INVITATION TO NEGOTIATE FOR PARTICIPANT DOCUMENTATION AND DEPENDENT ELIGIBILITY VERFICATION SERVICES ITN NO.: DMS 10/11-030

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1 INVITATION TO NEGOTIATE FOR PARTICIPANT DOCUMENTATION AND DEPENDENT ELIGIBILITY VERFICATION SERVICES ITN NO.: DMS 10/ AMENDMENT 1 The Department hereby provides the following: Answers to questions received, attached below. FAILURE TO FILE A PROTEST WITHIN THE TIME PRESCRIBED IN S (3) OF THE FLORIDA STATUES, OR FAILURE TO FILE A BOND OR OTHER SECURITY WITHIN THE TIME ALLOWED FOR FILING A BOND, SHALL CONSTITUTE A WAIVER OF PROCEEDINGS UNDER CHAPTER 120 OF THE FLORIDA STATUTES.

2 WRITTEN ANSWERS TO QUESTIONS RECEIVED All written questions are reproduced in the same format as submitted by the Respondent. Question #1 Page 6, Dependent documentation: How many employees and dependents are currently flagged for providing insufficient documentation? How many are identified as ineligible? Is this process only for new dependent adds? When did this process begin with NorthgateArinso? Answer #1 Based on a March 25, 2011 system query, 16,217 dependents covered under medical insurance are pending some type of documentation and 2,024 employees covered under medical insurance and are pending some type of documentation. The system identified 24 possible ineligible dependents; however, this number is not representative of those ineligible due to divorce, remarriage (surviving spouse), etc. The process to elect changes for many qualifying events is self-service in the human resource information system (People First). Currently, the election can be made without supplying documentation. This includes both adds and drops. NorthgateArinso (formerly Convergys) became the human resource administrator for benefits in January Question #2 Has there ever been a full population (documentation collected) audit conducted? If yes, when and what were the results? Answer #2 No. Question #3 Page 8, States the total number of PPO & HMO contracts at 177,197. Please confirm the total number of employees you have covering dependents. Please include Employee + Spouse, and Employee + Family. Answer #3 See Attachment DSGI ITN Enrollment FY with Dependents for additional data. The State only offers individual and family tiers for health insurance. Question #4 Is there an average employer cost per dependent?

3 Answer #4 See the answer to #18. Question #5 Page 24. Section 3.01, A, 1; Any costs associated with the following must be paid by the Respondent: systems integration with the state s human resource system including, but not limited to, implementation of a secure FTP connection between the Respondent and NorthgateArinso for new interface files and system programming (including requirements development, design, coding and testing) to load/process the information/images transmitted. Please confirm if Respondent is responsible for costs incurred by the state s human resource system and NorthgateArinso to support the audit? Answer #5 The Contractor is responsible for preparing files that interface with the human resource system through a secure FTP connection. File development, design, coding and testing costs incurred by NorthgateArinso to load these interface files are the responsibility of the Contractor. At the point which the files are successfully loaded by NorthgateArinso, the Contractor s responsibility for costs incurred by NorthgateArinso ends. The extent of these costs may be minimal or significant depending on the compatibility of the Respondent s system. During the negotiation phase, each Respondent will have an opportunity to ask technical questions to assess costs prior to the best and final offers. Question #6 Pages 25, Please clarify what is meant by grace period (3 month). Does this fall within the appeals phase? Answer #6 With the initial response, the Department expects each Respondent to propose a process for implementing a three-month grace period, including parameters around its application and timing. In the negotiation phase, the Department may choose to stipulate the terms of the grace period. Question #7 Page 25, Regarding Medicare eligibility documentation. What would the State be asking us to verify? Medicare cards? Affidavit? HIC numbers? Would this be for dependents only or for all employees?

4 Answer #7 The vendor should obtain copies of Medicare cards for Medicare-eligible subscribers and their covered dependents. Ideally, the Department will receive HIC numbers in an electronic format that will populate our human resource information system (People First). Additionally, the Department looks for advice regarding proper documentation from Respondents through their proposals. Question #8 Page 25, Is the eligibility of a dependent contingent upon successfully providing SSN and Medicare information? For example: the subscriber has supplied all other documentation except confirmation of the SSN for their dependents, will those dependents not be eligible for coverage? Answer #8 While the Department looks for advice from Respondents through their proposals, we anticipate that eligibility will be contingent upon receipt of this information. Question #9 Is there a particular time The State of Florida would like to start the audit (i.e., post AE)? Answer #9 The Department anticipates the audit process following annual enrollment; however, we look to the Respondents to propose an optimal timeline in their response. The Department intends the eligibility audit communication process to begin no later than July Question #10 When does your Annual Enrollment period start and end? Answer #10 Open Enrollment for the 2012 plan year begins September 26, 2011, at 8 a.m. Eastern time and ends October 21, 2011, at 6 p.m. Eastern time. The State will also offer a two-week correction period from October 24, 2011, 8 a.m. Eastern time through November 4, 2011, 6 p.m. Eastern time.

5 Page 12, Pricing Methodology: Question #11 The Guaranteed Not-To-Exceed Fee. A fixed amount payable by the Department, subject to the availability of funding, not-to-exceed 12 months of historical claims costs for the disenrolled dependents. Can you confirm that the fixed fee is contingent on the number of employees audited at the time of audit (ie, if today there was 90,000 employees with covered dependents and by the time we actually collect the 1 st file that count has jumped to 98,000 due to time lapse of this proposal). Answer #11 The vendor is eligible for payment, pursuant to the terms of the ITN, for every ineligible or undocumented dependent removed, regardless of the number or size of the files. For each individual removed, the Department will look at the historical medical costs for the prior 12 months to establish the maximum vendor payment. Question #12 If a participant appeals and is not eligible but reinstated instead for a technicality during appeal (E.g. their employer gave them incorrect dates for a qualifying event), are they still included for fee calculation purposes? Answer #12 If dependents are ineligible, they will be included in the fee calculation, regardless of such technicalities. (Also, the Department will not reinstate ineligible dependents.) Question #13 Page 30, Performance Guarantee #4. Please confirm documents need to be processed and a file sent to NGA within 2 days of receipt of the documentation from a subscriber? Please confirm if Post Audit Reinstatements performance guarantee includes those documents received as part of a Level I Appeal (i.e. appeals need to be processed within 2 days)? Answer #13 Confirmed. Your description accurately captures the performance guarantee as written. The purpose of the guarantee is to ensure dependent coverage is reinstated as quickly as possible. Question #14 Page 33, Additional Reports: Is point #6 only during the time of the contract? Answer #14 The Department does not envision requiring Ad Hoc reports after termination of the contract so long as the termination date provides a sufficient time period after conclusion of the audit to finalize the project. The contract will not be terminated until such time that all required reports have been received and accepted by the state. Question #15 Attachment 12, Is it acceptable to provide any proposed edits to Attachment 12 or do we need to sign as is?

6 Answer #15 It is acceptable to propose edits for the Department s consideration. Question #16 What is the total number of subscribers that have dependents that would be in scope of this project? Answer #16 See Answer #3. Question #17 What is the average annual estimated cost per dependent to the plan? Answer #17 See Answer #18. Question #18 For costing purposes, what was the average claims experience of a dependent in the system for the past 3 years? We do not have this information available for the HMO plans; however, in the PPO plan, the average, annual net cost per dependent is as follows: Answer #18 FY $3, FY $3, FY $3,026.83