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REQUEST FOR PROPOSAL NS-48-12
for:
DentalFlexible Spending Account Administration
Proposal Requested By:
April 2012
ConfidentialThe information contained within this Request for Proposal, including census data, exhibits and attachments, is confidential and proprietary. This information shall not be used or disclosed except as authorized by Northern Kentucky University or an authorized representative of Mercer.
Table of Contents
SECTION I - GENERAL INFORMATIONA. Northern Kentucky University Profile.................................... 3B. Objective................................................................................. 3
SECTION II - PROCEDURESA. Submission Guidelines............................................................. 4B. RFP Project Plan and Timeline................................................ 5C. Selection Criteria..................................................................... 6
SECTION III - QUOTATION REQUIREMENTSA. Assumptions............................................................................. 7B. Coverage Continuity................................................................ 7C. Plan Design and Provisions...................................................... 7D. Plan Options............................................................................. 7E. Financials................................................................................. 7F. Performance Guarantees......................................................... 7G. References............................................................................... 8
EXHIBITS AND ATTACHMENTSI. QUESTIONNAIRE.............................................................. 9
A. Plan Level......................................................................... 9B. Administrative..................................................................11C. Performance Guarantees..................................................17D. Plan Design Questionnaire...............................................17
1. Dental........................................................182. FSA............................................................23
II. ATTACHMENTS, PLAN DESIGN, FINANCIAL ARRANGEMENTS 25
A. Experience........................................................................25B. Plan Design......................................................................26
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SECTION I - GENERAL INFORMATION
A. Northern Kentucky University Profile
Northern Kentucky University (NKU) has more than 15,000 students served by nearly 2,400 faculty and staff on a campus near Cincinnati. Located in the suburb of Highland Heights, Ky. - just seven miles southeast of Cincinnati – NKU has become a leader in Greater Cincinnati and Kentucky by providing a puclic school education for a fraction of the cost. NKU is one of the fastest growing universities in Kentucky.
For more information on NKU please visit their website at: www.nku.edu
B. Objective
The objective of this RFP is to check the market for competitive pricing, extended rate guarantees, performance guarantees and improved customer service.
Dental: NKU is interested in reviewing options for matching current plan designs. NKU would also like to review self-insured dental options.
FSA: NKU is looking for more automation including data file feeds; debit cards; online employee access to FSA balances; and extended customer service hours.
Bids are solicited for the following programs:
Dental currently insured by Aetna FSA Administration currently provided by Aetna
The Request for Proposal (RFP) will prompt you to respond with the potential capabilities to administer the Northern Kentucky University plans listed above. The target effective date for any change would be January 1, 2013.
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SECTION II - PROCEDURES
A.Submission GuidelinesProposals are due 5/7/12. Proposals received after this deadline may not be considered.
Please organize your response as follows:A. Executive summary or cover commentsB. Notarized Non-Collusion Form (form must be notarized) C. Confirm that your response complies with all RFP requirements; or,
include a statement of deviations.D. Plan Design DetailE. Financial AgreementsF. Performance Guarantee and Service StandardsG. Response to the QuestionnaireH. Other Attachments
1. Please prepare your responses in accordance with the requirements set forth in this document. We will assume your proposal complies with all of the specifications of this RFP, unless you clearly state any deviations in your proposal. This RFP may be amended or revoked at any time prior to a final agreement. Your response to this RFP, as well as any correspondence related to this RFP, will be considered part of your response. If you provide additional material to expand on your RFP response, please cross-reference it in the appropriate response areas and provide copies in both electronic (standard format) and hardcopy as noted below.
2. Your response should reflect data specific to the geographic markets to which you are responding, and the products being quoted in this proposal.
3. Deadline for Submission - Your Electronic Proposal must be received by NKU and Mercer no later than 5:00 PM on 5/7/12. NKU also requires 4 hard copies to be delivered no later than 5/8/12. Responses received after this date may not be considered.
4. Confidentiality - Information contained in this RFP must be considered confidential and should not be discussed with anyone except persons within your company, Northern Kentucky University or Mercer.
5. Questions - Please address any questions via email to Jeff Strunk at NKU. [email protected]
All answers to additional inquiries will be supplied to all participants in this RFP process.
6. Verbal Presentation/Site Review - Following evaluation of your response, we may request a site review with selected representatives of Northern Kentucky University and any representative assisting Northern Kentucky
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University in this process. Discussions during such verbal presentations will be considered carefully during the final evaluation.
7. Costs of Preparation - All costs associated with preparation and submission of your response, including presentations to Northern Kentucky University management are the sole responsibility of the supplier.
8. The RFP response and supporting material submitted will become the property of Northern Kentucky University and will not be returned.
