Commonwealth of Pennsylvania

Transcription

1 Commonwealth of Pennsylvania Date: April 27, 2015 Subject: Questions and Answers Solicitation Number: PSERS RFP Opening Date/Time: May 21, :30 PM Addendum Number: 1 To All Suppliers: The Commonwealth of Pennsylvania defines a solicitation Addendum as an addition to or amendment of the original terms, conditions, specifications, or instructions of a procurement solicitation (e.g., Invitation for Bids or Request for Proposals). List any and all changes: 1. Attached are the answers to the questions submitted in response to the RFP and the attendee list for the preproposal conference held on April 23, For electronic solicitation responses via the SRM portal: Attach this Addendum to your solicitation response. Failure to do so may result in disqualification. To attach the Addendum, download the Addendum and save to your computer. Move to My Notes, use the Browse button to find the document you just saved and press Add to upload the document. Review the Attributes section of your solicitation response to ensure you have responded, as required, to any questions relevant to solicitation addenda issued subsequent to the initial advertisement of the solicitation opportunity. For solicitations where a hard copy (vs. electronic) response is requested: Attach this Addendum to your solicitation response. Failure to do so may result in disqualification. If you have already submitted a response to the original solicitation, you may either submit a new response, or return this Addendum with a statement that your original response remains firm, by the due date to the following address: Except as clarified and amended by this Addendum, the terms, conditions, specifications, and instructions of the solicitation and any previous solicitation addenda, remain as originally written. Very truly yours, Name: Terrianne P. Mirarchi Title: Purchasing and Contracting Manager Phone: tmirarchi@state.pa.us Form Revised 02/26/08 Page 1 of 1

2 SIGN IN SHEET PSERS RFP Retiree Dental Insurance April 23, 2015 Name Company Tom Coster MetLife Karen Anderson Capital Blue Cross Julie Dannaway- Baer Capital Blue Cross Joe Roller Capital Blue Cross Philip Harris Financial Integrity Resources Mgmt Tony Pease Delta Dental Dave Carson Brenneman Printing

3 PSERS HEALTH OPTIONS PROGRAM RETIREE DENTAL INSURANCE RFP QUESTIONS AND ANSWERS QUESTIONS GROUP A 1. It would be helpful if you could provide any specific requirements PSERs has relating to appeals and grievances ANSWER: PSERS does not accept appeals involving benefit payments by insured products. Thus issues regarding services and benefits are between the insurer and the member. For appeals involving eligibility to enroll in an insured product, PSERS uses the following process: Initial appeal is reviewed by the third party administrator Second appeal reviewed by PSERS Director, Health Insurance Office Third appeal reviewed by PSERS Executive Staff Review Committee Forth appeal reviewed by Commonwealth administrative appeal judge Final appeal reviewed by the Retirement Board Offeror should provide a description of their appeals and grievances in their RFP response. PSERS expects the Contractor to fully handle all claims appeals. 2. Please provide a description of the data that would be subject to conversion from the current TPA s system ANSWER: Insurance carriers receive a file of the Health Options Program participants enrolled in their plan and corresponding premium payment from the third party administrator (TPA) monthly. The current TPA is CoreSource, Inc. The services of a third party administrator effective January 1, 2016 is currently out to competitive bid. 3. It would be helpful to clarify the respective roles of PSERS, the third party administrator (TPA), and the Offeror for the following items: a. It appears the Offeror is not responsible for the actual printing and mailing of enrollment kits to eligible retirees. Is our understanding correct? ANSWER: The Offeror will be required to assist in the development and distribution of communications. Please see section IV-2 D. Communications Administration. PSERS develops its own consolidated communications for all its programs and the Offeror would coordinate with PSERS, the HOP Administration Unit (TPA) and its consultant on the enrollment process and materials distribution. 04/23/2015 1

