MONROE COUNTY DISTRICT
SCHOOL BOARD
____________________________________________________________
Section VI
Proposal Forms
for
Section 125 Administration Services
SECTION VI
THE MONROE COUNTY DISTRICT SCHOOL BOARD
SECTION 125 ADMINISTRATION SERVICES
PROPOSAL FORMS
A. PROPOSER'S IDENTIFICATION
Name of Company:
FEIN/SS#:
Address:
Company Proposal
Contact:
Telephone Numbers
Daytime/After Hours:
E-mail:
Section VI – Page 1
SECTION 125 ADMINISTRATION ACCOUNT COST INFORMATION
Proposers can provide either a flat annual administrative fee or a per employee per month
(PEPM) fee for these services.
Flat annual administrative fee to include:
 All Section 125 administrative services listed in Section IV
 Including an Annual Benefits Booklet of all coverages
 Medical FSA debit card
$
If proposing a PEPM fee, please complete the chart below based on the coverages
outlined in the Scope of Services section of the RFP:
FSA –
DCA –
Flexible Spending Account
Dependent Care Account
Medical FSA - Per Employee Per
Month*
DCA - Per Employee Per Month*
Debit Card for FSA
129
X
$
X 12
$
8
X
$
X 12
$
129
X
$
X 12
$
FSA Plan Documents
Flat Rate
Not Applicable
$
DCA Plan Documents
Flat Rate
Not Applicable
$
Annual Benefits Booklet
1,000
Generic Communication Materials
X
$
X 12
$
X
$
X 12
$
Custom Communication Materials
If Any
X
$
X 12
$
Check Writing
Per
Check
X
$
X 12
$
X
$
X 12
$
X
$
X 12
$
X
$
X 12
$
Other Charges (list/describe below)
TOTAL ESTIMATED FSA/DCA/OTHER ANNUAL COST
$
*If the Per Employee Per Month option is proposed, indicate “Included” for the annual cost
of services above, and indicate the costs for services not included in the PEPM fee.
ONLINE ELECTRONIC ENROLLMENT SYSTEM COST INFORMATION
Proposers can provide either a flat annual fee or a per employee per month (PEPM) fee
for the enrollment system.
Flat annual administrative fee to include:
 All online electronic enrollment services listed in Section IV
$
Per Employee Per Month (PEPM) fee to include:
 All online electronic enrollment services listed in Section IV
$
Section VI – Page 2
SECTION 125 ADMINISTRATION SERVICES AND ONLINE
ELECTRONIC ENROLLMENT COST QUESTIONS
Attach necessary explanations and/or deviations.
1. If the School Board were to consider an alternative fee structure to pay for the Section
125 and online electronic enrollment services, what could you propose? If
commission based, what products and/or services would you propose to sell?
2. State here if there are any required minimums for any services, etc.
3. Are the costs subject to change based on any enrollment changes?
4. What cost guarantees will you provide beyond the first thirty-six (36) months?
5. Describe here how your firm expects to be remunerated in any way that differs from
above. State your total remuneration and be specific if there are any minimum and/or
maximum fees.
SECTION 125
QUESTIONS
ADMINISTRATION
SERVICES
COVERAGE
Attach necessary explanations and/or deviations.
If an answer is different depending on the type of account (FSA, DCA or Other, please
specify).
1. Confirm you are able to provide COBRA administration for the dental and vision
coverages. Explain.
2. Are you agreeable to take over FSA administration?
3. Explain how the runout and takeover process is completed. What is your
recommendation for the runout claims if a change is made to a new administrator?
4. How is the payment claims process completed? Please outline the claims payment
process.
5. Please describe your specific process to achieve compliance for reimbursement of
only eligible FSA Healthcare receipts with respect to FSA debit card usage
(substantiation process). Include a copy of your sample FSA substantiation letter and
educational brochure.
6. How will the funding be transmitted?
7. Have you provided detailed recommendations, and your plan to promote participation
in the School Board’s flexible spending account?
8. Have you stated and provided samples with your proposal of the type of
communications/enrollment system to be used for each benefit option?
Section VI – Page 3
9. What information will you need from the School Board initially and on an ongoing
basis? How often? In what format?
10. Will you prior to solicitation of enrollment, provide communications materials to
participants regarding options they may choose and the effect on their taxable
income, especially for dependent care deductions and for those that may an FSA
account as well?
11. Will you, with regard to dependent care, individually prepare and explain to
employees their options, to allow them to knowledgeably choose between flexible
spending accounts and itemizing the expense for federal income tax purposes?
12. What is your most realistic estimate of the least number of calendar days required for
the education phase and the enrollment of the School Board’s group?
