plans? Specifically, you will handle both the benefit determination (a.k.a., ERISA claim) and any mandatory benefit determination on review (a.k.a., ERISA appeals). ERISA reg. section (h)(3) requires that an adverse benefit determination be made by a named fiduciary of the plan and that will require your organization to take such a role. If not, please describe why you would be unwilling to agree to this request. Dental RFP 2018 TO BE COMPLETED ON AON ONLINE RFP TOOL 6

7 Questionnaire: Large Market Questionnaire While General this >> RFP General does not Information specify all of the requirements of ERISA Section 503 and related regulations, the client expects that you will be in compliance on all matters including, but not limited to, timing of response and content of response to plan participants. To the extent that a benefit package option is not "grandfathered" under the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively, the "Affordable Care Act") and is not otherwise exempt from complying as a "limited, excepted benefit" as defined in ERISA reg. section (c)(3), the client expects that your organization will comply with the new internal claims and appeals and external review processes for group health plans and group health insurance issuers. The client reserves the right to audit (or designate an independent third-party to audit) the selected health plan at any time during and up to three years following termination of the Contract/Administrative Agreement (with prior written notification). Administration >> Quality Assurance Which of the following are performed/reviewed as part of your standards for provider credentialing/recredentialing? Describe your provider credentialing process. a) State license b) Malpractice coverage c) Detailed malpractice history d) History of litigations/disciplinary action e) Fraud/felony convictions f) Membership in professional organization g) Regularly scheduled hours at least four days per week h) Availability of chair hours i) Service complaints j) Quality of care complaints k) Member grievances l) Member surveys m) Chart review n) On-site visits o) Emergency training (CPR) p) Other (specify) Dental RFP 2018 TO BE COMPLETED ON AON ONLINE RFP TOOL 7

8 Questionnaire: Large Market Questionnaire Who General conducts >> General initial and Information subsequent credentialing? How often are network providers recredentialed? Annually Every two years Other (specify) How frequently are providers given formal reports of their performance? What are your procedures for resolving patient grievances concerning care and treatment? Can members appeal to a third party? Please give the name of this third party. How frequently are patient satisfaction surveys sent out? Can patient satisfaction results be reported on a client-specific basis? What percentage of all network participants are typically surveyed each year? What were your most recent patient satisfaction survey results? Please attach a copy of your most a) Very Satisfied recent results. b) Satisfied c) Somewhat Satisfied d) Other Are network providers surveyed for their satisfaction levels with network administration? Please describe any other of your organization's cost management strategies. Administration >> Claims Administration/Member Services The preference of the client is to have dedicated units. Please confirm your organization will agree to a dedicated claims processing and customer service staff for the client account. Monthly Quarterly Semiannually Annually Biannually ne Provide your organization's definition of "dedicated" for claims processing and customer service on a percent of time basis. For the customer service team proposed to serve the client, provide the following information for the claim. For the claims processing team proposed to serve the client, provide the following information for the claim adjudicators. Provide the following statistics for the claim office that will handle the account for the client. We are requesting actual results for a designated claim office. a) Ratio of staff to members b) Average years of service a) Ratio of staff to members b) Average years of service a) Claim payment accuracy (number of correct payments divided by number or payments) Dental RFP 2018 TO BE COMPLETED ON AON ONLINE RFP TOOL 8

9 Questionnaire: Large Market Questionnaire General >> General Information b) Claim processing accuracy (number of claims processed with 100% accuracy divided by number of claims) c) Financial accuracy (dollars paid correctly divided by total dollars paid) d) Average turnaround time (x% in x business days) e) Average customer service telephone response time (seconds) f) Call abandonment rate (%) g) Percentage of incoming calls that are recorded h) Length of hold time i) First call resolution percentage j) Percentage of incoming calls that are logged k) Average number of days claims are pended Do the same representatives perform both customer service and claim processing functions, or are they specialized? Please indicate whether customer service representatives may reprocess claims. How long is claim history maintained online? Provide national performance goals for the following indicators. [SPECIFICS WILL BE NEGOTIATED WITH FINALISTS] a) Claim payment accuracy (Number of correct payments divided by total number of payments [percentage]). b) Claim processing accuracy (Number of claims processed with 100% accuracy divided by the total number of claims processed [percentage]). c) Financial accuracy (Dollars paid correctly divided by the total dollars paid [percentage]). d) Average claim turnaround time (Claim office receipt of a claim until the transaction is completely processed with check and/or EOB issued). Dental RFP 2018 TO BE COMPLETED ON AON ONLINE RFP TOOL 9

