Document 11049978

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Request for Proposal Medical Fully Insured and Administrative Services Only (ASO) with Stop Loss Insurance

St. Lucie Public Schools RFP # 16-13

ATTACHMENT F - MEDICAL PROPOSAL FORMS

PROPOSER’S GENERAL INFORMATON

Correct & Legal Name of Carrier/Proposer:

FEIN/SS#:

Address:

Primary Contact Name & Title:

Telephone Numbers

Daytime/After Hours:

Email Address:

Website Address:

1)

2)

3)

Where is the location of the claims payment facility that will service this account?

Indicate the name and title of the Account Representative(s) that will service this account and their office location.

Does your proposal include a full-time onsite service representative to be located at the School

District office and will you retain the existing onsite representative, currently a Florida Blue employee, at the School District’s discretion?

Request for Proposal Medical Fully Insured and Administrative Services Only (ASO) with Stop Loss Insurance

St. Lucie Public Schools RFP # 16-13

SERVICES INFORMATION

4) Indicate the plan or plans you are proposing:

Fully Insured _________

Self Insured _________

5) Please provide your ratings for the following rating services:

A. M. Best _____________

Moody’s _____________

Standard & Poor’s _____________

Fitch _____________

6) Are you able to administer the plan of benefits currently in place at the School District?

Yes _____ No ______

List any deviations:

7) Will you subcontract any specific work or services?

Yes ______ No _______

If yes, please provide the details (work to be performed, name, address, phone number etc.) for each service/subcontractor.

8) Please provide a sample package of your monthly reports.

9) In addition to the sample monthly report package provided, does your company offer on-line adhoc reporting and query capabilities? Are these available for both fully-insured and self-funded plans?

10) Provide a description of your overall data analysis and reporting capabilities to include ad-hoc and specialized reports and the associated costs. Be sure to explain any differences between fully-insured and self-funded plans.

11) What enrollment support will be provided to the School District?

12) Provide sample communication materials that would be used for the enrollment process.

Request for Proposal Medical Fully Insured and Administrative Services Only (ASO) with Stop Loss Insurance

St. Lucie Public Schools RFP # 16-13

13) The selected carrier will be expected to set-up eligibility/enrollment file feeds with FBMC to transmit enrollment data beginning with the fall 2016 open enrollment data for a 1/1/17 effective date. Please confirm your process and any required deadlines necessary to ensure the

EDI feed is set-up by the School District’s deadline.

14) Please provide a statement regarding no loss no gain for all covered members as of 12/31/16.

This response should apply to fully-insured and stop loss coverages.

15) Describe the wellness/population health management services offered as part of your proposal.

16) Are there additional wellness services that may be added; describe any associated additional costs.

17) It is expected that the selected carrier/administrator will monetarily contribute in support of the

School District’s wellness program on an annual basis. What wellness contribution is included within your proposal for 2017, 2018 and 2019? Explain any requirements existing for the use of these funds.

18) The School District has a point system in place whereby employees can earn incentives based on the points earned throughout the year (wellness activities, HRA, biometrics, health screening, etc.). Do you have capabilities to track points and provide access to the School District and its employees on the status of points earned?

19) Will you conduct an onsite HRA/Biometric event at various School District locations throughout the year? Please explain and disclose any additional costs.

Request for Proposal Medical Fully Insured and Administrative Services Only (ASO) with Stop Loss Insurance

St. Lucie Public Schools RFP # 16-13

MANAGED CARE NETWORK

20) Explain how the School District will have access to network providers on a statewide and national basis?

21) Do you have network access in all Florida Counties?

22) Did you provide a Geo Access Report? Yes ________ No ________

23) Did you provide a Disruption Report? Yes ________ No ________

24) Did you provide a copy of your current provider directory for Indian River, Martin, Okeechobee

and St Lucie Counties? Yes ________ No ________

25) To what extent will your company commit to adding providers who are participating with the

current network, but not contracted with your organization?

26) Confirm the number of in-network providers by specialty and County as indicated:

Adult Primary Care

Pediatricians

Specialists

St. Lucie Martin Indian River

Urgent Care

Hospitals

Laboratory

Retail Pharmacy

MANAGED CARE NETWORK DISCOUNTS

Under this section, discount information should be stated for the 2015 calendar year.

1) State your average primary care physician PPO discount in the local area

(Indian River, Martin, Okeechobee & St. Lucie Counties).

2) State your average specialist physician PPO discount in the local area

(Indian River, Martin, Okeechobee & St. Lucie Counties).

3) State your average in-patient hospital PPO discount in the local area

(Indian River, Martin, Okeechobee & St. Lucie Counties).

Request for Proposal Medical Fully Insured and Administrative Services Only (ASO) with Stop Loss Insurance

St. Lucie Public Schools RFP # 16-13

4) State your average out-patient facility PPO discount in the local area

(Indian River, Martin, Okeechobee & St. Lucie Counties).

5) State your average prescription drug discounts for retail and mail order, generic and brand

medications.

6) State your dispensing and administration fees per script, if applicable.

7) If rebates are generated, are they retained by your organization or shared with the client?

Please explain.

8) Please describe any Performance Guarantees you are offering based on network discounts.

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