9. Reservation of Rights - This is a Request for Proposal and is not an offer to purchase services on the part of Northern Kentucky University. Northern Kentucky University reserves the right to withdraw this RFP or to reject, at its sole discretion, any or all proposals submitted in response to this RFP. Further, Northern Kentucky University reserves the right to accept proposals from one or more prospective suppliers. Northern Kentucky University incurs no liability, whatsoever, by reason of such withdrawal or rejection. Acceptance is expressly limited to the purchase terms and conditions, as mutually agreed in writing.
10.Your proposal will be scored based on each answer provided.
11.Proposal Validity – Proposals in response to this RFP will be considered valid, for acceptance by Northern Kentucky University, for a period of two hundred fifty (250) days from the date of the submittal.
12.Proposal Binding - All representations made in Carrier's proposal are binding. Unless otherwise so stated in Carrier's proposal, Carrier agrees to the requirements set forth in RFP.
13.Contract situs should be Kentucky and comply with all State requirements.
14. We recognize that all vendors included in the RFP process may be unable to provide a proposal on all lines of coverage requested. As you respond to the questions in the RFP please indicate N/A for any questions that would not apply to the coverage quoted.
B.RFP Project Plan and Timeline
Process Step Date For Completion
RFPs Issued 4/23/12RFP confirmation email and additional questions due to Northern Kentucky
4/27/12 by 3:00pm
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University / MercerAdditional questions from respondents answered
5/2/12
RFP responses due and Sample Contracts
5/7/12 (electronic version) and 5/8/12 (for hard copies)
Evaluative report delivered to Northern Kentucky University
5/15/12
Notify Vendors of Finalist Status
5/21/12
Verbal Interviews/Presentations(Highland Heights, KY – greater Cincinnati area)
5/23/12 and 5/24/12
Site Reviews TBDOpen issue follow up 5/29/12Plan selection 6/1/12
Provide four bound copies, one unbound copy marked original and electronic copy via email to:
Jeff StrunkNorthern Kentucky UniversityProcurement ServicesLucas Administrative Center 617Nunn DriveHighland Heights, KY 41099(859) 572-5265FAX (859) [email protected]
Provide one electronic copy to:
Michele MistlerMercer Health & [email protected]
C. Selection CriteriaCarrier selections will not be based solely on financial position, but competitive pricing will be a major consideration to position your organization in the finalist review. Your organization’s ability to meet plan design parameters, streamline benefit plans and deliver timely and accurate administrative, claim and reporting requirements will also weigh heavily in the final decision. Before the final decision is made, we may also conduct a site
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visit of your claim paying or service facility, which will weigh further in our assessment of your administrative and claim capacities. Vendors may be required to participate in finalist presentations as determined necessary by Northern Kentucky University. Additionally, Northern Kentucky University reserves the right to negotiate further with any vendor respondent as it relates to plan design, performance guarantees, rates and any other component of this RFP.
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SECTION III - QUOTATION REQUIREMENTSA. AssumptionsYour proposal should assume that your organization and your proposal response comply with the following:
An assumed effective date of January 1, 2013. Please quote all plans with standard commissions. Northern Kentucky University may request a site tour of your claim and
administrative facilities prior to final carrier selection. Northern Kentucky University requires a 180 day renewal rate notice or
notice for a carrier-initiated contract cancellation. Carrier cancellation cannot be based upon plan performance specific to
Northern Kentucky University nor canceled for any reason other than non-payment of premium.
The products presented in your response are properly licensed and approved in all US locations; and, your contracts and certificates are in compliance with State and Federal laws.
Your rate guarantee will be binding except under the following scenarios:
15% change in employee population at one point in time, or due to one episode/event.
A legislated change in benefits that is expected to create additional plan costs.
Your organization has sufficient resources to provide timely and accurate underwriting, reporting and administrative services. Administrative processes may require customization from time to time.
For Dental Plan, Mercer and Northern Kentucky University will require a pre-implementation audit to ensure claim system and processes are in place prior to the effective date of coverage. It is expected that the selected vendor will pay all travel costs associated with the audit.
Carrier will accept liability for all its claim recommendations. Northern Kentucky University will be indemnified from any administrative or clinical decisions made by your organization.
Northern Kentucky University requires contracting with only one organization. Any outsourcing agreements you may have will be made solely between your organization and the organization you have selected to provide the services.
Northern Kentucky University requires that all vendors provide a 60 day billing lag/grace period. Please confirm any variation from this.
All selected Carriers are to provide Co-op Dollars to support Staff/Faculty Appreciation Week or another annual event on campus. This financial support will also include Brown Bag Lunch and Learns for employee education 6 times per year. An annual figure of $5,000 is required. Please confirm your ability to comply.
B. Coverage ContinuityNo individual will lose coverage due to a change in carrier.
C. Plan Design And ProvisionsClearly indicate any plan design provisions you are unable to duplicate.
D. Plan Options8
Proposals may include alternate benefit plan options, provisions or funding alternatives that improve financials, benefit offerings or plan administration. Please clearly indicate any options that are included.