13. State whether your service fees and/or other cost factors will be affected by the
number of enrolled participants including any minimum costs and/or requirements.
14. List the optional methods you can offer participants for paying for services from their
FSA account. Debit card is required. e.g. ID card, Check, ATM, etc.
15. Explain the full range of services available to the School Board and your experience,
expertise and data processing capability relative to the solicited services.
16. What hours will your service be available to employees by telephone?
17. Will participants have on-line access to information about their accounts?
18. Have you provided information with your proposal on specific personnel to be
assigned to the School Board?
19. Assuming an annual flat fee or PEPM rate, do you acknowledge that you shall be
strictly prohibited from any sales or marketing efforts regarding insurance or other
products? Do you agree that your involvement in marketing or sales activities of
unauthorized (by the School Board) products or services will result in termination of
the contract and forfeiture of any fees payable by the School Board?
20. Will you be utilizing the services of subcontractors in rendering this service? If so, it
is required that you provide the details on whom and what services they perform.
Section VI – Page 4
ONLINE ELECTRONIC ENROLLMENT SERVICES QUESTIONS
Attach necessary explanations and/or deviations.
1. Does the system have log-on capabilities by employees with secure access 24/7?
2. Explain the online enrollment capabilities for both administrator and employee.
3. Does the system have the ability to give step by step guidance for individual benefit
information for employees showing current benefits with current cost being paid by
employee and the available benefits with associated costs?
4. Explain system abilities for benefit management by School Board assigned staff to
update, revise, or delete benefits and associated costs, including new hires, family
status changes, terminations and COBRA notification.
5. Explain how the School Board can run reports and have the options to run ad-hoc
reporting based on their criteria needed.
6. Is this system compatible with and have the ability to provide PPACA reporting
requirements? Please detail and explain.
7. Does the system have the ability or would the system have an ability to interface/be
compatible with a payroll system? Is there a listing of specific payroll systems you
can provide?
8. Explain how the system interfaces with insurance carriers & third party
administrators to keep data up to date from new hires, terminations, and retirements.
9. What online and telephone support is available for staff during School Board business
hours?
10. Any additional information about the online electronic enrollment system that would
be helpful?
Section VI – Page 5
SECTION 125
SERVICES
ADMINISTRATION
SERVICES
REPORTING
Attach necessary explanations and/or deviations.
1. Will you prepare and mail quarterly individual account status reports to participants?
2. Will you provide a biweekly participation and account status reports to the School
Board?
3. Will you provide a summary Annual Report for employees?
4. Will you prepare an annual forfeiture report to the School Board?
5. Will you fulfill federal report filing requirements, including issuing 1099s to
providers?
6. Do you agree to the School Board retaining property rights, for the School Board’s
own use, to all materials, reports, produced by the administrator specifically for the
School Board?
7. Will you maintain books, records, documents, and evidence on costs and expenses for
services provided?
8. Will such records be presented to the School Board for audit, if desired by the School
Board?
9. Will you establish records necessary for maintaining account balances?
Section VI – Page 6
SECTION 125 ADMINISTRATION SERVICES INFORMATION
Attach necessary explanations and/or deviations.
1. Where is the administration and claims payment facility located?
_______________________________________________________________________
a. If not local, can the School Board contact the claims and/or administration departments
by a toll-free number?
Yes
No_____
b. Indicate the name of the account representative that will service this account.
2. Will re-enrollment be necessary? If so, will you participate in the process if requested by the
School Board?
3. Will you provide an plan document, booklets, and any other appropriate literature to describe
the benefits to employees?
4. Will the literature distributed to employees and subject to approval by the School Board?
5. Did you enclose samples of documents, communications materials, etc.? Please provide a
sample of all forms, communications materials, and reports you recommend for School
Board use.
6. Will you provide a local area telephone number or “800” number that employees may call
throughout the year for counseling, information or service regarding the plan(s)?
Section VI – Page 7
SECTION 125 ADMINISTRATION SERVICES STABILITY
1. Confirm the following:
a. Has, as of the proposal return date specified in the RFP, been successfully
operating for a minimum of five (5) consecutive years.
b. Submitted with the proposal, the last audited financial statement issued by
a certified public accountant, dated no earlier than 18 months prior to the
proposal date specified in this RFP.
2. Is the company authorized to do business in Florida?
3. Does your proposed program comply with all applicable Federal and Florida Statutes,
and will you assure future compliance?
4. Briefly describe your organization and its history, number of years of providing
services, legal structure, and ownership.
5. What year did the company begin business in Florida?
6. How many employees does your company have?
7. How many employees does your company have in Florida?

8. What comments can you offer in assurance of your financial stability and your long
term commitment to the Florida market, especially with regard to Monroe county and
surrounding counties?