10 Questionnaire: Large Market Questionnaire General >> General Information How are member inquiries logged and tracked? How many grievances have you had regarding the network in the prior calendar year per 1,000 members? Confirm the following are maintained or tracked by the processing system. What percentage of claims are audited on a predisbursement basis? What percentage of claims are audited on a postdisbursement basis? Will the client have designated customer service representatives (CSRs)? e) Average claim turnaround time: Percentage in 10 working days f) Average claim turnaround time: Percentage in 15 working days g) Average claim turnaround: Percentage in 14 calendar days h) Average claim turnaround: Percentage in 21 calendar days a) Various copayment levels b) Scheduled benefit amounts (by ADA procedure). Dental - Innetwork; out-of-network. c) Days/visits or other treatment maximums per plan design d) Accumulators (dollars) e) Individual deductible f) Annual maximum g) Orthodontia lifetime maximum h) Potential COB opportunities i) Tooth chart (flags potentially duplicate treatment) j) Other a) Total number of fulltime equivalent (FTE) customer service representatives The client may acquire companies throughout the year. Please confirm your organization's ability to accommodate being responsive and flexible in having the ability to use the acquired employee's EOB from prior company vendor to apply to their clients' plan's YTD deductible, OOP max, etc. What percentage of claims are auto-adjudicated? Dental RFP 2018 TO BE COMPLETED ON AON ONLINE RFP TOOL 10

11 Questionnaire: Large Market Questionnaire General Are there >> any General provisions Information that cannot be autoadjudicated by your system? If so, what provisions? Do customer service representatives have access to claims information? Do customer service representatives have online access to benefit plans? What additional training is provided for new client accounts? What are the telephone hours for your customer service unit servicing the client? How are after-hour phone calls handled? Please respond to the following regarding ID cards: Are all of your internal systems integrated? (e.g., claims payment, eligibility, and customer service) a) What is your normal process and method for ID card distribution? b) Can cards be customized for the client? c) What is your process for providing timely replacement cards or cards to new hires? d) Confirm the ID cards have a non social security number identifier and anyone with dependent coverage will be provided with 2 cards. What is the time lag between the eligibility and claims systems? Are all systems updated in real time? What procedures are not subject to R&C by your organization? How often are the R&C profiles updated? Describe in detail your current methodology for developing your Reasonable and Customary (R&C) database. The client requires 100% of calls (incoming and outgoing) to be recorded. a) How often is this information updated? b) To which procedures would R&C limits apply? a) Can your organization comply with this requirement? Dental RFP 2018 TO BE COMPLETED ON AON ONLINE RFP TOOL 11

12 Questionnaire: Large Market Questionnaire Does General your >> system General have the Information capability to record the computer screens accessed by customer service representatives during calls? Administration >> Network Management Please provide the following information about your national networks. a) Location b) Initial date of network operation c) Is network owned by your organization or subcontracted through a third party? If network is subcontracted, list network. d) Number of employer groups served by network as of the effective date of the prior year. e) Total members (employees and dependents) as of the effective date of the prior year. f) Total members (employees and dependents) as of the effective date of the current year. g) What percentage of general providers are accepting new patients? h) What is the annual rate of network providers turnover for the prior year? i) What is the annual rate of network providers turnover for the current year (projected)? Would you be willing to expand to any locations of the client where you do not currently have a network? Please describe any current expansion plans. What is the nature of the relationship between your organization and your providers? Are providers: Employees of your organization Subsidiary company Exclusive affiliation n-exclusive affiliation What is the provider credentialing, selection, and monitoring process? How do you maintain quality in your providers and the services they offer? How often are network providers visited by your quality assurance department? What are the average office hours of providers in the network? Dental RFP 2018 TO BE COMPLETED ON AON ONLINE RFP TOOL 12

