Supplier Q & A Template
RFX Number: ES-RFP-53900-428
Requesting State Entity: Georgia
Southern University
Issuing Officer: George Horn
email Address:
ghorn@georgiasouthern.edu
RFX Title:Student Health Insurance Plan
Date: 2/1/2012
RFX Initially Posted to Internet: 1/10/2012
Telephone: 912-478-5714
The purpose of this document is to provide answers to supplier questions.
Please see Questions and Answers included herein.
Note: This document is intended for informational purposes only. Any changes to the
RFX must occur through a published addendum (or through publication of a new version
of the RFX in Team Georgia Marketplace™). If multiple Q & A documents are posted,
the most recent Q & A shall govern in the event of a conflict.
#
QUESTIONS AND ANSWERS
Questions
1. 1The University of Georgia awarded a
. multiyear student health insurance
contract beginning 2011-12 and the
GA Tech multiyear student health
insurance RFP is due on 1/12/12.
Please advise if the University of
Georgia and Georgia Institute of
Technology are excluded from
participating in the RFP and if all
other University System members
are participating in the RFP.
2. 2There is a line for “Athletic” and one
. for “Supplemental Accident Plan”.
Can you please give us more detail
on what you are looking for here?
Do the current plans carry these
riders? If so, we will need to know
the Premium Collected, the Claims
Paid, the number of Enrollees in
each plan and the Plan Benefits for
the current year and previous four
years in order to underwrite it. Also,
Revised 02/11/11
Referenced
RFX Section
n/a
Cost Proposal
Sheet “Riders”
Answers
No University System school is excluded
from participating in any contract resulting
from this RFP. Participation in this
contract is not mandatory amongst all
USG Institutions.
Please see answer at the end of this
document as well as Attachment FF.
SPD-SPR004
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3.
4.
5.
6.
7.
8.
Questions
under “Supplemental Accident Plan”
what does “students enrolled in the
plan” mean? Is that a voluntary
rate?
3Who is the current contracting
. vendor with Georgia Board of
Regents; Pearce & Pearce or
Chartis?
4What specific services does Pearce
. & Pearce provide and what specific
services does Chartis provide?
eRFP Certification reads “ . . . the
State Entity certifies the use of
competitive sealed bidding will not
be practicable or advantageous to
the State of Georgia in completing
the acquisition described in this
eRFP. Thus, competitive sealed
proposals will be submitted in
responses to this eRFP.” These
sentences seem to contradict each
other, please clarify?
With Restrictions on Communicating
with Staff, does this apply to any
existing relationships? For example,
Mercer Atlanta is currently the broker
for the USG BOR employee medical
and dental programs
Standard Insurance Requirements
indicates “The foregoing policies
shall contain a provision that
coverage afforded under the policies
will not be canceled, or not renewed
or allowed to lapse for any reason
until at least thirty (30) days prior
written notice has been given to the
State Entity.” Casualty insurance
companies no longer automatically
issue endorsements that call for
such notice to be mailed to entities
other than the Named Insured. Can
this condition be waived.
Proposal Certification, please
confirm whether this section should
be number 3.3, rather than 1.3?
Revised 02/11/11
Referenced
RFX Section
Answers
Pearce & Pearce, subsidiary of Chartis
eRFP Section
1.1 Purpose of
Procurement
eRFP Section
1.1 Purpose of
Procurement
eRFP Section
1.1 Purpose of
Procurement
See eRFP Template, section 1.1
paragraph 1.
In order to use a sealed “Proposal” versus
a sealed “Bid” we are required to have
this certification stated.
eRFP Section
2.1.1 Restrictions on
Communicating
with Staff
The restriction on communications
pertains to this Proposal and not to
operations under an existing contract.
eRFP Section
3.1 – Standard
Insurance
Requirements
Insurance company must submit
endorsement.
eRFP Section
1.3
Yes, this paragraph should be paragraph
“3.3”. Revised eRFP Template will be
posted.
SPD-SPR004
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Questions
9.
What is the maximum file size limit
for documents to be uploaded to the
site?
10. Please define “lowest cost”, “lowest
total cost”, “total cost of ownership
(TCO)” and “greatest savings” as
they relate to this eRFP. Which
method will be used to determine the
most competitive cost proposal?
11. Who will comprise the Evaluation
Team; DOAS representatives
exclusively, DOAS and BOR USG
representatives or BOR USG
representatives exclusively? How
many Evaluators will comprise the
Team?
12. Student Health Insurance Program
(SHIP) Special Term Definitions –
includes several definitions not
typically included in student health
insurance plans. Does USG intend
that these provisions apply to
SHIP: COBRA, Conversion Charge
(applies to converting coverage to an
individual plan)?
13. In the absence of final regulations
with respect to student health
insurance plans and ACA, does USG
have a legal opinion on what benefits
if any should be changed? For
example, all caps removed from
essential benefits and the inclusion
of preventive care with no cost
sharing?
