County of Orange
Bid 017-201505-BV
5
Solicitation 017-201505-BV
Benefits Administration Outsourcing Services
Bid Designation: Public
County of Orange
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County of Orange
Bid 017-201505-BV
Bid 017-201505-BV Benefits Administration Outsourcing Services Bid Number
017-201505-BV
Bid Title
Benefits Administration Outsourcing Services
Bid Start Date
Jul 22, 2015 11:20:35 AM PDT
Bid End Date
Aug 26, 2015 4:00:00 PM PDT
Question & Answer End Date
Aug 4, 2015 4:00:00 PM PDT
Bid Contact
Barbara Voelkel
5
[email protected]
Standard Disclaimer The County of Orange is not responsible for and accepts no liability for any technical difficulties or failures that result from conducting business electronically.
Description The County is soliciting proposals for Benefits Administration Outsourcing Services for all Health and Welfare Benefit Programs offered to active employees and retirees, with services including but not limited to: 1) Determining, maintaining and distributing all eligibility and coverage information to vendors and participants for all the County’s benefit programs; 2) Providing full customer service for benefits enrollment and eligibility, including general and participant-specific communications, a call center, Interactive Voice Response (IVR) system and a full-service web site; 3) Providing Flexible Spending Account Administration for health care and dependent care accounts; 4) Providing premium collection via payroll and pension interfaces, and monthly billing for employees on leave of absence and some new retirees; 5) Providing COBRA administration when coverage terminates; and 6) Providing eligibility determination and reporting data for the IRC Section 4980H of the Affordable Care Act. The contract will become effective upon approval of the County of Orange Board of Supervisors (approximately February 2016) for implementation, with ongoing administration commencing January 1, 2017 through December 31, 2019. The contract will be renewable for an additional two years, subject to approval by the County’s Board of Supervisors. The contract will focus on outsourced benefits administration including annual open enrollment and on-going administration of eligibility and enrollment for all Health and Welfare Benefit Programs. The objective of the RFP is to obtain proposals from qualified firms interested in partnering with the County to provide these services.
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County of Orange
Bid 017-201505-BV
COUNTY OF ORANGE
HUMAN RESOURCE SERVICES Employee Benefits Division
REQUEST FOR PROPOSAL FOR Benefits Administration Outsourcing Services RFP NO. 017-201505-BV
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INSTRUCTIONS: 1. SUBMIT ONE (1) ORIGINAL HARD COPY, FIVE (5) HARD COPIES AND SIX (6) CD-ROMS OF YOUR PROPOSAL. 2. RETURN THIS PAGE SIGNED, WITH PROPOSAL. 3. ALL PROPOSALS ARE TO BE IDENTIFIED WITH RFP #, AND RETURNED IN A SEALED ENVELOPE OR PACKAGE. 4. DECLINATION - IN THE EVENT YOU ELECT NOT TO SUBMIT A PROPOSAL, INFORM US ON THIS FORM AND RETURN BY THE DUE DATE INDICATED. 5. FOR FURTHER INFORMATION, CONTACT:
REQUEST FOR PROPOSAL COUNTY OF ORANGE Human Resource Services, Employee Benefits 333 W. Santa Ana Blvd. Room 137 Santa Ana, CA 92701
PROPOSALS MUST BE RECEIVED ON OR BEFORE
August 26, 2015 BY 4:00 P.M. (PT)
(714) 834-6282
Barbara Voelkel Human Resource Services, Employee Benefits
[email protected] FAX (714) 834-7088
RFP Number: 017-201505-BV File Folder No: C001686
DATE: July 22, 2015
REQUEST FOR PROPOSALS (RFP) COVER PAGE The County of Orange Human Resource Services, Employee Benefits Division, hereinafter referred to as “County”, is soliciting proposals (“Proposals”) from interested firms, hereinafter referred to as “Offerors,” to provide Benefits Administration Outsourcing Services. The awarded contract, if any, hereinafter referred to as “Contract,” will be based on terms specified in the Contract between the County and awarded Offeror, referred to in the Proposed Contract and hereinafter referred to as “Contractor” providing Benefits Administration Outsourcing Services, refer to Section III, Attachment A of this Request for Proposals (RFP) for a description of the Scope of Work. This Request for Proposal is set out in the following format: SECTION I. Introduction and Instructions to Offerors SECTION II. Response Requirements SECTION III. Proposed Contract PROPOSALS ARE DUE August 26, 2015, by 4:00 PM (Pacific Time). Proposals must be submitted in sealed packages. See complete instructions in Section I. All questions and inquiries related to this RFP must be directed to: Barbara Voelkel (“Deputy Purchasing Agent”), via email through BidSync at www.bidsync.com (RFP # 017-201505-BV). For BidSync assistance, please contact the BidSync Vendor Support Team at 1-800-990-9339, select option 1. Offerors are not to contact other County personnel regarding any questions or clarifications concerning this RFP. The Assigned DPA will provide all official communication concerning this RFP. With respect to this RFP, any County response other than from the DPA and in writing will be unauthorized and the County shall bear no responsibility for any and all reliance upon the unauthorized communication. I have read and understand and agree to the terms and conditions herewith and I am submitting a response and concurrence to this solicitation.
Date:_______________________
Company Name:____________________________________
*Authorized Signature
Name
Title
*Authorized Signature
Name
Title
* If a corporation, this document must be signed by two corporate officers. The first signature must be either the Chairman of the Board, President, or any Vice President. The second signature must be the Secretary, an Assistant Secretary, the Chief Financial Officer, or any Assistant Treasurer.
RETURN THIS SHEET WITH YOUR RESPONSE
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TABLE OF CONTENTS Page No. COVER PAGE ............................................................................................................................... 1 TABLE OF CONTENTS .............................................................................................................. 2 SECTION I: INTRODUCTION AND INSTRUCTIONS TO OFFEROR ............................. .3 A. Introduction.................................................................................................................... 4 B. Proposed Time Schedule ................................................................................................ 5 C. Background .................................................................................................................... 5 D. Instructions to Offerors and Procedures for Submittal .................................................. 9 E. Evaluation Process and Criteria .................................................................................. 13 F. Selection/Award Process .............................................................................................. 14 G. County of Orange Child Support and EDD Requirements .......................................... 14 SECTION II: PROPOSAL RESPONSE REQUIREMENTS ................................................. 16 Minimum Qualifications ................................................................................................... 17 Part 1 1. Cover Page ................................................................................................................. 18 2. Validity of Proposal ................................................................................................... 18 3. Certification of Understanding ................................................................................... 18 4. Minimum Qualifications Statement ........................................................................... 19 5. Certificate of Insurance .............................................................................................. 19 6. Financial Information………………………………………………… ..................... 19 7. Bankruptcy Information/Pending Litigation……………………………… .............. 19 8. Child Support Enforcement and EDD Independent Contractor Requirements ....... ...19 9. Conflict of Interest ..................................................................................................... 20 10. Statement of Compliance ........................................................................................... 20 Part 2 Company Profile ............................................................................................................... 21 Part 3 Offeror’s Proposal Questionnaire ..................................................................................... 22 SECTION III: PROPOSED CONTRACT…………………………………… ........................ 44 Table of Contents……………………………………………………………………... ... 45 Proposed Contract……………………………………………………………………. .... 45 Attachment A – Scope of Work........................................................................................ 59 Attachment B – Compensation/Payment .......................................................................... 77 Attachment C – Staffing Plan …………………… .......................................................... 83 Attachment D – Proposed Implementation Plan/Project Schedule................................... 84 Attachment E – Sample Communication Plan ................................................................. 85 Attachment F – Performance Guarantees ......................................................................... 86 Attachment G –Business Associate Contract ................................................................... 90 Exhibit 1- County of Orange Child Support Enforcement Certifications ......................... 95 Exhibit 2- EDD Independent Contractor Reporting Requirement ................................... 96 Exhibit 3 – County of Orange Health & Welfare (Group) Benefit Programs .................. 97 Exhibit 4 – Active Employee Eligibility Matrix ............................................................. 105 Exhibit 5 – Retiree – Health & Health Grant Eligibility Matrix..................................... 108 Exhibit 6 - County Current Files - Type and Format Transfer Between Vendors .......... 111 Exhibit 7 – Eligibility Definitions and Required Documentation .................................. 113 7/22/2015 12:24 PM
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SECTION I INTRODUCTION AND INSTRUCTIONS TO OFFERORS
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SECTION I: INTRODUCTION AND INSTRUCTIONS TO OFFERORS A. Introduction The County is soliciting proposals for Benefits Administration Outsourcing Services for all Health and Welfare Benefit Programs offered to active employees and retirees, with services including but not limited to: 1) Determining, maintaining and distributing all eligibility and coverage information to vendors and participants for all the County’s benefit programs; 2) Providing full customer service for benefits enrollment and eligibility, including general and participantspecific communications, a call center, Interactive Voice Response (IVR) system and a full-service web site; 3) Providing Flexible Spending Account Administration for health care and dependent care accounts; 4) Providing premium collection via payroll and pension interfaces, and monthly billing for employees on leave of absence and some new retirees; 5) Providing COBRA administration when coverage terminates; and 6) Providing eligibility determination and reporting data for the IRC Section 4980H of the Affordable Care Act. The contract will become effective upon approval of the County of Orange Board of Supervisors (approximately February 2016) for implementation, with ongoing administration commencing January 1, 2017 through December 31, 2019. The contract will be renewable for an additional two years, subject to approval by the County’s Board of Supervisors. The contract will focus on outsourced benefits administration including annual open enrollment and on-going administration of eligibility and enrollment for all Health and Welfare Benefit Programs. The objective of the RFP is to obtain proposals from qualified firms interested in partnering with the County to provide these services. It is the County’s goal to find a Contractor who will be responsible for the administration of eligibility and enrollment for all of the County’s proposed year 2017 through 2021 Health and Welfare Benefit Programs. Actual benefits are administered by individual plan vendors. Only vendors with the capability of providing a complete outsourcing arrangement, including a call center, IVR, and web enrollment, will be considered in the selection process. It is important that the County provides its employee and retiree population with high quality customer service, state-of-the-art technologies, and direct access to tools and support for understanding and making benefit elections, which allows County benefits professionals to focus on high level objectives such as planning, analysis, audits, program management and design. Administration of ongoing services must begin on January 1, 2017. Implementation activities necessary to assume administration of ongoing services shall begin upon approval of the contract by the Board of Supervisors. Offerors must include a tailored work plan illustrating their approach to reaching the target dates in their response. This must be included in your response as Attachment D: Proposed Implementation Plan/Project Schedule. Refer to Section III, Attachment A, of this RFP for an expanded description of the Scope of Work. The County intends that the successful Offeror shall provide Benefits Administration Outsourcing RFP Services proposed in accordance with the terms and conditions set forth in Section III – Proposed Contract, including all Attachments and Exhibits.
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B. Proposed Time Schedule Date
Action
July 22, 2015
RELEASE OF RFP
August 4, 2015
Written Questions from Offerors Due by 4:00 P.M. (Pacific Time)
August 26, 2015
Deadline for Proposals (Closing Date) – On or before August 26, 2015 at 4:00 P.M. (Pacific Time)
August 26, 2015 – September 30, 2015
EVALUATION OF PROPOSALS
TBD
Offeror’s Oral Presentation – The most responsive proposals may be asked to give an oral presentation within three (3) calendar days of notification.
TBD
SUBMISSION FOR APPROVAL BY COUNTY BOARD OF SUPERVISORS
C. Background The Employee Benefits Division currently has twenty-three (23) benefit programs for approximately 17,660 employees belonging to nineteen (19) different bargaining units (units are described in further detail below) and ten (10) retiree health plans and a special “Retiree Medical Program” for approximately 5,843 retirees. The Division has Finance and Accounting units that process premium payments based on premium reporting provided under this proposed contract, and a customer service unit that handles referrals of elevated employee/retiree/provider phone calls and second level appeals. The current contractor providing benefits administration outsourcing services, Xerox HR Solutions, whose contract term will expire December 31, 2016, currently performs all of the County’s eligibility and enrollment processing, premium reporting and reconciliation. The County is going out to bid due to the expiration of the contract with the current contractor. In order to manage eligibility, the County’s current population is broken out into several groups which may belong to separate bargaining units with variations in eligible benefit options, plan design, and costs. A summary of program eligibility by employee group is included as Exhibit 4, “Active Employee Eligibility Matrix.” Each of the employee groups receives slightly different benefit options and the benefits structure may differ. Consequently, each group must be managed separately.
Benefit Programs for Active Employees and Eligible Dependents For a detailed description of the various benefit programs, see Exhibit 3 “County of Orange Health and Welfare (Group) Benefit Programs.”
Health Plans: The County currently offers employees and their eligible dependents four health plans, consisting of two self-funded PPO plans (there is one claims administrator and one pharmacy benefit manager handling administration of medical and prescription claims for these plans) and two California HMO plans (Currently, there are two vendors who each provide different HMO benefit plan designs). The number of health plans and plan designs may change from year to year depending on the outcome of labor negotiations and competitive solicitations, and the Selected Vendor must be able to accommodate annual updates to vendor interfaces, rates,
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web information and communication updates related to these changes. Judges and Peace Officers are not eligible to enroll under these active health plans. The County requires that employees provide written verification of dependent eligibility for all newly added dependents within sixty (60) days of the event that made the dependent eligible. Selected Vendor must administer this verification process as part of the scope of work. Exhibit 7 “Eligibility Definitions and Required Documentation” lists the current dependent eligibility and documentation requirements. In addition, there is one ACA qualified affordable health plan for ACA FTE employees who are not eligible under the County’s represented employee groups.
The OC Healthy Steps program is a wellness program that offers a Wellness Credit equal to 5% of premium as a biweekly incentive for each employee who completes all three annual steps: 1) Biometric Screening; 2) Health Risk Assessment; and 3) Non-Smoking Attestation.
Annual Wellwise rebate program under one of the two PPO plans (Wellwise Choice), for employees who do not file claims for health and prescription expenses for themselves and their dependents for a given year. Processing of the rebates is handled by the PPO claims administrator, but enrollment and eligibility history may be requested from the Selected Vendor for this contract for purposes of determining eligibility for the rebate.
Health Care Reimbursement Account (HCRA) for eligible employees. Method of claims reimbursement should include use of a Debit card as well as submission of reimbursement claim forms by various methods, including on-line, by fax or by U.S. Mail. Currently 1,437 active participants.
Dependent Care Reimbursement Account (DCRA) for all eligible employees. Currently approximately 310 active participants. Method of claims reimbursement should include submission of reimbursement claims forms by various methods, including on-line, by fax or by U.S. Mail.
Life, Accidental Death and Dismemberment (AD&D), Short and Long Term Disability (STD/LTD) for eligible employees. Currently, participation is as follows: 1) Basic Life: 2,202; 2) Basic AD&D: 5,161; and 3) STD/LTD: 2,083. Must calculate and report the value of imputed income for Life Insurance on a biweekly basis. Must be able to support on-line Evidence of Insurability (EOI) and electronic file transmission for life insurance claims. Amount of Life and AD&D basic and voluntary coverage options varies based upon employee group.
Self-funded Dental plan for eligible employees and their dependents. Currently approximately 1,957 active participants and 24 COBRA participants. The County requires that employees provide written verification of dependent eligibility for all newly added dependents within sixty (60) days of the event that made the dependent eligible. Selected Vendor must administer this verification process as part of the scope of work. Exhibit 7 “Eligibility Definitions and Required Documentation” lists the current dependent eligibility and documentation requirements.
“Optional Benefit Plan” (OBP) for approximately 2,115 eligible employees. The County provides each of these employee groups an annual benefit amount that eligible employees can elect to receive as taxable cash one time lump sum or allocate towards one or a combination of the following benefits: County 457 Defined Contribution plan (pre-tax contributions), HCRA, and voluntary AD&D premiums. The amount of this benefit varies by classification and pay class (full-time or part-time); participants must re-enroll during each open enrollment period or they will automatically receive the taxable cash lump sum.
Medical reimbursement plan for approximately 122 Judges that reimburses limited eligible health and prescription drug expenses. Reimbursement is limited to deductibles and coinsurance amounts only partially reimbursed by the Judges’ CalPERS health plan. This program is more restrictive than a traditional health care reimbursement account. This program was closed to new participants as of December 13, 2013.
Premium reimbursement plan for approximately 122 Judges that reimburses their contribution towards their CalPERS health and dental premiums. This program was closed to new participants as of December 13, 2013. County provides the Selected Vendor with the amount of the biweekly premiums.
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For specific groups of separated employees who are not eligible to receive the Retiree Health Grant (see description under Retiree section), a cash lump sum benefit upon termination of employment may be elected and then paid through the payroll process following notification by the Selected Vendor.
Continuation of benefits for COBRA participants and for employees who are disabled, are on Family Medical Leave or other unpaid leave status. Direct billing arrangements are needed for continuation of benefits when an employee is not on payroll, or is separated or retired from the County and/or on COBRA. Current enrollment estimates are as follows:
Active participants on Direct Billing – 87 Retirees on direct billing – 110 COBRA Employees Health – 29 COBRA Employees Dental – 20 COBRA Dependents Health – 12 COBRA Dependents Dental – 4
Employee Assistance Program (EAP) for all employees, their family members and significant others. In addition to customer service referrals, Selected Vendor will be required to provide headcounts needed by the County to pay the EAP vendor’s fees.
Unemployment benefits for all eligible employees, currently self-funded and administered through Equifax. Selected Vendor will be required to provide headcounts needed by the County to pay the vendor’s fees.
Section 1.62, Section 401 (a) and Section 457 Defined Contribution plans, administered by the County’s Defined Contribution administrator, Empower Retirement. Only required functions of the Selected Vendor are web links and customer service referrals.
Special Processing for Peace Officers: County of Orange Peace Officers and Law Enforcement Management are not covered under the above County health plans. The County contributes towards the cost of the Peace Officers’ health plans administered by the Peace Officers’ group administrator. The Selected Vendor will be involved in transmitting health plan bi-weekly changes in payroll deductions to the County based on enrollment information provided in Excel format by this group’s administrator. Unlike the County plans, the annual rate updates and open enrollment elections for this group are done on a mid-calendar year basis. There are six (6) fully insured health plans offered to this group. This group of employees may also participate in the County’s HCRA and DCRA programs. Monthly and ad hoc reporting may be required for this group. Peace Officer addresses must be kept confidential and will only be provided to the Selected Vendor if the Peace Officer signs a release upon making a HCRA or DCRA election. Unique to this group is its participation in the County’s Health Reimbursement Arrangement (HRA) program, an employer-sponsored tax-advantaged savings plan. Only required functions of the Selected Vendor for the HRA are web links and customer service referrals. Law Enforcement Managers are eligible for other County-offered supplemental benefits including Dental, Life, AD&D, STD/LTD, HCRA/DCRA, and OBP. See Exhibit 4 “Active Employee Eligibility Matrix.”
Benefits for Retirees and Surviving Spouses and/or Eligible Dependents For a detailed list of benefit programs, see Exhibit 3 “County of Orange Health and Welfare (Group) Benefit Programs.” For a detailed description of Retiree Health Program eligibility, see Exhibit 5 “Retiree – Health & Health Grant Eligibility Matrix.” The County offers the following benefit programs:
Two self-funded PPO health plans (one claims administrator, one pharmacy benefit manager for one of these plans)
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California HMO health plans (two different vendors for three plans)
HMO Medicare Advantage Plans (three different vendors for three plans)
PPO Medicare Advantage Plans (one vendor for two plans)
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Note: As part of the above-listed plans, the County offers “Mixed Enrollment” options for retirees and dependents where one participant is eligible for Medicare and one (or two) participant(s) is not eligible for Medicare. The family group must be enrolled with the same vendor but may be in different plan options.
The County requires that retirees also provide written verification of dependent eligibility for all newly added dependents within sixty (60) days of the event that made the dependent eligible. Selected Vendor must administer this verification process as part of the scope of work. Exhibit 7 “Eligibility Definitions and Required Documentation” lists the current dependent eligibility and documentation requirements. In addition, retirees must provide Medicare verification documentation within sixty (60) days of the retiree and/or dependent becoming eligible for Medicare, or upon retirement if they are already Medicare age when they retire.
Annual Wellwise rebate program for one out of the two self-funded PPO plans (Wellwise Retiree), for retirees who do not file claims for health and prescription expenses for themselves and their dependents for a given year, and/or for retirees who are non-smokers (subscriber only). Processing of the rebates is handled by the PPO claims administrator, but enrollment and eligibility history may be requested from the Selected Vendor for this contract for purposes of determining eligibility for the rebate.
A “Retiree Medical Plan” that provides eligible retirees and surviving spouses a Retiree Health Grant that is applied as a monthly credit towards the cost of County retiree health premium and/or Medicare Part B premiums. The retiree grant is calculated based on age at retirement, years of eligible service, and Medicare attainment and is indexed annually. Further detail is provided in Exhibit 3 “County of Orange Health & Welfare (Group) Benefit Programs.”
Selected Vendor must be able to calculate and report the value of imputed income received by Retirees for health and welfare benefits provided to their Domestic Partners.
Premium Deductions: Active Employees: Biweekly payroll deductions are sent from Selected Vendor and processed by the payroll system CAPS+ which is a payroll/financial system designed by American Management Systems (AMS) Advantage System, currently “Consultants to Government and Industry” (CGI) and supported by SAIC, Inc.
Employee and employer payroll deductions and biweekly imputed income must be determined by Selected Vendor based upon employee elections and will be transmitted electronically to the County payroll system for payroll processing on a biweekly basis.
Employees not receiving active payroll contributions (various unpaid leaves of absence) must be billed by Selected Vendor on at least a monthly basis with contributions being tracked, then forwarded to the County for payment of premiums. Lack of payment must result in notification and termination of coverage by Selected Vendor.
Retirees: Monthly premium deductions and grant credits for health and Medicare reimbursement are sent by Selected Vendor and processed through the Orange County Employees Retirement System (OCERS) via their Pension Gold Payroll System. Retiree pension deductions, eligible Retiree Health Grant for health and Medicare reimbursement will be determined by Selected Vendor based upon retiree elections and various eligibility data factors, and will be transmitted electronically to OCERS for processing on a monthly basis.
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Retirees who are in the 30-90 day process of setting up monthly pension deductions with OCERS, or retirees with insufficient pension funds from which to take monthly premium deductions must be billed by Selected Vendor on a monthly basis with contributions being tracked, then forwarded to the County for payment of premiums. Lack of payment must result in notification and termination of coverage by Selected Vendor.
Systems: Data interfaces will occur between the Selected Vendor’s system data and the County’s payroll system, Orange County Employees Retirement System (OCERS), insurance carriers, and other external vendor systems. The County’s current payroll system is a mainframe payroll system CAPS+ developed by CGI and supported by SAIC, Inc. The Selected Vendor must calculate deductions, credits, retroactive deductions, and calculate imputed income (life insurance and Domestic Partners). The Selected Vendor will receive at least bi-weekly indicative data feeds from the County’s CAPS+ system (may advance this to weekly at some point in the future). Detailed deductions and imputed income will be sent to payroll on a bi-weekly basis (may advance this to weekly at some point in the future) and may include retroactive deductions in the future. Retiree health plan deductions and retiree health grant amounts, including retroactive adjustments, must be passed to Orange County Employees Retirement System (OCERS) on a monthly basis. Selected Vendor will receive periodic intent to retire files from OCERS, as often as bi-weekly. It is anticipated a systems upgrade may occur. Selected Vendor may need to participate in analysis and implementation associated with this upgrade. The Selected Vendor is also expected to receive manual enrollment information via an Excel spreadsheet from the Peace Officers’ bargaining unit (AOCDS) and based on this information, determine payroll deductions and pass payroll deductions to the County through a payroll feed. Currently there are approximately 2,000 Peace Officers and Law Enforcement Managers covered under County Peace Officer health plans. Affordable Care Act: The County meets the definition of an applicable large employer (ALE) and therefore is subject to Internal Revenue Code (IRC) Section 4980H. Including the County, there are 7 ALE members. County is the designated reporting entity and responsible for FTE determination for all ALE members. Upon the County’s request, the Selected Vendor will be expected to perform the administration of benefits as well as collect and report all data to comply with IRC Section 4890 H. This may include but is not limited to performing FTE calculations, providing required offers of coverage, and preparing, filing, and/or distributing files and notices to the IRS and participants. D. INSTRUCTIONS TO OFFERORS AND PROCEDURES FOR SUBMITTAL By submitting a Proposal, the Offeror represents that it has thoroughly examined and agrees to provide the services required under this RFP as detailed in Section III, Attachment A, and that it is capable of providing the services to achieve the County’s objectives. Offeror must abide by all provisions of the Proposed Contract unless Offeror notes its objections in its Proposal. As noted below, if the Offeror cannot abide by any provisions of the Proposed Contract, Offeror must make notice of which provisions it cannot comply with in its Proposal Each Offeror must submit its Proposal in strict accordance with all requirements of this RFP and compliance must be stated in the Proposal. Deviations, clarifications and/or exceptions must be clearly identified and listed separately as alternative items for the County’s consideration. The Scope of Work specifications as detailed in Section III, Attachment A, are mandatory and the County will not accept any deviations or exceptions. 1. Clearly identified Proposals are due on or before August 26, 2015, no later than 4:00 P.M. PT, and are to be delivered in a sealed package with the following information: RFP No# 017-201505-BV for Benefits Administration Outsourcing Services.
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Deliver to: COUNTY OF ORANGE Human Resource Services, Employee Benefits 333 W. Santa Ana Blvd., Room 137 Santa Ana, CA 92701 Attn: Barbara Voelkel
HUMAN RESOURCE SERVICES, EMPLOYEE BENEFITS REGULAR BUSINESS HOURS: Monday through Friday
8:00 A.M. to 5:00 P.M. (PT)
Proposals must be time-stamped on the outside of the sealed package by the receptionist at Human Resource Services/Employee Benefits. The delivery location for the receipt of Proposals is the first floor of the Hall of Administration building, Room 137. It is the responsibility of the Offeror to ensure that delivery is made to the Human Resource Services/Employee Benefits receptionist at the above address by the due date and time specified. Delivery receipts are available upon request. 2. Clarifications: The County has attempted to provide all information available. It is the responsibility of each Offeror to review, evaluate and where necessary, request any clarification prior to submission of a Proposal. If any person contemplating submitting a Proposal for the proposed contract is in doubt as to the true meaning of any part of this RFP or finds discrepancies in or omissions from the specifications, he/she may submit a written request for clarification to the assigned Deputy Purchasing Agent, via www.bidsync.com (RFP # 017-201505-BV). For BidSync assistance, please contact the BidSync Vendor Support Team at 1-800-990-9339 and select option 1. 3. Addenda: Any interpretation of, or correction to, this RFP will be made only by addendum issued by the Deputy Purchasing Agent through BidSync. It is the Offeror’s responsibility to access the website www.bidsync.com throughout the entire process to obtain the most up-to-date information regarding this procurement process. The County will not be responsible for any other explanations, corrections to, or interpretations of the documents, including any oral information. There will be no Pre-Proposal Conference for this RFP. Questions regarding the contents of this Proposal must be submitted in writing (via www.bidsync.com (RFP # 017-201505-BV) on or before August 4, 2015, 4:00 pm. (Pacific Time). 4. Validity of Proposals: Proposals must be valid for a period of at least three hundred and sixty five (365) days from the Closing Date. No Proposal may be withdrawn after the Closing Date. 5. Proposal Copies: Each Offeror must provide one (1) hard copy original, and five (5) additional hard copies of its Proposal. One Proposal is to be clearly marked as “original” on the outside cover and contain original signatures. In addition, Offeror must submit six (6) CD-ROM copies, each of which contains an electronic copy of its Proposal, including its questionnaire answers. 6. Submission Format: All written Proposals shall be submitted on standard 8.5 x 11-inch paper. All pages should be numbered and identified sequentially by section. Proposals must be bound, tabbed and indexed in accordance with the information requested in Section II, Proposal Response Requirements. It is imperative that all Offerors responding to this RFP comply, exactly and completely, with the instructions set forth herein. All Proposals in response to this RFP shall be typewritten or word-processed (except where otherwise provided or noted), concise, straightforward, and should fully address each requirement and question. Although not as a substitute for a complete written response, additional material, such as technical documents, may be referenced in any response, if the material is included in the same section as additional information. Electronic versions of the proposal shall be submitted on CD-ROM. CD-ROM disks must include: County of Orange RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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a. Questionnaire (Microsoft Word format) b. Proposed Contract with any additions or deletions shown using “track changes” (Microsoft Word format) c. Scope of Work (Contractor must agree to all services listed in Section III, Attachment A, any additional services offered should be shown using “track changes”) (Microsoft Word format) d. Fee Proposal - Attachment B (Microsoft Word Format) e. Attachments C, D, E, and F (Microsoft Word format) It is not necessary to include an electronic version of the Cover Page or other certifications included in Part 1 of Section II of this RFP. Those items should be submitted in hard copy, with original signatures on the copy designated as “original”. In addition, it is not necessary to submit audited financial reports, marketing brochures or similar additional information in the electronic versions of the proposal. 7. Proprietary Information: Proposals are not to be marked as confidential or proprietary. Proposals submitted in response to this RFP may be subject to public disclosure as permitted by the California Public Records Act. All Proposals shall become the property of the County. The County reserves the right to make use of any information or ideas in the Proposals submitted. 8. Qualifications: By submitting a Proposal, the Offeror represents that it has thoroughly examined and become familiar with the services required under this RFP and that it is capable of providing the services to achieve the County’s objectives. 9. Compliance: Each Offeror must submit its Proposal in strict accordance with all requirements of this RFP and compliance must be stated in the Proposal. Deviations, clarifications and/or exceptions must be clearly identified and listed separately as alternative items for the County’s consideration. 10. Presentations: After the Closing Date, evaluation and Proposal clarification will commence. Offerors who submit Proposals most responsive to the County’s requirements may be asked to give an oral presentation of their Proposal to County staff. Selected Offerors should be prepared to make their oral presentation within three (3) calendar days after notification and be prepared to discuss all aspects of their Proposals in detail, including technical questions regarding the Proposal. Offerors shall not be allowed to alter or amend its Proposal through the use of the presentation process. In addition, Selected Offerors may be required to provide an on-site tour of the customer service and/or administrative facilities proposed under Offeror’s Proposal. 11. County Rights: The County reserves the right to negotiate modifications with any Offeror as necessary to serve the best interests of the County. Any Proposal may be rejected as non-responsive if it is conditional, incomplete or deviates from specifications in this RFP. The County reserves the right to waive, at its discretion, any procedural irregularity, immaterial defects or other improprieties which the County deems reasonably correctable or otherwise not warranting rejection of the Proposal. No such waiver will excuse a proponent from full compliance. 12. Expenses: Pre-contractual expenses are not to be included in, or as part of the Compensation/Payment for Contractor Services. Pre-contractual expenses are defined as including, but not limited to, expenses incurred by the Offeror such as costs incurred in: a. b. c. d.