13 Questionnaire: Large Market Questionnaire What General percentage >> General of network Information providers have weekend or evening hours? What percentage of your providers are reimbursed in the following ways? (These numbers must total 100%). Does your reimbursement system for providers include the following? If bonuses are paid, which factors determine the amount of incentive compensation? a) Discount off charges b) Fee Schedule c) Capitation d) Other (specify) a) Withholds b) Bonuses a) Cost results b) Utilization results c) Member satisfaction d) Other (please specify) What network management services will be delivered by a subcontractor or other outside organization? (Include any leased network arrangements) Confirm your organization will proactively provide material network changes to the client, including identification of the affected membership. Please detail the process, timing, frequency, and other important information about this notification process. How will you notify members of material network changes? Under what terms may providers withdraw from your network? How much advance notice must providers give before voluntarily leaving the network? Must an enrollee select a primary care dentist within your program? How often are participants allowed to change primary care providers? Can family members use different providers? What procedures or practices must be preauthorized (e.g., when is a treatment plan requested)? What is the dollar threshold? How many network providers were added each year for the past three years? Can providers be nominated? If so, how? a) Year 1 b) Year 2 c) Year 3 Dental RFP 2018 TO BE COMPLETED ON AON ONLINE RFP TOOL 13

14 Questionnaire: Large Market Questionnaire If General any part >> of your General network Information is leased, please state the percentage, identify the owner of the network and geographic service area. If you use leased networks to service this account, are the leased discounts loaded into your claims system? Administration >> Technology Capabilities Does your organization offer the capability to pay providers quickly and easily, directly from the member website? Does your organization's member website allow users to run reports to analyze their health care spending, so they can understand their healthcare expenses, and make informed plan selection decisions? Which of the following services are provided via the internet? If the response is no, include the plan and timing of when this may become available. a) If not, do you have any plans to do so in the future? When? b) If yes, when did you include this? a) If not, do you have any plans to do so in the future? When? b) If yes, when did you include this? a) General plan coverage information b) Provider directories c) Access to content information on preventive care and health d) Members can request additional or replacement ID cards e) Members can print ID cards from the site f) Members can member services g) Do you include providers that are not accepting the new patients? h) Provider selection where users enter search criteria i) Provider cost information Dental RFP 2018 TO BE COMPLETED ON AON ONLINE RFP TOOL 14

15 Questionnaire: Large Market Questionnaire General >> General Information j) Provider quality information k) Cost estimation/budgeting tools l) Deductible, out of pocket, and maximum tracking m) Claim lookup status n) Appointment reminders o) Members can download and print claim forms Describe smartphone capabilities. Describe the health content information available online. Administration >> Underwriting Assumptions COBRA participation percent above which you reserve the right to change rates/fees? Are retirees covered? Minimum employer contribution, if applicable Is your proposal a replacement or an option? Confirm the out of network percentile being proposed. Provide the percent of retained savings, if applicable. Confirm that your ASO fee is on a mature basis. Confirm the number of years your rates/aso fees are being held unchanged. Plan Information >> Provider Directories Will you provide hard copy network directories at no cost for employees and retirees who do not have internet access? Will you agree to absorb postage costs? How often do you update the hard copy provider directory? How often are provider directories updated online? Plan Information >> Summary Plan Documents (SPDs) Daily Monthly Quarterly Annually Dental RFP 2018 TO BE COMPLETED ON AON ONLINE RFP TOOL 15

16 Questionnaire: Large Market Questionnaire Will General you provide >> General reasonable Information assistance to the Plan and its designated agents in preparation of summary plan descriptions (SPDs) in compliance with the Department of Labor SPD content requirements set forth in ERISA reg. section ? Plan Information >> Explanation of Benefits (EOB) Provide sample EOB with an explanation for each section. Dental RFP 2018 TO BE COMPLETED ON AON ONLINE RFP TOOL 16

17 Associated Designs: Dental - PPO Commission: Commission Frequency Commission Type Requested Commission Monthly Percentage Type of Fee / Commission Initial Commission 0.00% Commission Expectation $0.00 Ongoing Commission 0.00% Paid To Aon Dental RFP 2018 TO BE COMPLETED ON AON ONLINE RFP TOOL 17

18 Design: Dental - PPO Effective Date Expiration Date Currency Allow Deviation Designs Allow Proposed Designs Design Type Design Comment 1/1/ /31/2018 United States Dollar (USD) -$ Required Plan Design >> General R&C Percentile Annual deductible Deductible applies to Annual maximum Services accruing towards annual maximum 90th 90th Individual deductible $100 Family deductible $300 Individual deductible $100 Family deductible $300 Prev. & Diag. Prev. & Diag. Annual maximum ($) $1,500 Annual maximum ($) $1,500 Prev. & Diag. Prev. & Diag. Dependent children to age 26 Plan Design >> Services Coinsurance Current Design Common Provisions Dental RFP 2018 TO BE COMPLETED ON AON ONLINE RFP TOOL 18