E. FinancialsIn addition, please provide your organization’s A.M. Best, Moody’s and Standard & Poors ratings; as well as a financial statement and/or a Dunn & Bradstreet report for your company unless otherwise submitted.
F. Performance GuaranteesPlease provide any Performance Guarantees for each line of coverage proposed including detailed specifics with your service standards and the associated dollars at risk you are willing to offer.
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G. ReferencesPlease provide three references of comparable size and industry to Northern Kentucky University. At least one of the references should be a higher education client. Also include a reference for a client that your organization has lost within the last 12 months that termed for reasons other than merger or acquisition. Include the contact information for the references’ key benefits administration staff person.
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I. QUESTIONNAIREA. Plan Level Questions
1. Provide a brief history of your organization, including ownership and number of years in business; State of Incorporation; and describe if publicly traded. Please describe any parent and subsidiary relationships.
2. Describe the management structure of your organization, specifically the management team responsible for overseeing the management of the proposed plans.
3. Describe your organization’s licensure for coverages quoted (where applicable).
4. What is your client retention rate for the last three years?
5. What has been your growth rate for the last three years?
6. Describe your organization’s financial condition and company ratings.
7. Describe your organization’s disaster recovery plans. When were these plans implemented and updated? Please specifically address your claim call center’s disaster recovery plan.
8. Describe your organization’s HIPAA compliance strategy.
9. Northern Kentucky University is interested in understanding what each vendor believes differentiates them in the marketplace. Articulate as thoroughly as possible your value proposition outlining the synergy and leverage that your organization brings to Northern Kentucky University.
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10. Are there any other provisions or value-added benefits that you recommend be added to any of the benefit plans you are proposing? Please describe them and indicate if there is a cost associated with the recommended benefit.
Key Contact for RFP:Name
Address
Phone
Fax
Email address
Location of the Following:Underwriting
Employee Customer Services
Claims Processing
Premium/Fee Payments
Enrollment/Eligibility
Contracts/Booklet Wording
Account Management
References:Provide three references of companies with 1,000+ employees. These references should be in a similar/related industry. At least one reference should be a higher education client. Also, provide one terminated reference that terminated coverage
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in the last 12 months for reasons other than acquisition.
B. Administrative QuestionsACCOUNT MANAGEMENT
1. Northern Kentucky University expects a dedicated Account Management Team to partner with Northern Kentucky University’s Benefits Team. Please explain how the team would be structured and provide resumés for the team members who would be appointed should your organization be awarded this business.
2. Please provide the average turnover rate on the account management team. The turnover rate should include terminations, job transfers and promotions.
3. Internal HR Department guidelines at Northern Kentucky University call for problem response and/or resolution within 24 hours. Confirm that you would agree to this time frame.
4. Northern Kentucky University’s HR Department expects to be informed and consulted prior to the mailing of non-routine communication materials to Northern Kentucky University employees. Describe your procedures for assuring that your Account Management Team will inform Northern Kentucky University of these mailings in advance. Additionally, please provide an outline of routine mailings along with a calendar of proposed
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mailing dates.
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5. Discuss the Account Management Team’s ability to keep Northern Kentucky University’s Benefits Team informed of significant business disclosures that could impact your services to Northern Kentucky University employees. For example, the departure of your CEO, legal rulings or earnings warnings.
6. Provide an example of a unique instance in which problem resolution included thinking “outside the box.” Northern Kentucky University is seeking assurance that the response to problem situations will not be the “company line.”
7. For the personnel assigned to the Northern Kentucky University account, please provide the number of other accounts that they support, the size of the employer groups they support and the product lines supported.
IMPLEMENTATION AND ENROLLMENT
1. Please provide a preliminary implementation plan and timeline that describes the transition process as you envision it. Identify each person who will be responsible for the transition process and his/her area of responsibility.
2. Describe the process steps, chronology and performance guarantees that support a complete, accurate and timely implementation process.
3. Will an Implementation Manager be assigned to Northern Kentucky University and if so please describe their role during implementation.
4. Northern Kentucky University
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utilizes SAP for eligibility and enrollment. Describe your standard procedures for interacting with an internal SAP system.
5. Is your organization willing to assist Northern Kentucky University with creating customized communication material if needed? Please provide sample communication material in both electronic and hard copy versions.
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6. Should Northern Kentucky University desire to mail out any communication materials in advance of open enrollment to announce the new benefit plan options, will your organization absorb the cost of the material and mailing?
7. Northern Kentucky University has an annual benefit fair prior to open enrollment. Please confirm your willingness to have a representative from your firm attend the benefit fair annually.