14. The excel spreadsheet cells that
indicate the attachment file name for
further information are password
protected. Will new, unprotected
spreadsheets or the password be
provided so that we may provide the
required information?
Revised 02/11/11
Referenced
RFX Section
eRFP Section
2.4
Answers
50 megabytes per file.
eRFP Section
6.3.1
A formula using weights is added into the
cost worksheet. A total cost will be
calculated using projected numbers of
enrollments in each category.
eRFP Section
6.6.1
One time cost negotiations may be
conducted by BOR members.
Negotiations involving technical issues
will include a member from DOAS.
eRFP
Attachment B
The USG recognizes that today’s health
insurance intentions may not be
tomorrow’s reality. An inclusive, rather
than exclusive, listing of special term
definitions is based on the fact that
Student Health Insurance is included as
part of the Patient Protection and
Affordable Care Act going forward, and
the corollary understanding that the
PPACA provisions are, and will continue
to, evolve over the next USG SHIP five
year contract period.
eRFP
Attachment B
In the absence of final PPACA regulations
it is unrealistic and unreasonable to
expect the USG to have a legal opinion
on what benefits, if any, should be
changed.
eRFP
Attachments D,
E, F
Revised Attachments D, E & F will be
posted.
SPD-SPR004
#
Questions
Referenced
RFX Section
15. How does “Policy Year Maximum”
relate to “Maximum Benefits” – terms eRFP
seem to be in conflict. Please clarify. Attachment K
16. Please confirm the premium rates
currently in force.
17. The RFP requests a rider for
increased Rx annual maximums,
however, according to PPACA,
benefits cannot have an annual limit.
Please confirm that the RFP should
be in compliance with PPACA and
not limit Rx benefits to an annual
maximum.
18. Can we have claims experience
broken out for mandatory graduates
and mandatory undergrads and
voluntary participants in total for the
entire USG?
19. The RFP requests a quote for a
Dental Plan Rider. Can you provide
a guideline for specific benefits to be
covered on this plan?
20. Please confirm that the claims paid
represent 100% of the claims paid by
the plan, including any claims
payments made to Student Health
Centers.
21. Please confirm that riders are being
offered at the group level, and not at
an individual level. For instance, if
the USG selects the dental rider,
then the dental rider would be
purchased by all the students on the
health plan.
22. Please confirm that Intercollegiate
Athletic Sports Coverage is excluded
under the student health plan.
Revised 02/11/11
Answers
Revised Attachment K will be posted.
Please see answer at the end of this
document.
Please see answer at the end of this
document.
Information requested is contained in the
USG Institutional demographic data and
the USG SHIP premium and claims
experience data provided in eRFP
Attachments P through DD.
Offerors should provide a plan they feel
will best fit our needs. Responses will be
evaluated based upon quality of the
programs offered.
The claims paid experience data
represents all claims paid by the plan,
inclusive of claims payments made to
Student Health Centers.
It is the intention of the USG to provide
the USG SHIP Riders as options for each
USG Institution to select, to then be
offered by the USG Institution at a group
level.
The USG SHIP excludes coverage for
intercollegiate sports, and nonintercollegiate sports, activity as follows:
injury resulting from the practicing for,
participating in, or traveling as a team
member to and from intercollegiate and
professional contest, competition or
activity, including travel to and from the
activity and practice, sporting events,
racing or speed contests; while
SPD-SPR004
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Questions
23. Please clarify what should go into
the column labeled “Standard (1)” /
(1) Insurance National Standard.
24. Each item in Attachment L refers to
Appendix K. Please clarify.
25. Some items (#40 and #46) in the
Mandatory Scored Response
Worksheet require a diagram / UML
diagram. If we provide clear and
complete responses but do not
provide a diagram, will our
responses be penalized?
26. What is meant by “digitally bill and
collect data”? Does this mean that
students enrolling voluntarily would
actually be billed by the company, or
is it referring to online enrollment?
27. Please provide information (any
claims data/policy information) on
your current intercollegiate sports
plan and your Accident only plan.
28. Does this refer to a true conversion
policy or the continuation of
coverage option?
Revised 02/11/11
Referenced
RFX Section
Attachments N
and O
Mandatory
Scored
Attachment D –
Mandatory
Response
Worksheet - #
21
Attachment F –
Additional
Scored
Responses - #1
Attachment F –
Additional
Scored
Responses - #2
Answers
participating in any practice or
conditioning program for such sport,
contest or competition; hang gliding;
parasailing; sky diving; glider flying; sail
planing; parachuting; or bungee jumping”.
Per the footnote, this should represent the
Insurance National Standard for each of
these categories.
Revised Attachment L will be posted.
Questions indicate that diagrams must be
provided in order to be deemed
responsive.