19 Design: Dental - PPO Effective Date Expiration Date Currency Allow Deviation Designs Allow Proposed Designs Design Type Design Comment 1/1/ /31/2018 United States Dollar (USD) -$ Required Current Design Plan Design >> General Classification of services 100% 80% 50% 100% 80% 50% Examination Fluoride - Children X-rays Routine cleaning Sealants (permanent molars) Common Provisions Emergency palliative treatment Simple restorations (fillings) Endodontics Surgical Periodontics Routine extractions Endodontics (RCT- molars) n-surgical Periodontics Inlays/onlays Dentures Implants Soft tissue impaction Partial/full bony impaction Crown & Bridge Oral surgery Extraction- erupted tooth Anesthesia Examination Fluoride - Children X-rays Routine cleaning Sealants (permanent molars) Emergency palliative treatment Simple restorations (fillings) Endodontics Surgical Periodontics Routine extractions t Covered t Specified t Specified Dental RFP 2018 TO BE COMPLETED ON AON ONLINE RFP TOOL 19

20 Design: Dental - PPO Effective Date Expiration Date Currency Allow Deviation Designs Allow Proposed Designs Design Type Design Comment 1/1/ /31/2018 United States Dollar (USD) -$ Required Current Design Common Provisions Plan Design >> General Endodontics (RCT- molars) n-surgical Periodontics Inlays/onlays Dentures Implants Soft tissue impaction t Specified Partial/full bony impaction t Specified Crown & Bridge Oral surgery Extraction- erupted tooth Anesthesia Frequency of services t Included Plan Design >> Orthodontia Orthodontia Covered by Plan Dental RFP 2018 TO BE COMPLETED ON AON ONLINE RFP TOOL 20

21 Design: Dental - Option 1 - PPO Effective Date Expiration Date Currency Allow Deviation Designs Allow Proposed Designs Design Type Design Comment 1/1/ /31/2018 United States Dollar (USD) -$ Alternate Plan Design >> General R&C Percentile Annual deductible Deductible applies to Annual maximum Services accruing towards annual maximum 90th 90th Individual deductible $100 Family deductible $300 Individual deductible $100 Family deductible $300 Prev. & Diag. Prev. & Diag. Annual maximum ($) $1,500 Annual maximum ($) $1,500 Prev. & Diag. Prev. & Diag. Dependent children to age 26 Plan Design >> Services Coinsurance Current Design Common Provisions Dental RFP 2018 TO BE COMPLETED ON AON ONLINE RFP TOOL 21

22 Design: Dental - Option 1 - PPO Effective Date Expiration Date Currency Allow Deviation Designs Allow Proposed Designs Design Type Design Comment 1/1/ /31/2018 United States Dollar (USD) -$ Alternate Current Design Plan Design >> General Classification of services 100% 80% 50% 100% 80% 50% Examination Fluoride - Children X-rays Routine cleaning Sealants (permanent molars) Common Provisions Emergency palliative treatment Simple restorations (fillings) Endodontics Surgical Periodontics Routine extractions Endodontics (RCT- molars) n-surgical Periodontics Inlays/onlays Dentures Implants Soft tissue impaction Partial/full bony impaction Crown & Bridge Oral surgery Extraction- erupted tooth Anesthesia Examination Fluoride - Children X-rays Routine cleaning Sealants (permanent molars) Emergency palliative treatment Simple restorations (fillings) Endodontics Surgical Periodontics Routine extractions t Covered t Specified t Specified Dental RFP 2018 TO BE COMPLETED ON AON ONLINE RFP TOOL 22

23 Design: Dental - Option 1 - PPO Effective Date Expiration Date Currency Allow Deviation Designs Allow Proposed Designs Design Type Design Comment 1/1/ /31/2018 United States Dollar (USD) -$ Alternate Plan Design >> General Endodontics (RCT- molars) n-surgical Periodontics Inlays/onlays Dentures Implants Soft tissue impaction t Specified Partial/full bony impaction t Specified Crown & Bridge Oral surgery Extraction- erupted tooth Anesthesia Frequency of services Plan Design >> Orthodontia Orthodontia Covered by Plan Orthodontia coinsurance Current Design Common Provisions t Included 50% 50% Orthodontia deductible $1,500 Coverage available for child? Adult? Coverage for children to age 19 Lifetime maximum--orthodontia Lifetime maximum - orthodontia Lifetime maximum - orthodontia Child only Child only $1,500 $1,500 Dental RFP 2018 TO BE COMPLETED ON AON ONLINE RFP TOOL 23

