VISION MINIMUM REQUIREMENTS
ALL VENDORS MUST COMPLETE THIS SECTION.
The following are proposal specifications. Please complete the following chart by responding in the right-hand
column. If you disagree with any of the criteria, you may not be considered. If the criteria do not apply to the
services you are quoting, please indicate “N/A.”
ENTER VENDOR NAME:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
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12.
13.
14.
15.
You have reviewed and accept the Plan’s eligibility provisions
outlined in the RFP.
You must be licensed in New Mexico or willing to obtain a license
in New Mexico.
Agree
Disagree
Agree
Disagree
Self-funded Quotes: ASO fees must be guaranteed for a minimum
of two (2) years from the effective date. A third year rate
guarantee is preferred. Fees must be the same for Years 1 and 2.
Fully Insured Quotes: Vision rates must be guaranteed for a
minimum of two (2) years. A three (3) or four (4) year guarantee is
preferred.
The rates/fees/premiums should be calculated NET of
commissions.
Renewal rates and fees must be submitted 120 days prior to the
contract renewal date.
You have included detailed plan summaries for all quoted plans.
The vendor will be responsible for producing the
Booklet/Certificate of Coverage / Summary Plan Description. The
client reserves the right to review/revise the Booklet/COC/SPD
prior to finalization.
Vendor agrees to provide a booklet draft within 60 days of the
effective date.
Vendors may be required to attend open enrollment meetings.
Vendor agrees to provide all standard reports to the client.
The client must be able to access reports online.
Insured coverage must be provided on a no-loss/no-gain basis for
all covered participants so the current group does not suffer a loss
of benefit solely due to the transfer of coverages to your firm.
You must agree to waive the “actively at work” provision for the
currently enrolled. The master contract will reflect the
elimination of the actively at work restriction or deferred effective
date for all initially enrolled active or inactive employees and
dependents. This will include only initial eligibles (those eligible
on the effective date of the contract) including COBRA continuees.
You are in compliance with all HIPAA Privacy, Electronic Data
Interface (EDI) and Security requirements.
Agree
Disagree
Agree
Disagree
Agree
Disagree
Agree
Disagree
Agree
Agree
Disagree
Disagree
Agree
Disagree
Agree
Agree
Agree
Agree
Disagree
Disagree
Disagree
Disagree
Agree
Disagree
Agree
Disagree
16.
17.
18.
19.
20.
21.
Your contract must require no more than a 30-day notice of
termination. Your contract cannot prohibit the group from
terminating coverage at any time. There must be no penalties for
late notification or for termination off anniversary.
Agree
Disagree
Agree
Disagree
You have specifically listed all deviations from the RFP and
coverage requirements on the Offeror’s Additional Terms and
Conditions.
NOTE: Deviations MUST be listed; you cannot simply make a
“general” reference to section(s) of the proposal.
You completed all questionnaires and exhibits in full and in the
format requested (e.g., Word or Excel – not PDF).
Agree
Disagree
Agree
Disagree
Insurance premium tax does not apply to public entity employers
including, but not limited to, cities, counties, school districts,
etc. If selected, premium tax will not be charged.
Vendor agrees to attend annual health and wellness fairs hosted
on site by CNM.
Agree
Disagree
Agree
Disagree
Vendor agrees to provide performance guarantees. Provide
details within your proposal.
VISION GENERAL QUESTIONNAIRE
ALL VENDORS MUST COMPLETE THIS SECTION.
ENTER VENDOR NAME:
Organizational Strength
1.
Do you carry an Errors & Omissions policy?
2.
Do you carry a comprehensive general liability policy?
3.
Does your company carry a fidelity bond?
4.
What is the normal lead-time required to implement a group?
5.
Finalists will be required to provide a formal and detailed
implementation plan.
6.
7.
Do you offer online eligibility maintenance for all clients?
8.
9.
When are premiums/fees due under your policy?