No mention is made of “data” in
Mandatory Response Worksheet
Question 21. “The Offeror will digitally bill
to and collect from all Voluntary USG
SHIP insured students, including
coverage for spouses and dependent
children” means that students and, where
appropriate the students spouse and
dependent children, enrolling voluntarily
will be billed by the company, with the
expectation that the billing and collection
will be provided as part of the digital
online enrollment process.
See answer for Question 2 at the end of
this document as well as Attachment FF.
Offeror may provide both options. A true
conversion policy option allowing a
student to permanently convert from the
USG SHIP group plan to an individual
policy; and a temporary continuation of
coverage option in cases where the
Consolidated Omnibus Budget
Reconciliation Act of 1985 (COBRA) may
not apply.
SPD-SPR004
#
Questions
29. Please define what “reasonable
deductible” means? Would there be
a set dollar requirement and if so,
what is the minimum deductible
amount for which you would approve
a waiver?
30. What is meant by “Policy Year
Maximum (Per Person): $3,000
Annual Maximum” as a policy year
maximum of $100,000 is already
indicated above that? Is this the outof-pocket maximum?
31. Under Behavioral Health, Outpatient
– for in-network it indicates a $20 copay only. Does that mean there is
100% coinsurance, or should it be
80% like all other benefits?
32. Under Prescription Drug Benefit,
what is meant by “UHC Pharmacy”?
Are the benefits described to the left
of Column A applicable only at UHC
Pharmacy? Should consideration of
those benefits as described be
included in the offeror response?
33. What is the difference between the
2nd bullet and the 4th bullet,
“Additional Rx” and “Additional Rx
Revised 02/11/11
Referenced
RFX Section
Attachment J –
Insurance
Requirements paragraph 4
Answers
The answer is in the context of the
referencing paragraph 3; i.e. “The
University System of Georgia requires all
students in the above (mandatory/hard
waiver) categories to have ‘reasonable,
comparable, creditable’ coverage to the
current system-wide student health
insurance plan provided.” This means
that a “reasonable deductible” would be
defined as a deductible that is
comparable to the USG SHIP insurance
plan deductible and/or co-pay per
individual, per year. Plans with noncomparable, non-creditable high
deductibles and/or co-pays per individual,
per year would not be approved and the
student would not be waived from the
mandatory USG SHIP enrollment and
payment.
Revised Attachment K will be posted.
Attachment KSummary Core
Plan – page 1,
3rd row
80% like all other benefits.
Attachment KSummary Core
Plan – page 6
Attachment KSummary Core
Plan – page 10
“UHC” Pharmacy means USG Institution
University Health Center (UHC)
Pharmacy. Copayment waiver for
generics; $5 preferred brand; $10 name
brand applies only to prescription drugs
received at a UHC Pharmacy. This
relates to the fact that USG Institution
UHC Pharmacies provide discounted
pricing for generic, preferred brand, and
name brand prescription drugs that are,
typically, significantly less expensive than
off-campus retail pharmacies.
Revised Attachment L will be posted.
Attachment L –
Core Plan
SPD-SPR004
#
Questions
Maximum”?
34. In regard to the 5th bullet, in order to
provide a quote for athletic coverage,
please provide details on the number
of athletes at each school as well as
any past claims data.
35. In regard to the 5th bullet - Provide
Athletic Coverage – would this
coverage be mandatory for all ICS
athletes or would it be waivable?
36. The report headings on each tab
designate “Top Providers.” Please
specify whether the providers are
listed in order of frequency of
utilization (i.e. # Bills or # Charges)
or cost to the plan (i.e. total dollars
paid).
37. Are the policy numbers for 10/11
accurate, considering there are
different carriers involved?
Referenced
RFX Section
Riders
Revised Attachment L will be posted.
Attachment L –
Core Plan
Riders
Attachment L –
Core Plan
Riders
This decision would be made by the USG
Institution(s) using the Athletic Coverage
Rider.
Attachment X –
5 Years Top
Providers
Total dollars paid
Attachment W –
Total Charges
and Claims
Paid)
38. The report headings on each tab
Attachment Y –
designate “Top 25 Premiums Paid by Top 25
ICD-10 Codes.” Please confirm that
Premiums Paid
the “Paid” column represents the
amount paid by the insurance to the
provider(s) for the treatment of the
diagnosis listed in the “ICD-9 Code”
column.
39. In the mandatory brochures it states, Mandatory
“Students who are not covered by a
Brochure, page
policy on the pre-approved waiver
2, bottom
list must purchase….the policy.”
paragraph
Please provide a copy of the preapproved waiver list for each school.
40. In the 11/12 brochure there is
continuation of coverage offered on
UGA 11/12
the mandatory plan, but it is limited
Mandatory
to $12,500. Would you like us to
Brochure, page
include in the quotation a similar
15
reduced-benefit continuation plan, or
would you like us to include a true
continuation coverage that maintains
the benefit levels specified in the
Revised 02/11/11
Answers
Data is accurate and does not indicate
different carriers.