Preparing its Proposal in response to this RFP; Submitting that Proposal to the County; Negotiating with the County any matter related to the Offeror’s Proposal and Any other expenses incurred by the Offeror prior to the date of award and execution, if any, of the Contract.
13. Notice: The County reserves the right to: a. b.
Negotiate the final Contract with any Offeror(s) as necessary to serve the best interests of the County. Withdraw this RFP in whole or in part, at any time without prior notice; or 11
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Award its total requirements to one Offeror or to apportion those requirements among two or more Offerors as the County may deem to be in its best interests.
In addition, negotiations may or may not be conducted with Offeror; therefore, the Proposal submitted should contain the Offeror’s most favorable terms and conditions, since the selection and award may be made without discussion with any Offeror. Furthermore, the County makes no representations that any Contract will be awarded to any Offeror responding to this RFP. 14. Joint Venture: Where two or more Offerors desire to submit a single Proposal in response to this RFP, they should do so on a prime/subcontractor basis rather than as a joint venture. The County intends to contract with a single firm or multiple firms but not with multiple firms doing business as a joint venture. 15. Lobbyist: The County does not require and neither encourages nor discourages the use of lobbyists or other consultants for the purpose of securing business. 16. Protest: Any actual or prospective bidder, proposer or contractor who alleges a grievance by the solicitation or award of a Contract may submit a grievance or protest to the appropriate agency/department Deputy Purchasing Agent. a. Procedure All protests shall be typed under the protester’s letterhead and submitted in accordance with the provisions stated herein. All protests shall include at a minimum the following information:
The name, address and telephone number of the protestor; The signature of the protestor or protestor’s authorized representative; The solicitation number; A detailed statement of the legal and/or factual grounds of the protest; The form of relief requested.
b. Protest of Bid/Proposal Specifications All protests related to bid or proposal specifications must be submitted to the Deputy Purchasing Agent no later than five (5) business days prior to the close of the proposal. Protests received after the five (5) business day deadline will not be considered by the County. In the event the protest of specifications is denied and the protester wishes to continue in the solicitation process, they must still submit a bid prior to the close of the solicitation in accordance with the bid/proposal submittal procedures provided in the bid/proposal. c. Protest of Award of Contract: In protests related to the award of a Contract, the protest must be submitted no later than five (5) business days after the notice of the proposed contract award is provided by the Deputy Purchasing Agent. Protest relating to a proposed contract award which is received after the five (5) business day deadline will not be considered by the County. d. Protest Process In the event of a timely protest, the County shall not proceed with the solicitation or award of the contract until the Deputy Purchasing Agent, the County Purchasing Agent or the Procurement Appeals Board renders a decision on the protest. Upon receipt of a timely protest, the Deputy Purchasing Agent will within ten (10) business days of the receipt of the protest, issue a decision in writing which shall state the reasons for the actions taken.
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The County may, after providing written justification to be included in the procurement file, make the determination that an immediate award of the Contract is necessary to protect the substantial interests of the County. The award of a Contract shall in no way compromise the protester’s right to the protest procedures outlined herein. If the protester disagrees with the decision of the Deputy Purchasing Agent, the protestor may submit a written notice to the Office of the County Purchasing Agent requesting an appeal to the Procurement Appeals Board, in accordance with the process stated below. e. Appeal Process If the protester wishes to appeal the decision of the Deputy Purchasing Agent, the protester must submit, within three (3) business days from receipt of the Deputy Purchasing Agent’s decision, a written appeal to the Office of the County Purchasing Agent. Within fifteen (15) business days, the County Purchasing Agent will review all materials in connection with the grievance, assess the merits of the protest and provide a written determination that shall contain his or her decision on whether the protest shall be forwarded to the Procurement Appeals Board. The decision of the County Purchasing Agent on whether to allow the appeal to go forward will be final and there shall be no right to any administrative appeals of this decision. E. EVALUATION PROCESS AND CRITERIA Proposals will be evaluated on the basis of the response to all requirements in this RFP. The County shall use the following criteria in its evaluations and comparisons of Offerors. No inference is to be drawn concerning relative importance of criteria based on the order presented. Contract award shall be made to the responsible Offeror whose proposal is most advantageous to the County, taking into consideration the applicable evaluation criteria set forth below. Please note, however, that the listing of fees as an evaluation criterion does not require the County to select the Offeror with the lowest fee proposal. The following criteria are listed in random order, not in order of importance. Responses will be evaluated on the basis of responsiveness to the questions and requirements in this RFP by an evaluation panel using the following criteria: 1. 2. 3. 4. 5. 6. 7.
Overall Responsiveness to the RFP Requirements Organization and Staff Qualifications and Experience Participant and Client Services Reporting and Technology Performance Guarantees Limitations and Caveats: including exceptions to the Proposed Contract and Scope of Work Cost
The weighting criterion is confidential and was established prior to the release of this RFP. Proposals deemed to meet all minimum RFP requirements will be scored based on established criteria, which have been weighted and will be assigned points that measure the responsiveness to each identified criterion. The total number of points earned will be tallied for each proposal, and the proposals will be rank ordered, based upon the Offeror(s) submitted written materials. Following the initial evaluation process, the highest ranking Offerors may be required as a finalist to: 1) provide a finalist presentation/interview, including a system demonstration, as it relates to requested and/or proposed services (as specified in Section D.10 above); 2) provide an on-site tour of the call center facilities proposed under Offeror’s proposal and/or administrative facilities; and/or 3) provide a sample web demo and County of Orange 13 RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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IVR test site for County to access and review as it relates to requested and/or proposed services. Please confirm you are able to accommodate this request should you be required to do so and list any special requirements, including turnaround time. In addition, the County will conduct follow-up calls to the references of the finalists to inquire about Offeror’s qualifications and experience providing the services within the scope of work. Results of follow up reference inquiries will be factored into final ratings.
F. SELECTION/AWARD PROCESS Appropriate County staff will prepare a slate of the finalists in order of ranking to present to the County Board of Supervisors. Upon approval from the Board of Supervisors, negotiations will commence with the selected Offeror. Upon successful completion of negotiations, the award and executed Contract will be submitted to the Board of Supervisors for approval. If a satisfactory contract cannot be negotiated in a timely manner, the County, in its sole discretion, may terminate negotiations with the selected Offeror and begin contract negotiations with the next finalist. The Proposed Contract contained in Section III of this RFP is the Contract proposed for execution. It may be modified to incorporate negotiated items and other pertinent terms and conditions set forth in this RFP, including special conditions and requirements and those added by addendum, and to reflect the Offeror’s proposal and qualifications. Exceptions to the terms and conditions of the Proposed Contract or the statements regarding Offeror’s inability to comply with any of the provisions thereof must be declared in the response to this RFP in Section II, entitled Response Requirements, Section 10, Statement of Compliance. G. COUNTY OF ORANGE CHILD SUPPORT AND EDD REQUIREMENTS 1. ORANGE COUNTY CHILD SUPPORT In order to comply with the child support enforcement requirements of the County, within ten days of notification of selection of award of Contract but prior to official award of Contract, the Selected Offeror agrees to furnish to the Purchasing Agent, or the agency/department deputy purchasing agent: a. In the case of an individual contractor, his/her name, date of birth, Social Security number, and residence address; b. In the case of a contractor doing business in a form other than as an individual, the name, date of birth, Social Security number, and residence address of each individual who owns an interest of 10 percent or more in the contracting entity; c. A certification that the contractor has fully complied with all applicable federal and state reporting requirements regarding its employees; and d. A certification that the contractor has fully complied with all lawfully served Wage and Earnings Assignment Orders and Notices of Assignment and will continue to so comply. Failure of the Offeror to timely submit the data and/or certifications required may result in the Contract being awarded to another Offeror. In the event a Contract has been issued, failure of the contractor to comply with all federal, state, and local reporting requirements for child support enforcement or to comply with all lawfully served Wage and Earnings Assignment Orders and Notices of Assignment shall constitute a material breach of the Contract. Failure to cure such breach within 60 calendar days of notice from the County shall constitute grounds for termination of the Contract. (Upon County request, Offeror shall utilize the form provided as Section III, Proposed Contract, Exhibit 1 of this RFP to satisfy this requirement) 2. EDD INDEPENDENT CONTRACTOR REPORTING REQUIREMENTS Effective January 1, 2001, the County is required to file federal Form 1099-Misc for services received from a “service provider” to whom the County pays $600 or more or with whom the County enters into a County of Orange RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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contract for $600 or more within a single calendar year. The purpose of this reporting requirement is to increase child support collection by helping to locate parents who are delinquent in their child support obligations. The term “service provider” is defined in California Unemployment Insurance Code Section 1088.8, subparagraph B.2 as “an individual who is not an employee of the service recipient for California purposes and who received compensation or executes a contract for services performed for that service recipient within or without the state.” The term is further defined by the California Employment Development Department to refer specifically to independent contractors. An independent contractor is defined as “an individual who is not an employee of the government entity for California purposes and who receives compensation or executes a contract for services performed for that government entity either in or outside of California.” The reporting requirement does not apply to corporations, general partnerships, limited liability partnerships, and limited liability companies. Additional information on this reporting requirement can be found at the California Employment Development Department web site located at http://www.edd.ca.gov/taxrep/txicr.htm To comply with the reporting requirements, County procedures for contracting with independent contractors mandate that the following information be completed and forwarded to the contracting agency/department immediately upon request: First name, middle initial and last name Social Security Number Address Start and expiration dates of contract Amount of contract (Upon County request, Offeror shall utilize the form provided as Section III, Proposed Contract, Exhibit 2 of this RFP to satisfy this requirement)
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SECTION II PROPOSAL RESPONSE REQUIREMENTS
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SECTION II: PROPOSAL RESPONSE REQUIREMENTS Proposals must be prepared simply and economically, providing a straightforward, concise description of capabilities to satisfy the requirements of this RFP. Emphasis should be on completeness and clarity of content with sufficient detail to allow for accurate evaluation and comparative analysis. Proposals must include three tabbed sections, Part 1, Part 2 and Part 3 and must be indexed in the order outlined below. List questions and your responses and/or attachments as numbered and listed within each section.
Minimum Qualifications The following is the criteria for an Offeror to be considered as an eligible candidate to bid on the requested services described in this RFP. Offeror must meet all of the following requirements: 1. Within the last five (5) years, implemented and provided ongoing administration for projects of similar size, scope and complexity. Must have client experience in a large employer environment (5,000 employees or more, 1,000 retirees or more, wherein the majority of employees are represented by collective bargaining units). It is desirable for Offeror to have at least one public sector client covering at least 10,000 employees and at least 3,500 retirees. 2. The ability to interface electronically with the client’s current payroll system, retirement system (OCERS), Centers for Medicare and Medicaid (CMS), and individual benefit plan vendors. Must be able to receive and send ANSI 834 HIPAA compliant files. Provide a series of reports, including premium reports and enrollment reconciliations, leave of absence reporting, bi-weekly or monthly census files for actives and retirees, and ad hoc reporting. 3. Provide an assigned account service team and dedicated call center team including access to benefits information and live customer service representatives through a toll free IVR system to provide proactive service solutions and quick responses. In addition, the County’s benefit staff will require real time access to the service provider’s eligibility and enrollment system and customer service/call tracking system. 4. Provide a web based enrollment system. 5. Have the ability to assume all benefits administration services identified in the Scope of Work, Attachment A, beginning January 1, 2017. 6. Submit proposal in the manner as requested in Section II of this RFP.
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Part 1: Complete this Section II, Part 1 and submit as Part 1 in first tabbed section of Proposal.
1. Cover Page All Proposals must be accompanied by a cover letter of introduction and executive summary of the Proposal. The cover letter must be signed by person(s) with authority to bind the Offeror. If the Offeror is a corporation, then signatures of two specific corporate officers are required for the cover letter and all required signatures throughout this RFP. The first corporate officer signature must be one of the following: 1) the Chairman of the Board; 2) the President; 3) any Vice President. The second corporate officer signature must be one of the following: a) Secretary; b) Assistant Secretary; c) Chief Financial Officer; d) Assistant Treasurer. In the alternative, a single corporate signature is acceptable when accompanied by a corporate resolution or other documentation demonstrating the legal authority of the signator to bind the corporation. An unsigned Proposal or failure to comply with the corporate signature requirements, if applicable, is grounds for rejection. All Proposals shall include in this first tabbed section, the cover page of this RFP and any subsequent addenda issued to this RFP.
2. Validity of Proposal The County requires that all Proposals be valid for at least three hundred and sixty five (365) days from this RFP’s closing date. Proposals which are not valid for at least three hundred and sixty five (365) days will be considered non-responsive and subject to rejection. Please state below how long this Proposal will be valid for. Offeror hereby certifies that Offeror’s Proposal is valid for three hundred and sixty five days from the RFP closing date. Validity of Response (in days)
Signature required
3. Certification of Understanding The County assumes no responsibility for any understanding of the Offeror or representation made by any of the County’s officers, employees or agents during or prior to the execution of any Contract resulting from this RFP unless: A. B.
Such understanding or representations are expressly stated in the Contract; and The Contract expressly provides that the County assumes the responsibility
By signing below, Offeror certifies that such understanding has been considered in this Proposal. (Signature required)
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4. Minimum Qualifications Statement Offeror hereby certifies that it meets all minimum qualifications and requirements as set forth in this RFP, Section II. (Signature required)
5. Certificate of Insurance Offeror hereby certifies Offeror’s willingness and ability to provide the required insurance coverage and certificates as set forth in Section III, Proposed Contract, Paragraph 20 et seq. (Signature required) If Offeror is unwilling or unable to provide the required insurance coverage, such exception to the Proposed Contract must be specifically stated and Offeror must provide a complete statement regarding the insurance coverage as required by this RFP. 6. Financial Information Selected Offeror may be requested to submit a complete financial statement for the two most recent years, prepared in accordance with generally accepted accounting principles. The financial statement must include a balance sheet and income statement. Offeror must be prepared to substantiate all information shown. Offeror must indicate here Offeror’s willingness to provide this information by signing below. ___________________________________________________________________________ (Signature required) 7. Bankruptcy Information/Pending Litigation If Offeror’s company has had a controlling interest in a company in bankruptcy or that has ever been declared bankrupt, Offeror must attach a statement indicating the bankruptcy date, court jurisdiction, trustee’s name and telephone number, amount of liabilities, amount of assets and current status of bankruptcy. Attach detailed information regarding any pending litigation, liens, or claims involving the Offeror. ________No action pending
________Information attached
___________________________________________________________________________ (Signature required) 8. Child Support Enforcement and EDD Independent Contractor Requirements Offeror hereby certifies Offeror’s willingness and ability to provide the required Orange County Child Support Enforcement and EDD Independent Contractor Reporting Requirements as indicated in RFP Section I and Section III Exhibits 1 and 2. (Signature required) County of Orange RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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9. Conflict of Interest Offeror hereby certifies that: (I) Offeror has provided the County with the disclosures required in (A) and (B) below as part of its Proposal, or (II) that no relationships as outlined in (A) and (B) exist. A.
Disclose any financial, business or other relationship with the County, any other entity that the County Board of Supervisors governs, or any County Board member, officer or employee, which may have an impact, effect or influence on the outcome of the services you propose to provide. Provide a list of current clients, employees, principals or shareholders (including family members) who may have a financial interest in the outcome of services you proposed to provide.
B.
Disclose any financial, business or other relationship within the last three (3) years with any firm or member of any firm who may have a financial interest in the outcome of the work.
(Signature required)
10. Statement of Compliance Offeror hereby certifies (Offeror must certify either A or B by signing below): A.
This Offeror is in strict compliance with this RFP including, but not limited to, the terms and conditions set forth in Section III – Proposed Contract and its Attachments and Exhibits and no exceptions are proposed.
(Signature required) OR B.
This Offeror is in strict compliance with this RFP, including the terms and conditions set forth in Section III – Proposed Contract and its Attachments and Exhibits, except for those exceptions expressly listed as required by this RFP and attached hereto.
(Signature required) Attachments for each proposed exception to this RFP, including, but not limited to Section III – Proposed Contract, including Attachment A, Scope of Work, must include: 1. The suggested rewording by way of track changes; 2. Reasons for submitting the proposed exception; and 3. Any impact the proposed exception may have on the services to be provided
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Part 2: Company Profile Complete this form and submit as Part 2 in the second tabbed section of Proposal. Company Legal Name: Company Legal Status (corporation, partnership, etc.): Business Address: Website Address: Telephone Number: (___)
Facsimile Number: (___)
Email Address: Length of time the firm has been in business:
Length of time at current location:
Years of experience: Is your firm a sole proprietorship?
Yes
No
If yes, Sole Proprietor’s social security number: Is your firm a sole proprietorship doing business under a different name: Yes If yes, please indicate sole proprietor’s name and the name you are doing business under: Is your firm incorporated: Federal Taxpayer ID Number:
Yes
No
No
If yes, State of Incorporation:
Regular business hours: Regular holidays and hours when business is closed: Contact person in reference to this RFP: Telephone Number: (___) Email Address:
Facsimile Number: (___)
Contact person for accounts payable: Telephone Number: (___) Email Address:
Facsimile Number: (___)
Name of service manager: Telephone Number: (___) Email Address:
Facsimile Number: (___)
In the event of an emergency or declared disaster, the following information is required: Name of contact during non–business hours: Telephone Number: (___) Facsimile Number: (___) Email Address: Cell or Pager Number:
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Part 3: Complete this section and submit as Part 3 in the third tabbed section of Proposal.
Offeror’s Proposal Questionnaire Offerors must submit with their Proposal the following Questionnaire, completed and identified as the Questionnaire. In addition to providing a printed version of this Questionnaire with your Proposal, you must enclose a copy on CD-ROM. The response must be in Microsoft Word format. This Questionnaire addresses the major aspects of the Benefits Administration Outsourcing Services. Answer only the questions asked, and refrain from making references to other preprinted materials, marketing and sales information. Your responses must relate to the facts requested. Your responses must reflect your organization’s current personnel. Each question is to be answered by appropriate personnel. In providing your responses to the questions below, restate each question in bold face type with your response directly below. 1. Proposal Description Offerors must provide a brief synopsis of their understanding of the County’s needs and how the Offeror plans to meet these needs. This should provide a broad understanding of the Offeror’s entire Proposal. It should also include a statement that the Offeror will provide all of the services included in Section III, Attachment A, “Scope of Work” or an explanation of any proposed exceptions to Attachment A. 2. Compensation / Payment Offerors must submit with their Proposal the Compensation / Payment section as outlined in Attachment B. In addition to providing a printed version of the compensation and pricing section with your Proposal, you must enclose a copy on CD-ROM. The response must be in Microsoft Word format. 3. Staffing Plan Offerors must submit with their Proposal the Staffing Plan as Attachment C in addition to responding to Section A.I.D. below. In addition to providing a printed version of the staffing plan with your Proposal, you must enclose a copy on CD-ROM. The response must be in Microsoft Word format. 4. Project Schedule/Implementation Plan a. Offerors must provide an implementation plan outlining the necessary tasks needed to install the County’s plans and begin performing the services outlined in Attachment A - Scope of Work. Include a timetable and name the parties responsible (include any resource requirements of the County staff). Identify: 1. Major milestones and key deliverables, including but not limited to: a. Web, IVR and Call Center b. Conversion of COBRA, Direct Billing, and Flexible Spending Account records as appropriate c. Interfaces/Systems d. Communications e. ACA Section 4980H 2. Scheduled meetings during the course of the project 3. The delivery of status reports County of Orange RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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Include as Attachment D – Proposed Implementation Plan/Project Schedule. b. Describe the process/project management methodology for implementation of all services including employee event packages and communications, Web, and IVR. Include: a. The roles and responsibilities of the County and the Offeror b. The testing process used to ensure system accuracy; include any roles and responsibilities of County staff c. How the transition from implementation to ongoing will be managed c. Describe any interdependencies (such as conversions of current elections from the incumbent vendor). 5. Sample Communication Plan Provide a detailed Communications Plan and project timetable beginning with the Contract award and continuing through the complete assumption of all services within this Contract. Include as Attachment E – Sample Communication Plan. 6. Questionnaire Offerors must submit with their Proposal the following Questionnaire, completed and identified as the Questionnaire, item 6 within Part 3 of the proposal. In addition to providing a printed version of this Questionnaire with your Proposal, you must include a copy on CD-ROM. The response must be in Microsoft Word format. This Questionnaire addresses the major aspects of the Scope of Work. Answer only the questions asked, and refrain from making references to other preprinted materials, marketing and sales information. Your responses must relate to the facts requested. Your responses must reflect your organization’s current personnel. Each question is to be answered by appropriate personnel.
SECTION A: GENERAL QUESTIONNAIRE
I. ORGANIZATION AND STAFF QUALIFICATIONS AND RELEVANT EXPERIENCE
A. Organizational and Financial Stability 1. Name and address of person to receive notices and who is authorized to make decisions, represent and legally bind the Offeror. Also provide the name, title, address, e-mail address and telephone and fax numbers of the person(s) who the County should contact with questions regarding your response. 2. Are you the Offeror, a subsidiary or affiliate of another company? Give full disclosure of all direct or indirect ownership and type of relationship with affiliate companies. If Offeror is a foreign corporation, submit a copy of Certificate of Good Standing for State of California. 3. Indicate whether any services will be subcontracted to another company and fully describe these services and the stability, background and qualifications of all companies that may provide subcontracted services, including audited financial statements for the last two (2) years. 4. Describe any pending discussions, negotiations or agreements to merge, spin off, or sell Offeror. 5. Offeror shall indicate whether Offeror, its principals, directors or majority shareholder(s), or any company Offeror hold or has held a controlling interest in, or which holds or has held a controlling interest in Offeror, has ever filed for or has been involuntarily put into bankruptcy or has been declared bankrupt. If yes, attach a County of Orange RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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statement indicating the bankruptcy date, court jurisdiction, trustee’s name and phone number, amount of liabilities, amount of assets and current status of bankruptcy. 6. Offeror shall provide detailed information regarding any existing or threatened litigation, criminal, civil or regulatory investigations, liens or claims involving Offeror, or any company Offeror holds a controlling interest in, or any company that holds an interest in Offeror, or any of the principal officers of the Offeror’s firm. (Exclude routine interpleaded actions, garnishments and similar routine matters involving family members that will reflect on your performance of services to the County.) 7. Has Offeror been cited or threatened with citation within the last five (5) years by any federal or state regulators for violations of any state or federal law or regulations? If so, please describe fully. 8. In the last five (5) years, has Offeror had a contract terminated by a client for cause? If so, please describe by whom and under what circumstances? Provide the name and telephone number of each client that has terminated Offeror's services for cause. 9. In the last five (5) years has Offeror failed or refused to complete a contract? If so, provide a detailed explanation. 10. Provide complete information and proof of existing and/or proposed legal organization structure within the County and where applicable, outside the County. Specifically, that Offeror is licensed to conduct business in the State of California. If not, attach an opinion of counsel giving his or her opinion as to whether he or she anticipates any difficulties in obtaining all necessary licenses prior to the effective date of the Contract. 11. In the past five (5) years has Offeror been denied a license to do business? If so, state the date of the denial, the license denied, the state in which the license was denied, the reason given for denial of the license, whether Offeror has had a bona fide change of ownership or management since Offeror license was denied and whether Offeror has eliminated the cause for which the license was denied. 12. In the past five (5) years has Offeror had a license to do business, a license to provide insurance and/or products or any other insurance license revoked or suspended? Has Offeror ever been reprimanded by a licensing agency? If so, please describe fully. 13. Describe your errors and omissions coverage. Describe the various types of insurance coverage and indemnification provided protect clients including: a. b. c. d. e.
Risk Covered Carriers Levels Limits Deductibles
14. Provide your most recent financial ratings from the following rating bureaus: Rating Bureau Standard & Poor’s A. M. Best Moody’s Fitch
Ratings/ Date of Rating
15. During the last five (5) years has your firm had any lawsuits brought against it covering the administration or claims processing of any plan? If so, please explain in detail.
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16. Provide your Annual Report for the last two (2) years. Offeror must also include independently audited financial statements for the last two (2) fiscal years. Audited financial statements are required; un-audited financial statements will not be accepted.
B. Offeror Experience 1. Complete the following table, indicating when services were first provided, number of employees of the largest single client, and future implementation dates (if applicable). If partial services, note which services are not provided: Service Provided
Provided Since (Year)
Number of Largest Current Employer Clients Size
Future Implementation Date
Sub-contracted (Yes/No)
1) Determine plan eligibility for multiple employee groups 2) Create and mail personalized benefit summaries, confirmation statements, and resource materials 3) Print, mail, and track various forms (beneficiary, Medicare assignment, dependent verification, etc.) 4) Track and report on enrollment by benefit type, plan and group 5) Provide dedicated customer service teams 6) IVR access to benefit information 7) Provide real-time web enrollment 8) Model Life Events via the web, e.g., determine costs to add or drop dependent or retire. 9) Perform on-line edits for incorrect elections or illogical combinations 10) Process Qualified Life Events (QLE) and Age-In events 11) Report eligibility to carriers electronically and work with carriers County of Orange RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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Service Provided
Provided Since (Year)
Number of Largest Current Employer Clients Size
Bid 017-201505-BV
Future Implementation Date
Sub-contracted (Yes/No)
directly to reconcile enrollment discrepancies 12) Provide on-line system access (view call history, documents sent, benefits eligibility, etc) to client’s benefit staff – read only 13) Administer HCRA and DCRA 14) Administer COBRA 15) Administer non-standard reimbursement programs such as Judges Medical Reimbursement 16) Administer monthly billing for employees on leave of absence and retirees 17) Administer life insurance, including calculating imputed income for life insurance, on-line submission of EOI and electronic claim processing. 18) Calculate imputed income for Domestic Partners (actives/retirees) 19) Calculate and pass payroll and pension deductions (actives and retirees) 20) Process retroactive payroll adjustments for retroactive enrollments or changes. 21) Calculate and administer monthly retiree Grants 22) Process subsidies for Retirees 23) Collect and retain Beneficiary information electronically, e.g., Life Insurance and AD&D County of Orange RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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Service Provided
Provided Since (Year)
Number of Largest Current Employer Clients Size
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Future Implementation Date
Sub-contracted (Yes/No)
policies 24) CMS reporting for Medicare Part D subsidies 25) Working with vendors to process and track pending elections and approvals into Medicare advantage plans 26) ACA Section 4890 H – FTE determination, offers of coverage & stability period management
2. What is the largest health and welfare benefit conversion Offeror has completed? 3. When did this conversion take place? 4. Identify a recent successful conversion. 5. What is the average size of clients to whom Offeror has provided IVR services? Web services? 6. What distinguishes Offeror’s organization from others the County might consider? C. References 1.