4 b. It appears the TPA will receive all enrollment selections from retirees and provide an enrollment file to Offeror for ongoing service. Is our understanding correct? ANSWER: The HOP Administration Unit will receive all membership applications and provide the Dental Contractor eligibility and enrollment information on an ongoing basis. The HOP Administration Unit maintains all eligibility and enrollment records to allow premiums to be paid through deduction from the retiree s monthly annuity check. If needed (e.g., small pension or surviving spouse) the HOP Administration Unit will receive and process payments from the participant. c. It appears the TPA will perform billing services. Will that include the TPA billing retirees directly at home and pension deductions? ANSWER: Yes, the TPA will perform all billing services including deductions and processing of direct payments. d. The Offeror s quote should not include fees payable to TPA for their services? ANSWER: Correct the Offeror should not include any fees to the TPA. PSERS may place an additional administration load on the quoted dental premium to cover any costs incurred by PSERS in the administration of the dental plan. e. Can PSERS provide their current TPA s name? ANSWER: The current TPA is CoreSource, however the TPA s services are currently under consideration in a separate procurement. 4. Please describe a scenario when it would be expected the dental carrier or their subcontractor would access the Commonwealth IT Facilities. We assume an eligibility file would be sent to the carrier via a secure transmission and reside on the carrier system for claim processing and customer service purposes. ANSWER: It is not expected that the Dental Contractor would be required to access the PSERS IT Facilities to retrieve information critical the proper administration of the plan. Eligibility and premium payment information would all flow through the HOP Administration Unit to/from the Dental Contractor. 5. Please confirm that PSERS is not seeking payment of an implementation fee to PSERS from the Offeror. ANSWER: Confirmed, PSERS is not seeking payment for implementation fees or implementation credit. Implementation fees refer to any special costs or fees you would charge associated with the implementation of the program charged to PSERS. 04/23/2015 2

5 6. To ensure an apples to apples cost comparison, it would be beneficial if PSERS provided a bit more detail regarding the desired plan design as it relates to allocation of services, frequency limitations, age limitations, and allowed charges (R&C) for out of network care. The following is an illustrative example of how that could be accomplished using a plan design supported by clinical research and appropriate for PSERS retiree population. Please note our understanding of the Commonwealth s insurance regulations are an insured plan situated in the Commonwealth of Pennsylvania cannot have a coinsurance difference for In versus Out of Network reimbursement of more than 20%. As such, we would suggest changing the In Network reimbursement for Basic Services from 75% to 70%. It is important to note Mississippi, Texas and Louisiana are Extraterritorial states and do not allow an In and Out of Network reimbursement difference for their residents regardless of the state of situs. Lastly, please confirm the basis for Out of Network reimbursement. We suggest the 80 th percentile Reasonable and Customary. ANSWER: Please quote the plan design as provided. If the Offeror feels that the current design does not meet the State requirements, please quote an alternative design and reference the State law or rule that is requiring this change. All information should be included in the Cost Proposal. Below are our clinically based procedure allocation and frequency limitation recommendations taking into account the above desired plan. Please confirm we should price accordingly. Plan Design Allocation of Services Preventive Basic Major Oral Exams Full-Mouth or Panoramic X-rays Bitewing X-Rays Intraoral, periapical, and extraoral x-rays Prophylaxis/Cleaning Fluoride Treatments Pulp vitality tests Diagnostic casts Bacteriological studies Sealants Space Maintainers Palliative Care Sedative Fillings Fillings Periodontal Maintenance Pulp Capping Therapeutic Pulpotomy Periodontics Non-surgical Simple Extractions Surgical Extractions/ Oral Surgery Recementations and Repairs Rebases/Relines General Anesthesia Consultations Inlays/Onlays Crowns Crown Build-ups Dentures Bridges Endodontics/Root Canal Periodontics - Surgical Placement of Implants Frequency Limitations / Exclusions Frequency Limitations Preventive 1 oral exam in 6 consecutive months 1 fluoride treatment in 12 consecutive months for dependent child to age 14 1 cleaning (oral prophylaxis) in 6 consecutive months Full mouth and panoramic x-rays: once per 60 months Bitewing x-rays: 1 set per calendar year for adults; 1 set in six consecutive months for children 04/23/2015 3