Section VI – Page 8
SECTION
125
REFERENCES
ADMINISTRATION
SERVICES
CLIENT
1. Indicate the number of currently contracted employers in the State of Florida.
2. Indicate the number of currently contracted public-sector employers in the State of
Florida.
3. List a minimum of four (4) current clients with similar size and/or industry as the
School Board with the following information:

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


Client Name
Contact Name and Title
Address
Phone and Fax
Email Address
Length of Client Relationship
State if a current or past client
Insurance Services Provided
Number of Employees
Section VI – Page 9
DEVIATIONS FROM MODEL PROGRAM
Indicate whether your proposal will or will not comply with the RFP with respect to the
coverage, service or provision listed below. All endorsements set forth in the RFP are to
be included VERBATIM in the contract unless indicated to the contrary on the Proposal
Form. The absence of any notation will be presumed to indicate full compliance.
Section
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RFP Provisions
Proposal Submission and Withdrawal
Amendment & Cancellation
Waiver/Rejection of Proposals
Minimum Qualifications of Proposer
Insurance Requirements
Late Proposals, Late Modifications and Late Withdrawals
Costs Incurred by Proposers
Exception to the RFP
Confidential and Proprietary Information
Negotiations of Proposals
Legal Requirements
Records/Audit
Investigation of Alleged Wrongdoings,
Litigation/Settlement/Fines/Penalties
Conduct of Proposers
Subcontracting
Assignment of Contract
Conflict of Interest
Public Entity Crimes Statement
Anti-Discrimination Clause
Discriminatory Vendor’s List
State Licensing Requirement
Drug Free Workplace
Bid Protest
Use of Proposal Forms
Irrevocability of Proposal
Contract Awards
Deviations from Model Program
Prohibition of Warranty Endorsement
Sole Agent Endorsement
Hold Harmless/Indemnification Provision
Termination and Non-Renewal Endorsement
Rerating Endorsement
Contract Period
Rate Guarantee Period
Remuneration
Access to Claim Files
Ownership of Claim Data
Audit Requirement
Eligibility & Enrollment
Scope of Coverage
Current Enrollment
Scope of Services
Section VI – Page 10
Will
Will Not
IV
IV
Administrative Services
Online Electronic Enrollment Services
ADDITIONAL COMMENTS/DEVIATIONS FROM MODEL PROGRAM
If your proposal does not fully comply with any provision, condition or requirement in
this RFP, explain fully (attach and identify additional pages as necessary) the alternative
provision, condition or requirement proposed.
ACKNOWLEDGMENT OF RECEIPT OF ADDENDA
The Proposer hereby acknowledges receipt of the following addenda:
1.
2.
3.
4.
CHECKLIST OF MATERIAL TO BE INCLUDED
The following material should be included as part of each of the completed responses to
this RFP including: one (1) paper original and four (4) paper copies (total of five (5)
paper proposals) and two (2) CD copies copy (with all documents in their original format,
Word, Excel, etc.)
1.
Completed Proposal Forms, and specimen contracts or policies as described in this
RFP.
2.
Acknowledgment of any addenda.
3.
Specimen copy or samples of the following:
a.
Contract
b.
Participation and Account Report examples
4.
Descriptive literature relevant to Section 125 Administration Services.
5.
Completion of financial ratings as outlined under “Section 125 Administrator
Stability” within this section of the RFP.
6.
Information on experience and references as requested on Proposal Forms.
Section VI – Page 11
PROPOSER'S WARRANTY
The undersigned person, by the undersigned's signature affixed hereon, warrants that:
1. The undersigned is an officer, partner or a sole proprietor of the company and the
enclosed proposal is submitted on behalf of the firm;
2. The undersigned has carefully reviewed all the materials and data provided on the
company's proposal on behalf of the company, and, after specific inquiry, believes all
the material and data to be true and correct;
3. The proposal offered by the company is in full compliance with the Minimum
Qualifications of Proposer set forth in Section II of this RFP;
4. The company authorizes the School Board, its staff or consultants to contact any of
the references provided in the proposal and specifically authorizes such references to
release either orally or in writing any appropriate data with respect to the company
offering this proposal;
5. The undersigned has been specifically authorized to issue a contract in full
compliance with all requirements and conditions, as set forth in this RFP, other than
those deviations noted above;
6. If this proposal is accepted, the contract will be issued as proposed.
Name of Firm/Insurer
Signature of Authorized Representative
Printed Name of Authorized Representative
Title of Authorized Representative
Date Signed by Authorized Representative
Section VI – Page 12