Confirmed.
Our RFP contains no “mandatory
brochure”. Unable to respond.
Our RFP contains no “mandatory
brochure”. Unable to respond.
SPD-SPR004
#
Questions
plan design?
41. Please provide the number of
students eligible to take mandatory
coverage and the number eligible to
take voluntary coverage.
42. Please provide the projected
enrollment and premium for the full
11/12 year, as we assume that the
Summer is not included in the
current 12,072 enrollment figure,
since the 10/11 full-year enrollment
was 18,569. If this is a true full-year
enrollment, please provide an
explanation as to why plan
enrollment is down by 35% year over
year.
43. Please provide data regarding the
number of waivers processed for
each campus. The past three years
is preferred.
44. Please describe the current process
for verifying or auditing waivers for
approval.
Revised 02/11/11
Referenced
RFX Section
Answers
Introduction 1.1
Purpose of
Procurement,
paragraph 3
See Attachment T for historical data.
Attachment Q
The 35% enrollment decrease reflects a
decision by the University of Georgia to
implement for the 2011-2012 year a
separate student insurance plan for their
mandatory category students.
Introduction 1.1
– Core Plan
Descriptions
See Attachment II.
Introduction 1.1
– Core Plan
Descriptions
Waivers are submitted online via a secure
website. All pertinent “other insurance
information” is submitted and information
is verified. We verify 100% of all waiver
submitted. This means that each plan
submitted is individually verified to be inforce, valid and collectible insurance
which meets the university’s standards,
including verifying specific benefits for the
school’s different programs (includes
exclusions, deductibles, copays,
coinsurance, etc. ). Once info is
submitted, each student receives an
email verifying receipt of the information
and informing the student of the waiver
process. Once the submitted information
is verified to be acceptable, the student
receives the second email informing him
that the waiver was verified and
approved, providing him with other
necessary information. Should a waiver
be declined, that student receives their
second email informing the student that
the waiver information has been declined
SPD-SPR004
#
Questions
Referenced
RFX Section
45. Does the University System currently Introduction 1.1
bill students who voluntarily enroll, or – Core Plan
would the University System be open Descriptions
to a process whereby students who
voluntarily enroll in the plan are billed
via the existing university student
account?
46. Please provide brochures for each
school for the last four years. In lieu
of brochures, please provide a
document by school or school
grouping showing the plan changes
for the past four years, including the
former benefit (i.e. going from $250
deductible to $500 deductible).
47. Please provide analysis of current
network discounts, including but not
limited to In-Patient, Out-Patient and
Rx.
48. Please provide the current pm/pm
fee for network access and savings.
Also, please tell us if the claims
experience provided includes
payments to the network.
49. Please provide rates for each school
for the last four years without school
fees included. In the case of shared
benefits and rates, schools may be
grouped together.
50. Please provide the claims paid as of
12/31/12 for the years 8/9, 9/10 and
10/11. Currently, the reports are only
through July 31, and this data is too
old to allow us to fairly evaluate the
claims to establish satisfactory future
rates. Please also provide the carrier
reports for each school.
Revised 02/11/11
Answers
and the reason(s) why the waiver was
declined. The email instructs the student
as to how he can edit the waiver and
resubmit it for approval. The university
has access to all waiver information in
real-time as well as the ability to import
this waiver information into their university
system.
We do not currently bill students, and no
we are not interested in billing voluntary
students.
See Attachment GG, Georgia Southern
University brochures, for this data. The
core plan is the same for all participating
USG entities.
Provider agreements are considered
proprietary.
Provider agreements are considered
proprietary.
See Attachment GG, Georgia Southern
University brochures, for this data. The
core plan is the same for all participating
USG entities. No rider premiums or
administrative fees are included.
Same carrier for all USG schools except
for University of Georgia mandatory
category students. Data provided is the
most recent we are able to obtain from
our current carrier.
SPD-SPR004
#
Questions
51. Please provide the claims for the
11/12 plan year through 12/31/12.
52. Please provide the carrier claims
reports for each school from which
the claims data in the RFP was
derived.
53. Please identify the schools that have
a Student Health Center. For those
that do, please verify if claims paid
for services at the SHC are payable
under the SHIP. Also, please verify if
they are included in the claims totals
we have; if not, please provide.
54. Please advise if there are any
capitation arrangements at any of
the SHCs and confirm if the
capitation amounts are included; if
not, please provide.
55. Many of the Excel documents
uploaded into the system are locked
for editing. Please provide these
same documents unlocked for
population.
56. Please provide any other vendor
questions and corresponding
answers regarding eRFP Number:
ES-RFP-53900-428.