Offeror must complete the table by providing three (3) references from current large clients (Counties, municipalities, large corporations of at least 5,000 employees or more, and 1,000 retirees or more), where total benefits administration is provided including health and welfare benefit programs, HCRA/DCRA, COBRA, a call center, Interactive Voice Response (IVR), and web technology. Public Sector experience and/or clients with collectively bargained benefit plans is highly preferred. If you are unable to provide three complete references covering all areas within the scope of work, i.e., health and welfare but not HCRA/DCRA, etc., you may provide additional resources to supplement the services missing from the three largest clients. Current Clients: Each reference listed should include all of the following information: Client Name and Address Name, title and telephone number of a person we may contact Number of covered 1) employees 2) retirees Description of relevant services provided to this client Length of time you have provided these services Client Name and Address Name, title and telephone number of a person we may contact Number of covered 1) employees 2) retirees Description of relevant services provided to this client Length of time you have provided these services Client Name and Address
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Name, title and telephone number of a person we may contact Number of covered 1) employees 2) retirees Description of relevant services provided to this client Length of time you have provided these services
2. Offeror must complete the table to provide two (2) references from clients whose contracts were terminated or were not renewed within the last 2 years. Terminated Clients: Each reference listed should include all of the following information: Client Name and Address Name, title and telephone number of a person we may contact Number of covered 1) employees 2) retirees Description of relevant services provided to this client Length of time you provided these services Date contract terminated Reason for termination/non-renewal
Client Name and Address Name, title and telephone number of a person we may contact Number of covered 1) employees 2) retirees Description of relevant services provided to this client Length of time you provided these services Date contract terminated Reason for termination/non-renewal D. Staffing Plan 1. Complete the table below for all personnel who will be assigned to the County’s account and their responsibilities. You may update the title for the roles shown, or add/combine titles as needed to reflect correct terminology and complete representation of critical roles within your organizational structure. 2. Provide an organizational chart showing these individuals and reporting relationships. 3. Include a biography/resume for each person shown in the organization chart. Title:
Relationship Manager / Account Director: Ultimately responsible for the overall satisfaction of the County. This individual shall analyze and assess the County’s needs to identify strategic opportunities and recommendations and shall support Offeror’s internal team as needed.
Responsibilities for the County Account Years with Company Years in Current Position Office Location Number of Clients and size of client Client reference: Company/name/email/telephone number County of Orange RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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Title:
Bid 017-201505-BV
Implementation Manager: Overall responsibility for successful implementation, works closely with the account team to ensure milestones and objectives are met.
Responsibilities for the County Account Years with Company Years in Current Position Office Location Number of Clients and size of client Client reference: Company/name/email/telephone number Title:
Ongoing Account Manager: Day to day operations manager who is in regular contact with the Offeror’s account team and the County Project Manager to proactively communicate and address issues and ensure contract requirements are being met on a daily basis. This individual manages the priorities, resources, and results of their team to ensure client objectives are met. Attends weekly client meetings
Responsibilities for the County Account Years with Company Years in Current Position Office Location Number of Clients and size of client Client reference: Company/name/email/telephone number Title:
Customer Service Manager: Responsible for the daily operation and oversight of the dedicated customer service team assigned to the County account. Responsible for ensuring proper training of staff, must monitor, report, and address service issues, and partner with the County Customer Service Manager to ensure quality service is being provided to County participants. Ultimately responsible for the overall customer satisfaction regarding participant services.
Responsibilities for the County Account Years with Company Years in Current Position Office Location Number of employees being supervised Client reference: Company/name/email/telephone number Title:
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Participant Advocate: Responsible for working directly with employees and retirees at the County’s request or through escalations within the call center, providing case management and resolving escalated issues, including, but not limited to, complex eligibility problems (for participants 29 p. 32
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and dependents), direct billing issues, and benefits errors. Position will partner with the County Customer Service Manager to ensure issues are resolved in a timely manner and will analyze root cause of escalations and identify trends, and working with the relationship manager and ongoing account manager to identify and implement solutions. Analyze and report on trends and recommendations as part of quarterly client meetings. Other duties as requested. Responsibilities for the County Account Years with Company Years in Current Position Office Location Number of employees being supervised Client reference: Company/name/email/telephone number Title:
Vendor Liaison: Responsible for working with County vendors (health plans, OCERS, Offeror’s subcontractors, etc.) to identify, research and resolve both individual participant issues and issues that have a global and/or further reaching operational implications to vendor relationships.
Responsibilities for the County Account Years with Company Years in Current Position Office Location Number of Clients and size of client Client reference: Company/name/email/telephone number Title:
Appeals and Issues Coordinator: Manage the County specific appeals process to ensure timeframes are met, complete information is provided to County for decision making, and global issues are identified and addressed internally. May coordinate with the participant advocate as needed.
Responsibilities for the County Account Years with Company Years in Current Position Office Location Number of Clients and size of client Client reference: Company/name/email/telephone number Title:
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Technical Analyst: Understanding of the day to day operational functions relative to the County account to act as a liaison between the Offeror’s programming staff, the Offeror’s account team and the County team to address issues, recommend solutions, and make ongoing improvements and changes as needed, including, but not limited to the web, IVR, reporting, vendor interfaces, customer service tools, event processing, and fulfillment. 30 p. 33
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Responsibilities for the County Account Years with Company Years in Current Position Office Location Number of Clients and size of client Client reference: Company/name/email/telephone number Title:
Systems Analyst: Ensures successful programming, transmission, receipt, and reconciliation of all interfaces to and from client, clients benefit vendors, Offeror’s subcontractors such as HCRA administrator (if applicable), County payroll system, OCERS, etc.
Responsibilities for the County Account Years with Company Years in Current Position Office Location Number of Clients and size of client Client reference: Company/name/email/telephone number Title:
Ongoing Project Manager: Manages implementation of ongoing changes, such as: new programs, annual changes in benefits, Open Enrollment, system updates, future ACA changes, and changes in subcontracts. Works closely with the account team to ensure milestones and objectives are met.
Responsibilities for the County Account Years with Company Years in Current Position Office Location Number of Clients and size of client Client reference: Company/name/email/telephone number Title: Other
(Describe)
Responsibilities for the County Account Years with Company Years in Current Position Office Location Number of Clients and size of client Client reference: County of Orange RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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Company/name/email/telephone number 4. How do you staff/source ongoing project work requested by a client without impacting the delivery of day-today operational work? 5. For all positions above who will not be dedicated 100% to the County, indicate the number of small (<1,000 employees), medium (1,000 to 4,999) and large (>5,000) clients to which they are currently assigned. If given the County account, what other clients, if any, will they remain responsible for after taking on the County account responsibility. What are the sizes of those accounts (if any) Implementation Manager must remain on the account for at least six (6) months or until the program can be transitioned to the dedicated account management team whichever occurs later. 6. If the Implementation Manager is not the ongoing account manager, describe the coordination during implementation, the transition plan and timeframes.
II. PARTICIPANT AND CLIENT SERVICES A. Call Center 1. Call Center information: Where will the call center be located? Can you provide a dedicated customer service team? What hours will customer service representatives (CSRs) be available for calls? Is the call center available on weekends and holidays? How many CSRs will be dedicated to the County during Open Enrollment? How many CSRs will be dedicated to the County during ongoing months? List the holidays for which the call center is typically closed 2. Are there any restrictions to the dedicated toll-free number that will be provided for the County? 3. Describe the routing of calls to the dedicated customer service team and how overflow will be managed on days with large call volume? 4. Describe your Customer Service Representative (CSR) training program and its frequency. Include anticipated time needed to bring a new CSR onto the County’s account. 5. CSR turnover rate: What was the Offeror’s CSR turnover rate in: 2013: 2014: 2015 to date:
Define your turnover calculation:
6. Briefly describe your recruitment process for CSRs. 7. How do you support multilingual services through the call center or access to translation representatives? 8. What services are provided to support the hearing impaired? 9. Describe the information available on-line to assist CSRs with their work. County of Orange RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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10. How is the IVR tied to the administrative system so an individual’s record appears as a CSR receives a call? 11. What information is provided to the dedicated County CSRs to facilitate the managing, tracking, and reporting of escalated issues and appeals? Describe the process. 12. Do you survey customers on call center performance? How often? How are results provided to the client? Is the surveyor independent of the call center? 13. If surveys are conducted, describe the survey process and provide a sample survey. Detail your proposed methodology including participant selection, minimum number of respondents to achieve statistical significance, mode of communication and calculations used to determine final satisfaction score. 14. What participant and County information does a CSR have access to? Do CSRs sign any confidentiality agreements regarding this information? Are CSRs trained in HIPAA requirements? 15. Performance Measure: Performance Measure Abandonment rate Response time / average speed of answer Average call length Average hold time First call resolution percentage Written inquiry response and resolution Participant satisfaction ratings (survey)
What is your internal standard?
2013 Results
2014 Results
16. Describe your call tracking capabilities including unresolved calls and call backs. 17. Are all telephone calls recorded? 18. How are the recordings organized? 19. What is the method of retrieval for recorded calls and how long does such retrieval take? Will the County be able to listen to a recorded call upon request? 20. Will there be a separate Open Enrollment CSR team or will the County’s dedicated CSRs handle Open Enrollment calls? Are you able to route calls for active employees and retirees separately to designated CSRs for handling? 21. How will calls be routed during periods of unusually heavy call volume through the dedicated toll-free number during 1) ongoing administration and 2) Open Enrollment? 22. What steps are taken if call volumes exceed anticipated levels? What plans are in place if the call center location experiences any closures due to inclement weather, etc.? 23. If your organization subcontracts with an external vendor to administer any benefits (HCRA/DCRA, COBRA, direct billing), identify which services and provide the following information: a. Indicate if calls for the subcontracted services are handled by the designated customer service team. b. Describe the information that is available to the designated team for responding to inquiries regarding the subcontracted service. c. Explain any circumstances in which the participant will speak directly to representatives from the subcontracted external Contractor. d. Detail call routing procedures for escalated issues. e. How do you monitor call center results for the subcontractor? County of Orange 33 RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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24. If there is a separate participant service unit handling subcontracted services, confirm they will support the same hours of operation as those noted in table II.A.1 above. 25. Describe your IVR capabilities, i.e., is it information only or can certain actions be taken via the IVR system? 26. Does the IVR allow callers to opt out of the system to a live operator? 27. Describe how enrollment elections are taken when participants call in through the IVR (if applicable). 28. Can customer service representatives go on-line to the IVR call concurrently with the caller to provide assistance with system use? 29. Provide a typical IVR call tree, including text spoken at each step. 30. Describe the ability to customize scripts based on client needs. 31. Describe your IVR call distribution method. 32. Does the IVR capture on-line call/transaction history? What information is captured? 33. Does the IVR include a voice mail feature that allows callers to leave messages if calling after hours? If yes, when are these messages retrieved, logged, and answered? Can the caller key over prompts? 34. Comment on the IVR’s use of the following technologies: a. Speech recognition (include accuracy ratings and plans to integrate) b. Electronic messaging E-mail, phone mail) c. Facsimile 35. What IVR support is provided to hearing impaired? 36. IVR System: a. How many hours is the IVR available per day? b. When is maintenance performed on the IVR? c. How long is the system down for maintenance? d. What message will callers hear during this down time? e. Will calls be routed to an alternate call center? 37. What system backup is in place for the IVR? How long will the IVR be assisted with an uninterrupted power supply if the system should go down? 38. Is the IVR updated on a real-time basis? B. Web Self-Service System 1. a. Describe the participant services you currently offer on the proposed web site tool following table: On-line Capability Current participants (Y/N) Provider locator, by plan (describe method, link to provider site in new window, etc.) Email or on-line access to customer service Real-time responses to participant questions (customer service live chat) Cost Share calculators (copayments, coinsurance) County of Orange RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
and complete the Prospective participants (Y/N)
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Plan Selection Tools / Interactive Plan Comparisons Flexible Spending Account projections/cost calculators Customized participant messaging for plan design changes or alerts Individual enrollment history (how far back will history be available) Current coverage and options Ability to designate beneficiaries Downloadable forms posted by Offeror and County Links to County benefit plan vendors (describe method) Access to Flexible Spending Account claims history and account balance PIN reminder on-line On-line versions of written benefit materials Model a life event for potential options and costs Other: b. Confirm the following services are available to participants on the proposed web site tool. Yes or No Review Coverage Overview for participant’s automatic benefit coverage Cost of benefit elections Confirm dependents covered under benefit plans Enroll for coverage during enrollment period (Open Enrollment, New Hire, Status Change) Use tools such as Compare/Evaluate Health Plans to make decisions about benefits View plan documents, SBCs and health plan provider directories Report most Qualified Life Event changes Change dependent information Review status of dependent eligibility and Medicare verification documentation Request forms Direct Billing payments and payment history COBRA election and payments Flexible Spending Account balances and information Access to Life insurance vendor system for electronic submission of Evidence of Insurability (EOI) Primary Care Physician Selection 2. What are the Offeror’s web hosting capabilities? 3. Can customer service representatives go on-line on to the web concurrently with the caller to provide assistance with system use? 4.
What on-line tools are provided to employees/retirees to support enrollment decisions? Can the participant model a qualified life event?
5. Can the Offeror email confirmation of the participant’s on-line transaction to an email address? 6. Can participants upload required documents (e.g., dependent verification documents, Medicare cards) to a secure location on the web site? County of Orange 35 RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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7. What management reports are created based on web transactions? Include samples of standard system reports. 8. When is maintenance performed on the web self-service system? How long is the system down? What message will participants see during this down time? 9. What system backup is in place for the web self-service system? How long will the system be assisted with an uninterrupted power supply (UPS) if the system should go down? 10. What security methods do you use to protect participant information and County information with the web selfservice system? How do participants identify themselves (personal identification number, Social Security number, other)? 11. How is the privacy/security of the County information maintained in the course of implementation, testing, and live system operation on the web? 12. Will the Offeror’s access requirements support multiple web browsers? Which browsers are supported? 13. Describe the Offeror’s internet and intranet connectivity. 14. What is the bandwidth of the Offeror’s connection to the internet? 15. What is the number of concurrent users that the system can support? 16. Is the web updated on a real-time basis? If not, how often is it updated? 17. Describe the ability to customize web self-service screens based on client needs. Be specific as to the degree and type of customization permitted. Provide a sample of a web screen that was customized for another client. Submit this screen sample as compared with a screen showing text/functions that are standard and cannot be customized. 18. Can the participant email questions through a “Contact Us” site on the web and receive a reply within 24 hours? In what form is the participant response (e.g., direct email, message on web site, etc.)? 19. Are on-line satisfaction surveys provided? If so, describe the process and provide a sample survey. Detail your proposed methodology including participant selection, minimum number of respondents to achieve statistical significance, mode of communication and calculations used to determine final satisfaction score. 20. Provide a web site address, log in instructions, and passwords to allow the evaluation committee to browse a live or sample web site that is representative of Offeror’s capabilities and functions. 21. Offeror should comment on their Research and Development involvement. Also define relationships with other technology partners, such as internet, intranet, IVR, web based enrollment, decision support tools, recorded calls and workflow organizations. 22. Are there any web upgrades being planned in 2016 or 2017? C. Communication Services 1. Describe the Offeror’s capabilities and limitations on personalized fulfillment, such as benefit summaries showing current and available elections along with associated costs for self and enrolled dependents, imputed income, beneficiary elections and eligible options as well as pending elections and confirmation documents. Be specific regarding the level of customization and the impact on cost.
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Sample Fulfillment Items
Describe capabilities / limitations
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Standard/ Non-standard
Benefits Enrollment Summaries Confirmation Statements Pending Election Documents Beneficiary Designations Event Notifications (new hires, Medicare age-in, etc.) Dependent/Medicare Verification Requests Termination Notices Other: 2. Describe the Offeror’s standard communication pieces for a client’s enrollment and ongoing administration for active, Family Leave, Leave of Absence, COBRA and retired participants. 3. Provide sample open enrollment and new hire communication pieces that the Offeror has created. 4. Provide samples of all communications available for the following programs: a. HCRA (welcome packets, claim forms, quarterly notices, explanation of benefits/denial) b. DCRA (welcome packets, claim forms, quarterly notices, explanation of benefits/denial) c. COBRA (welcome packet, monthly invoice, reminder notice (if applicable) termination notice, etc.) d. Direct Billing (welcome packet, monthly invoice, reminder notice (if applicable), termination notice, etc.) 5. Does the Offeror provide communication development/design services, e.g., design of newsletters, participant notifications, program booklets/pamphlets, etc. If there are additional costs associated with this they must be listed in Attachment B, Cost Summary. 6. What additional communication services does the Offeror provide? If there are costs associated with this they must be listed in Attachment B, Cost Summary. 7. Describe the Offeror’s form fulfillment capabilities, including the type of services the Offeror provides to clients for open enrollment and ongoing administration activities. D. Administration Capabilities 1. Payroll Processing a. How are payroll deductions validated for accuracy before submission to the County’s payroll system? b. What the normal frequency that Offeror accepts transmission of status changes and other changes to employee information from your clients? Does Offeror have any clients with real time or weekly transmission? c. Does Offeror’s system allow future dated transactions? d. Multiple updates to an employee record can be processed within a single cycle, e.g., pay period that can affect the eligibility for benefits and subsequent payroll deductions. Does Offeror’s system allow processing multiple transaction rows from the County on the same file of employee data to your system? If no, describe how Offeror’s system process will manage the transactions to ensure the employee’s accurate payroll deduction is taken. e. Does Offeror send full files or and changes only files? How does Offeror ensure that the client’s payroll system and Offeror’s administrative system remain reconciled? f. Does Offeror have experience in processing employees with both Active health and COBRA dental? Describe how Offeror manages this mixed population. 2. ACA Section 4980H
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a. Does Offeror provide FTE determination for any clients? Describe Offeror’s capability for providing the determination for new hires, initial measurement, and ongoing. Describe how Offeror manages different types of employees and ensures appropriate offers of coverage as employees change status? b. Does Offeror provide Section 4980H reporting for any clients? Describe Offeror’s capability for providing reporting support? 3. Wellness Program a. Does Offeror have any clients with a Wellness program? Describe Offeror’s capability for supporting Wellness programs. b. Does Offeror have any clients with different employee contributions to their health plan premium if they participate in a Wellness program? Are the differences a flat dollar amount or a percentage? Describe Offeror’s capability to handle different employee contributions by plan and tier for employees based upon their participation in a Wellness program. 4. Briefly describe the type of retiree subsidy programs you are currently administering (program requirements, calculation of benefit amount, etc.). 5. Describe the types of retiree health plans (e.g., HMO, PPO, Medicare Advantage, and Medicare Supplement) that Offeror administers. Describe any unique processing, programming, and/or administration that the Offeror performs for each of the types of retiree health plans 6. Describe how Offeror manages conversion of an employee to a retiree. a. How are retiree elections managed? b. Described how changes in coverage, payroll deductions, update of employee information such as address are managed during this transition. 7. Describe Offeror’s process for managing life events such as new hires, change of eligibility/coverage, leaves, intents to retire, etc., that occur during the Open Enrollment period. How does Offeror track and ensure proper elections for both current year and new plan year? 8. What is the Offeror’s follow-up system for alerting employees of outstanding documentation or actions (e.g., Evidence of Insurability (EOI) form or dependent verification forms needed)? 9. Password/Verification a. How does the Offeror issue and maintain Personal Identification Numbers (PINs)/passwords (IVR and web)? b. How are employee calls regarding misplaced PINs/passwords handled? c. Does Offeror provide an alternate verification method (AVM)? 10. Describe the Offeror’s services for carrier premium payment reporting and retroactive premium adjustments. 11. Describe the Offeror’s services for carrier eligibility file and premium reconciliation reporting. 12. How will the County’s vendors/carriers contact the Offeror for eligibility information/resolution? 13. Describe the Offeror’s direct billing capabilities. Can the Offeror’s system handle billing some participants whose billing status may change on a bi-weekly basis? Can Offeror’s system issues invoices more than one time a month? 14. Describe the services the Offeror provides to support COBRA, leave of absence (LOA) and Family Medical Leave (FMLA) administration (e.g., notification, billings, banking arrangements, tracking payments, notifying carriers, etc.). 15. a. Describe the services the Offeror provides to support the administration of: – Health Care and Dependent Care Reimbursement Accounts County of Orange RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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– – –
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Annual Open Enrollment and ongoing administration for the Optional Benefit Plan (OBP), as described in Exhibit 3 Judges’ medical reimbursement account and premium reimbursement account as described in Exhibit 3 Other Benefit Plans (including calculations of lump sum payouts) as described in Exhibit 3
b. What is the turnaround time for processing reimbursements under these plans? What is the method for filing claims under these plans, e.g., fax, mail, on-line or other? 16. Describe Offeror’s method of collecting verification documentation of eligibility for plan benefits. Describe the process for each of the following: newborn, marriage, divorce, legal separation, eligibility for Medicare Part A and/or Part B. 17. Describe any arrangements you currently have with the Centers for Medicare and Medicaid Services (CMS) for verifying Medicare A & B enrollment status of retirees. Describe in detail the system and processes you have in place with other large clients for enrolling retirees into Medicare Advantage Plans. 18. Complete the table below to show whether your file transmission processes with vendors are changes only or full file. Feel free to describe the process for clarification or indicate if you are able to do both. File / Interface Health plan interfaces Dental plan interfaces Life and AD&D interfaces LTD/STD interfaces HCRA enrollment and elections DCRA enrollment and elections COBRA Direct Billing Active Payroll Retiree pension deductions Wellness Vendor Other
Changes Only
Full File
19. Describe your reconciliation process for ensuring that every eligible participant is accounted for: a. On eligibility interfaces to health and welfare vendors b. On files that generates premium collection (payroll file, retiree pension file, direct billing file, COBRA, etc.) 20. What is the frequency of this reconciliation? 21. What queries or audits do you have in place to identify participants who are covered but not paying premiums? 22. Describe the types of situations that require manual processing of a participant’s event and/or election. 23. What is your process for ensuring accuracy of these manual processes? 24. Benefits eligibility, programs and other processes can change over time. Describe your process and frequency for reviewing existing programming and processing for updates/changes to improve processing accuracy, effectiveness and efficiency. E.
Ongoing Client Support
1. Describe the client’s access to system that includes Management Rights to view individual employee and retiree accounts. System must also allow County to review call history, forms sent, etc. Describe the training County of Orange 39 RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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provided to the client at implementation and ongoing as needed to the County’s benefit staff on the use of the online system. If this results in an additional cost or there are limits to the number of County staff members who may access the system, please note in Attachment B, Cost Summary. 2. What written documentation such as a procedures manual or system reference material do you maintain? Is this documentation in a format that can be shared with the client team? What cross-training and succession planning do you have in place for various team members? 3. What is the process and timing for notifying the County of any errors or commissions committed by the Offeror’s staff and/or system that affect the service provided to the County’s participants? Describe Offeror’s process for refunding the County or a participant directly when Offeror makes an administrative error to the participant’s record which results in a financial loss to either the County or the participant. 4. If subcontractors will be used, describe how they will be managed and audited. How is performance monitored and audited. How are issues resolved? What are their termination provisions? 5. Describe ongoing project management activities and their timing. F. Reports 1. Provide a table of all standard management reports that will be regularly provided to the County, including but not limited to web activity, call volume, appeal/issue tracking, event processing. Include options for sub-totals by employee group, plan, etc. and/or variations in reporting categories available. A sample table is shown below: Category
Report Name
Frequency
Key Data Elements Included
Description/Comments
Customer Service (call volume, appeal/issue tracking, etc.) Event Processing (number of new hire events, births, etc.) Web Utilization Subcontracted Services 2. Provide samples of standard management reports. 3. Provide samples of premium reports showing enrollment sent to vendors and the basis for payment of benefit premiums. 4. Provide sample of all reports available for ACA Section 4980. Describe Offeror’s ability to customize reports. 5. Provide samples of all reports available for the following programs: a. HCRA (enrollment, claims activity, forfeiture, participant notifications, etc.) b. DCRA (enrollment, claims activity, forfeiture, participant notifications, etc.) c. COBRA (enrollment, premiums collected by plan, etc., participant notifications) d. Direct Billing (enrollment, premiums collected by plan, participant
notifications,
etc.)
6. Describe any adhoc report writing capabilities that are available. Describe the ad hoc reporting allowance hours that will be made available to the County on an annual basis. 7. What management reports are created throughout the enrollment process? Do they include: County of Orange RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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a. b. c. d. e. f. g. h. i.
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Number of enrolled by plan, date and location Number of enrolled by actives, retirees and COBRA Those who have not enrolled by date and location Those requesting dependent changes The call volume by time of day The reasons given for employees “opting out” of the system to a live operator Number of transactions completed via the IVR vs. the Web Number and listing of incomplete transactions Other?
Include samples of standard system reports. 8. Describe your capacity to produce communication materials. Do you produce these materials or are these services subcontracted? G. System Related Services 1. Name and describe the system hardware and software that the Offeror will use to provide the services proposed. 2. Is the hardware and software currently in place and fully implemented? 3. Describe Offeror’s ability to automate all areas described in the Scope of Work - Attachment A. Please list areas that the Offeror will be unable to automate and therefore must process manually. 4. Name and describe the systems the Offeror expect to use to provide the services proposed. 5. Are systems integrated and real time? (e.g., real time concurrent updates to web, IVR, database) 6. If system is real time, can the County access the data on a real time basis or is there a delay? If there is a delay, specify the amount of time, e.g., number of hours. 7. Describe the system’s audit trails for IVR, on-line and direct health and welfare system enrollment. 8. Describe the Offeror’s printing and mailing capabilities. 9. What remote site capabilities will the County have? Remote report writing capabilities? Query capabilities? 10. Does the Offeror have a dedicated programming staff? If so, how many programmers are on staff full-time? Part-time? 11. Describe the Offeror’s security protocols for file, data and web access. 12. Submit a copy of the Offeror’s disaster recovery plan and describe the plan including: a. Frequency of backup b. Site of backup storage c. Retention schedule d. Method of backup e. Secondary processing site(s) 13. How long is history maintained on-line? 14. How much history can Offeror’s system accept from the current contractor? What types of historical information can you receive and store, i.e., transaction history, enrollment history, call history, imaged forms, etc.? County of Orange RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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15. Describe the Offeror’s back-up and restoration capabilities and process. 16. What is the Offeror’s strategy for supporting its client base during a disaster? 17. What is the Offeror’s future system direction and strategy? 18. Describe any significant system changes scheduled for implementation: a) during the next twelve (12) months, and b) during the next five (5) years. Include the purpose of these changes. 19. What security methods are used with the IVR and the website? How do participants identify themselves on the IVR and the website? What protections are implemented to protect participant privacy? (e.g., personal identification number, Social Security Number, other). Does the Offeror have experience using an employee ID number as the participant identifier instead of the Social Security Number? 20. Does your system have the ability to send future dated transactions to vendors on interface files? 21. How will the privacy of the County information be maintained in the course of implementation and live IVR operation? H. Interfaces 1. What interface media does the Offeror’s system support (e.g., tape, FTP, disk, etc.)? The Offeror will transfer eligibility data (weekly) electronically to each of the County’s carriers/vendors. With which of the following carriers/vendors has the Offeror interfaced? ADP Anthem Blue Cross Blue Shield of California Catamaran Rx Centers for Medicare and Medicaid Services (CMS) Cigna HMO COBRAServ Health and Welfare Consultants (enrollment reports) Hartford Insurance Kaiser Permanente HMO Orange County Employees Retirement System (OCERS) or other pension system Standard Insurance StayWell Health Management (Wellness) SCAN HMO 2. How does the Offeror verify that outgoing interfaces are received and processed? How does the Offeror verify interface discrepancies/rejections? What type of reconciliation process does the Offeror have in place? 3. Can the Offeror create interface files formatted to the County’s internal payroll system layout? Will the file be changes only or a full file? The method that works best for the County is for the County to receive a Changes Only file all the time. County will need a full file at Open Enrollment. 4. Listed in Exhibit 6 is a list of interfaces going into and out of the County payroll system. Identify if you currently send and receive these types of files with other clients and describe any modifications to timing, file type, etc. that will be required to accommodate these County files. 5. What process is used to identify when files arrive from the County (e.g., automatic trigger, polling)? 6. What edits do(es) the Offeror’s system(s) perform on payroll data entering the system? How does the Offeror follow up on data errors? How will the County be informed of data transmission status (e.g., control total County of Orange RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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reports)? 7. Describe how incoming files are processed by the Offeror (e.g., processed immediately, placed in a cue and processed by effective date, etc.). 8. How is the County notified of file transfer status (i.e., successful transfers, errors, etc.)? 9. Describe the Offeror’s method for file encryption. I. Implementation 1. Submit detailed implementation plan as “Attachment D – Proposed Implementation Plan / Project Schedule”. 2. Describe the method in which you will be able to load the prior contractor’s data, including call history, scanned images, census files, reports, ACA determination and reports, etc. 3. Provide a description of a recent acquisition whereby you loaded data and history going back to or farther than the year 2008. 4. Describe how you will accurately manage and coordinate changes of eligibility, direct billing, pension deductions, Grant changes, COBRA, etc. that is reported in 2017 retroactively to 2016. How will you coordinate with the prior contractor to ensure accurate eligibility, billing, and payroll and pension deduction going forward? 5. Describe how you will accurately manage and coordinate transition of FTE determination, offers of coverage, and reporting for ACA Section 4980H from prior contractor. 6. Describe how you will manage HCRA/DCRA claims submitted erroneously to you during the first quarter of 2017 for 2016 claims. The County may allow carryover of unused FSA amounts into the next calendar year. How will you coordinate with the prior contractor to ensure 2016 claims are processed? 7. Describe how you will manage Customer Service inquiries and issues related to benefits eligibility during 2016. Describe a typical scenario. J.