24 Design: Dental - Option 2 - Base Plan - PPO Effective Date Expiration Date Currency Allow Deviation Designs Allow Proposed Designs Design Type Alternate Design Comment 1/1/ /31/2018 United States Dollar (USD) -$ Plan Design >> General R&C Percentile Annual deductible Deductible applies to Annual maximum Services accruing towards annual maximum 90th 90th Individual deductible $100 Family deductible $300 Individual deductible $100 Family deductible $300 Prev. & Diag. Prev. & Diag. Annual maximum ($) $1,000 Annual maximum ($) $1,000 Prev. & Diag. Prev. & Diag. Dependent children to age 26 Plan Design >> Services Coinsurance Current Design Common Provisions Dental RFP 2018 TO BE COMPLETED ON AON ONLINE RFP TOOL 24

25 Design: Dental - Option 2 - Base Plan - PPO Effective Date Expiration Date Currency Allow Deviation Designs Allow Proposed Designs Design Type Alternate Design Comment 1/1/ /31/2018 United States Dollar (USD) -$ Current Design Plan Design >> General Classification of services 100% 80% 50% 100% 80% 50% Examination Fluoride - Children X-rays Routine cleaning Sealants (permanent molars) Common Provisions Emergency palliative treatment Simple restorations (fillings) Endodontics Surgical Periodontics Routine extractions Endodontics (RCT- molars) n-surgical Periodontics Inlays/onlays Dentures Implants Soft tissue impaction Partial/full bony impaction Crown & Bridge Oral surgery Extraction- erupted tooth Anesthesia Examination Fluoride - Children X-rays Routine cleaning Sealants (permanent molars) Emergency palliative treatment Simple restorations (fillings) Endodontics Surgical Periodontics Routine extractions t Covered t Specified t Specified Dental RFP 2018 TO BE COMPLETED ON AON ONLINE RFP TOOL 25

26 Design: Dental - Option 2 - Base Plan - PPO Effective Date Expiration Date Currency Allow Deviation Designs Allow Proposed Designs Design Type Alternate Design Comment 1/1/ /31/2018 United States Dollar (USD) -$ Current Design Common Provisions Plan Design >> General Endodontics (RCT- molars) n-surgical Periodontics Inlays/onlays Dentures Implants Soft tissue impaction t Specified Partial/full bony impaction t Specified Crown & Bridge Oral surgery Extraction- erupted tooth Anesthesia Frequency of services t Included Plan Design >> Orthodontia Orthodontia Covered by Plan Dental RFP 2018 TO BE COMPLETED ON AON ONLINE RFP TOOL 26

27 Design: Dental - Option 2 - Buy Up Plan Effective Date Expiration Date Currency Allow Deviation Designs Allow Proposed Designs Design Type Design Comment 1/1/ /31/2018 United States Dollar (USD) -$ Alternate Plan Design >> General R&C Percentile Annual deductible Deductible applies to Annual maximum Services accruing towards annual maximum 90th 90th Individual deductible $50 Family deductible $150 Individual deductible $50 Family deductible $150 Prev. & Diag. Prev. & Diag. Annual maximum ($) $2,000 Annual maximum ($) $2,000 Prev. & Diag. Prev. & Diag. Dependent children to age 26 Plan Design >> Services Coinsurance Current Design Common Provisions Dental RFP 2018 TO BE COMPLETED ON AON ONLINE RFP TOOL 27

28 Design: Dental - Option 2 - Buy Up Plan Effective Date Expiration Date Currency Allow Deviation Designs Allow Proposed Designs Design Type Design Comment 1/1/ /31/2018 United States Dollar (USD) -$ Alternate Current Design Plan Design >> General Classification of services 100% 80% 50% 100% 80% 50% Examination Fluoride - Children X-rays Routine cleaning Sealants (permanent molars) Common Provisions Emergency palliative treatment Simple restorations (fillings) Endodontics Surgical Periodontics Routine extractions Endodontics (RCT- molars) n-surgical Periodontics Inlays/onlays Dentures Implants Soft tissue impaction Partial/full bony impaction Crown & Bridge Oral surgery Extraction- erupted tooth Anesthesia Examination Fluoride - Children X-rays Routine cleaning Sealants (permanent molars) Emergency palliative treatment Simple restorations (fillings) Endodontics Surgical Periodontics Routine extractions t Covered t Specified t Specified Dental RFP 2018 TO BE COMPLETED ON AON ONLINE RFP TOOL 28