57. For the 2011-2012 policy year,
please provide the following
information through 12-31-2011 for
each University/College participating:
a) Premium Collected;
b) Claim Utilization Reports;
and,
c) Enrollment
58. Please provide each participating
College’s/University’s Student Health
Center Fee Schedule.
59. Please provide a breakout of claims
Revised 02/11/11
Referenced
RFX Section
Answers
Current carrier advises there is not
sufficient time to provide this data.
Same carrier for all USG schools except
for University of Georgia mandatory
category students. Data furnished in the
RFP was derived from carrier reports.
Additional carrier claim reports would be
redundant.
See Attachment HH.
They are included in claims totals.
All USG Institution SHC’s have capitation
arrangements in place to the extent that
services are primarily supported by a
mandatory semester health fee that all
full-time undergraduate and graduate
students are required to pay. For
additional information see Attachment
HH.
Revised Attachments D, E and F will be
posted.
Questions and answers received will be
posted on the Georgia Bid Registry for all
vendors to see.
Current carrier advises there is not
sufficient time to provide this data.
See Attachment JJ.
Current carrier advises there is not
SPD-SPR004
#
Questions
Referenced
RFX Section
paid at the College’s/University’s
Student Health Center for the last 3
years.
60. Please provide more detailed
utilization reports for the last 3 years
to include:
a) Inpatient Hospital;
b) IP/OP physician visits;
c) IP/OP physician visits;
d) IP/OP surgery;
e) Lab; and,
f) X-ray, etc.
61. Please provide the top 10 providers
for each participating institution.
62. Do the current and previous rates
include any admin fees? If so, please
provide.
sufficient time to provide this data.
Current carrier advises there is not
sufficient time to provide this data.
Data not available.
If by “administration fees” you mean fees
requested by USG Institutions to help
support the administration of the USG
SHIP on the Institution’s campus -- no.
Revised Attachment L will be posted.
63. In Attachment L - additional RX – it
asks for every $250 and every $100
benefit increase. Please explain why
both are requested.
64. For the Athletic coverage, we are
unsure what exactly is being
requested. Please describe to
include:
a) Is it to be paid as any
other injury?
b) Please provide what is
the maximum benefit
level being requested?
65. In Attachment K, Page 1 (3rd item)
Please clarify what is being
requested.
66. In Attachment K, Page 10. Please
confirm a three tier drug plan is
acceptable (vs generic and brand).
67. Please confirm that all schools
Revised 02/11/11
Answers
Attachment K,
Page 1 (3rd
item)
In Attachment
K, Page 10
This is a Core Plan Rider so we are
requesting Athletic coverage primarily
related to those benefits that would
otherwise be excluded in the Core Plan
for student participating in intercollegiate
athletics – i.e., coverage for
intercollegiate sports activity including
injury resulting from the practicing for,
participating in, or traveling as a team
member to and from intercollegiate
athletic events. We are asking the
Offeror to determine the maximum benefit
level, in conjunction with the most cost
effective premium pricing, based on their
professional expertise and experience.
Revised Attachment K will be posted.
A three tier drug plan is acceptable.
No University System school is excluded
SPD-SPR004
#
Questions
shown in the reports will be
participating in the consortium.
68. Do any of the institutions provide
services at the health center which
are not billed to the carrier? If yes
what are those services.
69. Please confirm the official names of
the following Universities:
a) College of Coastal
Georgia
b) Georgia Health Sciences
University
70. In Attachment Q it states a
participating University as “GA Tech
ELI Pr.” Please provide the full
official name of this institution.
71. In the Mandatory Scored Response
Worksheet, question #46, Please
advise on what is being asked in
Letter B. Enrollment –
Authentication/Authorization. Please
also advise on what is being asked
in Letter D. Claims – Penalty.
72. Does each of the participating
institutions currently have an
Intercollegiate Sports plan? Please
provide policies, claims experience,
policy year premium, premium rates,
large claims information, list of sports
included, enrollment in the plan,
large claims information greater than
$5000 for 11/12, 10/11, 09/10 and
08/09 paid through 12/31/11. Claims
data should be paid through
12/31/11.
73. The RFP requests an “Athletic”
quote. Please explain what you are
requesting, if this is not the same as
the request for an Intercollegiate
Sports quote. If you currently have
an Athletic plan or rider, provide
enrollment, claims experience, policy
Revised 02/11/11
Referenced
RFX Section
Answers
from participating in any contract resulting
from this RFP. Participation in this
contract is not mandatory amongst all
USG Institutions.
Most services provided at the USG
Student Health Centers (SHCs) and the
USG Counseling Centers are not billed to
the carrier. See Attachment HH.
Confirmed.
Georgia Institute of Technology
Do your information technology business
practices provide for authentication and
authorization with respect to appropriate
user access? Do your business practices
include internal penalties specific to the
above mentioned claims performance
standards, timeliness of processing, and
accuracy?
No.
See Answer for Question #2 at the end of
this document as well as Attachment FF.