Performance Guarantees
Offeror will determine fees at risk on a quarterly basis for services provided in the preceding three months. The amount of this fee will be calculated as a percentage of the Base Fees. Penalties will be deducted from the next fee statement to the County following determination. Complete Attachment F – Performance Guarantees and submit as part of the proposal.
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SECTION III PROPOSED CONTRACT FOR
Benefits Administration Outsourcing Services
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SECTION III: CONTRACT
Proposed Contract Table of Contents .................................................................................................................................. 45 Recitals …………………………………………………………………………………………….. .... 47 ARTICLES
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43.
Scope of Work ................................................................................................................................ 47 Pricing............................................................................................................................................. 47 Invoicing/Payment .......................................................................................................................... 47 Contract Term................................................................................................................................. 47 Entire Agreement............................................................................................................................ 47 Amendments ................................................................................................................................... 47 Governing Law and Venue ............................................................................................................. 47 Appropriation/Contingency of Funds ............................................................................................. 48 Taxes............................................................................................................................................... 48 Delivery .......................................................................................................................................... 48 Independent Contractor .................................................................................................................. 48 Assignment or Sub-contracting ...................................................................................................... 48 Non-Discrimination ........................................................................................................................ 48 Performance .................................................................................................................................... 48 Errors and Omissions...................................................................................................................... 48 Warranty ......................................................................................................................................... 49 Patent/Copyright Material/Propriety Infringement......................................................................... 49 Compliance with Laws .................................................................................................................. 49 Indemnification............................................................................................................................... 49 Insurance......................................................................................................................................... 49 Confidentiality ................................................................................................................................ 52 Contractor Personnel ...................................................................................................................... 52 County and Contractor Project Manager ....................................................................................... 52 Reports/Meetings ............................................................................................................................ 52 Ownership of Documents. .............................................................................................................. 52 Title to Data .................................................................................................................................... 52 Records……………. ...................................................................................................................... 53 Audit/Inspections ............................................................................................................................ 53 Publication ...................................................................................................................................... 53 Conflict of Interest .......................................................................................................................... 53 Termination .................................................................................................................................... 53 Breach of Contract .......................................................................................................................... 54 Disputes…. ..................................................................................................................................... 54 Orderly Termination ....................................................................................................................... 55 Force Majeure ................................................................................................................................. 55 Consent to Breach Not Waiver ....................................................................................................... 55 Remedies Not Exclusive................................................................................................................. 55 Notices ............................................................................................................................................ 55 County Child Support Enforcement ............................................................................................... 56 Change of Ownership ..................................................................................................................... 56 Precedence ...................................................................................................................................... 56 Headings ......................................................................................................................................... 56 Severability…. ................................................................................................................................ 56 County of Orange 45
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44. 45. 46. 47. 48. 49. 50. 51. 52. 53. 54.
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Calendar Days ................................................................................................................................ 56 Attorney Fees.................................................................................................................................. 56 Interpretation .................................................................................................................................. 56 Authority......................................................................................................................................... 57 Health Insurance Portability and Accountability Act (HIPAA) .................................................... 57 Survival........................................................................................................................................... 57 Employee Eligibility Verification .................................................................................................. 57 Bills and Liens ................................................................................................................................ 57 Changes .......................................................................................................................................... 57 Terms and Conditions..................................................................................................................... 57 Incorporation .................................................................................................................................. 57 Proposed Contract Signature Page ................................................................................................. 58
Attachments Attachment A – Scope of Work ............................................................................................................ 59 Attachment B – Compensation/ Payment ............................................................................................. 77 Attachment C – Staffing Plan ............................................................................................................... 83 Attachment D –Proposed Implementation Plan/Project Schedule ........................................................ 84 Attachment E – Sample Communication Plan ...................................................................................... 85 Attachment F – Performance Guarantees ............................................................................................. 86 Attachment G –Business Associate Contract ........................................................................................ 90 Exhibits Exhibit 1- County of Orange Child Support Enforcement Certifications ............................................. 95 Exhibit 2- EDD Independent Contractor Reporting Requirement ........................................................ 96
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PROPOSED CONTRACT THIS Contract for the Benefits Administration Outsourcing Services hereinafter referred to as (“Contract”) is effective _________ by and between the County of Orange, a political subdivision of the State of California, hereinafter referred to as “County” and ____________, with a place of business at _______________, hereinafter referred to as “Contractor”, which are sometimes individually referred to as “Party,” or collectively referred to as “Parties.” RECITALS WHEREAS, Contractor responded to a Request for Proposal (“RFP”) for the Benefits Administration Outsourcing Services; and WHEREAS, the Contractor represents that its services shall meet or exceed the requirements and specifications of the RFP; and WHEREAS, the County Board of Supervisors has authorized the Purchasing Agent or his designee to enter into this Contract with Contractor for Benefits Administration Outsourcing Services. NOW, THEREFORE, the Parties mutually agree as follows: ARTICLES 1. Scope of Work: The Scope of Work for this Contract is attached hereto as Attachment A. 2. Pricing: The Contract, as specified in Attachment B hereto, includes full compensation for providing all services to be provided under this Contract. 3. Invoicing/Payment: All invoicing and payment for services performed under this Contract shall be as specified in Attachment B, hereto. 4. Contract Term: This Contract shall commence upon execution of all necessary signatures and approval by the County Board of Supervisors, and shall continue in effect through December 31, 2019. The Contract may be renewed thereafter for two (2) additional one (1) year periods upon mutual agreement of both Parties. The County does not have to give a reason if it elects not to renew this Contract. 5. Entire Agreement: This Contract, including its Attachments, contains the entire contract between the Parties with respect to the matters herein and there are no exceptions, alternatives, substitutions, revisions, understandings, agreements, restrictions, promises, warranties or undertakings, whether oral or written, other than those set forth herein or referred to herein. 6. Amendments: No alteration or variation of the terms of this Contract shall be valid unless made in writing and signed by the Parties. 7. Governing Law and Venue: This Contract has been negotiated and executed in the State of California and shall be governed by and construed under the laws of the State of California, without reference to conflict of laws provisions. In the event of any legal action to enforce or interpret this Contract, the sole and exclusive venue shall be a court of competent jurisdiction located in Orange County, California, and the Parties hereto agree to and do hereby submit to the jurisdiction of such court, notwithstanding Code of Civil Procedure section 394. Furthermore, the Parties specifically agree to waive any and all rights to request that an action be transferred for trial to another venue.
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8. Appropriation/Contingency of Funds: This Contract is subject to and contingent upon applicable budgetary appropriations being approved by the County of Orange Board of Supervisors for each fiscal year during the Term of this Contract. If such appropriations are not approved, this Contract will be immediately terminated without penalty to the County. 9. Taxes: Unless otherwise provided herein or by law, price quoted does not include California state sales or use tax. 10. Delivery: Time of delivery of services is of the essence in this Contract. County reserves the right to refuse any services and to cancel all or any part of the services that do not conform to the prescribed Scope of Work. 11. Independent Contractor: Contractor shall be considered an independent contractor and neither Contractor, its employees, nor anyone working under Contractor shall be considered an agent or an employee of County. Neither Contractor, its employees nor anyone working under Contractor, shall qualify for workers’ compensation or other fringe benefits of any kind through County. 12. Assignment or Sub-contracting: The terms, covenants, and conditions contained herein shall apply to and bind the heirs, successors, executors, administrators and assigns of the Parties. Furthermore, neither the performance of this Contract nor any portion thereof may be assigned or sub-contracted by Contractor without the express written consent of County. Any attempt by Contractor to assign or sub-contract the performance or any portion thereof of this Contract without the express written consent of County shall be invalid and shall constitute a breach of this Contract. Notwithstanding the foregoing, the County consents to the subcontractors listed in Attachment C.3. Irrespective of any assignment of subcontracting with respect to any portion of this Contract, Contractor shall remain fully responsible and liable for the performance of all services required herein including but not limited to compliance with all relevant state and federal codes, regulations, ordinances, orders, or statutes. Notwithstanding this paragraph or any other terms or provisions set forth in this Contract or its Attachments, no participant specific data including but not limited to name, personal health information, social security numbers, addresses, information regarding dependents, or date of birth may be sent outside the United States of America by Contractor, its affiliates, or their employees, directors, or subcontractors. Contractor is required to receive approval from County for any subcontractor engaged to perform work specific to the County or to access County participant data before that work is performed. Failure to receive approval will be considered a breach of this Contract. 13. Non-Discrimination: In the performance of this Contract, Contractor agrees that it will comply with the requirements of Section 1735 of the California Labor Code and not engage nor permit any sub-contractors to engage in discrimination in employment of persons because of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, marital status, or sex of such persons. Contractor acknowledges that a violation of this provision shall subject Contractor to all the penalties imposed for a violation of anti-discrimination laws or regulations including but not limited to Section 1720 et seq., of the California Labor Code. 14. Performance: Contractor shall perform all work under this Contract, taking necessary steps and precautions to perform the work to County’s satisfaction. Contractor shall be responsible for the professional quality, technical assurance, timely completion and coordination of all documentation and other services performed by the Contractor under this Contract. Contractor shall perform all work diligently, carefully, and in a good and workman-like manner; shall furnish all labor, supervision, machinery, equipment, materials, and supplies necessary therefore; shall at its sole expense obtain and maintain all permits and licenses required by public authorities, including those of County required in its governmental capacity, in connection with performance of the services; and, if permitted to sub-contract, shall be fully responsible for all work performed by subcontractors. 15. Errors and Omissions: All reports, files and other documents prepared and submitted by Contractor shall be complete and shall be carefully checked by the professional(s) identified by Contractor as Project Manager and key personnel, prior to submission to the County. Contractor agrees that County review is discretionary and County of Orange 48 RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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Contractor shall not assume that the County will discover errors and/or omissions. If the County discovers any errors or omissions prior to approving Contractor’s reports, files and other written documents, the reports, files or documents will be returned to Contractor for correction. Should the County or others discover errors or omissions in the reports, files or other written documents submitted by Contractor after County approval thereof, County approval of Contractor’s reports, files or documents shall not be used as a defense by Contractor in any action between the County and Contractor, and the reports, files or documents will be returned to Contractor for correction at no charge to County. 16. Warranty: Contractor expressly warrants that the services covered by this Contract are: 1) merchantable and good for the ordinary purposes for which they are used; and 2) fit for the particular purpose for which they are intended. Acceptance of this Contract shall constitute an agreement upon Contractor’s part to indemnify, defend and hold County and its indemnities, as identified in paragraph 19 below and as more fully described in paragraph 19, harmless from liability, loss, damage and expense, including reasonable counsel fees, incurred or sustained by County by reason of the failure of the services to conform to such warranties, faulty work performance, negligent or unlawful acts, and non-compliance with any applicable state or federal codes, regulations, ordinances, orders, or statutes, including the Occupational Safety and Health Act (OSHA) and the California Industrial Safety Act. Such remedies shall be in addition to any other remedies provided by law. 17. Patent/Copyright Materials/Proprietary Infringement: Contractor shall be solely responsible for clearing the right to use any patented or copyrighted materials in the performance of this Contract. Contractor warrants that any software as modified through services provided hereunder will not infringe upon or violate any patent, proprietary right or trade secret right of any third party. Contractor agrees that, in accordance with the more specific requirement contained in paragraph 19 below, it shall indemnify, defend and hold County and County Indemnitees harmless from any and all such claims and be responsible for payment of all costs, damages, penalties and expenses related to or arising from such claim(s), including, but not limited to, attorney’s fees, costs and expenses. 18. Compliance with Laws: Contractor represents and warrants that services to be provided under this Contract shall fully comply, at Contractor’s expense, with all standards, laws, statutes, restrictions, ordinances, requirements, and regulations (collectively “laws”), including, but not limited to those issued by County in its governmental capacity and all other laws applicable to the services at the time services are provided to and accepted by County. Contractor acknowledges that County is relying on Contractor to ensure such compliance, and pursuant to the requirements of paragraph 19 below, Contractor agrees that it shall defend, indemnify and hold County and County Indemnitees harmless from all liability, damages, costs and expenses arising from or related to a violation of such laws. 19. Indemnification: Contractor agrees to indemnify, defend with counsel approved in writing by County, and hold harmless County, its elected and appointed officials, officers, employees, agents and those special districts and agencies which County’s Board of Supervisors acts as the governing Board (“County Indemnitees”) from any claims, demands or liability of any kind or nature, including but not limited to personal injury or property damage, arising from or related to the services, products or other performance provided by Contractor pursuant to this Contract. If judgment is entered against Contractor and County by a court of competent jurisdiction because of the concurrent active negligence of County or County Indemnitees, Contractor and County agree that liability will be apportioned as determined by the court. Neither Party shall request a jury apportionment. 20. Insurance: Prior to the provision of services under this contract, the Contractor agrees to purchase all required insurance at Contractor’s expense, including all endorsements required herein, necessary to satisfy the County that the insurance provisions of this contract have been complied with. Contractor agrees to keep such insurance coverage, Certificates of Insurance, and endorsements on deposit with the County during the entire term of this contract. In addition, all subcontractors performing work on behalf of Contractor pursuant to this contract shall obtain insurance subject to the same terms and conditions as set forth herein for Contractor. Contractor shall ensure that all subcontractors performing work on behalf of Contractor pursuant to this County of Orange 49 RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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agreement shall be covered under Contractor’s insurance as an Additional Insured or maintain insurance subject to the same terms and conditions as set forth herein for Contractor. Contractor shall not allow subcontractors to work if subcontractors have less than the level of coverage required by County from Contractor under this agreement. It is the obligation of Contractor to provide notice of the insurance requirements to every subcontractor and to receive proof of insurance prior to allowing any subcontractor to begin work. Such proof of insurance must be maintained by Contractor through the entirety of this agreement for inspection by County representative(s) at any reasonable time. All self-insured retentions (SIRs) and deductibles shall be clearly stated on the Certificate of Insurance. If no SIRs or deductibles apply, indicate this on the Certificate of Insurance with a zero (0) by the appropriate line of coverage. Any self-insured retention (SIR) or deductible in an amount in excess of $25,000 ($5,000 for automobile liability), which shall specifically be approved by the County Executive Office (CEO)/Office of Risk Management upon review of contractor’s current audited financial report. If the Contractor fails to maintain insurance acceptable to the County for the full term of this contract, the County may terminate this contract. Qualified Insurer The policy or policies of insurance must be issued by an insurer with a minimum rating of A- (Secure A.M. Best's Rating) and VIII (Financial Size Category as determined by the most current edition of the Best's Key Rating Guide/Property-Casualty/United States or ambest.com). It is preferred, but not mandatory, that the insurer be licensed to do business in the state of California (California Admitted Carrier). If the insurance carrier does not have an A.M. Best Rating of A-/VIII, the CEO/Office of Risk Management retains the right to approve or reject a carrier after a review of the company's performance and financial ratings. The policy or policies of insurance maintained by the Contractor shall provide the minimum limits and coverage as set forth below: Coverage
Minimum Limits
Commercial General Liability
$1,000,000 per occurrence $2,000,000 aggregate
Automobile Liability including coverage for owned, non-owned and hired vehicles
$1,000,000 per occurrence
Workers Compensation
Statutory
Employers Liability Insurance
$1,000,000 per occurrence
Professional Liability
$10,000,000 per claims made or per occurrence
Network Security and Privacy Liability
$5,000,000 per claims made or per occurrence
Required Coverage Forms The Commercial General Liability coverage shall be written on Insurance Services Office (ISO) form CG 00 01, or a substitute form providing liability coverage at least as broad.
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The Business Auto Liability coverage shall be written on ISO form CA 00 01, CA 00 05, CA 0012, CA 00 20, or a substitute form providing coverage at least as broad. Required Endorsements The Commercial General Liability policy shall contain the following endorsements, which shall accompany the Certificate of Insurance: 1) An Additional Insured endorsement using ISO form CG 2010 or CG 2033 or a form at least as broad naming the County of Orange its elected and appointed officials, officers, agents and employees as Additional Insureds. 2) A primary non-contributing endorsement evidencing that the Contractor’s insurance is primary and any insurance or self-insurance maintained by the County of Orange shall be excess and non-contributing. The Network Security and Privacy Liability policy shall contain the following endorsements which shall accompany the Certificate of Insurance: 1) An Additional Insured endorsement naming the County of Orange, its elected and appointed officials, officers, agents and employees as Additional Insureds. 2) A primary and non-contributing endorsement evidencing that the Contractor’s insurance is primary and any insurance or self-insurance maintained by the County of Orange shall be excess and non-contributing. The Workers’ Compensation policy shall contain a waiver of subrogation endorsement waiving all rights of subrogation against the County of Orange, its elected and appointed officials, officers, agents and employees. All insurance policies required by this contract shall waive all rights of subrogation against the County of Orange, its elected and appointed officials, officers, agents and employees when acting within the scope of their appointment or employment. Contractor shall notify County in writing within thirty (30) days of any policy cancellation and ten (10) days for non-payment of premium and provide a copy of the cancellation notice to County. Failure to provide written notice of cancellation may constitute a material breach of the contract, upon which the County may suspend or terminate this contract. If Contractor’s Professional Liability is a “Claims Made” policy, Contractor shall agree to maintain Professional Liability coverage for two (2) years following the completion of the contract. The Commercial General Liability policy shall contain a severability of interests clause also known as a “separation of insureds” clause (standard in the ISO CG 0001 policy). Insurance certificates should be forwarded to the agency/department address listed on the solicitation. If the Contractor fails to provide the insurance certificates and endorsements within seven (7) days of notification by CEO/Purchasing or the agency/department purchasing division, award may be made to the next qualified vendor. County expressly retains the right to require Contractor to increase or decrease insurance of any of the above insurance types throughout the term of this contract. Any increase or decrease in insurance will be as deemed by County of Orange Risk Manager as appropriate to adequately protect County. County shall notify Contractor in writing of changes in the insurance requirements. If Contractor does not deposit copies of acceptable Certificates of Insurance and endorsements with County incorporating such County of Orange RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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changes within thirty (30) days of receipt of such notice, this contract may be in breach without further notice to Contractor, and County shall be entitled to all legal remedies. The procuring of such required policy or policies of insurance shall not be construed to limit Contractor's liability hereunder nor to fulfill the indemnification provisions and requirements of this contract, nor act in any way to reduce the policy coverage and limits available from the insurer. 21. Confidentiality: Contractor agrees to maintain the confidentiality of all County and County-related records and information pursuant to all statutory laws relating to privacy and confidentiality that currently exist or exist at any time during the term of this Contract. All such records and information shall be considered confidential and kept confidential by Contractor and Contractor’s staff, agents and employees. 22. Contractor Personnel: Contractor warrants that all Contractor personnel engaged in the performance of work under this Contract shall possess sufficient experience and/or education and the required licenses set forth herein in good standing to perform the services requested by the County. County expressly retains the right to have any of the Contractor personnel removed from performing services under this Contract to the County. Contractor shall effectuate the removal of the specified Contractor personnel from providing any services to the County under this Contract within one business day of notification by County. County shall submit the request in writing to the Contractor’s Project Manager. The County is not required to provide any reason, rationale or additional factual information if it elects to request any specific Contractor personnel be removed from performing services under this Contract. 23. County and Contractor Project Manager: The County shall appoint a project manager to act as liaison between the County and the Contractor during the term of this Contract (“County’s Project Manager”). The County Project Manager shall coordinate the activities of the County staff assigned to work with the Contractor. Contractor shall appoint a project manager to direct the Contractor’s efforts in fulfilling Contractor’s obligations under this Contract (“Contractor’s Project Manager”). Contractor’s Project Manager shall be subject to approval by the County and shall not be changed without the written consent of the County’s Project Manager. The County’s Project Manager shall have the right to require the removal and replacement of the Contractor’s Project Manager from providing services to the County under this Contract. The County’s Project Manager shall notify the Contractor in writing of such action. The Contractor shall accomplish the removal within 1 calendar day after written notice by the County Project Manager. The County is not required to provide any reason, rationale or factual information in the event it elects to request the removal of Contractor’s Project Manager from providing services to the County under this Contract. 24. Reports/Meetings: The Contractor shall develop reports and any other relevant documents necessary to complete the services and requirements as set forth in this Contract. The County’s Project Manager and the Contractor’s Project Manager will meet on reasonable notice to discuss the Contractor’s performance and progress under this Contract. If requested, the Contractor’s Project Manager and other project personnel shall attend all meetings. The Contractor shall provide such information that is requested by the County for the purpose of monitoring progress under this Contract. 25. Ownership of Documents: The County has permanent ownership of all directly connected and derivative materials produced under this Contract by the Contractor. All documents, reports and other incidental or derivative work or materials furnished hereunder shall become and remain the sole properties of the County and may be used by the County as it may require without additional cost to the County. None of the documents, reports and other incidental or derivative work or furnished materials shall be used by the Contractor without the express written consent of the County. 26. Title to Data: All materials, documents, data or information obtained from the County data files or any County medium furnished to the Contractor in the performance of this Contract will at all times remain the property of the County. Such data or information may not be used or copied for direct or indirect use by the County of Orange 52 RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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Contractor after completion or termination of this Contract without the express written consent of the County. All materials, documents, data or information, including copies, must be returned to the County at the end of this Contract in an electronic form agreed to by the County. 27. Records: The Contractor shall keep an accurate record of time expended by Contractor and the sub-contractors working for Contractor in the performance of this Contract. Such record shall be available for periodic inspection by the County at reasonable times. 28. Audits/Inspections: Contractor agrees to permit the County’s Auditor-Controller or the Auditor-Controller’s authorized representative (including auditors from a private auditing firm hired by the County) access during normal working hours to all books, accounts, records, reports, files, financial records, supporting documentation, including payroll and accounts payable/receivable records, and other papers or property of Contractor for the purpose of auditing or inspecting any aspect of performance under this Contract. The inspection and/or audit will be confined to those matters connected with the performance of the Contract including, but not limited to, the costs of administering the Contract. The County will provide reasonable notice of such an audit or inspection. The County reserves the right to audit and verify the Contractor’s records before final payment is made. Contractor agrees to maintain such records for possible audit for a minimum of three years after final payment, unless a longer period of records retention is stipulated under this Contract or by law. Contractor agrees to allow interviews of any employees or others who might reasonably have information related to such records. Further, Contractor agrees to include a similar right to the County to audit records and interview staff of any sub-contractor related to performance of this Contract. Should the Contractor cease to exist as a legal entity, the Contractor’s records pertaining to this Contract shall be forwarded to the surviving entity in a merger or acquisition or, in the event of liquidation, to the County’s Project Manager. 29. Publication: No copies of schedules, written documents, and computer based data, photographs, maps or graphs, resulting from performance or prepared in connection with this Contract, are to be released by Contractor and/or anyone acting under the supervision of Contractor to any person, partnership, company, corporation, or agency, without prior written approval by the County, except as necessary for the performance of the services of this Contract. All press releases, including graphic display information to be published in newspapers, magazines, etc., are to be administered only by the County unless otherwise agreed to by both Parties. 30. Conflict of Interest: The Contractor shall exercise reasonable care and diligence to prevent any actions or conditions that could result in a conflict with the best interests of the County. This obligation shall apply to the Contractor; the Contractor’s employees, agents, and relatives; sub-tier Contractor’s and third parties associated with accomplishing services hereunder. The Contractor’s efforts shall include, but not be limited to establishing precautions to prevent its employees or agents from making, receiving, providing or offering gifts, entertainment, payments, loans or other considerations which could be deemed to appear to influence individuals to act contrary to the best interests of the County. The County Board of Supervisors policy prohibits its employees from engaging in activities involving a conflict of interest. The Contractor shall not, during the period of this Contract, employ any County employee for any purpose. 31. Termination: In addition to any other remedies or rights it may have by law, County has the right to terminate this Contract without penalty immediately with cause or after 30 days’ written notice without cause, unless otherwise specified. Cause shall be defined as any breach of this Contract, any misrepresentation or fraud on the part of the Contractor. Exercise by County of its right to terminate the Contract shall relieve County of all further obligations. In addition to any other remedies or rights it may have by law and as set forth in this Contract, Contractor has the right to terminate this Contract without penalty after 365 days written notice County of Orange RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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without cause, unless otherwise specified. The County shall have the right to terminate your services for all but not limited to the following reasons and timeframes: a.