8. How does your organization correspond with plan participants? Please provide sample plan participant correspondence.
DOCUMENTATION
1. Will your organization provide all necessary DOL and IRS reporting summaries?
2. Will your firm draft ERISA Summary Plan Description for coverages quoted?
3. For any self-funded plans, will your organization agree to create at your cost the SPD on behalf of Northern Kentucky University?
CUSTOMER SERVICE, CLAIMS AND BENEFIT ADMINISTRATIONThe next two sections (Customer Service and Claims and Benefits Administration) are structured assuming that customer service and claims processing are one unit. If this is not the case, provide your answers accordingly. If you are proposing multiple products please respond to the questions as it would apply to each coverage proposed if your response would vary amongst products.
1. Describe the structure of your claim team. Provide resumés for the point members.
2. Do you have a customer service team within your claim team to answer employee questions?
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3. Confirm that the Northern Kentucky University HR Department will have email access to members of the claim and customer service teams. Additionally, please confirm that NKU will have a Senior contact member available to address any concerns of the HR/Benefit team.
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4. Describe the experience level and performance expectations for your claim and customer service department personnel. Provide job descriptions that identify expectations in the areas of communication skills, analytical ability and problem solving.
5. Does your organization have a reward and/or recognition program for outstanding customer service?
6. Describe your quality assurance or audit program for the customer service unit. Does your organization have a quality assurance committee? Please describe.
7. Describe your training program for customer service personnel. Do you have a mentoring program for customer service?
8. What has been the annual rate of turnover for the past three years for claim and customer service personnel?
9. Will you provide Northern Kentucky University its own 800#? Is there a separate charge for this service? Will the 800# provide a personalized answer acknowledging a Northern Kentucky University employee?
10. Will you provide the following dedicated services for Northern Kentucky University employees:
A customer service email address
Fax line Voice mail These do not have to be
exclusively for use by Northern Kentucky University employees, but should have restricted use within your customer service department.
11. Describe your customer
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service call tracking systems. Describe how email correspondence is integrated into the customer service call tracking. Does your system allow you to report performance metrics such as first call resolution, turnaround times, etc… Please outline the capabilities of your system.
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12. What are your protocols for management of customer service phone lines when you are experiencing a high volume of calls?
13. Provide the hours of operation for the customer service unit.
14. Provide the hours of operation of the claim team if it differs from the customer service unit. Additionally, please provide the address of all claim offices that you will be proposing for Northern Kentucky University.
15. Do you have multilingual customer service staff? If so, what are the available languages? If not, how will you accommodate Northern Kentucky University with their demographic needs?
16. Describe your capabilities for providing TDD and other services to hearing impaired employees.
17. Describe your escalation protocols for customer service.
18. How frequently do you conduct customer satisfaction surveys? What are the most recent results? What percentage of members participates in the survey? Can the survey be NKU specific and if so is there a cost associated with this?
19. Are any of your customer service operations located offshore from the United States? If so, please specify the location and hours of operation for same.
20. Are your claim analysts provided any incentives for quantity or quality of work?
21. Please describe your claim intake or submission process for each line of coverage quoted.
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22. Where there is data entry for claim processing or correspondence submitted, do you use scanning or imaging? Please describe.
23. Are claim payment checks generated daily? Are they mailed daily? Are they printed at the same location where claims are processed?
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24. Discuss your organization’s claim documentation and storage process and record retention policy. How long and in which media are claims stored?
25. Specific to claim administration, describe your organization’s internal controls and auditing standards. Does your organization engage an independent auditor to evaluate internal controls? When was the last audit?
26. Will you provide a separate, secure email box for communications between designated Northern Kentucky University benefits personnel and your claims administration personnel?
27. Confirm (for dental claims) your firm will pay out of network claims at the 70th percentile for R&C (reasonable & customary basis.
ELIGIBILITY ADMINISTRATION
1. Confirm your ability to accept electronic eligibility transmission from SAP? What frequency is available for file transmission? Confirm the transfer site for the file transmission is a secure site.
2. Provide your Eligibility File Layout. Can you accept the 834 format?
3. Are there any fees for developing the file feed or for transmitting files? If NKU cannot provide the data in your preferred layout do you have an IT team available to assist in converting data to a usable format? If so, any fee for this service?
4. If manual eligibility update is
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required outside of the transmission, please comment on your preferred method of receiving this data from Northern Kentucky University. Would an eligibility email from Northern Kentucky University suffice or can Northern Kentucky University login to your system to make updates?
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C. Performance GuaranteesPlease comment on your willingness to offer Performance Guarantee standards and to place a percentage of your administrative fees/premium at risk. Please indicate if your performance guarantees vary by line of coverage quoted. Please be certain to provide your standard performance guarantee metrics for each coverage quoted AND indicate your willingness to include an “overall satisfaction” guarantee based upon the client’s general satisfaction with all aspects of the plans proposed.Please indicate clearly:
The percentage of fees/premium at risk. Your proposed percentage will determine the total minimum fees / premium at risk.