6 Basic Space maintainers: limitation of one space maintainer per lifetime per area for premature loss of primary teeth for dependent children to age 14 Sealants: limitation of one application of sealant material for each non-restored permanent 1st and 2nd molar tooth of a dependent child to age 19, once every 60 months Periodontal maintenance where periodontal treatment (including scaling, root planing, and periodontal surgery such as gingivectomy, gingivoplasty, gingival curettage and osseous surgery) has been performed. Periodontal maintenance is limited to 4 times in any year less the number of teeth cleanings received during such 12-month period. Filling Replacement: 24 months Periodontal scaling and root planning but not more than once per quadrant in any 24 month period. Major Initial installation of full or removable Dentures: (1) after the person receiving such services was covered under The MetLife Retiree Dental Benefits program for 12 months (applicable to New York Group Policies only); (2) when needed to replace congenitally missing teeth; or (3) when needed to replace natural teeth that are lost while the person receiving such benefits was covered under The MetLife Retiree Dental Benefits program. Addition of teeth to a partial removable Denture: (1) after the person receiving such services was covered under The MetLife Retiree Dental Benefits program for 12 months (applicable to New York Group Policies only); (2) when needed to replace congenitally missing teeth; or (3) when needed to replace natural teeth that are lost while the person receiving such benefits was covered under The MetLife Retiree Dental Benefits program. Replacement of non-serviceable Denture if such Denture was installed more than 84 months prior to the replacement. Replacement of an immediate, temporary full Denture with a permanent full Denture if the immediate, temporary full Denture cannot be made permanent and such replacement is done within 12 months of the installation of the immediate, temporary full Denture. Relinings and rebasings of existing removable Dentures if at least 6 months have passed since the installation of the existing removable Denture; and not more than once in any 36 month period. Repair of Dentures; but not more than once in a 12 month period. Adjustments of Dentures, if at least 6 months have passed since the installation of the Denture and not more than once in any 12 month period. Replacement of any Cast Restoration with the same or a different type of Cast Restoration but no more than one replacement for the same tooth surface within 84 months of a prior replacement. Prefabricated stainless steel crown or prefabricated resin crown, in either case, only for primary teeth and limited to once per tooth in a 60 month period. Core buildup, but no more than once per tooth in a period of 84 months. Posts and cores, but no more than once per tooth in a period of 84 months. Consultations, but not more than once in a 12 month period. Root canal treatment, but not more than once in any 24 month period for the same tooth. Periodontal surgery, including gingivectomy, gingival curettage and osseous surgery, but no more than one surgical procedure per quadrant in any 36 month period. Placement of Implant but not more than once for the same tooth position in an 84 month period. Repair of implant supported prosthetics, but not more than once in a 12 month period. Repair or re-cementing of Cast Restorations, but not more than once in a 12 month period. Tissue Conditioning, but not more than once in a 36 month period. 04/23/2015 4

7 ANSWER: PSERS is requesting coverage by the major categories provided in Appendix C. All Offerors should provide a detail description of those services which are included under the major categories provided. An Offeror may propose a second bid based upon a more detailed description of their plan design as it relates to allocation of services. The second bid and a detailed description of services should be submitted in their Cost proposal. 7. Please confirm the # of Contract is current participants in the HOP Medical Plans and the # of Lives is the eligible lives. ANSWER: The term Contract refers to the participants in the HOP Medical Plan excluding spouses. Lives includes the spouses and other dependents of those participants (contracts) that are enrolled in the HOP Medical Plans. 8. Can a retiree cancel Dental enrollment at next year s Open Selection period? ANSWER: Yes, retirees are allowed to terminate coverage at any time. Retirees will be eligible to re-enroll during the next Option Selection Period if they remain enrolled in a qualifying HOP Medical plan. PSERS is willing to negotiate dental coverage restrictions so that the Contractor will not be faced with adverse selection scenarios. Option Selection Periods are annual periods that allow for members to select between HOP coverage offerings, however these are not Open Enrollment Periods. Members are only allowed to enroll in HOP programs as a result of a qualifying event, or during a specified and Board approved Open Enrollment Period. Historically, PSERS has held Open Enrollment Periods every five years; however, these must be approved by the Board and are not guaranteed to occur. 9. Can spouses age 65 and dependents enroll before retiree reaches age 65. ANSWER: Yes, spouses are eligible to enroll at age 65 regardless of retiree s current age. PSERS does provide communications of a qualifying event to retirees six months before their 65 th birthday. However, PSERS does not track the age of spouses before enrollment in HOP plans and therefore they do not receive the same communications. Dependent children are eligible at the time of the spouse, if the spouse reaches age 65 before the retiree. QUESTIONS GROUP B 10. Is there an available census? How many lives will be covered? ANSWER: This program will be a new, voluntary benefit offering for the members enrolled in the HOP Medical Plan or Pre-65 Medical Plan, and as such there is no current participation. However, members have expressed high interest in Dental Coverage through PSERS annual member survey. PSERS conducts ongoing surveys of the Health Options Program membership and eligible PSERS retirees to determine satisfaction with plan offerings. In the most recent survey PSERS received 3,376 responses, and of those 89% expressed interest in paying an additional premium for Dental Coverage. 04/23/2015 5