Immediately upon the firm committing a material breach of the terms of the Contract with the County.
b. Immediately for violation of any fiduciary duty or if the Contractor commits a fraud or criminal act in providing the agreed upon services. c. If the Contractor sells all of their assets or transfers control of management or operations of its business or this Contract to any third party, the County may immediately terminate with written notice. d. Immediately with appropriate written notice if there has been a filing of a petition for voluntary or involuntary bankruptcy or dissolution involving Contractor;, Immediately with appropriate written notice if Contractor has a filing under Title 11 of the United States Bankruptcy Code, the firm becomes subject to any voluntary or involuntary insolvency, cession or similar proceedings or the Contractor has made an assignment for the benefit of creditors. e. Thirty days appropriate written notice to Contractor, if the County determines there has been a significant decline in the firm’s financial condition. In the event Contractor attempts to terminate this Contract or otherwise ceases delivery of the services provided in Attachment A – Scope of Work, without complying with the Termination provisions herein, Contractor agrees to pay the County as damages the sum of: (1) the County’s (including County consultants and advisors) costs and expenses in procuring a new contractor to perform the services, (2) the additional fees, expenses and other compensation paid to the new contractor in excess of what would have been paid to Contractor had Contractor fully performed the services under this Contract and (3) any and all other costs, expenses, damages or liabilities of the County resulting from Contractor’s improper termination of this Contract of the failure to perform Contract services. 32. Breach of Contract: The failure of the Contractor to comply with any of the terms, provisions, covenants or conditions of this Contract shall constitute a material breach of this Contract. In such event the County may, and in addition to any other remedies available at law, in equity, or otherwise specified in this Contract: a. Afford the Contractor written notice of the breach and ten (10) calendar days or such shorter time that may be specified in this Contract within which to cure the breach; and/or b. Discontinue payment to the Contractor for and during the period in which the Contractor is in breach; and offset against any monies billed by the Contractor but yet unpaid by the County those monies disallowed pursuant to the above; and/or c. Terminate this Contract immediately, without penalty to the County. 33. Disputes: The Parties shall deal in good faith and attempt to resolve potential disputes informally. If a dispute concerning a question of fact arising under the terms of this Contract is not disposed of in a reasonable period of time by the Contractor’s Project Manager and the County’s Project Manager, such matter shall be brought to the attention of the Purchasing Agent by way of the following process: a. The Contractor shall submit to the Deputy Purchasing Agent a written demand for a final decision regarding the disposition of any dispute between the Parties arising under, related to, or involving this Contract, unless the County, on its own initiative, has already rendered such a final decision. b. The Contractor’s written demand shall be fully supported by factual information, and, if such demand involves a cost adjustment to this Contract, the Contractor shall include with the demand a written statement signed by a senior official indicating that the demand is made in good faith, that the supporting data are accurate and complete, and that the amount requested accurately reflects the amount for which the Contractor believes the County is liable. County of Orange 54 RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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c. Pending the final resolution of any dispute arising under, related to, or involving this Contract, the Contractor agrees to diligently proceed with the performance of his Contract, including the provision of services. The Contractor’s failure to diligently proceed shall be considered a material breach of this Contract. Any final decision of the County shall be expressly identified as such, shall be in writing, and shall be signed by the County’s Purchasing Agent or his designee. If the County fails to render a decision within 90 days after receipt of the Contractor’s demand, it shall be deemed a final decision adverse to the Contractor’s contentions. 34. Orderly Termination: Upon termination or other expiration of this Contract, each Party shall promptly return to the other Party all papers, materials, and other properties of the other held by each for purposes of execution of the Contract. In addition, each Party will assist the other Party in orderly termination of this Contract and the transfer of all aspects, tangible and intangible, as may be necessary for the orderly, non-disruptive business continuation of each Party. At the end of the term of this Contract or in the event of termination of this Contract by either party, the Contractor agrees to provide County with a computer history tape (in a form and format reasonably acceptable to the County) with all information necessary to transfer the records of each member's history of enrollment, eligibility, billing applicable claims, and any other necessary communications or information held by the Contractor within thirty (30) days of the effective date of the termination of this Contract. County may request copies of individual files necessary to reconstruct individual histories on specified members for up to ten (10) years after termination of this Contract. At the end of the term of this Contract, or in the event of termination of the Contract by either Party and Contractor, upon the County’s request, agrees to continue the administration of claims incurred prior to the effective ending date of this Contract for a period of twenty four months after the termination date. In compensation for this service, County agrees to remit the run-out fees identified in Attachment B. 35. Force Majeure: Contractor shall not be in breach of this Contract during any delay beyond the time named for the performance of this Contract caused by any act of God, war, civil disorder, employment strike or other cause beyond its reasonable control, provided Contractor gives written notice of the cause of the delay to County within 36 hours of the start of the delay and Contractor avails himself of any available remedies. 36. Consent to Breach Not Waiver: No term or provision of this Contract shall be deemed waived and no breach excused, unless such waiver or consent shall be in writing and signed by the Party claimed to have waived or consented. Any consent by any Party to, or waiver of, a breach by the other, whether express or implied, shall not constitute consent to, waiver of, or excuse for any other different or subsequent breach. 37. Remedies Not Exclusive: The remedies for breach set forth in this Contract are cumulative as to one another and as to any other provided by law, rather than exclusive; and the expression of certain remedies in this Contract does not preclude resort by either Party to any other remedies provided by law. 38. Notices: Any and all notices, requests demands and other communications contemplated, called for, permitted, or required to be given herein shall be in writing, except through the course of the County’s Project Manager and Contractor’s Project Manager routine exchange of information and cooperation during the terms of the work and services. Any written communications shall be deemed to have been duly given upon actual inperson delivery, if delivery is by direct hand or upon delivery on the actual day of receipt or no greater than four calendar days after being mailed by US certified or registered mail, return receipt requested, postage prepaid, whichever occurs first. The date of mailing shall count as the first day. All communications shall be addressed to the appropriate Party at the address stated herein or such other address as the Parties hereto may designate by written notice from time to time in the manner aforesaid. County: County of Orange RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
Human Resource Services/Employee Benefits Attn: Benefits Outsourcing Program Manager 55 p. 58
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333 W. Santa Ana Blvd., Room 137 Santa Ana, Ca 92701 cc:
Human Resource Services/Employee Benefits Attn: Barbara Voelkel, Deputy Purchasing Agent 333 W. Santa Ana Blvd., Room 137 Santa Ana, Ca 92701
Contractor:
TBD
39. County Child Support Enforcement: Contractor is required to comply with the child support enforcement requirements of the County. Failure of the Contractor to comply with all federal, state, and local reporting requirements for child support enforcement or to comply with all lawfully served Wage and Earnings Assignment Orders and Notices of Assignment shall constitute a material breach of the Contract. Failure to cure such breach within 60 calendar days of notice from the County shall constitute grounds for termination of this Contract. 40. Change Of Ownership: Contractor agrees that if there is a change or transfer in ownership of Contractor’s business prior to completion of this Contract, the new owners shall be required under terms of sale or other transfer to assume Contractor’s duties and obligations contained in this Contract and complete them to the satisfaction of County. Contractor must notify County at least ninety days (90) before any change or transfer in ownership. County has right to terminate contract upon notification of a change in ownership. Contractor bears all costs for a change in ownership including but not limited to .costs incurred by Contractor and including but not limited to costs incurred by the County to accommodate the change in ownership or associated with that change of ownership. Contractor must insure that any change or transfer in ownership will not result in any loss of paper recordings, electronic information, or voice recordings or information. Contractor must insure that contact information used to access IVR, customer service representatives, internet/Web access, and any other services provided under this contract is not changed. Any changes must receive written approval by the County Project Manager. Nothing in this paragraph should be read to limit Contractor’s duties or obligations for any reason including a change or transfer in ownership of Contractor’s business. 41. Precedence: The documents herein consist of this Contract and its Attachments. In the event of a conflict between or among the Contract documents, the order of precedence shall be the provisions of the main body of this Contract, i.e., those provisions set forth in the articles of this Contract, and then the Attachments and Exhibits. 42. Headings: The various headings and numbers herein, the grouping of provisions of this Contract into separate clauses and paragraphs, and the organization hereof are for the purpose of convenience only and shall not limit or otherwise affect the meaning hereof. 43. Severability: If any term, covenant, condition or provision of this Contract is held by a court of competent jurisdiction to be invalid, void, or unenforceable, the remainder of the provisions hereof shall remain in full force and effect and shall in no way be affected, impaired or invalidated thereby. 44. Calendar Days: Any reference to the word “day” or “days” herein shall mean calendar day or calendar days, respectively, unless otherwise expressly provided. 45. Attorney Fees: In any action or proceeding to enforce or interpret any provision of this Contract, or where any provision hereof is validly asserted as a defense, each Party shall bear its own attorney’s fees, costs and expenses. 46. Interpretation: This Contract has been negotiated at arm’s length and between persons sophisticated and knowledgeable in the matters dealt with in this Contract. In addition, each Party has been represented by County of Orange 56 RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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experienced and knowledgeable independent legal counsel of their own choosing, or has knowingly declined to seek such counsel despite being encouraged and given the opportunity to do so. Each Party further acknowledges that they have not been influenced to any extent whatsoever in executing this Contract by any other Party hereto or by any person representing them, or both. Accordingly, any rule of law (including California Civil Code Section 1654) or legal decision that would require interpretation of any ambiguities in this Contract against the Party that has drafted it is not applicable and is waived. The provisions of this Contract shall be interpreted in a reasonable manner to affect the purpose of the Parties and this Contract. 47. Authority: The Parties to this Contract represent and warrant that this Contract has been duly authorized and executed and constitutes the legally binding obligation of their respective organization or entity, enforceable in accordance with its terms. 48. Health Insurance Portability and Accountability Act (HIPAA): Contractor understands and agrees that the disclosure of PHI by a health care component of a covered entity is subject to the HIPAA Privacy Rule, Contractor understands and agrees that it is a Business Associate of County for the purposes of the HIPAA Privacy Rule. Therefore, the provisions set forth in Attachment G hereto shall be operative and control the Business Associate relationship of the parties. Nothing in Attachment G shall be considered a waiver of the limitation on subcontracting as set forth in this Contract. 49. Survival: Notwithstanding any provision to the contrary herein, the provisions of paragraphs 15, 16, 17, 18, 19, and 20 shall survive the termination of this Contract. 50. Employee Eligibility Verification: The Contractor warrants that it fully complies with all Federal and State statutes and regulations regarding the employment of aliens and others and that all its employees performing work under this Contract meet the citizenship or alien status requirement set forth in Federal statues and regulations. The Contractor shall obtain, from all employees performing work hereunder, all verification and other documentation of employment eligibility status required by Federal or State statutes and regulations including, but not limited to, the Immigration Reform and Control Act of 1986, 8 U.S.C. §1324 et seq., as they currently exist and as they may be hereafter amended. The Contractor shall retain all such documentation for all covered employees for the period prescribed by the law. The Contractor shall indemnify, defend with counsel approved in writing by County, and hold harmless, the County, its agents, officers, and employees from employer sanctions and any other liability which may be assessed against the Contractor or the County or both in connection with any alleged violation of any Federal or State statutes or regulations pertaining to the eligibility for employment of any persons performing work under this Contract. 51. Bills and Liens Contractor shall pay promptly all indebtedness for labor, materials, and equipment used in performance of the work. Contractor shall not permit any lien or charge to attach to the work or the premises, but if any does so attach, Contractor shall promptly procure its release and, in accordance with the requirements of paragraph 19 above, indemnify, defend, and hold County harmless and be responsible for payment of all costs, damages, penalties and expenses related to or arising from or related thereto. 52. Changes: Contractor shall make no changes in the work or perform any additional work without County’s specific written approval. 53. Terms and Conditions: Contractor acknowledges that it has read and agrees to all terms and conditions included in this Contract. 54. Incorporation: This Contract and its Attachments A through G are attached hereto and incorporated by reference and made a part of this Contract.
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PROPOSED CONTRACT SIGNATURE PAGE The Parties hereto have executed this Contract on the dates shown opposite their respective signatures below. CONTRACTOR*
Print Name
Title
* DO NOT SIGN THIS PAGE AT THIS TIME* Signature Date
Print Name
Title
* DO NOT SIGN THIS PAGE AT THIS TIME* Signature Date * If the Contractor is a corporation, signatures of two specific corporate officers are required as further set forth. The first corporate officer signature must be one of the following: 1) the Chairman of the Board; 2) the President; 3) any Vice President. The second corporate officer signature must be one of the following: a) Secretary; b) Assistant Secretary; c) Chief Financial Officer; d) Assistant Treasurer. In the alternative, a single corporate signature is acceptable when accompanied by a corporate resolution demonstrating the legal authority of the signature to bind the company. ************************************************************************************* County of Orange, a political subdivision of the State of California _____________________________________________________________________________________ Print Name Title _____________________________________________________________________________________ Signature
Date
************************************************************************************* Approved by Board of Supervisors on: Date
_____________________
APPROVED AS TO FORM: ___________________________ Deputy, Office of County Counsel Orange County, California
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ATTACHMENT A SCOPE OF WORK PHASE I The Scope of Work includes the Proposed Implementation Plan/Project Schedule. See Attachment D – Proposed Implementation Plan/Project Schedule PHASE II As indicated in the introduction, the County is soliciting proposals for Benefits Outsourcing Administration Services including Call Center, Communications, IVR and web technology to support all Health and Welfare programs offered by the County. The Contract will begin upon Board approval (estimated to be February 2016) for the plan year beginning January 1, 2017. The Offeror must certify that ALL services listed below will be provided to the County by the Offeror or their subcontractors. Each item that cannot or will not be fully provided by the implementation date must be so noted in the proposal with a brief explanation as part of Part 3, “Proposal Questionnaire” Question 1.
Definitions a. The Board. The Board of Supervisors for the County of Orange is the legislative and policy making body of the County and is responsible for the review and approval of all service agreements and/or contracts with the County. b. Employee Benefits Division. A Division of Human Resource Services of the County responsible for the design, implementation and on-going administration of the County’s various employee benefit plans and programs. c. Human Resource Services (HRS). The County’s HRS is comprised of various divisions and sections that provide a wide array of personnel and employee services to County departments and agencies. The Chief Human Resources Officer reports directly to the County Executive Officer (CEO). The Contractor shall provide the following services: I.
Annual Enrollment Services
1. Conduct annual health and welfare benefit enrollment for employees, COBRA participants, and retirees in Fall 2017 for Plan Year 2018; Contractor must be prepared to assume administration for all benefits effective January 1, 2017. 2. During Open Enrollment, Contractor must also coordinate the fourth quarter transition events, e.g., new hire, add/drop dependent, change of address, changes in eligibility status as the result of ACA FTE measurement and implementation of stability period, etc. 3. Provide daily statistical Open Enrollment reporting and monthly reporting showing enrollments via the Call Center and enrollments via the web. 4. Conduct annual benefit enrollments each fall thereafter (2017 through 2019 plus during any renewal and/or run-out periods). 5. Enroll newly eligible participants and process status changes for plan benefits commencing January 1, 2017 to December 31, 2019 and during any renewal and/or run-out periods. 6. Confirm eligibility and effective dates of each participant for all benefits, based on the County’s eligibility rules and definitions. Review and update written benefit eligibility rules and effective dates annually. 7. Process and validate participant elections. County of Orange RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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8. Notify retiree of Medicare enrollment requirements 90 days prior to retiree//survivor or their dependents turning age 65; allow for enrollment event. 9. Mail out and process specialized forms related to plans requiring Medicare Assignment, e.g., Kaiser Senior Advantage Plan (KPSA) Medicare assignment form according to established processes. 10. Produce annual benefit statements for all employees, COBRA participants, and retirees. 11. Produce personalized annual enrollment summaries and confirmation statements; mail out benefits enrollment guide or Quick Start Guide at annual enrollment and with certain qualified life events, and additional notices (includes Notice of Privacy Practice (NPP) and Summaries of Benefits and Coverage (SBCs)) along with benefit summaries or confirmation statements, as required. 12. Notify participants of Life Insurance Evidence of Insurability (EOI) requirements where applicable and provide web access to vendor’s EOI interface. If unable to provide electronic access, mail necessary paperwork for participant completion. 13. If necessary, forward any received EOI paperwork completed by participants to appropriate carrier for review. Entry into applicable systems any increases approved by carrier. 14. Report pending coverage information on participant’s confirmation statement. 15. Verify dependent student eligibility information annually for age 19 and older dependents for Management and Attorney Dental plan using established process; series of notification letters are mailed to the employee; allow employees to verify student status via the web. 16. Notify participant when dependent is no longer eligible for coverage (e.g., child turning age 26) and provide COBRA enrollment information. 17. Review and process requests for Qualified Medical Child Support Order (QMCSO) including the completion of appropriate forms and notification of all affected parties of action taken. 18. Process participant life/status changes via IVR, web, and through the Call Center throughout the calendar year. 19. Collect and transmit PCP information for new enrollees where required (annually and as needed). 20. Transmit eligibility data to the County’s contracted benefit vendors and entities in HIPAA compliant agreed upon formats on a weekly basis. 21. Issue Medicare Creditable/Non-Creditable Coverage letters prior to Open Enrollment to active and retired participants age 65 and older, in accordance with CMS guidelines, and to participants and participant’s spouse who age-into Medicare during the calendar year; Contractor and County are responsible for the annual maintenance and updates to the Creditable coverage letters. 22. Request and verify written documentation of eligibility for all dependents, e.g., Birth, Marriage, Divorce, fulltime Student status (dental coverage only), Domestic Partner, and verification of Medicare enrollment for all Medicare eligible retirees. 23. Administer COBRA, including all notifications, billings, and premium collection and detailed reporting. Reports should include summary and detailed information as described in Section XIX. 24. Administer direct bill for Active employees on leave and retirees who cannot have the billing deducted direct from pension, including all notifications, billings, and premium collection and detailed reporting. Reports should include summary and detailed information as described in Section XIX. 25. Respond to telephone and written inquiries from employees, retirees, and COBRA participants regarding health and welfare benefit plans; provide for communication via the call center representative and using an on-line tool which is responded to within 24 business hours. 26. Follow up in writing requesting missing information when a participant fails to provide the necessary documentation of qualified life event and/or Medicare eligibility and terminate coverage if necessary. 27. Respond to telephone and written inquiries from the County’s Human Resource Services, Employee Benefits staff regarding participant inquiries and administration. 28. Provide for a method of directly reimbursing a participant when Contractor has created an error and there is urgency such that the participant needs the refund before the next payroll cycle or pension file run. 29. Reimburse the County and/or the participant directly where the Contractor made an error resulting in an adverse financial impact to the County and/or its participants. 30. Administer reports of Death and Disability including interaction with participant, beneficiary and carriers. 31. Be the record holder of all life insurance policy amounts and beneficiary information. Contractor shall provide access for updating beneficiary information via the web. Contractor must also coordinate Life Insurance updates, including those that require Evidence of Insurability (EOI) with the County’s Life Insurance provider. County of Orange RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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32. Administer the 1% cash lump sum benefit to eligible employees who separate from the County who are not eligible for the Retiree Health Grant; be able to distinguish those who are eligible from those who are not. 33. Provide eligibility to County’s PPO administrator for annual Wellwise rebates. 34. Administer Kaiser, Anthem Blue Cross, SCAN, and any other vendor’s Low Income Subsidy (LIS) Amounts (described in more detail under Cyclical Processing). 35. Report enrolled participants located in New York and Massachusetts for the purpose of reporting surcharges as required by the state of New York and Massachusetts. 36. Coordinate information (eligibility updates, web links, reporting and reconciliation) with Life Insurance vendor, Accidental Death and Dismemberment (AD&D) vendor and Salary Continuance vendor. 37. Maintain benefit information and establish a web link for the following benefit programs so that employee calls can be routed appropriately: a. Peace Officers’ benefit plans offered through their bargaining unit b. Life, AD&D, STD/LTD, vision and dental plans for general employees, (non-management, non-Peace Officers) offered through their bargaining units c. All County health plan carriers and Administrators (includes provider directories) d. Unemployment benefits for all County employees e. Employee Assistance Program (EAP) for all employees f. Wellness program for active employees 38. Administer the County’s enrollment and eligibility as it relates to Employee Married to Employee (EME), Retiree Married to Employee (RME), and Retiree Married to Retiree (RMR) provisions (includes enrollment and disenrollment forms, grant eligibility, etc.) by linking the combined elections of two individual participants. 39. Collect and report Medicare information; file necessary reports to the Centers for Medicare and Medicaid Services (CMS), and provide information to the County or its other vendors to manage Medicare reporting processes (e.g., Medicare Part D subsidy, Medicare Secondary Payer (MSP), etc.) as necessary during the term of this Contract. II. Affordable Care Act (ACA) (IRC Section 4980H) 1. FTE Determination & Eligibility The County meets the definition of an applicable large employer (ALE) and therefore is subject to IRC Section 4980H. Including the County, there are 7 ALE members. County is the designated reporting entity and is responsible for FTE determination for all ALE members. Listed below is a description of the type of County employees and the County’s chosen methodology for FTE determination. Types of employees for which FTE determination and eligibility must be determined: a. General County employees – These are generally employees who the County has hired to work 30 hours/week or more, are provided health coverage under County eligibility rules, and whose health plan benefits are administered by the Contractor. b. General County Part-time employees expected to work 20-29 hours/week. These are employees who are provided health coverage under County eligibility rules and whose health plan benefits are administered by the Contractor. c. General County Part-time Employees expect to work less than 20 hours/week - These are part-time employees working less than 20 hours/week who are not offered health plan benefits under County eligibility rules. d. Peace Officers – These are employees who have health plan coverage managed by AOCDS. This includes both ACA FTE and not FTEs. e. Extra Help FTE – These are hourly employees who are anticipated to work over 30 hours/week and are not seasonal employees. These employees will be offered one health plan option to meet ACA requirements. f. Extra Help Variable – These are employees whose hours are variable. These employees FTE status will be determined by the measurement period. g. Extra Help Seasonal – These are employees who are hired at about same time of year and will not extend to more than six months. Employees may work more than 30 hours/week. County of Orange RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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h. Extra Help Working Retirees – This group is retired from the County. Under County rules, an Extra Help Retiree is limited to 960 hours per calendar year. However, if an employee retires, and there is not a 13 week period between the separation date and their rehire as an Extra Help Working Retiree (“W” status), they are considered a FTE for the remainder of the stability period. The County is using a Lookback method for the ongoing and initial measurement periods. If an employee in a stability period changes from a non-FTE to a status where they are expected to work more than 30 hours/week, coverage should be offered consistent with the County eligibility rules. If an employee in an FTE status changes to a non-FTE status, health coverage will be maintained but coverage options may change. The County is not using Rule of Parity for Rehires. Any employee who is rehired in 13 weeks or less will not be considered a new hire for ACA FTE purposes. Employees who are determined to be FTE under the ACA measurement and who would not normally be offered coverage under the County’s health plan eligibility rules will be offered the Sharewell Choice Plan only with ACA rates. These employees will have the option to opt out of County coverage. COBRA coverage may still be elected, if applicable. The County reserves the right to revisit this methodology. Complete technical specifications and business requirements shall be documented during the implementation process. Interpretation of ACA regulations will be based upon the County’s interpretation by its consultant and Counsel. The County is willing to discuss any differing interpretation with the Contractor’s compliance and/or attorneys. 2. FTE Determination and Offer of Coverage Contractor will provide all FTE calculations and associated eligibility administration required to meet FTE coverage as required by Section 4980H using the County’s chosen methodology for FTE calculations listed above. This includes but is not limited to: a. Load and process bi-weekly hours file from County for FTE calculation. File format and data must be in a mutually agreed upon format. b. For each employee: 1) Determine FTE status for news hire, rehire, initial measurement period, and ongoing measurement period; 2) Determine if a change in status or pay class code affects FTE status and/or coverage eligibility; and 3) Determine FTE status and health plan eligibility and provide Eligibility Determination Service. c. Provide any services in this Attachment A as the result of any changes in eligibility due to changes in FTE status. Track and ensure that employees are offered coverage consistent with FTE status. Ensure that coverage for FTEs is maintained throughout stability periods. d. Provide Contractor’s standard reports associated with FTE determination and one customized FTE report on a monthly basis. e. Provide the following reports annually for the ongoing measurement period and FTE determination: 1) Summary report of number of FTEs by types of employees listed above. 2) Detailed report of employees included in ongoing determination. Report should be by employee and include at least: Name, SSN, Employee ID, agency code, bargaining unit, total hours, current pay class code, and FTE determination (FTE or non-FTE). 3) Detail reported of employees not included in ongoing determination. Report should be by employee and include at least: Name, SSN, Employee ID, agency code, bargaining unit, total hours, and current pay class code. 3. Reporting The reporting population includes but is not limited reporting for County Employees (including employees in AOCDS health plans), retirees in self-funded health plans, COBRA participants in self-funded health plans, and HRA participants. Participants will be segregated by employer EIN. County of Orange RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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County of Orange
Bid 017-201505-BV
Contractor shall provide files with all necessary data to the County in a mutually acceptable format to meet IRC Section 6055 & 6056 reporting requirements and to generate IRS Forms 1094 and 1095 for all required participants. a. The reporting population includes but is not limited to reporting for County Employees (including employees in AOCDS health plans), retirees in self-funded health plans, COBRA participants in selffunded health plans, and HRA participants. Participants will be segregated by employer EIN. b. Employer EINs may be added or delete without additional cost. Any changes to data required by the Federal government will be incorporated without additional cost to the County. c. Contractor shall generate files for the County with all necessary data in a mutually acceptable format to generate corrections for previously filed 1094 and 1095 files/forms. d. Contractor shall accept and store data for AOCDS health plan coverage and dependent data for IRS Section 6055 & 6056 reporting. e. Contractor shall accept and store data HRA coverage data, upon County’s request for any required Section 6055 reporting. 4. IRC Section 6055 & 6060 Reporting Upon the County’s request, perform IRC Section 6055 & 6056 reporting requirements on behalf of the County. This may include but is not limited to: a. Generate and electronically file all required files/forms to the IRS, including corrections. b. Generate and distribute all required employee forms, including corrections. c. Respond to IRS to resolve any issues related to the transmission of data including but not limited to transmission issues and exceptions. d. Provide data as requested by the County to meet County Auditor-Controller requirements. e. Provide reports and/or files to County on a mutually agreed upon format and frequency. County will be reviewing filing data and need management reports. f. Develop a plan to review and audit filing data for accuracy. County reserves the right to review plan and provide feedback. Frequency of review and audit must be mutually agreed upon by County and Contractor. Contractor must provide results to County, develop a corrective action plan to resolve any inaccuracies, and if necessary, submit corrections to appropriate parties. g. Provide customer service support to include IVR, call center support, printed fulfillment, including County specific communication, and web. h. Confirm and/or provide data to the County or IRS inquiries to confirm FTE status and/or offer of coverage for any employee, retiree or COBRA participant and answer any other questions associated with IRC Section 4980H employer penalties. III. Benefits Data Warehouse 1. Provide a Benefits Data Warehouse for the County to query a number of reports to be designed at implementation and allow County to use the Benefits Data Warehouse to generate Ad hoc reports. 2. Provide the County with monthly active census reports showing all enrolled health plan participants and which reconciles to premium reports. The reports will include Health Plan, Tier, Wellness Status, and premium amount. In addition to demographic data, census reports must also include billing source. Census reports must also account for all participants on Direct Bill and COBRA. 3. Provide the County with monthly retiree census reports showing all enrolled health plan participants and reconciles to premium reports. In addition to the retiree demographic data, census reports must also include but not limited to following information: billing source (i.e., OCERS pension), Retiree Grant Amount, Grant Usage, Medicare Part B reimbursement. 4. Provide the County with monthly active census reports for other benefits as requested. 5. Generate summary or detail reports based upon various criteria including but not limited to: a. Active – Summary and Detail Report 1) Plan & option. Separate Active employees with Wellness participation and those with exemption status 2) Employer – County, Courts, Special District 3) Labor Group and Bargaining Unit County of Orange RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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4) Separate COBRA subscribers from remaining population 5) Subscribers and Dependents b. Retirees - Summary and Detail Report 1) Plan and option 2) Grant Eligibility 3) Subscribers and Dependents 6. System needs to be flexible enough to add reports or request reports based upon user defined criteria. User defined criteria must be approved by County 7. System needs to be able to retain historical data. 8. Import the data so that it can be readily used by County Employee Benefits staff. IV. Administration Systems 1. Build and maintain benefits administration system to handle the County’s health and welfare benefit programs. a. County may add new health and benefit programs, bargaining units, etc. which may affect the administration systems. See Ongoing Changes Section. b. Administrative system must be able to manage the following mixed eligibility: Active Health and COBRA Dental (Active Plan); Retiree Survivor Health and Dental Dependent COBRA (Active Plan); Retiree Health and Dental COBRA (Active Plan). All administration and processing must be provided in a manner which does not require special manual intervention or interruption of coverage, elections or billing as the participant moves to a mixed eligibility status. c. For intent to retires, the administrative system must allow employees to elect their retiree coverage up to 60 days in advance while maintaining employee deductions until the pay date associated with the last day of work. Carrier eligibility and premium reports must accurately reflect active and retiree coverage months during transition. d. Survivors of safety/peace offices killed in line of duty must be offered County coverage at employee rates. Administrative system must be able to handle Survivor elections and billing. 2. Convert employee demographic and election data from the County’s CAPS+ system. 3. Build and test the interfaces between the CAPS+, OCERS and the Contractor’s systems. If during the term of the contract, system upgrades occur to CAPS+ or OCERS systems, which do not require programming changes to the existing interfaces, Contractor will participate in testing at no additional charge. 4. Build and test interfaces to convert data from other County systems such as Word and Excel programs used to support direct billing and other vendor systems such as the COBRA administrator, the HCRA and DCRA administrator, and Life Insurance claims. 5. Build and test interfaces to systems including the County’s payroll system, all county insurance carriers, wellness vendor, and any other related providers. 6. Reporting of monthly/quarterly vendor reconciliation status, results and outstanding items to County (reconciliation of vendor eligibility interfaces, direct billing reconciliation, FSA administration reconciliation, etc.). 7. Calculate plan eligibility, rates, credits, plan limits, imputed income (life insurance, Domestic Partners, active and retired), and deductions. 8. Maintain participant database which holds annual participant elections and the County’s plan election cost information for multiple plan years of all health and welfare benefit coverages. 9. Maintain audit trail of participant election information transactions to ensure enrollment is within plan enrollment periods. 10. Maintain historical benefits enrollment information and have the ability to quote health and welfare benefits as requested by employees, retirees and/or County HRS/Employee Benefits dating back to January 1, 2017 11. Investigate and reconcile all eligibility questions and reports from carriers based on loading of transmitted eligibility information. V. Call Center and Operations Support 1. Provide a dedicated toll-free telephone number. 2. Provide a dedicated customer service team for the County. County of Orange 64 RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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3. 4. 5. 6. 7.