29 Design: Dental - Option 2 - Buy Up Plan Effective Date Expiration Date Currency Allow Deviation Designs Allow Proposed Designs Design Type Design Comment 1/1/ /31/2018 United States Dollar (USD) -$ Alternate Plan Design >> General Endodontics (RCT- molars) n-surgical Periodontics Inlays/onlays Dentures Implants Soft tissue impaction t Specified Partial/full bony impaction t Specified Crown & Bridge Oral surgery Extraction- erupted tooth Anesthesia Frequency of services Plan Design >> Orthodontia Orthodontia Covered by Plan Orthodontia coinsurance Current Design Common Provisions t Included 50% 50% Orthodontia deductible $1,500 Coverage available for child? Adult? Coverage for children to age 19 Lifetime maximum--orthodontia Lifetime maximum - orthodontia Lifetime maximum - orthodontia Child and Adult Child and Adult $1,500 $1,500 Dental RFP 2018 TO BE COMPLETED ON AON ONLINE RFP TOOL 29

30 Associated Design's: Dental - PPO, Dental - Option 1 - PPO, Dental - Option 2 - Base Plan - PPO, Dental - Fee: ASO Fee Frequency Total Employees Enrolled Total Members Covered Fee Year 1 Mature Year 2 Mature Year 3 Mature Year 4 Mature Year 5 Mature Base Fee Claims Fiduciary Claims Processing Network Access Utilization Management Other Total Fees Fee Assumptions Fee Assumptions Year 1 Mature Year 2 Mature Year 3 Mature Year 4 Mature Year 5 Mature Enrollment Estimated Paid Claims per Employee Estimated Network Penetration Percentage Estimated Number of Transactions Additional Fee Information >> Self Insured Fee Questions Are these rates guaranteed for term of agreement? Do the mature rates include run-out claims for 12 months after end of contract? Monthly (PEPM) Dental RFP 2018 TO BE COMPLETED ON AON ONLINE RFP TOOL 30

31 Design: Dental - PPO Rates: Proposed Dental - PPO Rates Description: Commission Basis: Rates are net of Commissions All Employees Contribution Total (100% Employer Paid) Frequency Monthly Per Unit Flat Rate EE EE + Spouse EE + Children EE + Family Rate Lives (Required) 11,511 5,264 2,522 4,206 Annual Total Cost Comment Rate Information Rate Guarantee End Date Participation Requirements Multi-line Discount Rate Caveats Additional Rate Information >> Fully Insured Rate Questions Fully-insured funding arrangement. To what date are your rates/fees guaranteed (for fixed rate guarantees)? If applicable, please describe how your rate/fee increases are capped in future years beyond your fixed rate guarantee. Is your dental plan willing to provide rate guarantees beyond three years? Rates conform to all applicable state mandates? Attach list of mandates by state. Provide all rates on a coverage tier per month basis (i.e. Employee Only, Employee + Spouse, Employee + Child(ren), Family) All actively-at-work will be waived for employees and dependents to be covered on the effective date and at all other times while the contract is in force (i.e., employees on disability, etc.). Dental RFP 2018 TO BE COMPLETED ON AON ONLINE RFP TOOL 31

32 Provide trend factors for the following periods: All dental program rates should be guaranteed for a minimum of three years. Please describe underlying rate assumptions. Are there minimum participation requirements? If so, please describe. Will your organization accept assignment of benefits directly to out-ofnetwork providers, upon request? Are HIPAA certificates included? If no, include the additional charge as a line item in your financial proposal. Dental RFP 2018 TO BE COMPLETED ON AON ONLINE RFP TOOL 32