8 For more information on the on the members eligible for this benefit please see Page 3 of Appendix C. Census information will be provided upon receipt of the signed NDA, Appendix G of this RFP 11. Will multiple dental insurance carriers be selected and offered for the members to choose from? ANSWER: Only one Offeror will be select to administer the Dental Plan and only one plan of benefits will be established at this time. PSERS may modify this in the future. 12. What criteria must a retiree meet to be eligible for medical/dental benefits? ANSWER: The Dental plan will only be available to those retirees and their dependents who are enrolled in the HOP Medical Plan, the HOP Pre-65 Medical Plan, or any other Medicare Supplement or Pre-65 medical benefit option offered by PSERS. 13. Will there be a specified Open Enrollment period? ANSWER: Members make plan selections during an Option Selection Period where plans are open to existing participants for change. Newly eligible retirees have a six-month open enrollment window to select plan options. For the initial enrollment of this plan for 2016, the PSERS Board may authorize an open enrollment period to allow retirees who did not previously elect coverage another opportunity to enroll in the Health Options Program. Members that did not elect Dental during the open enrollment period, but did enroll in an eligible HOP Medical Plan will be allowed to select Dental coverage in the next Option Selection Period. PSERS historically has conducted Open Enrollment periods for its retiree membership once every five years. As 2015 represents the fifth year in this cycle, the PSERS board may authorize an Open Enrollment where a qualifying event is not required for enrollment. a. Will members be allowed to terminate their coverage at any time? ANSWER: As a voluntary Program, Health Options Program participants may terminate coverage by notifying the HOP Administration Unit. Terminations are effective the first of the month following receipt of notification. Once an individual terminates coverage, they must have a Qualifying Event to re-enroll. A participant of the Health Options Program may change their coverage once a year during the Option Selection Period. PSERS would work with the Offeror to establish enrollment criteria to discourage participants from dropping after services have been performed and claims paid. b. Will members be allowed to enroll or re-enroll at any time? ANSWER: All Health Options Program members have the annual opportunity to select plans during the Option Selection Period for the next calendar year. Please see the answer to 11. a. above. 04/23/2015 6

9 14. Is PSERS willing to accept multiple dental plan designs and/or alternative plan designs such as: c. DHMO plans ANSWER: PSERS is only requesting a Dental PPO (DPPO) product at this time. d. Waiting periods for major services? ANSWER: While waiting periods have not been requested, the Offerors should submit the detail of any services included in their proposal and the medical evidence that supports the use of these offerings/services. Any alternative design and corresponding premium should be included in the Offeror s Cost submission. 15. Is there a consultant or broker of record for the PSERS RFP and if so, are there commissions to be factored in and paid? ANSWER: PSERS retains The Segal Group as its consultant. No commissions should be factored into the proposal. If commissions are included automatically in your pricing and cannot be removed, please disclose the amounts and indicate whether you are willing to provide all or a portion of those commissions to PSERS to reimburse PSERS for administrative costs incurred in procuring or monitoring this contract. 16. Can you tell us who the TPA is? ANSWER: The current TPA is CoreSource, however the TPA s services are currently under consideration in a separate procurement. 17. Are there additional TPA fees to be paid by the Dental Insurance Carrier? ANSWER: The Offeror should not include any fees to the TPA. PSERS may place an additional administrative load on the quoted dental premium to cover any costs incurred by PSERS in the administration of the dental plan, but this is outside of what should be included in the Offeror s quote. 18. How will the new dental plan be marketed to the members? ANSWER: Health Options Program members will receive information on the Dental Plan in their annual Option Selection Period personalized statements and enrollment kits. The plan will also be communicated to newly eligible retirees in special personalized statement and enrollment kits as well as at meetings conducted by the TPA for such newly eligible retirees. At this time vendors are not required to attend any of these meetings. If the Retirement Board decides to conduct an open enrollment, all PSERS retirees will be notified of the plans available through the Program. 19. Do member communication materials need to meet certain criteria? 04/23/2015 7

10 ANSWER: PSERS must approve all communication materials provided by the carrier as part of the enrollment process. The Dental Contractor will participate with PSERS, the communications consultant and the TPA in development of Option Selection Period materials and enrollment materials. The Contractor may be responsible for distribution of any approved additional communications requested directly from the member. 20. Why is the retiree dental plan being marketed at this time? ANSWER: PSERS has identified a demand for this product through its annual member survey. In addition, PSERS typically conducts Open Enrollment periods for its retiree membership once every five years. As 2015 represents the fifth year in this cycle, the PSERS board may authorize an Open Enrollment where a qualifying event is not required for enrollment. 21. In reference to the proposed HOP Dental plan in listed Appendix C Page 3, is there a more detailed description of all requested benefits. ANSWER: All Offerors should provide a detail description of those services that are included under the major service categories listed in Appendix C. Please see the answer to Question #6 for more detail. 22. Page 15, II-13, Domestic Workforce Utilization Certification states that the form contained in Appendix B should be in the same sealed envelope with the Technical Submittal. Should this form be included in our Technical Submittal binders and on the CD/flash drives, or should this piece be in a separate folder in the Technical Submittal package? ANSWER: The Domestic Workforce Utilization Certification should be included in your Technical Submittal and does not have to be in a separate folder. 23. Page 15 includes section II-14, Non Cost Submittal/Technical Submittal Questions. Section II, Proposal Requirements, shown on page 10, does not state how section II-14 should be submitted. Please advise which Submittal should contain our responses to section II-14. ANSWER: The Non Cost Submittal/Technical Submittal Questions. should be included in your Technical Submittal and does not have to be in a separate folder. 24. Should Appendix D, Proposal Cover Sheet, be included in all three proposal submissions? ANSWER: Yes, please include the proposal cover sheet will all three submissions. QUESTIONS GROUP C 25. Could you please provide more information regarding eligible dental participants enrolled in HOP Medical Plan as of January 2015 on Appendix C Page 3? ANSWER: Census information will be provided upon receipt of the signed NDA, Appendix G of this RFP 04/23/2015 8

