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

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1 CALVERT COUNTY PUBLIC SCHOOLS ITB: # CCPS-INSUR-VIS-2017 DATE OF ISSUE: PROPOSAL INSTRUCTIONS FOR VISION BENEFITS CALVERT COUNTY PUBLIC SCHOOLS Contents: Section 1 - General Instructions Section 2 - Current and Requested Plan Information Section 3 - Performance Standards Sent via secure Proposal forms; census; plan information Name of Firm Submitting Bid

2 SECTION 1 - GENERAL INSTRUCTIONS A. Background Calvert County Public Schools (CCPS) is soliciting proposals for a benefits plan administrator/insurer for the Vision plan offered to eligible employees, retirees, and dependents. There are approximately 2,630 employees and retirees covered for vision benefits B. Geographic Accessibility Report You must provide a Geo Access Report for the Vision network you are quoting. Use the employee zip codes provided on the enclosed census files. Please produce the geo-access reports using all participants on the census. To determine if an employee is covered by your service area, use a standard of two (2) vision providers within ten (10) miles. The report should be broken out by County. You must also complete Proposal Forms V3 and V4 C. Proposal Forms In order for your proposal to be considered, the enclosed Proposal Forms TV1 through TV6 and PV1 through PV4 must be completed and returned with your proposal based upon the coverage options you are quoting. Proposal Forms are included in the electronic bid package in Microsoft Excel/Word format. D. Funding All plans are requested on an ASO (i.e. self-insured) basis. E. Questionnaire The enclosed questionnaires (Proposal Form TV1 and PV1) must be completed and returned with your proposal. F. Census Data Census data are included with the electronic bid package in Microsoft Excel. G. Network Directories Network directories for each network you are proposing must be included with your proposal. Directories must be provided on disk in Excel format. However, if you have a website, you may provide that in lieu of a directory on disk. Please provide one (1) hard copy of your directory. You must also complete Proposal Form V5 which provides a summary of your networks by location. H. Commissions Assume no commissions are payable. I. Run-out Assume the current vendor will pay the run-out. -2-

3 SECTION 2 - CURRENT AND REQUESTED PLAN INFORMATION A. Current Plan - The current vision plan is described in the booklet provided in the electronic bid package. Information on employee/retiree contributions is included in the Medical RFP. B. Requested Plan Design and Funding Duplicate current plan design and funding. C. General Vision benefits are currently administered by CareFirst BlueCross BlueShield. D. Funding The CareFirst BlueCross BlueShield is self-insured using the same funding arrangement as described in the medical ITB -3-

4 SECTION 3 - PERFORMANCE STANDARDS Certain tasks are critical to the successful implementation and ongoing operation of the CCPS program. The successful vendor must be willing to agree substantially to the following performance standards and associated penalties for not meeting the standards. Not meeting one of the specified criteria within each category will result in 50% of the penalty being awarded to CCPS. Additional penalties within each category will be pro-rated over the remaining items using the outstanding penalty dollars. Unless specifically stated otherwise in your proposal, your company agrees to these standards without exception. Performance Standard Fee-based Penalty 1. Implementation 4% of fees Produce and make available electronically, or via paper if requested, up-todate provider directories at least weekly. Provider directories must be updated and available prior to the enrollment period; note, enrollment period begins before employee meetings. Code benefits in claim system with 100% accuracy and present testing results. Provide CCPS with a benefits and financial contract within two months of the plan effective date. Provide a team trained in CCPS benefits to attend all employee meetings. Representatives must be fluent on all plan offerings you are proposing. Provide internal training schedule and attendance records. 2. ID Cards 2% of fees Produce and distribute ID cards prior to the effective date error free. It is the carrier s responsibility to work with CCPS to achieve error free distribution. Produce and distribute ID cards within five (5) working days of receipt of new employee information from CCPS 3. Eligibility 2% of fees Billing and enrollment (eligibility): (0.5% each) Initial - 95% loaded in system within three (3) working days Upload eligibility to enrollment system with 100% accuracy assuming clean files from client group. Ongoing % loaded in system within three (3) working days Maintain accurate up to date enrollment in the system at all times 4. Claims Processing 3% of fees Claims Turnaround- 87% of claims received will be processed within 14 calendar days Claims Dollar Accuracy- 99% Claims Procedural Accuracy- 97% 5. Network Maintenance 3% of fees Maintain a satisfactory number of open providers in all locations (90% of providers identified during proposal phase). If, within one year, your network is not being maintained or that employees are not able to access in-network providers (less than 80% of total claims are in network), the penalties will -4-

5 Performance Standard apply Maintain an online provider directory with updates no less than bi-weekly Fee-based Penalty Provider network GeoAccess and disruption reports will demonstrate less than a 5% change in network providers from originally quoted network statistics 6. Customer Service 5% of fees 90% of all customer calls to the call center will be answered within 30 seconds For time on hold criteria, use an abandonment rate of no more than 5% Provide callback to insured individuals or CCPS s designated administrator for unresolved issues or inquiries within 24 hours Provide response to written inquiries within 7 calendar days of receipt Duplicate errors on part of carrier if CCPS documents a consistent pattern of mistakes or errors that go uncorrected for a substantial period of time (not to exceed two quarters), it will be determined you have not met this standard 7. Participant Satisfaction 1% of fees Conduct annual member satisfaction survey and achieve overall rating of 85% or better. (Survey format and rating methodology to be agreed upon by both parties.) Survey results must be provided to accounts within 45 days of survey completion date 8. Account Management 4% of fees Account Manager will partner with CCPS to: Provide comprehensive assistance for the client in support of top-tier customer service Provide timely response and follow-up on phone calls and s from the client Meet with the client s benefit staff as needed to meet objectives and oversee the annual open enrollment process, including participation in employee information meetings Provide ongoing assistance with any issues escalated by designated benefits contacts 9. Client Reporting 1% of fees Client-specific reporting package as agreed upon will be provided within 45 days from the close of the established reporting period Carrier will formally notify CCPS in writing when a standard is not met. Carrier will provide backup information. Carrier will pay penalties within 30 days of written notification. -5-