33 Design: Dental - Option 1 - PPO Rates: Proposed Dental - Option 1 Rates Description: Commission Basis: Rates are net of Commissions All Employees Contribution Total (100% Employer Paid) Frequency Monthly Per Unit Flat Rate EE EE + Spouse EE + Children EE + Family Rate Lives (Required) 11,511 5,264 2,522 4,206 Annual Total Cost Comment Rate Information Rate Guarantee End Date Participation Requirements Multi-line Discount Rate Caveats Additional Rate Information >> Fully Insured Rate Questions Fully-insured funding arrangement. To what date are your rates/fees guaranteed (for fixed rate guarantees)? If applicable, please describe how your rate/fee increases are capped in future years beyond your fixed rate guarantee. Is your dental plan willing to provide rate guarantees beyond three years? Rates conform to all applicable state mandates? Attach list of mandates by state. Provide all rates on a coverage tier per month basis (i.e. Employee Only, Employee + Spouse, Employee + Child(ren), Family) All actively-at-work will be waived for employees and dependents to be covered on the effective date and at all other times while the contract is in force (i.e., employees on disability, etc.). Provide trend factors for the following periods: Dental RFP 2018 TO BE COMPLETED ON AON ONLINE RFP TOOL 33

34 All dental program rates should be guaranteed for a minimum of three years. Please describe underlying rate assumptions. Are there minimum participation requirements? If so, please describe. Will your organization accept assignment of benefits directly to out-ofnetwork providers, upon request? Are HIPAA certificates included? If no, include the additional charge as a line item in your financial proposal. Dental RFP 2018 TO BE COMPLETED ON AON ONLINE RFP TOOL 34

35 Design: Dental - Option 2 - Base Plan - PPO Rates: Proposed Dental - Option 2 Base Rates Description: Commission Basis: Rates are net of Commissions All Employees Contribution Total (100% Employer Paid) Frequency Monthly Per Unit Flat Rate EE EE + Spouse EE + Children EE + Family Rate Lives (Required) 5,756 2,632 1,261 2,103 Annual Total Cost Comment Rate Information Rate Guarantee End Date Participation Requirements Multi-line Discount Rate Caveats Additional Rate Information >> Fully Insured Rate Questions Fully-insured funding arrangement. To what date are your rates/fees guaranteed (for fixed rate guarantees)? If applicable, please describe how your rate/fee increases are capped in future years beyond your fixed rate guarantee. Is your dental plan willing to provide rate guarantees beyond three years? Rates conform to all applicable state mandates? Attach list of mandates by state. Provide all rates on a coverage tier per month basis (i.e. Employee Only, Employee + Spouse, Employee + Child(ren), Family) All actively-at-work will be waived for employees and dependents to be covered on the effective date and at all other times while the contract is in force (i.e., employees on disability, etc.). Provide trend factors for the following periods: Dental RFP 2018 TO BE COMPLETED ON AON ONLINE RFP TOOL 35

36 All dental program rates should be guaranteed for a minimum of three years. Please describe underlying rate assumptions. Are there minimum participation requirements? If so, please describe. Will your organization accept assignment of benefits directly to out-ofnetwork providers, upon request? Are HIPAA certificates included? If no, include the additional charge as a line item in your financial proposal. Dental RFP 2018 TO BE COMPLETED ON AON ONLINE RFP TOOL 36

37 Design: Dental - Option 2 - Buy Up Plan Rates: Proposed Dental - Option 2 Buy Up Rates Description: Commission Basis: Rates are net of Commissions All Employees Contribution Total (100% Employer Paid) Frequency Monthly Per Unit Flat Rate EE EE + Spouse EE + Children EE + Family Rate Lives (Required) 5,755 2,632 1,261 2,103 Annual Total Cost Comment Rate Information Rate Guarantee End Date Participation Requirements Multi-line Discount Rate Caveats Additional Rate Information >> Fully Insured Rate Questions Fully-insured funding arrangement. To what date are your rates/fees guaranteed (for fixed rate guarantees)? If applicable, please describe how your rate/fee increases are capped in future years beyond your fixed rate guarantee. Is your dental plan willing to provide rate guarantees beyond three years? Rates conform to all applicable state mandates? Attach list of mandates by state. Provide all rates on a coverage tier per month basis (i.e. Employee Only, Employee + Spouse, Employee + Child(ren), Family) All actively-at-work will be waived for employees and dependents to be covered on the effective date and at all other times while the contract is in force (i.e., employees on disability, etc.). Provide trend factors for the following periods: Dental RFP 2018 TO BE COMPLETED ON AON ONLINE RFP TOOL 37

38 All dental program rates should be guaranteed for a minimum of three years. Please describe underlying rate assumptions. Are there minimum participation requirements? If so, please describe. Will your organization accept assignment of benefits directly to out-ofnetwork providers, upon request? Are HIPAA certificates included? If no, include the additional charge as a line item in your financial proposal. Dental RFP 2018 TO BE COMPLETED ON AON ONLINE RFP TOOL 38