8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. VI.
Bid 017-201505-BV
Provide a dedicated participant advocate. Respond to participant and the County staff questions. Provide multi-lingual support or access to translation representatives. Assist employees with IVR and web enrollment/access needs. Ensure dedicated customer service representatives are available 7:30 a.m. to 5:30 p.m. PT. Monday through Friday, excluding the following holidays: New Year’s Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day and Christmas Day. Serve in a participant advocate role to handle inquiries and solve eligibility or claim payment issues with carriers; have the ability to conference in carrier to achieve resolution. Have the ability to warm transfer a participant call to health carriers and vendors. Provide staffing and continuous evaluation of service levels to the performance agreements set forth in this Contract. Provide call tracking system and activity reports. Provide digitized call recording system and access for County to call recordings upon request. Provide case management system with read only system access to all County benefit department employees. Provide access to customer service knowledge base systems for the purposes of review and recommending updates to County benefit information as required on an ongoing basis. Provide the County with weekly updates on customer service activities including the reporting of trends and issues. Forward communications to participants. Follow up with participants on the return of necessary forms and completion of enrollment activities. Assist participants by taking benefit elections/transactions (annual enrollment, qualified life events, etc.). Handle participant data requests. Execute data file loads and transmissions and audits to ensure accuracy. Advise the County of any employee benefit issues and/or problems and provides solution where applicable. Conduct customer service performance surveys and provide results to the County quarterly. Notify the County if there is any interruption of the phones that would prevent calls being routed to County’s dedicated customer service team. Provide resolution of escalated customer service issues initiated by the County within 3 business days. COBRA Processing
1. Identify change in employment status from demographic feed and/or loss of dependent or participant coverage changes from the web, or customer service unit. 2. Create and distribute termination of coverage notices within the timeframes required by law. 3. Administer COBRA including all notifications, billings, collection of premiums, reporting to carriers on eligibility and payment of premiums. 4. Notify County payroll of deduction termination through the CAPS+ payroll feed. 5. Notify carriers of change of participant benefit elections resulting from status change through eligibility feed. 6. Answer COBRA participant inquiries. 7. Provide monthly detailed reporting to the County for all COBRA participants. 8. Remit to the County all COBRA premium contributions collected on behalf of the County no later than the 20th day of each month. 9. Support timely resolution of escalated issues and appeals relative to COBRA. 10. Reconcile COBRA enrollment between plan years to reflect changes in elections, coverage, and billing by January 20th. Reconciliation should include subcontractor’s records if applicable. VII. Communication and Enrollment Materials 1. Prepare, edit, print and mail out annual and ongoing benefits communications, e.g., guidebook, newsletters, customized letters and required notices. Additional communication strategy and design services such as branding and developing customized newsletters, enrollment guides, posters, etc. shall be provided at the County’s written request subject to the rates identified in Attachment B. 2. Create annual enrollment communications including benefits summaries and confirmation statements. County of Orange 65 RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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Bid 017-201505-BV
3. Create on-going enrollment benefit summaries and confirmation statements for new hires and status change events. 4. Maintain and distribute materials required to complete enrollments such as beneficiary and Evidence of Insurability forms, if not available electronically. 5. Maintain and distribute annual enrollment and new hire packages. 6. Create life event packages, e.g., child turning age 19, 25, or 26, retiree turning age 65. 7. Maintain and distribute status change event worksheets and forms related to status change events. 8. Create employee communication pieces that clearly explain the functionality and access to web and IVR systems. 9. Create an employee/retiree communication piece that addresses the transition to the Contractor or Contractor’s vendor for COBRA, HCRA/DCRA, Judges, OBP, and monthly direct billing for active employees and retirees. 10. Create an employee/retiree communication piece explaining significant updates to the web. 11. Distribute enrollment materials as triggered by new hire, status change, and annual enrollment events. 12. Distribute any additional piece(s) of communication that the County and Contractor deem necessary and/or communications that we are required to send to stay in compliance with Federal and/or State laws. Maintain and mail plan collateral materials to plan participants upon request or as needed. 13. Mail out all Open Enrollment materials, e.g., Guidebooks, benefits enrollment summaries, confirmation statements, Summaries of Benefits and Coverage, HIPAA Privacy notice, Notice of Creditable coverage, PIN Reminders, etc. VIII. Client and Vendor Services 1. Provide access to Contractor’s database for the County’s Human Resource Services, Employee Benefits staff for purposes of inquiry and to view Case Management transactions and reporting (standard and ad hoc). 2. Provide onsite training to the County benefit staff on how to use the system. 3. Provide connectivity to the County systems in a cost effective manner 4. Provide access to Contractor’s database to the County via the Internet for inquiry. 5. Provide the County with viewing access to imaged documents. 6. Provide view-only access to the Contractor’s case management and call tracking system to County Benefits staff. 7. Update participant information on-line for carriers who permit this access. 8. Provide “Management Rights” access for the County Benefits staff to view current and historical benefit elections for County employees, retirees and COBRA participants. 9. Provide on-line read-only system access to all County Benefits staff. 10. Handle first level appeals received by the Contractor; forward to County, in a timely manner, second level appeals where applicable along with timeline and supporting documentation. Create and maintain an appeals status log (appeals received and current status) and submit to County on weekly basis.
IX. Eligibility Determination 1. Identify newly eligible participants and determine effective dates based on each plan’s eligibility and ACA Section 4980. 2. Identify for each participant the eligible plans, costs, options and plan provisions and ACA Section 4980. 3. Ensure offer of coverage is provided during stability periods. 4. Validate eligibility of benefit elections. 5. Administer plan eligibility provisions defined by the County and perform “reasonableness” edits against data driving eligibility. 6. Confirm benefit elections. 7. Determine and administer eligibility for qualified life event changes. 8. Transmit eligibility information to carriers and vendors. 9. Resolve any eligibility issues directly with carriers, including reconciliation. X. Employment Classification and Family Status Change Administration County of Orange 66 RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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Bid 017-201505-BV
1. Accept and process enrollment changes via web or through the Call Center. 2. Distribute enrollment information based on events triggered on the demographic feed or through notification of family status change on the web or through the Call Center. 3. Distribute supplemental forms and information required to complete the enrollment process (e.g., Evidence of Insurability form for Life insurance, if not provided electronically, Kaiser Senior Advantage enrollment form, etc.) 4. Follow-up with participants on the return of necessary forms and completion of enrollment activities. 5. Create and distribute confirmation statements. 6. Answer participant inquiries regarding the status change, resulting enrollment events and timeframe in which to respond. 7. Pass eligibility and enrollment information to carriers on a weekly basis. 8. Calculate deduction and imputed income and pass this information to the County’s CAPS+ payroll system. 9. Administer resulting benefit impacts of benefit pay changes. 10. Administer resulting benefit impacts of employment classification change. XI. Family Medical Leave (FMLA) and Other Leave of Absence Administration 1. Receive information from County payroll system regarding employees who are going on FMLA, unpaid leaves, and other types of leave of absence. 2. Determine appropriate status (paid or unpaid leave, Short Term Disability (STD) or Long Term Disability (LTD) for Management/Attorney/Craft & Plant groups) and establish appropriate payroll deduction or direct bill premium amounts and administer any changes to HCRA/DCRA/OBP participation and contribution amounts. 3. Coordinate with STD/LTD Administrator the amounts to be credited to the monthly premium report as a result of Waiver of Premiums. 4. Direct bill those employees who have to pay for their own premiums and are on unpaid leave status. 5. Accept participant payments via check or online payment services. 6. Provide website and IVR access for billing participants showing account information, including payment status, 24 hours a day, seven days a week. 7. Notify County when employee shows up as Return from Leave and coverage is about to be termed. 8. Receive information from County Payroll System on which employees have returned to active work status, send applicable benefit information and adjust payroll deductions and HCRA/DCRA/OBP accordingly. 9. Provide a bi-weekly FMLA/LOA status and deductions report to the County's Human Resource Services, Employee Benefits Department. 10. Report on any transactions that are inconsistent with the County’s leave policies based on transmitted Payroll file. 11. Provide the County with recorded calls as needed on specific participant issues through the use of an advanced call tracking system. 12. Provide the County with the results of billing accuracy and customer service audits for these programs, even if subcontracted. 13. Bill and collect contributions for all participants who do not have deductions taken from the County Payroll System (unpaid and/or partially paid leaves), where applicable. Provide reports that include detailed accounts receivables and collections. See Reporting Section. 14. Remit to the County all premium contributions collected on behalf of the County no later than the 20th day of each month. 15. Reconcile enrollment between plan years to reflect changes in elections, coverage, and billing by January 20th. Reconciliation should include subcontractor’s records if applicable. XII. HCRA, DCRA, Judges Medical Reimbursement Account Administration – “Spending Account Administration” 1. Create participant accounts. 2. Fund accounts through County payroll feeds (bi-weekly). County of Orange 67 RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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Bid 017-201505-BV
3. 4. 5. 6. 7.
Provide both Debit Card (real time) and claim forms as methods of reimbursement. Distribute Claims forms upon request; provide on-line access to claim forms. Allow participants to submit claims and backup documentation on-line, by fax or by mail. Provide on-line models and calculators. Provide web-portal access to account history, balance, review of reimbursement status, client specific eligibility guides, and tracking out of pocket healthcare expenses. 8. Reimburse eligible participant claims within 15 days of receipt of claim by issuing checks or direct deposits on a daily basis. 9. Create and distribute notifications such as explanation of payment, check or direct deposit, account balances, claim denial, partial payments, returned checks, etc., within 15 days. 10. Maintain account balances. 11. Respond to participant questions about the County’s Section 125 Plan based on information provided by the County. 12. Reconcile elections, payroll deduction registers, OBP allocated amounts to HCRA, and claim payments. 13. Answer participant questions regarding claims, balances, eligible expenses, etc., via Call Center; hours of operation shall be 5:00 a.m. PT to 5:00 p.m. PT, Monday through Friday. 14. Provide Toll Free Interactive Voice Response System available for account balance and claim payment information, 24 hours a day, seven days a week. 15. Create forfeiture reports to participants and the County annually. 16. Provide Quarterly participant statements and management reports to the County with the specified data elements and sorts by required deadlines. 17. Provide reminder in January of each year to the participant of the claims filing deadline for eligible claims incurred in the prior plan year. County is considering implementing the allowed roll-over period. If implemented, communicate appropriate claims filing deadline. 18. Provide the County with recorded calls through the system to the County as needed on specific participant issues through the use of an advanced call tracking system. 19. Ensure quality control of customer service responses given for the spending accounts. 20. Provide County with imaged claims on an as needed basis for review of second level appeal and/or escalated claims issues. 21. Consult with IRS on claims received for questionable expenses. 22. Accept after-tax contributions for HCRA participants on unpaid leave or on COBRA. 23. Provide the County with the results of processing accuracy and customer service audits for these programs, even if subcontracted. 24. Conduct HCRA/DCRA administration; if service is subcontracted, Contractor must ensure appropriate controls and periodic audit functions are in place. Contractor must provide for the use of a Debit Card. 25. Track and provide a report of each employee’s annual OBP elections, to the following categories: a. Lump sum taxable cash – County’s payroll feed b. 457 Defined Contribution plan –County’s payroll feed c. Payroll credit AD&D premiums – County’s payroll feed d. HCRA (Section 125) – Contractor/County’s payroll feed (combo) 26. Edit each employee’s OBP annual elections to ensure that they do not exceed the maximum OBP amount allowed for each eligible employee. Web should automatically edit the maximum limits. 27. Edit each employee’s HCRA election to ensure that the total OBP amount allocated to HCRA and the amount of the employee’s salary redirection (pre-tax contributions) do not exceed the annual HCRA contribution limit. Web should also edit the maximum limits. 28. Conduct quarterly and year end reconciliations for all HCRA and DCRA accounts with County and subcontractor, if applicable; this includes a reporting and reconciliation of all forfeitures. 29. Supply census data for the annual HCRA/DCRA/OBP non-discrimination testing. 30. If at such time in the judgment of the County there is a sufficient number of complaints of slow claims processing to warrant an audit, County may require a count of all claims on hand. Each claim will be tabulated for date received and number of working days awaiting communication to claimant, or issue of payment. If the number of claims exceeding fifteen (15) calendar days waiting processing is greater than 5%, Contractor shall have seven (7) calendar days to complete claims processing for these claims. 31. Process Judges Medical Reimbursement account claims in accordance with instructions provided by County. County of Orange 68 RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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XIII. Cyclical Processing 1. The County indicative data information (IDF) is passed bi-weekly to the Contractor for its CAPS+ HR/Payroll system, Contractor system should accept all entries into the County’s CAPS+ system showing the transaction history within a given reporting period, e.g., employee went from active “A” status to Family Leave “F” and returned to “A” status all within the same bi-weekly pay period. IDF may also contain future dated transactions. 2. Upon the County’s request, with mutual agreement from the Contractor, accept indicative data from the County weekly. 3. Process AOCDS changes in health plan enrollment on a bi-weekly frequency in an automated manner. 4. Provide the County benefit plan active employee deduction information to County payroll in file format and transmission protocol based upon County requirements. Information should include but not be limited to: a. All new deductions with effective dates b. Changes in deductions; this would include an expiration record for old deductions and new deduction record for the change c. Separate payroll options codes that distinguish the rates of Employees with Wellness participation and no Wellness participation. Each option should give net rate and be able to identify employees by health plan, tier and Wellness status. 5. Administer ACA 4980H processing and reporting. 6. Provide the County detailed benefit plan retiree deduction information to OCERS. 7. Receive and process Intent to Retire and Deferred Commencement events from OCERS on a twice monthly basis. See Retiree Health Grant Section. 8. Process OCERS files twice a month. Upon the County’s request process OCERS files weekly to accommodate high volume of retirements in February and March. 9. Administer Retiree Health Grant. 10. Process direct bill to pension updates and retroactive retiree processing with OCERS on a monthly basis. 11. Provide health plan carriers eligibility information for participants on a weekly. 12. Generate and process all files and reports to support County Wellness program. This includes but is not limited to: a. Provide Wellness vendor eligibility information on a monthly basis. b. Provide additional eligibility files for OC Healthy Steps program. c. Process information from Wellness vendor to reflect employee participation and health plan options. d. Provide County with annual file of employees with wellness participation status. 13. Administer COBRA weekly. 14. Administer HCRA, DCRA, and Judges Medical Reimbursement account. 15. Administer OBP. 16. Administer direct bills for leaves of absence. Initial invoices for participant should be processed within 7 days of receipt of leave of absence event. 17. Administer disabilities on occurrence basis. 18. Administer death claim processing on occurrence basis. 19. File necessary reporting to the Centers for Medicare and Medicaid Services (CMS). 20. Administer the Low Income Subsidy (LIS) Amounts (Kaiser, SCAN, and/or Anthem Blue Cross shall pass a file with individual names and the month of coverage and low income subsidy amount). Contractor shall verify if the retiree paid any out-of-pocket amounts. If so, they get the lesser of the low income subsidy or the amount they paid out-of-pocket. For these people, an adjustment needs to go to them either via OCERS pension deduction or Contractor’s Direct Bill system. May include another file transmission and reconciliation. Retiree would get a credit to his/her health premium. If the retiree did not pay out-of-pocket, the amounts belong to the County. A separate report would accompany the premium report showing by plan the low income subsidy credit. It would segregate by plan: a. Anthem Blue Cross, SCAN, and Kaiser b. County credit vs. retiree credit c. Billing type OCERS vs. Direct Bill for retiree credit County of Orange RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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Bid 017-201505-BV
The LIS report shall be used to reduce the premium payment. The premium payment would still reflect the standard amount. Frequency would quarterly or annually. Contractor would need to allow for flexibility in processing should CMS requirements require a more frequent adjustment. XIV. Interfaces (Carriers and the County) 1. 2. 3. 4. 5. 6. 7.
8. 9. 10.
11. 12. 13. 14. 15. 16.
17.
Define requirements for interfaces based on carrier requirements. Develop standard interfaces using carrier’s standard layouts and formats. Accept the County CAPS+ feeds using standardized transmission methods (PGP/FTP). Accept the County’s hours feeds using standardized transmission methods (PGP/FTP). Provide transmission status reports to the County following each transmission. Provide exception transmission report for County review and resolution. Reports must be segregated between record failures and warnings. Content and format must be approved by County. Be able to create, send and receive ANSI 834 compliant files; include Medicare indicator flag (where applicable). Must be able to accommodate mixed family enrollment scenarios (one in Medicare plan, one in non-Medicare plan) and specialized Medicare advantage enrollment requirements. Develop payroll interfaces to the County CAPS+ using the County’s format. Develop interface to OCERS in the format provided by OCERS. Produce vendor feeds using electronic transmission methods where applicable, e.g. includes all carrier eligibility/enrollment transmissions such as Catamaran Rx, Blue Shield of California (Health and Dental), Kaiser, Cigna, Standard Insurance, Anthem Blue Cross, Centers for Medicare and Medicaid (CMS), The Hartford, SCAN HMO, etc. Transmit participant deductions via (PGP/FTP) to the County bi-weekly (may increase cycle to weekly). All interface files must be flexible enough to allow for changes in coding, e.g., foreseeable switch in number of digits for agency org and employee ID. Participate in any impact analysis and testing for potential systems upgrades. Process retroactive adjustments to payroll deductions as specified by the County, for retroactive enrollments, deductions, and credits to OCERS, or direct bill vendor when applicable. Carefully review and take appropriate actions for edits, errors and omissions reported to the Contractor by the OCERS. If directed by the County, provide quarterly deduction reconciliation reports for identifying retroactive adjustments, in lieu of processing individual retroactive adjustments to employee payroll deductions; report format and data elements will be defined during implementation. For Peace Officers and Law Enforcement Managers, receive enrollment information from the bargaining unit (AOCDS) determine and input payroll deductions and pass this information to County’s Payroll through payroll feed; additional information relating to HCRA/DCRA will also need to be accounted for in Contractor’s enrollment and eligibility system.
XV. IVR and Web Systems 1. Build and maintain IVR and web systems for Open Enrollment and ongoing new hire enrollment and status changes. 2. Build and maintain IVR and web systems for active, COBRA, disabled, terminated, retiree and survivor plan participants. 3. Build and maintain a web based employee and retiree modeling tool, e.g., input desired health plan criteria and yield health plans that ranked the highest based on available costs and features and model an event and inform participant new cost tied to the event so participants can compare health plan features. a. Optional Health Plan Comparison Tool (see additional fees, Attachment B) 1) Mapping of 1.5 years of claims and enrollment data from each County health plan vendor (vendor required to meet minimum data specifications) 2) Utilize participants actual medical and prescription drug utilization and charge information from previous plan years to assist with prediction of future costs 3) Using claims information, apply County plan designs for selected health plan options, and apply modeling algorithms to determine the employees cost share under each option. County of Orange 70 RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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4) Apply actual participant specific premiums and incorporate into overall annual costs. 4. Provide toll-free access during Call Center hours of operations for participants to do the following through a benefit center representative: a. Verify dependents and elections b. Enroll in benefits c. Request/receive forms d. Receive plan information e. Perform status changes, qualified life events such as adding/removing dependents f. Receive spending account balance and activity g. Perform all event and change processing h. Information on where to contact the benefit plan 5. Provide 24/7 access via the Benefits Center web site for participants to do the following: a. Verify dependents and elections b. Enroll in benefits c. Request/receive forms d. Receive plan information e. Perform status changes, qualified life events such as adding/removing dependents f. Receive spending account balance and activity g. Perform all event and change processing h. Information on where to contact the benefit plan 6. Provide IVR capability to opt out to a benefits service representative to provide information and/or take participant elections during Call Center hours of operations. 7. Provide IVR call transfer capabilities to carriers and related groups (EAP, etc.). 8. Maintain PIN numbers and passwords for participants; include ”Forget your PIN” feature on the web site. 9. Provide web links to other vendor sites, e.g., health plans, unions, etc. 10. Maintain and distribute plan documents, Summaries of Benefits and Coverage, benefits forms, and claim forms on-line. 11. Provide for the update of plan documents and forms via the web throughout the year. 12. Provide a “contact us” feature via the web site 13. Provide the County with 10 -15 random recorded calls (mixture of active and retiree calls) monthly for review. 14. Provide a demonstration for County’s use at the County’s Annual Health Fair to demonstrate web features for County participants. XVI. Ongoing Changes 1. Have ability/flexibility to change and/or add new retiree and/or active health plan options and/or vendors at no cost to the County, e.g., Consumer Driven Health Plan with an HSA, limited to one (1) per year, system/programming updates (web, Call Center, fulfillment, IVR, etc.) related to a change in County health and welfare plan vendor. To the extent the change involves interfaces between Contractor and the vendor, the fee will be waived provided Contractor has an existing relationship with the carrier and traditional/best practice approach is used. 2. County may add new health and benefit programs, bargaining units, etc. which may affect the administration systems. Contractor must have ability and flexibility to add new programs (e.g., Wellness Program, Health Reimbursement Arrangement (HRA), Long Term Care, Vision, etc.), bargaining unit, and options; change benefit groupings and other key data elements to allow for proper benefits eligibility; and meet County’s deduction and reporting needs within required implementation deadlines. County expects that Contractor will be able to update its system so that County can transmit actual HR system data rather than building cross walk matrices to avoid changes. Contractor shall modify the set-up in its administrative system if initial set-up does not perform to County satisfaction and creates eligibility errors requiring manual intervention. The addition of new functionality and/or programs may be subject to Attachment B, subparagraph 6. “Additional Fees.” 3. Have ability/flexibility to add additional or eliminate bargaining units to the Retiree Health Grant administration. The addition of new functionality and/or programs may be subject to Attachment B, subparagraph 6. “Additional Fees.” 4. Update web, IVR, fulfillment, training, and system programming necessary to implement annual changes in participant group eligibility from one existing option to another at no charge to County. Examples include County of Orange 71 RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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5.
6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20.
Bid 017-201505-BV
adding a new bargaining unit to an existing benefit eligibility group on the employee eligibility matrix or Craft and Plant group becoming eligible for a different group on the employee eligibility matrix. Update web, fulfillment, training, and system programming necessary to implement annual changes in plan benefits information such as copayments, deductibles, etc. at no charge to County. Implementation of new benefits programs and/or development of new unique participant eligibility groups shall be subject to Attachment B, subparagraph 6 “Additional Fees.” Update written documentation of plan provisions, event rules, and special processes. Program and test ongoing updates to plan provisions, event rules, and special processes Administer Contract in accordance with County rules documents. Calculate/upload/verify employer and employee costs and coverage amounts. Produce benefits summary statements (mass mailing). Produce Confirmation Statements (mass mailing). Update requirements definitions (rules and processing guidelines) at least annually. Update eligibility and zip code tables. Update rate tables (twice annually). Update and store all enrollment packets, plan documents, web links, and all other applicable forms. Full cycle system testing. Review and update system as applicable all carrier feeds. Enrollment edit/follow up processing-default elections. Periodic web site updates for changes from the County. Train Call Center on updated changes.
XVII. Production and Mailroom Support 1. Maintain electronic participant “files” for benefit information. 2. Maintain electronic records of correspondence received and sent. 3. Maintain image of incoming mail with date tracking; call center representatives and the County must be able to view imaged documents. 4. Store, collate, and fulfill enrollment packets, forms, guidebooks, and notifications. XVIII. Project Management and Administration Consulting 1. Produce initial and subsequent requirements definition for each plan. 2. Recommend process improvements. 3. Review applicable plan documents and report any discrepancies as they pertain to administration of the health and welfare plans as per the plan documents provided by County. 4. Compare existing administrative processes with Contractor’s best practices. 5. Notify County of upcoming compliance issues that Contractor is implementing for its other clients. 6. Review plan design materials provided by County or its outside consultant. Update Contractor business requirements and administration documents for plan designs. 7. Implement into existing web systems and administrative functions, any plan changes and/or modifications to existing benefit programs that may occur during the term of the Contract as specified in Section XVI, Ongoing Changes. 8. Provide separate project manager for Open Enrollment and all major implementation of changes. XIX. Reporting 1. Provide the County with required reports on a predetermined basis. Reports will be delivered on CD and in hardcopy and/or other electronic media as required; all reports will need to be sent via electronic copy to the County. 2. Conduct quarterly meetings with the County to review account status and performance. 3. Create monthly reports on Contractor’s performance against mutually agreed to performance standards. 4. Provide bi-weekly report showing all errors on active and retiree uploads; Contractor will designate a team of systems staff to work collaboratively with the County and/or its vendors to resolve all systems issues. County of Orange 72 RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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5. Provide weekly Dashboard report showing Customer Service Staffing levels, Escalations from the County, Exception Processing, Human Resources/Agency Referrals, Weekly Training Focus, Weekly Call Volume, and Items for Discussion. 6. Track and report on the number of retirees electing to opt out of a health plan on a monthly basis. 7. Provide direct bill reports to include breakdown by type of participant, e.g., active, retiree, or COBRA, including type of leave. Reports must also include summary and detailed accounts receivables and collections report including but not limited to participant type, name, plan, and tier, month of coverage, collection amount and accounts which will be cancelled for non-payments. 8. Provide monthly client reporting packages. 9. Provide access to on-line reporting tools as they become available. 10. Handle ad hoc reporting requests; provide allowance of 50 hours of ad hoc reporting per each Contract year. Unused ad-hoc hours can be carried over to the following Contract year and any subsequent renewal years. Each Contract year will have a maximum number of ad hoc reporting hours not to exceed 100 hours. 11. Provide comprehensive annual enrollment reports. 12. Provide the County with a comprehensive management reporting package including monthly and quarterly participant services reports. 13. Provide access to on-line reporting tools (see also the Benefits Data Warehouse and Reporting section below) 14. Create/provide monthly carrier billing/premium reports at both the summary and participant level for all health and welfare benefit plan carriers and any reports necessary for the County to make the carrier payments. 15. Create, adjust for retroactive actions, and reconcile premium reports for monthly premium payment. 16. If not available as part of the online reporting tool, provide one (1) County Master Data File per year at no additional charge to County, format of file to be confirmed in writing prior to the start of work. If the Benefits Data Warehouse and/or the On-line reporting tool cannot provide the data files necessary to conduct annual mailings to participant sub-populations by plan, coverage level, bargaining unit, age, and Medicare status, Contractor shall provide up to five (5) mailing data files for purposes of annual Open Enrollment communications. 17. Provide electronic monthly deduction reports to the County (active employees) and OCERS (retirees). Census data including agency codes (work location) are required for each participant record. File also must allow for an adjustments field. County must be able to use census files to compare them against its systems. 18. Provide monthly financial analysis and reconciliation for Actives and Retirees in a format acceptable to County. Data should provide summary and detail and must be able reconcile premiums paid to carrier versus amounts collected via, payroll, direct bill and/or pension. Adjustments should also be included. Contractor must provide/discuss results, causes of variances between premiums paid and collections, and recommended solutions to solving any variances. 19. Provide any data files/reports as requested by the County to complete analysis and/or calculation for the ACA Excise tax. XX. Retiree Health Grant 1. Accurately determine eligibility, and calculate Retiree Health Grant for specific bargaining units according to established rules. a. Load separate retiree health plan rates from active rates. b. Program the calculation of grant amounts for each grant scenario according to County eligibility rules, currently noted below (but subject to future change): 1) Maximum grant adjustment amount each year is between 3% and 5% depending on bargaining unit upon retirement. 2) Once retiree becomes Medicare eligible, reduce Grant by 50% (current retirees age 65 no reduction; current retirees age 64 or younger 50% reduction once Medicare A & B eligible (A, if at no cost) – but no sooner than one year from Board adoption date (dates vary by bargaining unit). 3) Employees retiring after Board adoption date (date varies by bargaining unit), 7.5% reduction to Grant for each year pre-60 years of age; 7.5% increase to Grant for each year worked after age 60 up to age 70. 4) The 7.5% adjustment does not apply to Safety positions. 5) Program unique setup as it relates to disability retirements. County of Orange 73 RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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6) Survivors receive 50% reduction of Retiree’s Grant. 7) Employees hired before 8/1/1993 may be eligible for buyback. c. Perform eligibility and elections for participants with Retiree Health and Active Dental COBRA in an automated fashion and without manual intervention for processing. Contractor’s system should be able to manage the following mixed eligibility Retiree Survivor Health and Active Dental Dependent COBRA; and Retiree Health and Active Dental COBRA. All services must be provided in a manner that does not require special manual intervention or interruption of coverage, elections or billing as the participant moves to a mixed eligibility status. d. All retirees who are eligible for Retiree Health only (no Grant) should be identifiable by a single field and value in the Contractor’s system. Contractor should be able provide reports/files by which the County can easily identify these retirees by this field and value. 2. Track, calculate and report for each retiree the data elements listed below. Automate the calculation for each retiree eligible for the Retiree Grant. a. The Grant for the intent to retiree based upon the intent date. b. The final Grant based upon the actual data at time of retirement. c. The applicable monthly premium rate. d. The monthly grant amount to be applied to reduce health plan premium. e. The monthly grant amount to be applied to Medicare B premiums, including high income tiers. f. The net monthly health premium deduction. g. Retroactive health plan eligibility, premium and Grant adjustment. Retroactive adjustments must be calculated for all Retiree deaths irrespective of date when death is reported. h. Accept dates associated with service hour buy back as it relates to the Retiree Health Grant. This process includes using pre-established criteria for determining eligible buy back service hours when buy hack hours as provided on the OCERS interface. Only hours of buy back within eligible date ranges will be accepted for purposes of calculating the Grant. Contractor will calculate the eligible buyback. i. Agency code for which the participant retired. Contractor must be able to keep the original agency code in place even in situations where a retired worker returns to work as a Working Retiree, possibly under a new agency. j. Bargaining Unit for which the participant retired. Contractor must be able to keep the original bargaining unit in place even in situations where a retired worker returns to work as a Working Retiree, possibly under a different bargaining unit. 3 Provide necessary files and summary and detail of health enrollment, health premiums, and health and Medicare grant reimbursement amounts to the County and OCERS. 4. Conduct monthly analysis of Grant and Retiree Health data to ensure proper administration of Grant. Review should include but not be limited to: Medicare status vs Health enrollment plan/Medicare eligibility; Medicare reduction vs Health enrollment plan/Medicare eligibility; Number of Medicare family participants vs Health enrollment plan/Medicare eligibility 5. County shall also review Retiree Grant calculations on monthly basis. Contractor must respond to questions from County on calculation within five (5) business day. Corrections to inaccurate Grant calculations must be corrected by the next pension file following ten (10) days after identification of error unless otherwise specified by the County. XXI. Rules and Processing Guidelines Documentation 1. 2. 3. 4. 5.