What is the grace period?
If premium is paid after the grace period, is a penalty and/or
interest charge assessed?
 If yes, explain in detail.
What percentage of claims is auto-adjudicated through your system?
Will you agree to offer a Performance Guarantee with financial
penalties?
 If yes, indicate what percentage or dollar amount you are putting
at risk. Include your proposed performance guarantee in your
proposal.
12.
No
Yes
No
Yes
No
Agree
Disagree
Yes
No
Yes
No
Yes
No
What mediums do you accept for plan enrollment?
 If so, is there a charge?
 Is there a charge for hard copy maintenance?
For insured coverages: for the first and each renewal year, what
periods of time will be used as the basis for determining renewal
recommendations?
10.
11.
Yes
Which of the following tasks can members and plan sponsor
representatives perform online? You may indicate N/A if not applicable
to the line of coverage you are quoting.
Members
Plan Sponsor
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Enrollment (New Hires and Open Enrollment)
Changes in Status
Billing (Plan Administrators only)
Claim inquiry
Provider search
Access provider directories
Physician/provider cost and quality comparison
ID card request
Electronic EOB
Terminations
Other
N/A
13.
14.
Is there an additional cost for online services?
 If yes, describe.
BRIEFLY describe the services you offer to support the client’s human
resources / benefits team.
Yes
No
15.
16.
17.
18.
19.
20.
21.
Are you able to provide data that benchmarks the client’s experience
against the following :
 Your book of business
 National norms
 Similar sized municipalities
Please provide cost to provide benchmark reports, if any.
Provide a list of all standard and optional reports available and
associated costs (if any). Please provide sample reports.
Report
Frequency
Additional Cost?
Standard?
Indicate amount.
Optional?
What is the lag time on reports from your firm?
Does the client/consultant have the ability to access your database in
real time for purposes of:
 Tracking plan experience
 Utilization patterns
 Other available plan information
 How is this ability provided?
 Is there an additional charge to the client?
 If so, what is the charge?
Briefly describe your company’s experience with public sector clients,
including school districts, public higher education organizations, and
public entities in New Mexico.
How many colleges and universities are current clients?
Please provide the following information.
(New Mexico public sector employers are preferred.)
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
Three (3) current client references
At least one of these references should be from a client of similar
size. Provide -
Yes
Yes
Yes
No
No
No
Comments
Yes
Yes
Yes
No
No
No
Yes
No
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Client Name
Contact
Address
Telephone number
Type of coverage (e.g., medical, life)
Approximate # of employees covered by each contract
22.
Please provide the following information.
(New Mexico public sector employers are preferred.)
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Two (2) former clients, who may be contacted.
Provide  Client Name
 Contact
 Address
 Telephone number
 Type of coverage (e.g., medical, life)
 Approximate # of employees covered by each contract
 Reason for termination
Client Management Team
23. Describe your company’s client management structure.
24. Describe how your company handles client management
responsibilities and transition when a member of the team:
 Goes out on extended leave (more than 2 weeks)
 Leaves the company
25. Provide a brief bio detailing the experience and background of each
individual that would be assigned to the CNM account.
26. Provide the office location (city) that each member of the account
management team works from.
27. Does your company have a local office in the Albuquerque area?
 If not, what is the closest office?
28. How many onsite meetings does the account team commit to attending
throughout the year for:
 Implementation
 Ongoing account management and reporting
 Open enrollment
29. Will CNM be assigned a dedicated representative?
 How many other accounts will this individual service?
 What amount of time will the representative’s time will be
available to service the CNM account?
VISION QUESTIONNAIRE
ENTER VENDOR NAME:
ALL VENDORS QUOTING VISION COVERAGE MUST COMPLETE THIS SECTION.
Organizational Strength
1.
Deviations from the specifications:

Will your organization underwrite and administer
the benefit program exactly as shown in this
material?

Will your organization require any additional
information or impose restrictions on benefit
selections?

What occurrences would require your organization
to change its proposed rates and fees for the
proposed effective date?
Network Accessibility
2.
During each of the last two years, what percentage of
claims processed by your organization was for services
provided by a network provider?
3.
Are any authorization forms or ID cards issued and/or
required?
4.
With regard to network directories, please respond to
the following items. (NOTE: Do NOT include a provider
directory with your proposal.)

Are your directories available on the internet or a
website?

If your provider directories are not available online,
how frequently are they updated and distributed?

How are members, plan sponsors and providers
notified of changes?
Yes
No
5.
Do you own your provider network, or do you
subcontract?

6.
Own
If you subcontract, please identify network.
Do you contract with chain stores or retail stores?
Chain Stores
Retail Stores
Neither

7.
8.
9.
If so, which ones?
Do you offer a mail service contact lens program?
What level of in-network utilization for you project for
the CNM vision plan? Explain your basis for this
projection.
During each of the last two years, what percentage of
claims processed by your organization was for services
provided by a network provider?
Subcontract