A description of the standards A description of the guarantees A description of the penalties for non-performance
All evaluations will be made on a quarterly basis. If for any reason you cannot provide information on a quarterly basis then please indicate so with your performance guarantee proposed.
D. Confirmations
Confirm that your pricing for all products includes the following services. If there are additional charges that may be required, please clearly detail these charges.
Plan Implementation
Employee Communication and Open Enrollment Materials
Certificates of Coverage, Contracts and Plan Documents
Eligibility Records
Payroll Deduction Interface, if necessary
Claim Processing
Assignment Processing
Underwriting and Reserve Analysis
Toll-free Customer Service Hotline
Quarterly Premium, Claim and Reserve Reporting, Utilization Reports, Loss Ratio, when applicable
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DentalGeneral1. What differentiates your organization from other vendors?
2. What educational services can you provide to NKU (i.e. Lunch and Learns, etc…)? Is there a cost for these services and how often will you provide the services?
Dental Provider Relations and Network Access1. What are your selection criteria, credentialing requirements, certification
requirements and level of malpractice coverage required for network providers?
2. Describe the current process for monitoring and measuring provider satisfaction.
3. Please provide a GeoAccess report for each proposed network that includes the following:
Prepare an individual report for each of the 6 practice specialties (General Dentistry, Endodontists, Oral Surgeons, Orthodontists, Periodontists, and Prostodontists)
Include the total number of employees with and without access by zip code. (The number of employees with and without access should be combined in the same report not separate reports.)
Each section includes the total number of providers within a given zip code.
Each section includes the total number of employees within a given zip code.
Please make sure that all your employee totals equal the number of employees on the file or indicate invalid zip code.
Please export the results of the GeoAccess reports into Excel utilizing the format below. (Please do not provide in PDF format.) An Excel report for each practice specialty noted above should be provided in your RFP response as a separate tab in the Excel file. Maps are not necessary.
Sample Format
General Dentists Access Average Distance
County State Total EEs Providers 2 in 10 1
Provider2
Providers
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Kenton KY 1 4 100% 2.0 2.2
4. We have also included a dental provider listing in the appendix. Please develop a disruption analysis of all providers utilized by NKU members in 2011 based on your par plan providers.
5. Does your organization lease any networks? If so, where and from whom?
6. Please describe your method of contracting with dentists?
7. What is your willingness/ability to address the expansion and/or customization of a network to meet NKU’s needs? Identify your overall strategy, timetable and resources.
8. Does your organization accept member nominations? Describe the process.
9. What is the average time it takes from the provider contract signing to update information on claims and member services systems?
10.What is your annual network turnover rate for 2010 and 2011?
11.Are you proposing more than one network? If you are proposing more than one dental plan, are any of the plans proposed tied to a different network? Please explain in detail.
12.Describe the procedures you follow to notify employers and employees of existing and potential network disruptions.
13.How will you notify NKU of any network issues that could potentially impact its employees?
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Dental Claims and Administration
1. Please complete the table below indicating what services your member services department provides.
Category Yes NoConfirm eligibilityProvide claim information, including coverage, benefits, payments, status, and proceduresAccess to NKU specific dental benefits Access to NKU specific dental benefits for open-enrollment prior to the initial effective date Explain how the plan works Issue new ID cardSend member packets and informationProvide information on area providers (network inquiries)Assist members with the open enrollment processRefer provider relations inquiries to the appropriate staffFollow up on claim problemsAssist in initiating the grievance and/or appeal processDocument inquiries/calls
2. Are member service representatives authorized to make real-time payment adjustments?
3. Are member service inquiries / pending claims and their resolution tracked on the system?
4. With respect to pending claims, please address the following:a. Who is notified when a claim is pending (i.e. member, provider)?
b. Do you follow up on pended claims? If yes, in writing or by phone?
How frequently?
c. Who is notified when a pending claim is denied (i.e. member, provider)?
5. Please indicate your plan’s service capabilities via your IVR and web-based interfaces.
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6. Do you process network claims with the same claim adjudication system as non-network claims?
7. What percentage of claims processed by your organization was for services provided by a network provider?
8. Are the Claim, Eligibility, Utilization Management, and Provider applications within one system or multiple? If multiple systems, please describe the method and frequency that relative data is transferred from one system to the next.
9. Where is the data entry for claim processing? Do you use any scanning or imaging technology? Please describe.
10.What percentage of claims are currently auto-adjudicated?
11.Explain the claim process for network provider claims. For non-network provider claims?
12.Does your organization have any system conversions planned within the next two years? If yes, please explain.
13.How often are you able to accept electronic data? Please indicate if any of these frequencies would result in additional cost.