The Athletic Rider is added by individual
USG Institutions opting for this for this
Rider for students participating in
intercollegiate athletics for coverage
specific to their participation in
intercollegiate athletics, including team
competition and practice. Data on
SPD-SPR004
#
Questions
Referenced
RFX Section
year premium, large claims
information, premium rates and
policies for 11/12, 10/11, 09/10 and
08/09.
74. The RFQ request a Supplemental
Accident plan. Confirm that this will
be a Mandatory plan for all students.
Who will be eligible for the Do you
currently offer this type of plan. If
yes, provide claims experience,
enrollment, rates, annual premium,
and policies for 11/12, 10/11, 09/10
and 08/09.
75. With respect to #14: It is commonly
understood that SAS-70s are
generally prepared for self-insured
clients, and they are used to help
external auditors gain comfort when
auditing the claims expense
accuracy. While [we] provide SAS-70
audits to large, self-insured clients,
[our] services fully insured student
insurance cases in which a SAS-70
is not appropriate. As an alternative,
we can guarantee that the school will
have the right to conduct an audit of
our claims accuracy. Will our “No”
response to this question
automatically disqualify our proposal
in this scenario?
76. What is meant by “digitally bill and
collect data”? Does this mean that
students enrolling voluntarily would
actually be billed by the company, or
is it referring to online enrollment?
Attachment D –
Mandatory
Response
Worksheet - #
21
77. Please provide 4 years of claims
data and policy information on the
Attachment F –
Additional
Revised 02/11/11
Answers
Athletic Rider enrollment and claims
experience is addressed in the answer to
question?
Mandatory Rider Plan for all USG
Institutions opting for the Rider.
We would be willing to review
independent audit data the Offeror
typically provides for and maintains as an
alternative. Any audit of the Offeror’s
claims is the financial responsibility of the
Offeror.
No mention is made of “data” in
Mandatory Response Worksheet
Question 21. “The Offeror will digitally bill
to and collect from all Voluntary USG
SHIP insured students, including
coverage for spouses and dependent
children” means that students and, where
appropriate the students spouse and
dependent children, enrolling voluntarily
will be billed by the company, with the
expectation that the billing and collection
will be provided as part of the digital
online enrollment process.
Intercollegiate sports plan and accident
plan information is included in the answer
SPD-SPR004
#
Questions
intercollegiate sports plan/plans and
the Accident only plans. Please
include claims through 12-31-11
(partial year 4).
78. Please define what “reasonable
deductible” means? Would there be
a set dollar requirement and if so,
what is the minimum deductible
amount for which you would approve
a waiver?
79. What is meant by “Policy Year
Maximum (Per Person): $3,000
Annual Maximum” as a policy year
maximum of $100,000 is already
indicated above that? Is this the outof-pocket maximum?
80. Under Behavioral Health, Outpatient
– for in-network it indicates a $20 copay only. Does that mean there is
100% coinsurance, or should it be
80% like all other benefits?
81. Under Prescription Drug Benefit,
what is meant by “UHC Pharmacy”?
Are the benefits described to the left
of Column A applicable only at UHC
Pharmacy? Should consideration of
those benefits as described be
included in the offeror response?
Revised 02/11/11
Referenced
RFX Section
Scored
Responses - #1
Attachment J –
Insurance
Requirements paragraph 4
Attachment KSummary Core
Plan – page 1,
3rd row
Answers
for Question 72 and is included in claims
data.
The answer is in the context of the
referencing paragraph 3; i.e. “The
University System of Georgia requires all
students in the above (mandatory/hard
waiver) categories to have ‘reasonable,
comparable, creditable’ coverage to the
current system-wide student health
insurance plan provided.” This means
that a “reasonable deductible” would be
defined as a deductible that is
comparable to the USG SHIP insurance
plan deductible and/or co-pay per
individual, per year. Plans with noncomparable, non-creditable high
deductibles and/or co-pays per individual,
per year would not be approved and the
student would not be waived from the
mandatory USG SHIP enrollment and
payment.
Revised Attachment K will be posted.
The correct Annual Out-of Pocket
Maximums section can be found in the
Summary Core Plan page 3, Row 1.
Attachment KSummary Core
Plan – page 6
80% like all other benefits.
Attachment KSummary Core
Plan – page 10
“UHC” Pharmacy means USG Institution
University Health Center (UHC)
Pharmacy. Copayment waiver for
generics; $5 preferred brand; $10 name
brand applies only to prescription drugs
received at a UHC Pharmacy. This
relates to the fact that USG Institution
UHC Pharmacies provide discounted
pricing for generic, preferred brand, and
name brand prescription drugs that are,
typically, significantly less expensive than
SPD-SPR004
#
Questions
Referenced
RFX Section
Answers
off-campus retail pharmacies.
82.
83.
84.
85.
86.
87.