Fully and accurately document all rules and processing guidelines for all County health and welfare plans. Update the rules and processing guidelines on an as needed basis and send updates to the County. Provide the County an opportunity to review the guidelines at least semi-annually. Submit to the County the finalized guidelines as an electronic PDF Document. Ensure all updates to the rules and processing guidelines are accurately transferred to the on-line web tool, communications and call center reference tools.
XXII. Run-out processing
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1. Process Open Enrollment through final year of Contract. If at the end of the final year, Contract is transitioned to another contractor, Contractor will ensure the smooth transition to the new contractor and carryout the Open Enrollment Period and transfer enrollment data following the close of Open Enrollment. All relevant Open Enrollment elections and statistical reporting must be provided by Contractor no later than January 31st following the prior Open Enrollment period. 2. Agree to provide all necessary reporting and electronic media to ensure the smooth transition to new contractor. This includes all historical imaged data, CMS reporting, and ANSI 834 compliant files. Contractor agrees to transfer data in a timely manner so new contractor can upload and view data prior to the start of January 1st implementation. 3. Process and reconcile run-out claims related to the HCRA/DCRA/OBP/Judge/COBRA/Leave billing. Claims filing deadline for the HCRA/DCRA plans is a specified date following the close of the plan year. Contractor shall ensure smooth transition of COBRA and Leave billings to new contractor. Contractor shall manage all final payments for coverage through the end of the plan year, including retroactive processing/notifications. All relevant files and statistical reporting must be provided by Contractor to the new contractor no later than May 31. 4. Process ACA FTE ongoing measurement ACA reporting for final year of Contract. Process FTE hours and initial measurement periods until transitioned to new contractor. All relevant data associated IRC Section 4980H data must be provided to new contractor in a mutually agreed upon timeframe. 5. Finalize all appeals on hand. Should some appeals result at a later date, Contractor agrees to provide historical documentation. 6. Provide upon request, individual recorded telephone calls and/or participant history and other information as needed by new contractor to respond to specific participant, client, or vendor inquiries or appeals. 7. Provide new contractor all rules and processing guidelines on hand. XXIII. Secure Email 1. Provide a secure email and file exchange workspace. Contractor shall comply with State and Federal laws for maintaining secure email. XXIV. Self-Audits and Operational Audits 1. Perform at the County’s request, self-audits or routine self-audits, including manual queries and/or processes, and audit the sub-contractors. Audits can be performed by the Contractor and/or auditors designated by the County to examine on-site records, transactions, and systems relating to the benefits and services provided to the plan using any reasonable method of auditing. 2. Reimburse County for costs relating to a bi-annual operational audit conducted by County with a firm selected by County. 3. Finalize and document an ongoing audit plan by June 30, 2017. 4. On an annual basis, review, evaluate and document in Rules and Assumption Documentation, all manual queries, and administrative processes performed on the County accounts. XXV. System Maintenance and Support 1. Maintain all hardware and software owned and operated by Contractor in the administration of the County’s benefit programs. 2. Ensure systems operate in compliance with plan provisions and administrative procedures. 3. Ensure systems are operational during normal scheduled hours. 4. Respond to and expeditiously fix any system-related issues. 5. Maintain back-up and disaster recovery plans for database and administration of the County’s benefit plans. Maintain and routinely test security protocols. 6. Conduct regular SAS 70 reviews with results submitted to the County. 7. Should transition of the County’s benefit plans and administration be moved to another of the Contractor’s platform, the transition to the new platform is to occur without interruption and at no cost to the County. County of Orange RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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XXVI. Web Enhancements 1. Routinely monitor its web site and provide the County recommendations for changes to the way in which the material is presented and accessed throughout the year and during Open Enrollment. 2. Provide quarterly recommendations for web messaging updates to continue to engage participants and communicate current benefit events or resources XXVII. Year-end Processing 1. Produce Imputed Income file for the County payroll on company paid basic life insurance (to accompany per pay period calculations). 2. Produce detailed enrollment report for benefit plans. 3. Work with County systems analyst to reconcile the HCRA/DCRA year-to-date contribution amounts between County payroll system, participant elections, and HCRA/DCRA administration records. 4. Provide information necessary for the County and/or its designee to issue Annual 1099 forms to report imputed income (where applicable) for enrolled/retired Domestic Partners. 5. Provide information for employees/retirees to complete the cost of healthcare reporting on W-2. Other County Benefit programs, however services NOT being requested as part of this Contract:
Extra Help Defined Benefit Retirement Plan 401(a) Plan 457 Defined Contribution Plan Defined Contribution Extra Help Retirement Plan Retirement Pension Plan Administration Health Reimbursement Arrangement Program
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ATTACHMENT B COMPENSATION/PAYMENT 1. Compensation: This is a fixed fee price Contract between the County and Contractor for services as provided in this Contract. The Contractor agrees to accept the specified compensation as set forth in this Contract as full remuneration for performing all services and furnishing all staffing and materials required, for any reasonably unforeseen difficulties which may arise or be encountered in the execution of the services until acceptance, for risks connected with the services, and for performance by the Contractor of all its duties and obligations hereunder. The County shall not pre-fund any reimbursement accounts or refunds. 2. Firm Discount and Pricing Structure: Contractor guarantees that prices quoted are equal to or less than prices quoted to any other local, State or Federal government entity for services of equal or lesser scope. Contractor agrees that no price increases shall be passed along to the County during the term of this Contract not otherwise specified and provided for within this Contract. 3. Contractor’s Expense: The Contractor will be responsible for all costs related to photo copying, telephone communications, fax communications, and parking while on County sites during the performance of work and services under this Contract. The County will not provide free parking for any service in the County Civic Center. 4. Payment Term: Invoices are to be submitted within 30 days from the date Contractor completes deliverables as defined in the Attachment A - Scope of Work. Contractor shall reference Contract number on invoice. Payment will be net 30 days after receipt, and approval, by County of an invoice in a format acceptable to the County and verified and approved by the agency/department and subject to routine processing requirements. Invoices shall cover services not previously invoiced. The Contractor shall reimburse the County for any monies paid to the Contractor for services not provided or when services do not meet the Contract requirements. Payments made by the County shall not preclude the right of the County from thereafter disputing any items or services involved or billed under this Contract and shall not be construed as acceptance of any part of the services. 5. Payment – Invoicing Instructions, Miscellaneous Fees, and Other Charges: The Contractor will provide an invoice on the Contractor’s letterhead for services rendered. Each invoice will have a number and will include the following information: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.
Contractor’s name and address Contractor’s remittance address, if different from 1 above Name of County agency/department Delivery/service address Contract Number Date of order Type of fees/service Sales tax, if applicable Dates of fees/service Brief description of fees/service – detail hourly rates Contractor’s Federal I.D. Number
The County’s Project Manager, or designee, is responsible for approval of invoices and subsequent submittal of invoices to the County Auditor-Controller for processing of payment. The responsibility for providing an acceptable invoice to the County for payment rests with the Contractor. Incomplete or incorrect invoices are not acceptable and will be returned to the Contractor for correction. County of Orange 77 RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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Invoices and support documentation are to be forwarded to: Benefits Outsourcing Program Manager Human Resource Services, Employee Benefits 333 W. Santa Ana Blvd., Room 137 Santa Ana, CA 92701
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RATE QUOTATION SHEET When providing fee quotes, provide fees as requested. If any services requested in the RFP fall outside the Contractor’s standard services (offered at additional costs), they must be clearly defined. If additional costs are not identified separately, County will assume quotes for setup and enrollment processing include all RFP requirements. 1. Rate Guarantee - Indicate the period of time for which Contractor’s fees are guaranteed. Describe how significant increases or decreases in employee size affect Contractor’s pricing. 2. One-time Implementation Fees – specify a one-time fixed fee that covers all implementations costs for work as outlined in the Scope of Work (Attachment A). $______________/one-time fee 3. Ongoing Fees a. Specify a fixed annual fee that covers all work as outlined in Attachment A, Scope of Work, with the exception of those fees set forth in paragraphs 4 and 5 below. Annual amounts will be paid in quarterly installments. Include the fee for each year in the contract and renewal period(s). Year Year 2017
$___________/year Breakdown: Quarter 1 = $____________ Quarter 2 = $____________ Quarter 3 = $____________ Quarter 4 = $____________
Year 2018
$___________/year Breakdown: Quarter 1 = $____________ Quarter 2 = $____________ Quarter 3 = $____________ Quarter 4 = $____________
Year 2019
$___________/year Breakdown: Quarter 1 = $____________ Quarter 2 = $____________ Quarter 3 = $____________ Quarter 4 = $____________
Year 2020 (renewal year)
$___________/year Breakdown: Quarter 1 = $____________ Quarter 2 = $____________ Quarter 3 = $____________
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Fixed Annual Fee
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Year
Fixed Annual Fee Quarter 4 = $____________
Year 2021 (renewal year)
$___________/year Breakdown: Quarter 1 = $____________ Quarter 2 = $____________ Quarter 3 = $____________ Quarter 4 = $____________
b. Provide annual cost savings Retiree population and all related retiree benefits administration were removed from this Contract: $_______________ c. Provide annual cost of savings if Health Care Reimbursement Account Administration were removed from this Contract and any related contract cost savings associated with elimination of this program: $_______________ 4. ACA Section 4980H – FTE Determination and Offer of Coverage County may request Contractor perform these services for any or all Contract years. Specify a fixed annual fee that covers all work as outlined in Attachment A, Scope of Work, Section II.2. Annual amounts will be paid in quarterly installments. Include the fee for each year in the contract and renewal period(s). Year
Fixed Annual Fee
Year 2017
$___________/year Breakdown: Quarter 1 = $____________ Quarter 2 = $____________ Quarter 3 = $____________ Quarter 4 = $____________
Year 2018
$___________/year Breakdown: Quarter 1 = $____________ Quarter 2 = $____________ Quarter 3 = $____________ Quarter 4 = $____________
Year 2019
$___________/year Breakdown: Quarter 1 = $____________ Quarter 2 = $____________ Quarter 3 = $____________ Quarter 4 = $____________ $___________/year
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Year
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Fixed Annual Fee Quarter 1 = $____________ Quarter 2 = $____________ Quarter 3 = $____________ Quarter 4 = $____________ $___________/year
Year 2021 (renewal year)
Breakdown: Quarter 1 = $____________ Quarter 2 = $____________ Quarter 3 = $____________ Quarter 4 = $____________
5. IRC Section 6055 & 6060 Reporting County may request Contractor perform these services for any or all Contract years. Specify a fixed annual fee that covers all work as outlined in Attachment A, Scope of Work, Section II.4. Annual amounts will be paid in quarterly installments. Include the fee for each year in the contract and renewal period(s). Fixed Annual Fee to be paid after files submitted and accepted by IRS
Year Reporting for Year 2017 (to be completed in 2018)
$___________/year
Reporting for Year 2018 (to be completed in 2019)
$___________/year
Reporting for Year 2019 (to be completed in 2020)
$___________/year
Reporting for Year 2020 (renewal year) (to be completed in 2021)
$___________/year
Reporting for Year 2021 (renewal year) (to be completed in runout in Year 2022)
$___________/year
6. Additional Fees Specify the hourly rates for the additional services or changes in services approved by the County Board of Supervisors after the approval of this Contract. Examples of additional services include plan design changes, “addition” of benefits vendors and/or programs, postage, additional ongoing files, and/or ongoing reports. This would also include regulatory and/or legislative changes that the County is required to implement to remain in compliance with California and/or Federal Law and requirements. *Be sure to identify any and all costs necessary to implement the change, e.g. programming, communication, mailing, web updates, Interactive Voice Response (IVR) updates, files, reporting, etc. (This additional fees section does not include introduction of new technology, implementing best practices, business process improvements as those components are to be included in the ongoing annual fees.) County will assume no additional costs, if none are identified here. Propose either a global hourly rate or hourly rates per staff. Global Rate:
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$______________/hour*
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Job Title
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Hourly Rate $___________/hour
$___________/hour
$___________/hour
7. Other Fees Specify any fees for services not included in the base annual fee or sections 2 through 6 above or sections 8 and 9 below. Description of Service
Rate
8. Run out Fees – Propose run-out fees to ensure a smooth transition to new Contractor at the termination of this Contract. 9. Communication Design/Development Fees –Propose fees for design, development, printing, and distribution of general participant notifications, booklets, newsletters, etc., that are not included in the base annual fee. Description of Service
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Rate
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ATTACHMENT C STAFFING PLAN
1. Primary Staff to perform Contract duties Name
Classification/Title
Roles and Responsibilities
2. Alternate staff (for use only if primary staff are not available) Name
Classification/Title
Roles and Responsibilities
Substitution or addition of Contractor’s key personnel in any given category or classification shall be allowed only with prior written approval of the County Project Manager. The Contractor may reserve the right to involve other personnel, as their services are required. The specific individuals will be assigned based on the need and timing of the service/class required. Assignment of additional key personnel shall be subject to County Project Manager approval. County reserves the right to have any of Contractor personnel removed from providing services to County under this Contract. County is not required to provide any reason for the request for removal of any Contractor personnel. 3. Sub-contractor(s) In accordance with Article 12 “Assignment or Sub-Contracting”, listed below are Sub-contractor(s) anticipated by Contractor to perform services specified in Attachment A, Scope of Work.
Company Name
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Staff Name
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ATTACHMENT D PROPOSED IMPLEMENTATION PLAN/PROJECT SCHEDULE
Provide an implementation plan outlining the necessary tasks needed to install the County’s plans and begin performing the services outlined in Attachment A - Scope of Work. Include a timetable and name the parties responsible (include any resource requirements of the County staff). Identify: 1. Major milestones and key deliverables, including but not limited to: a. Web, IVR and Call Center b. Conversion of COBRA, Direct Billing, and Flexible Spending Account records as appropriate c. Interfaces/Systems d. Communication e. ACA Section 4980H 2. Scheduled meetings during the course of the project 3. The delivery of status reports
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ATTACHMENT E SAMPLE COMMUNICATIONS PLAN Provide a detailed Communications Plan and project timetable beginning with the Contract award and continuing through the complete assumption of all services within this Contract. Please indicate the level of involvement you will need from incumbent administrator and the County. Provide the location where each process step takes place.
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ATTACHMENT F
PERFORMANCE GUARANTEES The data necessary to determine whether the Performance Guarantees have been met shall be reported to the County on a quarterly basis unless otherwise noted, . The County reserves the right to audit the performance reporting results for a given period to validate their accuracy and approve the self-determined results. 1. Indicate the amount you are willing to place at risk (per year) to meet performance guarantees for the County: Annual performance guarantee
Guarantee
Amount at risk
$____ per year
Total dollars at risk not to exceed 2. If you cannot agree to the following, or have additional performance guarantees you are willing to offer under this proposal, track changes to the following table with your proposed quarterly Operational Performance Guarantees. Amount Service County Specific Standard: Results must be reported for County Specific of Fees at Performance population, not book of business. Risk Element A. System Availability
Three separate measures: 1. Service Center is open 99% of the scheduled time (defined as able to accept phone calls and process transactions, and excluding any scheduled or mutually agreed upon downtime). 2. IVR is available 99% of the scheduled time (defined as fully functional, excluding any scheduled or mutually agreed upon downtime). 3. Internet is available 99% of the scheduled time (defined as fully functional, excluding any scheduled or mutually agreed upon downtime).
B. Two separate measures: 1) Call Handling 1. Case Specialist Response: 85% of callers reach a Case Specialist within 30 seconds. 2. Abandonment Rate: Less than 3% of callers abandon after the first 30 seconds in queue prior to reaching as service center representative. 2) Open Enrollment Call Handling
Two separate measures: 1. Case Specialist Response: 85% of callers during Open Enrollment reach a Case Specialist within 30 seconds. 2. Abandonment Rate: Less than 3% of callers during Open Enrollment abandon after the first 30 seconds in queue prior to reaching as service center representative.
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Service Performance Element C. 1) Case Management
County Specific Standard: Results must be reported for County Specific population, not book of business.
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Amount of Fees at Risk
Two separate measures: 1. 90% of calls to the customer service center are resolved on the same business day. Measurement excludes items pending a response/submission from the participant. 2. 95% of calls to the customer service center are resolved within 20 business days.
2) Open 90% of calls to the customer service center during Open Enrollment are Enrollment Case resolved on the same business day. Measurement excludes items pending a Management response/submission from the participant. 3) Escalation Processing D. Response to written inquiries
E. Statement Timeliness
85% of County directed escalations resolved within 5 business days. 95% of participant-written inquiries (including e-mail) that are responded to within five business days and ten business days, respectively. Response time for all participant-written inquiries will be based on the number of business days subtracting the date received by the Contractor from the date the response was sent. Up to three separate measures: 1. 99% of Open Enrollment Kits mailed 5 business days before the start of open enrollment or within agreed upon schedule. 2. 99% of confirmation statements mailed within 5 business days of request. 3. 99% of agreed on participant correspondence mailed within 5 business days of trigger event (COBRA notifications, HCRA & DCRA forms, HCRA quarterly statements, etc.)
F. Data Handling 1. No more than one Client provided payroll/HR data file, excluding bad files received from the County, posted and fully reconciled outside of 3 business days for each quarter. 2. No more than one Contractor provided carrier and other third party administrator files delivered more than one day beyond scheduled delivery date per quarter. 3. No more than one Contractor provided payroll deduction file will be delivered outside of the County Payroll Calendar delivery schedule per quarter. G. Participant Satisfaction County of Orange RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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Service Performance Element
County Specific Standard: Results must be reported for County Specific population, not book of business.
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Amount of Fees at Risk
higher based on a 10 point scale. H. Direct Billing 100% of bills will be postmarked no later than 5 business days prior to the first of the month for which the bills are being issued. I. HCRA/DCRA and Judges Claims Processing Timeliness
J. HCRA/DCRA and Judges Claims Processing Accuracy K. Annual Open Enrollment
L. ACA FTE determination M. ACA Reporting
N. Implementation
3.
95% of all claims processed within 15 calendar days. Processing time is measured from the date the claim is received by Contractor to the date it is processed (i.e.; paid, denied, or pended for external information) If at such time in the judgment of the County there is a sufficient number of complaints of slow claims processing to warrant an audit, County may require a count of all claims on hand. Each claim will be tabulated for date received and number of working days awaiting communication to claimant, or issue of payment. If the number of claims exceeding fifteen (15) calendar days awaiting processing is greater than 5%, Contractor shall have 7 calendar days to complete claims processing for these claims.
99% of all claims paid accurately based on the applicable coverage and plan guidelines. Any claims requiring reprocessing due to an error in original processing shall be counted. Calculated as the number of claims audited and found to be processed and paid without error divided by the total number of claims paid.
90% of all mutually agreed Contractor Open Enrollment key project plan milestones will be achieved by the due date agreed upon by County and Contractor prior to finalization of each annual Open Enrollment project plan. 100% FTE initial and ongoing FTE determination and offers of coverage performed within required time requirements.
100% of Participant forms are issued by IRS deadline All IRS forms and files are submitted and accepted by IRS deadline “System ready” for open enrollment by the date agreed upon by both parties. All agreed to implementation milestones and requests for information during implementation must be met for agreed upon “system ready” date.
Complete the table below with your standard Account Management Satisfaction metric. Please fill in your standard in the “Contractor Standard” column:
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County of Orange
Service Area
Bid 017-201505-BV
County Standard
O. Account management satisfaction (County specific)
Contractor Guarantee
Contractor Standard
> 95%
Based on the results of the Contractor’s quarterly survey or report card submitted to County’s benefits staff. Designated participants of County’s benefits staff will complete a quarterly report card to evaluate the Contractor’s account team, or the overall service performance. Guarantee will be measured using a mutually agreed upon survey tool to be developed and modified, if necessary, on an annual basis. Account team may be scored on: technical knowledge, accessibility, interpersonal skills, communication skills, and overall performance. Contractor’s overall service may be scored on such dimensions as proactive communication of issues and recommendations, timeliness and accuracy of reports, responsiveness to day-to-day needs, adequacy of staffing and training, and overall ability to meet performance expectations. 4. For each Service Performance Element (A – K), please provide actual Book of Business (BOB) results measured for CY 2014. If you subcontract for any services listed in this proposal, then you must also include your Performance Guarantees in place to monitor and guarantee the work being performed by subcontractor.