14.Can the system accept future and retroactive effective and termination dates? If yes, please describe.
15.What is the maximum period of time that a member’s enrollment can be retroactively adjusted (i.e., 90 days)?
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16.Do you provide ID cards? If yes, please explain (Employee and Member).
17.Are ID Cards generic or customized? How often are they mailed?
18.Describe your firms’ dental initiatives for high risk individuals.
19.Describe your firms’ wellness initiatives as it relates to oral health.
Dental Financial1. If NKU were to self-insure the dental plan, please provide your ASO fee.
2. Would you offer a multi-year rate/fee guarantee on the dental if insured? Self-insured?
3. What type of educational opportunities can you provide employees? Is there a cost for this? What frequency?
4. How often do you provide premium and claim data reporting?
5. For non-covered claim expenses, does your firm offer a discount to employees (i.e., does discount continue after maximum is reached)? Please be specific.
6. Please provide dental trend factors for 2010, 2011, and expected 2012.
Product 2010 2011 2012 ExpectedPPO Indemnity
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7. With respect to Reasonable & Customary (R&C) charges please answer the following:a. What database and percentile do you routinely use for R&C
determination?
b. What services are subject to R&C determinations?
c. How frequently do you update your R&C schedules?
d. When was the last update?
e. Please provide the percentage of the last 2 increases to the R&C charges and provide the dates of those changes.
f. Who is responsible for charges in excess of R&C?
9. Please completed the following grid for zip code 41099?
ADA Proc Code
ADA Procedure Description
80th
percentile R&C
90th
percentile R&C
PPO negotiate
d fee120 Periodic oral evaluation 272 Bitewings - two films 274 Bitewings - four films 330 Panoramic film 1110 Prophylaxis – adult 1120 Prophylaxis – child 1203 Topical application of
fluoride (prophylaxis not included) - child
2140 Amalgam - one surface, permanent
2150 Amalgam - two surfaces, permanent
2385 Resin-based composite - one surface, posterior-permanent
2386 Resin-based composite - two surfaces, posterior-permanent
2387 Resin-based composite - three surfaces, posterior-permanent
2740 Crown - porcelain/ceramic substrate
2750 Crown - porcelain fused to high noble metal
2751 Crown - porcelain fused to predominantly base metal
2752 Crown - porcelain fused to noble metal
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2790 Crown - full cast high noble metal
2950 Core buildup, including any pins
3320 Bicuspid (excluding final restoration)
3330 Molar (excluding final restoration)
4341 Periodontal scaling and root planning, per quadrant
7110 Single tooth 7240 Removal of impacted tooth -
completely bony
8020 Limited orthodontic treatment of the transitional dentition
8030 Limited orthodontic treatment of the adolescent dentition
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Dental Technology/Reporting1. Please indicate which information can be found on your website:
Dental Management Policies and Procedures Provider/Network Service Area Dental Health Information
Preventive Care Schedules Other (please specify)
2. Please indicate with a “Yes” or “No” which employer, member or provider transactions can be performed on your website.
Member
Employer
Provider
Benefits Check eligibility Update eligibility Real-time verification of deductible and/or lifetime max balance
View directories by product Order ID cards Claim status/transaction inquiries View the EOB Complaints/Issues Dental Management Policies and Procedures
Process Claims Other (please specify)
Dental Member Services (2011 or most recent measured period)1. Please indicate for your call center:
a. Average Speed of Answer b. Abandonment Rate c. First call resolution
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Flexible Spending Account (FSA)FSA General1. What differentiates your organization from your competitors?
2. Do you have debit card capabilities? If so, please describe for both
Healthcare and Dependent Care accounts.
3. Do you have the capacity to administer direct roll-over to the FSA accounts (e.g., paperless filing)?
4. Do you currently have electronic interfaces established with outside FSA administrators? If so, with whom?
5. Please provide all assumptions and details for pricing.
6. Describe your funding requirements.
7. Describe your standard banking arrangements, including:a. Name of bank used for master account
b. Timing for funding and fixed cost request (i.e., how often).
c. Basis for funding (issued or cleared).
d. Funding method (ACH draft or transfer, wire, check).
e. Requirement for zero balance account
8. For reimbursement payments, is a direct deposit option offered in lieu of a
per check?
9. How frequently are checks issued for dependent care, for medical care?
10.Provide detailed explanation of dependent care reimbursement options (e.g. direct reimbursement to provider, automatic reimbursement).
11.Describe your process for substantiating claims processed via the debit card.
12.Do you provide quarterly statements to participants? How are they typically delivered to the participant (mail, on-line access, etc.)?
13.Are Explanations of Benefits (EOB) available on-line?
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14.Please provide all assumptions and details for pricing.
15.Any one-time set-up charges?
16.Any ongoing annual renewal fee?