88.
89.
90.
What is the difference between the
2nd bullet and the 4th bullet,
“Additional Rx” and “Additional Rx
Maximum”?
In regard to the 5th bullet, in order to
provide a quote for athletic coverage,
please provide census for athletes at
each school.
In regard to the 5th bullet - Provide
Athletic Coverage – would this
coverage be mandatory for all ICS
athletes or would it be waivable?
The report headings on each tab
designate “Top Providers.” Please
specify whether the providers are
listed in order of frequency of
utilization (i.e. # Bills or # Charges)
or cost to the plan (i.e. total dollars
paid).
The report headings on each tab
designate “Top 25 Premiums Paid by
ICD-10 Codes.” Please confirm that
the “Paid” column represents the
amount paid by the insurance to the
provider(s) for the treatment of the
diagnosis listed in the “ICD-9 Code”
column.
In the mandatory brochures it states,
“Students who are not covered by a
policy on the pre-approved waiver
list must purchase….the policy.”
Please provide a copy of the preapproved waiver list for each school.
Please identify any student health
insurance rates that include
administrative fees collected by the
institutions and the amount of the
administrative fee for each.
Please provide claims for the 11/12
plan year through 12/31/12.
Can the University System provide
data regarding the number of
Revised 02/11/11
Attachment L –
Core Plan
Riders
Revised Attachment L will be posted.
Attachment L –
Core Plan
Riders
Revised Attachment L will be posted.
Attachment L –
Core Plan
Riders
This decision would be made by the USG
Institution(s) using the Athletic Coverage
Rider.
Attachment X –
5 Years Top
Providers
Total dollars paid
Attachment Y –
Top 25
Premiums Paid
Confirmed.
Mandatory
Brochure, page
2, bottom
paragraph
Our RFP contains no “mandatory
brochure”. Unable to respond.
See Attachment GG, Georgia Southern
SHIP Plan Brochures.
Current carrier advises there is not
sufficient time to provide this data.
See Attachment II.
SPD-SPR004
#
Questions
Referenced
RFX Section
waivers processed for each
campus? The past three years is
preferred.
91. Can the University System describe
the current process for verifying or
auditing waivers for approval?
92. Does the University System currently
bill students who voluntarily enroll, or
would the University System be open
to a process whereby students who
voluntarily enroll in the plan are billed
via the existing university student
account?
93. Please clarify Policy Year Maxim(per Attachment K
person (“$3,000 annual Maximum)?
page 1
What benefit does this Maximum
refer to?
94. What preventative services are cover
under Office Visit?
95. Will University of Georgia and
Georgia Institute be participants of
this group?
Attachment K
page 3
96. Is it possible to provide the TAX ID
#s for those providers listed in the
report?
97. Is the indemnification requirement
listed in the sample contract a
mandatory requirement as written or
can it be modified?
Attachment 5
– 5 years Top
Providers
Attachment H Sample
Contract
98. Is it required that non-participating
hospital based physicians be paid as
par under all in network hospitals
regardless of their participating
status?
99. Is it required by the plan to recognize
assignment when a student is seen
Attachment K Core Plan
Revised 02/11/11
Attachment K –
Core Plan
Answers
See answer for question 44.
No the USG system does not currently bill
students who voluntarily enroll, nor would
the USG system be open to doing so in
the future.
Revised Attachment K will be posted.
The correct Annual Out-of Pocket
Maximums section can be found in the
Summary Core Plan page 3, Row 1.
Annual physical exam and related
laboratory work
The University of Georgia non-mandatory
category students currently participate
and will continue to participate in the USG
SHIP. The USG SHIP is open to, and
encourages, future participation by the
University of Georgia for the mandatory
category students and Georgia Institute of
Technology for mandatory and voluntary
student categories.
Information not available.
Section 7 of the eRFP Template (Contract
Terms and Conditions) discusses the
contract and how to address exceptions
to those terms when submitted a
response.
No
No
SPD-SPR004
#
Questions
by a non-participating provider?
100. Is a pregnancy conceived in a prior
contract period to be covered by the
current carrier or covered by the
contract period in which the baby is
born?
101. Does the plan require all claims to be
received, processed, adjudicated
and paid within the United States?
a.
If not, are we required to
disclose those functions that are
performed outside of the United
States?
102. Does this general business
requirement allow the current broker
to represent carriers other than
NUFIC?
103. Can all the required worksheets be
submitted under single, but separate,
files for the technical and cost
proposal?
a.
Or are we required to submit
the individual worksheets as they are
posted on the website?
104. Please provide the definitions for the
following
a.
Total Paid – Does this include
the members obligations, discounts
or any other adjustments?
b.
Total Charges – Does this term
represent all eligible claims and uneligible claims?
105. Is it possible to obtain a claim and
utilization report thru 12-31-2011 for
all contract periods e.g. 2007, 2008,
2009, 2010, & 2011?