11 a. Will employees at these counties be permitted to attend Open Enrollment and Option selection group and/or individual meetings? ANSWER: This program will only be offered to retirees and their dependents. Current employees are not included in this program. PSERS does not conduct meetings during Option Selection Periods. PSERS may conduct meetings if an open enrollment is conducted. PSERS conducts meetings in the spring and fall each year for retirees turning age 65. All meeting will be conducted by the TPA, and the dental contractor is neither required nor permitted to attend these meetings. b. Will there be meeting space and rooms reserved by the PSERS to conduct these meetings? ANSWER: The Dental Contractor will not be required or allowed to attend or handle logistics for any meetings PSERS schedules with its retirees. 26. How do employees traditionally enroll for benefits at PSERS? Will the dental insurance plan be a paper or electronic enrollment? ANSWER: Enrollment is completed through a paper-based form. Information about the programs is available electronically as well. Members are advised at six months of their 65th birthday of eligibility and provided information on coverage offerings. Spouses are also eligible at age 65, however PSERS does not track the ages of spouses for qualifying event notifications. 27. Who is the incumbent consultant you mentioned on RFP Page 31 of 35 D. Communications Administration 4. Participant Meetings? ANSWER: PSERS retains The Segal Group as its consultant. 28. Who is the incumbent TPA? Can you please further describe how your TPA works with the existing medical and the future dental insurance carrier? ANSWER: The TPA will provide the Dental Contractor eligibility and enrollment information on an ongoing basis. The TPA will also be responsible for the billing and collection of Dental premiums. The current TPA is CoreSource, however the TPA s services are currently under consideration in a separate procurement. 29. Can the PSERS provide a census file of the eligible members for underwriting purposes? ANSWER: Census information will be provided upon receipt of the signed NDA, Appendix G of this RFP 30. Will the PSERS provide addresses and contact information of eligible members to facilitate marketing of the selected vendor program? 04/23/2015 9

12 ANSWER: No, marketing of the program will be done only through PSERS and included in the regular Option Selection Period materials. 31. We noted on your website HOPbenefits.com that the Health Options Program offers hospital, medical/surgical, and prescription drug benefits for Medicare-eligible and non-medicare-eligible individuals. Does the PSERS currently offer any other voluntary plans? ANSWER: PSERS Health Options Program is a voluntary enrollment program for PSERS retirees and their spouses and dependents. All programs are voluntary. The plans listed are those currently offered under the program. c. If yes, please identity name of the carrier, products offered. d. If yes, how are these plans enrolled, i.e. online or in person enrollment meetings? Please describe. e. Do you expect this plan to be enrolled in coordination with the existing voluntary plans or separately? QUESTIONS GROUP D ANSWER: The Dental Benefit plan will be offered as a separate election for members enrolled in the HOP Medical Plan and Pre-65 Medical Plan. 32. According to the directions, it does not appear that Part III is part of the submission. The RFP requests a submission for the technical submittal, cost submittal and small/diverse business. However in Part III, for example IV-3, B Emergency Preparedness, there are clearly questions being asked, which I don t see where they fit in the technical submittal, cost submittal or small biz submission. Part III of this procurement provides a description of the selection process and criteria under consideration for reward. The Offeror is not required to submit any section of Part III. Emergency Preparedness is included in Part IV: Work Statement, this section refers to those services that the Offeror must provide. 33. Do you have the total call volume, call type (Billing, Enrollment, Customer Service) by month for the past 12 months? I did not see it included in the RFP. There is currently no call volume as this product is not currently offered. 04/23/