17.Base administration fee?
18.Debit card fee?
19.Any minimum monthly charge?
20.Can participants receive multiple debit cards? Is there a fee for these cards?
21.Is there a fee for lost or replacement cards?
22.Do you provide complete discrimination testing, including testing on the Flexible Dependent Care accounts (125/127 Regs.)?
23.Describe your ability to offer limited FSA (in tandem with HDHP Plan).
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24.Your proposal should address the following services as well, including pricing (if services are included in the proposed participant fees, please indicate):
a. Enrollment Materials
b. On-site Enrollment Assistance
c. Reimbursement (direct deposit vs. checks)
d. New members packets, production and mailing
FSA Communications1. What marketing and communication material is available to members
and/or employers at no cost and/or at additional cost? Please provide samples. Identify any of these materials that may be customized at no additional cost to NKU.
2. Do you provide a communications budget for implementation and ongoing communication and marketing of the plan? If so, then what is the budgeted amount?
3. Will you ensure that employee communications are reviewed by NKU prior to distribution?
4. Please describe how customized communication materials are developed. Do you have communications personnel in-house (as employees, not independent contractors)? If so, how many communications personnel are there, and how are they organized to support your clients’ communication needs?
Miscellaneous1. What is your firm’s average auto-substantiation rate for claims submitted
via debit card?
2. What is your member/claim services results for 2011 (or most current measured period)
a. Average Speed to Answer Phone b. Average Call Abandonment Rate c. Average Claim Turnaround Time
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II. Attachments, Plan Design, Financial ArrangementsA. ExperiencePlease contact Jeff Strunk (859-572-5265) to have attachments emailed to you. The following experience exhibits will be provided as separate attachments:
FSA Enrollment Statistics Premium versus Claims and Utilization (split by Delta Dental for 2009-
2010 & Aetna 2011 & YTD 2012) Current Eligibility Waiting Periods (Dental) Census (password protected Excel file) Dental Provider Utilization to perform a disruption analysis (Excel file) Dental Benefit Summaries
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B. Plan Design - Summary
Plan SummaryNKU Dental (Premier Plan)
Carrier: Aetna
Eligibility Definition: All full time and part time employees working a minimum of 20 hours.
Contributory: Employer pays 90% of employee rate; Part time employees pay 100% of the cost.
Current Rates: EE: $38.40 EE/SP $76.79 EE/CH $86.16 EE/FAM $124.78
Rate Guarantee: 1/1/13
Deductible $50 individual / $150 family (minor and major services only)
Preventive Services 100%Minor Services 90%Major Services 60%Maximum Benefit Per Benefit Period $2,000Orthodontia 50%Orthodontia Maximum $2,000 lifetimeDependent Age Limit 26 for dental / 19 for orthodontia
Dental Benefit Summary details are attached and should be modeled from.
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Plan SummaryNKU Dental (PPO Plan)
Carrier: Aetna
Eligibility Definition: All full time and part time employees working a minimum of 20 hours
Contributory: Employer pays 90% of employee rate; Part time employees pay 100% of the cost.
Current Rates: EE $19.20 EE/SP $38.37 EE/CH $36.46 EE/FAM $57.57
Rate Guarantee: 1/1/13
In-Network Out-NetworkDeductible $25 individual / $75 family $25 individual / $75 family Preventive Services 100% 100%Class I, II and III 80% 60%Class IV 50% 40%Maximum Benefit Per Benefit Period
$1,500 $1,000
Orthodontia Not Covered Not CoveredOrthodontia Maximum Not Covered Not CoveredDependent Age Limit 26 26
Dental Benefit Summary details are attached and should be modeled from.
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Plan SummaryNKU Flexible Spending Account (FSA)
Administrator: Aetna
Eligibility Definition: All full time and part time employees working a minimum of 20 hours
Minimum (all accounts) $60Maximum (all accounts) $5,000 (will change to $2,500
for medical in 2013)
Enrollment: Current Participants 2012 Annualized Contributions
Health Care 291 $420,814Limited Health Care 27 $30,144Dependent Care 33 $124,865
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AUTHENTICATION OF BID, STATEMENT OF NON-COLLUSION, NON-CONFLICT OF INTEREST AND BIDDER
CERTIFICATIONS
By signing below the Contractor swears or affirms, under the penalty of false swearing as provided by KRS 523.040, that he/she is in compliance with all of the following:
1. That I am the bidder (if the bidder is an individual), a partner in the bidder (if the bidder is a partnership), or an officer or employee of the bidding corporation having authority to sign on its behalf (if the bidder is a corporation).