106. May an independent broker submit
two separate offers from different
carriers?
Referenced
RFX Section
Answers
Attachment K –
Core Plan
Since the State of Georgia mandates
coverage for maternity expense and
routine newborn care as a sickness the
coverage applies to the contract period in
which the baby is born.
Preferred but not required.
a. Preferred but not required.
Attachment K –
Core Plan
1.3 – Proposal
Certification #4 Collusive
Bidding
#4 – Pg 11 of
18
Attachment W
This section prohibits two bidding offerors
from collaborating together in submitting
their separate bids.
All the required worksheets should be
returned in the same format that they
were posted.
*Please note, there should be no cost
information listed on the technical
proposal documents.
a. No, the amount represents
paid only.
b. Total charges includes
charges payable within the
plan. Denied amounts are
not included.
Current carrier advises there is not
sufficient time to provide this data.
The eSource system in which each
Offeror will respond will only accept one
response from each Offeror.
2. Athletic Rider
A mandatory rider for student athletes (excluding football) can be added to the USGSHIP mandatory plan(s) which will provide students with comprehensive medical
Revised 02/11/11
SPD-SPR004
insurance up to a $10,000 ($330 per semester) or $40,000 ($388 per semester)
maximum benefit per covered ICS Injury. The rider cost by term would be assessed
twice a year: Fall (August – December) and Spring/Summer (January – July). The rider
will pay the same as the student plans, subject to coinsurance, copays and deductibles.
Just like the mandatory plans, students can waive out of the intercollegiate rider if they
have another group plan which will cover participation in intercollegiate sports. In prior
years, the $10,000 Athletic Rider was $318 and the $40,000 Athletic Rider was $375,
and the enrollees were the same for each school.
School
$40,000 Athletic Rider
Clayton State University
Columbus State University
Athletes
48
33
$10,000 Athletic Rider
Abraham Baldwin
Augusta State University
Georgia Institute of Technology
Kennesaw State University
North Georgia College & State
Valdosta State University
TOTAL:
10
16
18
24
19
8
176
Student Accident Plan
The Student Accident Plan requires mandatory enrollment of all full-time students at the
university. Premiums are $16 per student per year or $8.00 per student per semester
(Fall and Spring/Summer). Benefits are as outlined on the attached document. This
optional rider has not been selected by a university.
16. 2011-2012 PREMIUM RATES
Mandatory Graduate
Student
Spouse
One
Child
2+
Children
Annual
$1206
$3611
Fall Spring/Summer
$521
$685
$1553
$2058
$1819
$782
$1037
$3611
$1553
$2058
Mandatory Undergraduate
Student
Spouse
Revised 02/11/11
Annual
$1132
$3381
Fall Spring/Summer
$489
$643
$1454
$1927
SPD-SPR004
One
Child
2+
Children
$1703
$732
$971
$3381
$1454
$1927
Voluntary
Student
Spouse
One
Child
2+
Children
Annual
$1639
$5098
Fall Spring/Summer
$705
$934
$2192
$2906
$2574
$1107
$1467
$5098
$2192
$2906
17. Student health insurance plans can contain annual dollar limits, but there is a
specified transition period to 2014 when no annual limits will be allowed. Annual limits for
“essential health benefits” are completely prohibited for policy years beginning on or
after January 1, 2014. However, annual limits on “essential health benefits” may be
imposed in student health plans for policy years prior to January 1, 2014 if such limits
are no less than the following amounts:


$100,000 for policy years beginning on or after January 1, 2012 but before
September 23, 2012; and
$2 million for policy years beginning on or after September 23, 2012 but
before January 1, 2014
Annual dollar limits will be prohibited for policy years beginning on or after January 1,
2014. For example, a student health insurance plan with a $100,000 annual limit that
renews on August 1, 2012, may retain the $100,000 limit for the 2012/2013 plan year,
but will be required to increase its annual limit to no less than $2 million when it renews
on August 1, 2013. The plan will be required to eliminate its annual limit when it renews
on August 1, 2014.
The $100,000 minimum annual limit amount indicated above is provided under a
transition period for policy years beginning on or after January 1, 2012 but before
September 23, 2012. Without this transition period, the minimum annual limit amount for
policy years beginning on or after September 23, 2011 but before September 23, 2012
would have been $1.25 million.
For these purposes, “essential health benefits” include:



Ambulatory patient services;
Emergency services;
Hospitalization;
Revised 02/11/11
SPD-SPR004







Maternity and newborn care;
Mental health and substance use disorder services, including behavioral
health treatment;
Prescription drugs, including the Rider for Rx annual maximums
Rehabilitative and habilitative services and devices;
Laboratory services;
Preventive and wellness services and chronic disease management; and
Pediatric services, including oral and vision care.
Revised 02/11/11
SPD-SPR004