2. That the submitted bid or bids covering the Bid Package indicated have been arrived at by the bidder independently and have been submitted without collusion with, and without any agreement, understanding or planned common course of action with any other contractor, vendor of materials, supplies, equipment or services described in the Invitation for Bid, designed to limit independent bidding or competition; as prohibited by provision KRS 45A.325;
2A. Any agreement or collusion among bidders or prospective bidders which restrains, tends to restrain, or is reasonably calculated to restrain competition by agreement to bid at a fixed price, or to refrain from bidding, or otherwise, is prohibited. The provisions of KRS 365.080 and 365.090, which permit the regulation of resale price by contract, do not apply to sales to the State.
2B. Any person who violates any provisions of Kentucky Revised Statute 45A.325 shall be guilty of a felony and shall be punished by a fine not less than five thousand dollars nor more than ten thousand dollars, or be imprisoned not less than one year nor more than five years, or both such fine and imprisonment. Any firm, corporation, or association which violates any of the provisions of KRS 45A.325 shall, upon conviction, be fined not less than ten thousand dollars nor more than twenty thousand dollars.
3. That the content of the bid or bids have not been communicated by the bidder or its employees or agents to any person not an employee or agent of the bidder or its surety on any bond furnished with the bid or bids and will not be communicated to any such person prior to the official opening of the bid or bids;
4. That the bidder is legally entitled to enter into the contracts with the Commonwealth of Kentucky and is not in violation of any prohibited conflict of interest, including those prohibited by the provisions of KRS 45A.330 to .340 and 164.390; and
5. That I have fully informed myself regarding the accuracy of the statements made, including Bid Amount.
6. Unless otherwise exempted by KRS 45.590, the Bidder intends to comply in full with all requirements of the Kentucky Civil Rights Act and to submit data required by the Kentucky Equal Employment Act upon being designated the successful bidder.
7. That the Bidder, if awarded a contract, would not be in violation of Executive Branch Code of Ethics established by KRS 11A.990.
8. Campaign Finance Laws Pursuant to KRS 45A.110 and KRS 45A.115 the undersigned hereby swears or affirms, under penalty prescribed by law for perjury, that neither he/she, individually, nor, to the best of his/her knowledge and belief, the corporation, partnership, or other business entity which he/she represents in connection with this procurement, has knowingly violated any provisions of the campaign finance laws of the Commonwealth of Kentucky, and that the award of a contract to him/her, individually, or the corporation, partnership or other business entity which he/she represents, will not violate any campaign finance laws of the Commonwealth.
9. Worker's Compensation and Unemployment Insurance Pursuant to KRS 45A.480, the undersigned hereby swears or affirms, under penalty of perjury, that all contractors and subcontractors employed, or that will be employed under the provisions of this contract shall be in compliance with the requirements for worker's compensation insurance under KRS Chapter 342 and unemployment insurance under established KRS Chapter 341.
10. Vendor Report of Prior Violations The Bidder/Owner shall reveal to the University, prior to this award of a contract, any final determination of a violation by the Contractor within the previous five (5)
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year period of the provisions of KRS Chapters 136, 139, 141, 337, 338, 341, and 342. The Contractor is further notified this statute requires that for the duration of this contract, the Contractor shall be in continuous compliance and the Contractor's failure to reveal a final determination of a violation or failure to comply with the cited statutes for the duration of the contract, shall be grounds for the Contractor's disqualification by the University from eligibility to bid or submit proposals to the University for a period of two (2) years. Please list any final determination(s) of violation(s) including the date of determination and the state agency issuing the determination. If no violations have occurred, type none in the space below.
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* KRS Chapter 136 - Corporation and Utility Taxes; * KRS Chapter 139 - Sales & Use Tax; * KRS Chapter 141 - Income Taxes; * KRS Chapter 337 - Wages & Hours; * KRS Chapter 338 - Occupational Safety & Health of Employees; * KRS Chapter 341 – Unemployment Compensation; * KRS Chapter 342 - Worker's Compensation
KRS VIOLATION DATE STATE AGENCY __________________________ __________ __________________________________________________ __________ _______________________
READ CAREFULLY - SIGN IN SPACE BELOW - FAILURE TO SIGN INVALIDATES BID or OFFER
AUTHORIZED SIGNATURE: ____________________________________ DATE: ___________________NAME (Please Print Legibly): _ ________________________________________________________________
FIRM: ___________________________________________________________ FED ID. OR SSN#: _________________________________________________
PERMANENT ADDRESS: _________________________ ________ _________ ____________________
STREET CITY STATE ZIP
CONTACT PERSON: _ ____________________________________
TITLE: _________________________
TELEPHONE NO: __________________ FAX NO: _________________ E-MAIL: _______________________________*****************************************************************************State of _________________________________) County of _ ______________________________)The foregoing statement was sworn to me this _____________________ day of___________________, 20 _____, by _________________________________.___________________________________________(Notary Public)My Commission expires: ______________________
THIS DOCUMENT MUST BE NOTORIZED
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