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89 p. 92
County of Orange
Bid 017-201505-BV
ATTACHMENT G BUSINESS ASSOCIATE CONTRACT A. GENERAL PROVISIONS AND RECITALS 1. The Parties agree that the terms used, but not otherwise defined below in Paragraph B, shall have the same meaning given to such terms under the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191 (“HIPAA”), the Health Information Technology for Economic and Clinical Health Act, Public Law 111-005 (“the HITECH Act”), and their implementing regulations at 45 CFR Parts 160 and 164 (“the HIPAA regulations”) as they may exist now or be hereafter amended. 2. The Parties agree that a business associate relationship under HIPAA, the HITECH Act, and the HIPAA regulations between the Contractor and County arises to the extent that Contractor performs, or delegates to subcontractors to perform, functions or activities on behalf of County pursuant to, and as set forth in, the Contract that are described in the definition of “Business Associate” in 45 CFR § 160.103. 3. The County wishes to disclose to Contractor certain information pursuant to the terms of the Contract, some of which may constitute Protected Health Information (“PHI”), as defined below in Subparagraph B.10, to be used or disclosed in the course of providing services and activities pursuant to, and as set forth, in the Contract. 4. The Parties intend to protect the privacy and provide for the security of PHI that may be created, received, maintained, transmitted, used, or disclosed pursuant to the Contract in compliance with the applicable standards, implementation specifications, and requirements of HIPAA, the HITECH Act, and the HIPAA regulations as they may exist now or be hereafter amended. 5. The Parties understand and acknowledge that HIPAA, the HITECH Act, and the HIPAA regulations do not pre-empt any state statutes, rules, or regulations that are not otherwise pre-empted by other Federal law(s) and impose more stringent requirements with respect to privacy of PHI. 6. The Parties understand that the HIPAA Privacy and Security rules, as defined below in Subparagraphs B.9 and B.14, apply to the Contractor in the same manner as they apply to a covered entity (County). Contractor agrees therefore to be in compliance at all times with the terms of this Business Associate Contract and the applicable standards, implementation specifications, and requirements of the Privacy and the Security rules, as they may exist now or be hereafter amended, with respect to PHI and electronic PHI created, received, maintained, transmitted, used, or disclosed pursuant to the Contract. B. DEFINITIONS 1. “Administrative Safeguards” are administrative actions, and policies and procedures, to manage the selection, development, implementation, and maintenance of security measures to protect electronic PHI and to manage the conduct of Contractor’s workforce in relation to the protection of that information. 2. “Breach” means the acquisition, access, use, or disclosure of PHI in a manner not permitted under the HIPAA Privacy Rule which compromises the security or privacy of the PHI. a. Breach excludes: i. Any unintentional acquisition, access, or use of PHI by a workforce member or person acting under the authority of Contractor or County , if such acquisition, access, or use was made in good faith and within the scope of authority and does not result in further use or disclosure in a manner not permitted under the Privacy Rule. ii. Any inadvertent disclosure by a person who is authorized to access PHI at Contractor to another person authorized to access PHI at the Contractor, or organized health care arrangement in which County participates, and the information received as a result of such disclosure is not further used or disclosed in a manner not permitted under the HIPAA Privacy Rule. iii. A disclosure of PHI where Contractor or County has a good faith belief that an unauthorized person to whom the disclosure was made would not reasonably have been able to retain such information. b. Except as provided in paragraph (a) of this definition, an acquisition, access, use, or disclosure of PHI in a manner not permitted under the HIPAA Privacy Rule is presumed to be a breach unless Contractor demonstrates that there is a low probability that the PHI has been compromised based on a risk assessment of at least the following factors: i. The nature and extent of the PHI involved, including the types of identifiers and the likelihood of re-identification; County of Orange 90 RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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County of Orange
Bid 017-201505-BV
ii. The unauthorized person who used the PHI or to whom the disclosure was made; iii. Whether the PHI was actually acquired or viewed; and iv. The extent to which the risk to the PHI has been mitigated. 3. “Data Aggregation” shall have the meaning given to such term under the HIPAA Privacy Rule in 45 CFR § 164.501. 4. “Designated Record Set” shall have the meaning given to such term under the HIPAA Privacy Rule in 45 CFR § 164.501. 5. “Disclosure” shall have the meaning given to such term under the HIPAA regulations in 45 CFR § 160.103. 6. “Health Care Operations” shall have the meaning given to such term under the HIPAA Privacy Rule in 45 CFR § 164.501. 7. “Individual” shall have the meaning given to such term under the HIPAA Privacy Rule in 45 CFR § 160.103 and shall include a person who qualifies as a personal representative in accordance with 45 CFR § 164.502(g). 8. “Physical Safeguards” are physical measures, policies, and procedures to protect CONTRACTOR’s electronic information systems and related buildings and equipment, from natural and environmental hazards, and unauthorized intrusion. 9. “The HIPAA Privacy Rule” shall mean the Standards for Privacy of Individually Identifiable Health Information at 45 CFR Part 160 and Part 164, Subparts A and E. 10. “Protected Health Information” or “PHI” shall have the meaning given to such term under the HIPAA regulations in 45 CFR § 160.103. 11. “Required by Law” shall have the meaning given to such term under the HIPAA Privacy Rule in 45 CFR § 164.103. 12. “Secretary” shall mean the Secretary of the Department of Health and Human Services or his or her designee. 13. “Security Incident” means attempted or successful unauthorized access, use, disclosure, modification, or destruction of information or interference with system operations in an information system. “Security incident” does not include trivial incidents that occur on a daily basis, such as scans, “pings”, or unsuccessful attempts to penetrate computer networks or servers maintained by Contractor. 14. “The HIPAA Security Rule” shall mean the Security Standards for the Protection of electronic PHI at 45 CFR Part 160, Part 162, and Part 164, Subparts A and C. 15. “Subcontractor” shall have the meaning given to such term under the HIPAA regulations in 45 CFR § 160.103. 16. “Technical safeguards” means the technology and the policy and procedures for its use that protect electronic PHI and control access to it. 17. “Unsecured PHI” or “PHI that is unsecured” means PHI that is not rendered unusable, unreadable, or indecipherable to unauthorized individuals through the use of a technology or methodology specified by the Secretary of Health and Human Services in the guidance issued on the HHS Web site. 18. “Use” shall have the meaning given to such term under the HIPAA regulations in 45 CFR § 160.103. C. OBLIGATIONS AND ACTIVITIES OF CONTRACTOR AS BUSINESS ASSOCIATE: 1. Contractor agrees not to use or further disclose PHI County discloses to Contractor other than as permitted or required by this Business Associate Contract or as required by law. 2. Contractor agrees to use appropriate safeguards, as provided for in this Business Associate Contract and the Contract, to prevent use or disclosure of PHI County discloses to Contractor or Contractor creates, receives, maintains, or transmits on behalf of County other than as provided for by this Business Associate Contract. 3. Contractor agrees to comply with the HIPAA Security Rule at Subpart C of 45 CFR Part 164 with respect to electronic PHI County discloses to Contractor or Contractor creates, receives, maintains, or transmits on behalf of County. 4. Contractor agrees to mitigate, to the extent practicable, any harmful effect that is known to Contractor of a Use or Disclosure of PHI by Contractor in violation of the requirements of this Business Associate Contract. 5. Contractor agrees to report to County immediately any Use or Disclosure of PHI not provided for by this Business Associate Contract of which Contractor becomes aware. Contractor must report Breaches of Unsecured PHI in accordance with Paragraph E below and as required by 45 CFR § 164.410. County of Orange 91 RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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Bid 017-201505-BV
6. Contractor agrees to ensure that any Subcontractors that create, receive, maintain, or transmit PHI on behalf of Contractor agree to the same restrictions and conditions that apply through this Business Associate Contract to Contractor with respect to such information. 7. Contractor agrees to provide access, within fifteen (15) calendar days of receipt of a written request by County, to PHI in a Designated Record Set, to County or, as directed by County, to an Individual in order to meet the requirements under 45 CFR § 164.524. 8. Contractor agrees to make any amendment(s) to PHI in a Designated Record Set that County directs or agrees to pursuant to 45 CFR § 164.526 at the request of County or an Individual, within thirty (30) calendar days of receipt of said request by County. Contractor agrees to notify County in writing no later than ten (10) calendar days after said amendment is completed. 9. Contractor agrees to make internal practices, books, and records, including policies and procedures, relating to the use and disclosure of PHI received from, or created or received by Contractor on behalf of, County available to County and the Secretary in a time and manner as determined by County or as designated by the Secretary for purposes of the Secretary determining County’s compliance with the HIPAA Privacy Rule. 10. Contractor agrees to document any Disclosures of PHI County discloses to Contractor or Contractor creates, receives, maintains, or transmits on behalf of County, and to make information related to such Disclosures available as would be required for County to respond to a request by an Individual for an accounting of Disclosures of PHI in accordance with 45 CFR § 164.528. 11. Contractor agrees to provide County or an Individual, as directed by County, in a time and manner to be determined by County, that information collected in accordance with the Contract, in order to permit County to respond to a request by an Individual for an accounting of Disclosures of PHI in accordance with 45 CFR § 164.528. 12. Contractor agrees that to the extent Contractor carries out County’s obligation under the HIPAA Privacy and/or Security rules Contractor will comply with the requirements of 45 CFR Part 164 that apply to County in the performance of such obligation. 13. Contractor shall work with County upon notification by Contractor to County of a Breach to properly determine if any Breach exclusions exist as defined in Subparagraph B.2.a above. D. SECURITY RULE 1. Contractor shall comply with the requirements of 45 CFR § 164.306 and establish and maintain appropriate Administrative, Physical and Technical Safeguards in accordance with 45 CFR § 164.308, § 164.310, § 164.312, and § 164.316 with respect to electronic PHI County discloses to Contractor or Contractor creates, receives, maintains, or transmits on behalf of County. Contractor shall follow generally accepted system security principles and the requirements of the HIPAA Security Rule pertaining to the security of electronic PHI. 2. Contractor shall ensure that any subcontractors that create, receive, maintain, or transmit electronic PHI on behalf of Contractor agree through a contract with Contractor to the same restrictions and requirements contained in this Paragraph D of this Business Associate Contract. 3. Contractor shall report to County immediately any Security Incident of which it becomes aware. Contractor shall report Breaches of Unsecured PHI in accordance with Paragraph E below and as required by 45 CFR § 164.410. E. BREACH DISCOVERY AND NOTIFICATION 1. Following the discovery of a Breach of Unsecured PHI , Contractor shall notify County of such Breach, however both Parties agree to a delay in the notification if so advised by a law enforcement official pursuant to 45 CFR § 164.412. a. A Breach shall be treated as discovered by Contractor as of the first day on which such Breach is known to Contractor or, by exercising reasonable diligence, would have been known to Contractor. b. Contractor shall be deemed to have knowledge of a Breach, if the Breach is known, or by exercising reasonable diligence would have known, to any person who is an employee, officer, or other agent of Contractor, as determined by federal common law of agency. 2. Contractor shall provide the notification of the Breach immediately to the County Privacy Officer at: Thea Bullock, County Privacy Officer 405 W. 5th Street County of Orange RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
Or Linda Le, Deputy County Privacy Officer 405 W. 5th Street 92 p. 95
County of Orange
Santa Ana, CA 92701 (714) 834-3154
[email protected] [email protected]
Bid 017-201505-BV
Santa Ana, CA 92701 (714) 834-4082
[email protected] [email protected]
a. Contractor’s notification may be oral, but shall be followed by written notification within 24 hours of the oral notification. 3. Contractor’s notification shall include, to the extent possible: a. The identification of each Individual whose Unsecured PHI has been, or is reasonably believed by Contractor to have been, accessed, acquired, used, or disclosed during the Breach; b. Any other information that County is required to include in the notification to Individual under 45 CFR §164.404 (c) at the time Contractor is required to notify County or promptly thereafter as this information becomes available, even after the regulatory sixty (60) day period set forth in 45 CFR § 164.410 (b) has elapsed, including: (1) A brief description of what happened, including the date of the Breach and the date of the discovery of the Breach, if known; (2) A description of the types of Unsecured PHI that were involved in the Breach (such as whether full name, social security number, date of birth, home address, account number, diagnosis, disability code, or other types of information were involved); (3) Any steps Individuals should take to protect themselves from potential harm resulting from the Breach; (4) A brief description of what Contractor is doing to investigate the Breach, to mitigate harm to Individuals, and to protect against any future Breaches; and (5) Contact procedures for Individuals to ask questions or learn additional information, which shall include a toll-free telephone number, an e-mail address, Web site, or postal address. 4. County may require Contractor to provide notice to the Individual as required in 45 CFR § 164.404, if it is reasonable to do so under the circumstances, at the sole discretion of the County. 5. In the event that Contractor is responsible for a Breach of Unsecured PHI in violation of the HIPAA Privacy Rule, Contractor shall have the burden of demonstrating that Contractor made all notifications to County consistent with this Paragraph E and as required by the Breach notification regulations, or, in the alternative, that the acquisition, access, use, or disclosure of PHI did not constitute a Breach. 6. Contractor shall maintain documentation of all required notifications of a Breach or its risk assessment under 45 CFR § 164.402 to demonstrate that a Breach did not occur. 7. Contractor shall provide to County all specific and pertinent information about the Breach, including the information listed in Section E.3.b.(1)-(5) above, if not yet provided, to permit County to meet its notification obligations under Subpart D of 45 CFR Part 164 as soon as practicable, but in no event later than fifteen (15) calendar days after Contractor’s initial report of the Breach to County pursuant to Subparagraph E.2 above. 8. Contractor shall continue to provide all additional pertinent information about the Breach to County as it may become available, in reporting increments of five (5) business days after the last report to County. Contractor shall also respond in good faith to any reasonable requests for further information, or follow-up information after report to County, when such request is made by County. 9. Contractor shall bear all expense or other costs associated with the Breach and shall reimburse County for all expenses County incurs in addressing the Breach and consequences thereof, including costs of investigation, notification, remediation, documentation or other costs associated with addressing the Breach. F.
PERMITTED USES AND DISCLOSURES BY CONTRACTOR 1. Contractor may use or further disclose PHI County discloses to Contractor as necessary to perform functions, activities, or services for, or on behalf of, County as specified in the Contract, provided that such use or Disclosure would not violate the HIPAA Privacy Rule if done by COUNTY except for the specific Uses and Disclosures set forth below. a. Contractor may use PHI County discloses to Contractor, if necessary, for the proper management and administration of Contractor. b. Contractor may disclose PHI County discloses to Contractor for the proper management and administration of Contractor or to carry out the legal responsibilities of Contractor, if: County of Orange 93 RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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County of Orange
Bid 017-201505-BV
i. The Disclosure is required by law; or ii. Contractor obtains reasonable assurances from the person to whom the PHI is disclosed that it will be held confidentially and used or further disclosed only as required by law or for the purposes for which it was disclosed to the person and the person immediately notifies Contractor of any instance of which it is aware in which the confidentiality of the information has been breached. c. Contractor may use or further disclose PHI County discloses to Contractor to provide Data Aggregation services relating to the Health Care Operations of Contractor. 2. Contractor may use PHI County discloses to Contractor, if necessary, to carry out legal responsibilities of Contractor. 3. Contractor may use and disclose PHI County discloses to Contractor consistent with the minimum necessary policies and procedures of County. 4. Contractor may use or disclose PHI County discloses to Contractor as required by law. G. OBLIGATIONS OF COUNTY 1. County shall notify Contractor of any limitation(s) in County’s notice of privacy practices in accordance with 45 CFR § 164.520, to the extent that such limitation may affect Contractor’s Use or Disclosure of PHI. 2. County shall notify Contractor of any changes in, or revocation of, the permission by an Individual to use or disclose his or her PHI, to the extent that such changes may affect Contractor’s Use or Disclosure of PHI. 3. County shall notify Contractor of any restriction to the Use or Disclosure of PHI that County has agreed to in accordance with 45 CFR § 164.522, to the extent that such restriction may affect Contractor’s Use or Disclosure of PHI. 4. County shall not request Contractor to use or disclose PHI in any manner that would not be permissible under the HIPAA Privacy Rule if done by County. H. BUSINESS ASSOCIATE TERMINATION 1. Upon County’s knowledge of a material breach or violation by Contractor of the requirements of this Business Associate Contract, County shall: a. Provide an opportunity for Contractor to cure the material breach or end the violation within thirty (30) business days; or b. Immediately terminate the Contract, if Contractor is unwilling or unable to cure the material breach or end the violation within (30) days, provided termination of the Contract is feasible. 2. Upon termination of the Contract, Contractor shall either destroy or return to County all PHI Contractor received from County or Contractor created, maintained, or received on behalf of County in conformity with the HIPAA Privacy Rule. a. This provision shall apply to all PHI that is in the possession of Subcontractors or agents of Contractor. b. Contractor shall retain no copies of the PHI. c. In the event that Contractor determines that returning or destroying the PHI is not feasible, Contractor shall provide to County notification of the conditions that make return or destruction infeasible. Upon determination by County that return or destruction of PHI is infeasible, Contractor shall extend the protections of this Business Associate Contract to such PHI and limit further Uses and Disclosures of such PHI to those purposes that make the return or destruction infeasible, for as long as Contractor maintains such PHI. 3. The obligations of this Business Associate Contract shall survive the termination of the Contract.
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County of Orange
Bid 017-201505-BV
EXHIBIT 1 County of Orange Child Support Enforcement Certifications Requirements A.
In the case of an individual Contractor, his/her name, date of birth, Social Security number, and residence address: Name: D.O.B: Social Security No: Residence Address:
B.
In the case of a Contractor doing business in a form other than as an individual, the name, date of birth, Social Security number, and residence address of each individual who owns an interest of 10 percent or more in the contracting entity: Name: D.O.B: Social Security No: Residence Address: Name: D.O.B: Social Security No: Residence Address:
(Additional sheets may be used if necessary) "I certify that Company name is in full compliance with all applicable federal and state reporting requirements regarding its employees and with all lawfully served Wage and Earnings Assignment Orders and Notices of Assignments and will continue to be in compliance throughout the term of the Contract with the County of Orange. I understand that failure to comply shall constitute a material breach of the contract and that failure to cure such breach within 60 calendar days of notice from the County shall constitute grounds for termination of the contract. Authorized Signature
County of Orange RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
Name
Title
Date
95 p. 98
County of Orange
Bid 017-201505-BV
EXHIBIT 2 EDD Independent Contractor Reporting Requirements Effective January 1, 2001, the County of Orange is required to file federal Form 1099-Misc for services received from a “service provider” to whom the County pays $600 or more or with whom the County enters into a contract for $600 or more within a single calendar year. The purpose of this reporting requirement is to increase child support collection by helping to locate parents who are delinquent in their child support obligations. The term “service provider” is defined in California Unemployment Insurance Code Section 1088.8, subparagraph B.2 as “an individual who is not an employee of the service recipient for California purposes and who received compensation or executes a contract for services performed for that service recipient within or without the state.” The term is further defined by the California Employment Development Department to refer specifically to independent Offerors. An independent contractor is defined as “an individual who is not an employee of the ... government entity for California purposes and who receives compensation or executes a contract for services performed for that...government entity either in or outside of California.” The reporting requirement does not apply to corporations, general partnerships, limited liability partnerships, and limited liability companies. Additional information on this reporting requirement can be found at the California Employment Development Department web site located at www.edd.ca.gov/txicr.htm. To comply with the reporting requirements, County procedures for contracting with independent Offerors mandate that the following information be completed and forwarded to the contracting agency/department immediately upon request: First name, middle initial and last name Social Security Number Address Start and expiration dates of contract Amount of contract
____________________________________________________________________________________ First Name Middle Initial Last Name SSN________________________________________________________________________________ Contract Number_____________________Dollar value of contract_____________________________ Start Date___________________________Expiration Date___________________________________
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County of Orange
Bid 017-201505-BV
EXHIBIT 3 COUNTY OF ORANGE SPONSORED HEALTH AND WELFARE (GROUP) BENEFIT PROGRAMS The County offers various Health and Welfare (Group) Benefit Programs and retirement plans to various groups of eligible active employees and retirees. This exhibit provides information on general eligibility definition, the group of employees eligible under each plan, and the actual plans offered.
Active Employees Eligibility
For Health and Welfare, eligible employees include: – Full-time, regular, limited term and probationary employees, and part-time employees who work a minimum of 20 hours per week. – Extra-help employees who work a minimum of 20 hours – Part-time employees or Extra-help employees who have been determined to be an ACA FTE and are in the stability period.
For Health and Welfare, eligible dependents include: – A lawful spouse, including same-sex spouse – Domestic Partners – Any unmarried child of the employee who is: Under 26 years of age Disabled Court awarded custody Survivor of peace officer/safety employee killed in line of duty. The County requires eligibility verification documentation (e.g., birth certificate, marriage certificate) must be submitted for any dependent added to an employee’s health plan within 60 days of the date of the event which made the employee or dependent eligible. In addition, an annual full-time student audit is conducted for dependents on the County Management and Attorney Dental plan.
Plans Offered
The County currently offers to all eligible active employees four (4) health plans, consisting of two (2) selffunded PPO plans (2 claims administrators – health and prescription claims) and two (2) California HMO plans (2 vendors). The number of health plans and plan designs may change from year to year depending on the outcome of labor negotiations. Judges and Peace Officers are not eligible to enroll under these medical plans. Exception: there are a few judges who qualified for retiree health in a prior County assignment. Rates are on a 3-tier basis: Employee Only; Employee w/1 Dependent and Employee w/2 or More Dependents. Approximately 15,113 active employees are covered in these plans. The plans are insured or administered by the following carriers/administrators: – Blue Shield of California – claims administrator for the self-funded PPO health plans (Wellwise Choice and Sharewell Choice) Sharewell Choice with different rates is the option offered to Extra-help employees who work a minimum of 20 hours or to Part-time employees or Extra-help employees who have been determined to be an ACA FTE and are in the stability period. – Catamaran Rx – administrator for the self-funded Pharmacy benefit for one (1) of the two (2) PPO plans (Wellwise Choice) – Cigna Choice (fully insured HMO) – Kaiser Choice (fully insured HMO) County of Orange RFP 017-201505-BV File Folder C001686
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County of Orange
Bid 017-201505-BV
The OC Healthy Steps program is a wellness program that offers a 5% bi-weekly premium incentive for each employee who completes all three steps: 1) Biometric Screening; 2) Health Risk Assessment; and 3) NonSmoking Attestation. Those who do not complete the Healthy Steps program during a designated period in the summer will have a 5% increase in their premium deduction the following January. Employees enrolled in the Sharewell Choice plan are not required to participate, and those hired after a specified date of a given year will automatically receive the lower premium deduction the following plan year. Other unusual circumstances may exist for individual employees (e.g., on a leave of absence during the designated period). The program is administered by a separate vendor who will submit files to the Selected Vendor for this Contract to determine employee bi-weekly payroll deduction.
A rebate program for employees enrolled in the Wellwise Choice plan. Eligibility for this annual rebate is as follows: – Employees who do not file health claims and do not fill prescriptions for themselves and their dependents during the previous year are eligible for the “no claims rebate” for that year. – Historical eligibility files for the plan year are compared with data files from Blue Shield of California and Catamaran Rx to determine who qualifies for the rebates. All Wellwise Choice participants receive a letter after the plan year regarding their rebate eligibility. Participants log on to the Blue Shield of California web site and a payment is issued on the employee’s paycheck.
One self-funded Dental Plan (silent PPO) offered to a select group of employees and their eligible dependents: Management, Elected Officials, Attorneys and Court Administrative Officials (Judges are excluded). The County pays 100% of the cost of this plan. Employees have the option to opt-out of dental coverage either at initial enrollment, during open enrollment, or if they become eligible at any point during the plan year. Eligible part-time participants share in the cost of the Dental Plan. This plan is administered by Blue Shield of California.
Basic Life insurance offered to eligible employee classifications who are Management, Elected Officials, Attorneys, Court Administrative Officials, Craft & Plant Unit Employees, and Judges. The premium for this plan is 100% paid for the County. This coverage is insured by The Hartford. –
In general, Management and Attorney Groups receive $100,000 basic life insurance whereas Executive Managers, Elected Officials (including Judges) receive $125,000 basic life insurance coverage, and Craft & Plant receives $10,000. Coverage is a flat dollar amount, not tied to salary.
Additional Life Insurance offered to employees who are eligible for Basic Life. This is a voluntary plan; employee premiums are on an after-tax basis. This coverage is insured by The Hartford. Evidence of Insurability is required with certain elections. – Multiple of fixed basic life amounts (1X, 2X, 3X).
Extra Additional Life Insurance offered to employees who are eligible for Basic Life on an after-tax basis. This coverage is insured by The Hartford. – Multiples of $50,000 up to $250,000
Dependent Life offered to eligible dependents of the above employees. This plan is offered on a voluntary, after-tax basis and insured by The Hartford. – All employees eligible for Basic Life, except Craft and Plant: Spouse at $20,000; child at $5,000. Craft and Plant employees: Spouse at $5,000; Child at $1,000.
Accidental Death and Dismemberment Insurance (AD&D) that includes the benefits listed below. coverage is insured by The Hartford. County of Orange RFP 017-201505-BV File Folder C001686
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County of Orange
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Bid 017-201505-BV
Basic AD&D for all eligible employees, paid for 100% by the County. The benefit schedule mirrors the Basic Life benefit schedule except additional classes such as the Peace Officers and Probation Units are eligible for some basic AD&D amounts. Voluntary AD&D, paid for 100% by employees. Coverage is available for employee only or employee and family, except Peace Officers. Amounts available are $20,000, $40,000, $60,000, $80,000, $100,000, $150,000 and $200,000. Craft and Plant employees are eligible for separate benefit amounts of $10,000, $20,000, $30,000, $40,000 and $50,000.
Short Term Disability (STD), a.k.a. Salary Continuance plan offered to Executive, Administrative and Law Enforcement Management, Attorneys, Craft and Plant Engineers and Court Administrative Officials (Judges and Elected Officials excluded). This is a self-funded plan paid for 100% by the County. – Claims are administered by Standard Insurance. – Plan pays 60% of salary with no monthly benefit maximum limit except for Attorneys at $7,200. Benefits are paid up to 12 months. – After 192 hours of Annual Leave or sick leave days (depending on class of employees) are exhausted, benefits are provided from the first day for accident and 8th day for illness. – For employees on STD, the County pays for their health and dental as if employee was on payroll; employee pays his share of health and voluntary Life and AD&D, if applicable through the Direct Bill process. – Those receive Catastrophic Leave Donation hours must first exhaust those donations before Salary Continuance benefit becomes effective.
Long term disability (LTD) plans offered to certain eligible employee classifications who are Management, Elected Officials, Attorneys, Craft and Plant Unit Employees, and Court Administrative Officials (Judges and Elected Officials excluded). The County pays for 100% of the premium for this coverage. – This plan is fully insured by Standard Insurance. – Benefits vary by employee classification. – Employees on LTD pay for 100% of all health and welfare benefits, except County pays for the LTD premium and basic and voluntary Life Insurance amounts when eligible for a waiver of premium. – Benefits are:
60% of eligible earnings up to $2,000 of monthly benefit for Craft and Plant Unit employees.
60% of eligible earnings up to $7,200 of monthly benefits for Attorneys
60% of eligible earnings for all other eligible classifications.
Health Care Reimbursement Account (HCRA) (Section 125 Plan) – Available as a stand-alone plan and/or through Optional Benefit Plan (described below). The plan is available to all employees who are eligible to participate in the County sponsored health plans. – Employees who are eligible under the Optional Benefit Plan (OBP) described below can fund all or part of their HCRA contributions with their OBP dollars. – Dependent Care Reimbursement Account (DCRA) (Section 125 Plan) – All employees who work 20 hours or more per week are eligible. Optional Benefit Plan (OBP) – this benefit is provided to Judges, Elected Officials, Executive and Administrative Management and Attorneys. – The County provides an annual benefit amount that these employees can use for various purposes. County of Orange RFP 017-201505-BV File Folder C001686
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Annual benefits amounts are: Judges, Elected Officials and Executive Management – $4,500; Administrative Management – $3,500; Attorneys $2,000 (amounts are reduced by half for eligible parttime employees) Employees can elect once a year during open enrollment to allocate their benefit amount to one or a combination of the following:
Lump sum
457 Defined Contribution plan (option not available to Judges)
HCRA (Section 125) – see above
Payroll credit for AD&D premiums
Judges’ Medical Reimbursement Plan – this is a plan that reimburses eligible Judges who are covered under the CALPERS medical plans, for their CALPERS medical deductibles and co-payments. This program was closed to new participants as of December 10, 2013. – No limit on reimbursement amount – Claims filing date is March 31st for prior plan year claims (same deadline as HCRA/DCRA)
Judges’ Premium Reimbursement Plan – this is a plan that reimburses eligible Judges who are covered under the CALPERS medical plans, for their CALPERS premiums. This program was closed to new participants as of December 10, 2013.
An Employee Assistance Plan (EAP) program offered to all employees through Aetna Resources for Living. – Plan is 100% paid for by the County
Cash Lump Sum benefit – eligible employees who terminate their employment or retire from the County and are not eligible to receive the monthly Retiree Health Grant amount (see description under Retiree section) receive a cash benefit equal to the final average hourly compensation times one (1) percent, times their Qualifying hours; certain frozen dates apply and vary by bargaining unit. – The average hourly rate will be calculated based on the employee’s salary over the paid 6,240 eligible work hours preceding termination or frozen date (whichever applies). – Qualifying hours are determined based on the number of regular hours worked, excluding overtime, while in an eligible classification. One full year of credited service is the equivalent of 2,080 hours (hours are frozen).
Extra Help Retirement Plan – Defined Benefit Plan for part-time (less than half time) and extra help employees (not covered by Orange County Employee Retirement Office). – Plan is closed to new hires, only administrative requirement is customer service referral back to County. – A separate Defined Contribution Plan is now available to extra help employees or employees working less than part-time.
Health Reimbursement Arrangement - an employer-sponsored tax-advantaged savings plan. County and employee contributions are deposited into an individual Defined Contribution plan. The balance becomes available upon separation/retirement from the County and may be withdrawn from the account for reimbursement of eligible medical expenses on a tax-free basis. Currently only Peace Officers and Law Enforcement Managers are enrolled in this program; however, other bargaining units may elect this option at a later date.
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Retirees Eligibility
For the retiree health plans (e.g., PPO, HMOs, and Medicare Advantage plans), all County retirees and surviving spouses who are receiving a monthly pension check from the Orange County Retirement Systems (OCERS) are eligible to enroll under these plans. Currently, the Retiree Health Grant (Grant) is limited to certain bargaining units who meet the minimum eligibility requirements. County retirees receiving an OCERS pension check may participate in the County’s retiree health plans even when they are not Grant eligible, e.g. Eligibility Workers (AFSCME) so long as they maintained continuous County health plan coverage at the time of retirement (may elect to defer this date). –
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Each retiree must enroll in a health plan within 30 days from retirement (activating their OCERS pension. Until pension is established, Contractor must provide a Direct Bill arrangement to bill the retiree for the difference in retiree health plan premium, less any applicable Grant amount. Once a retiree or a surviving spouse terminates enrollment in any of the plans, he/she is not allowed to enroll back into the plan. The only exception is for employees who are eligible to receive retirement pension but elect to defer until a later date (deferred retiree) – these employees may have a break in County sponsored health plan coverage between their termination date and the date they activate their retirement pension. Deferred retirees have 30 days after they activate their retirement to enroll in a County sponsored retiree health plan.
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Retirees and surviving spouses do not have to be eligible for a Grant (as described below) to enroll in a health plan, as long as they are receiving a monthly pension check from OCERS. Surviving dependents may also be eligible.
For the Retiree Health Program (as described below), retirees and surviving spouses are eligible for the Retiree Health Grant (Grant) if they meet the following requirements: – Retiree must have a minimum of 10 years of service from the County, unless granted a disability retirement. – For service-connected disability retirement, no minimum years of service is required. However, if retired from a non-service connected disability, a minimum of 5 years of service is required. – An eligible surviving spouse of a retiree is eligible for a 50% of the retiree’s Grant. – Retirees and surviving spouses must be receiving a monthly pension check from OCERS to be eligible to receive a Grant.
Refer to Exhibit 5 “Retiree – Health & Health Grant Eligibility Matrix” for detailed information.
The County requires eligibility verification documentation (e.g., birth certificate, marriage certificate) must be submitted for any dependent added to an employee’s health plan within 60 days of the date of the event which made the employee or dependent eligible.
Plans Offered The County offers the following benefit programs:
Ten (10) health plans, including two (2) self-funded PPOs, three (3) HMOs, three (3) Medicare Advantage HMO plans and two (2) Medicare Advantage PPO plans
A rebate program for retirees enrolled in the Wellwise Retiree plan. Eligibility for this annual rebate is as follows:
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Bid 017-201505-BV
Retirees who do not file health claims and do not fill prescriptions for themselves and their dependents during the previous year are eligible for the “no claims rebate” for that year. Those who filed health claims and filled prescriptions during a given year but are non-smokers are eligible for the non-smoker rebate for that year. Historical eligibility files for the plan year are compared with data files from Blue Shield of California and Catamaran Rx to determine who qualifies for the rebates. All Wellwise Retiree participants receive a letter after the plan year regarding their rebate eligibility. Participants log on to the Blue Shield of California web site or send back a written affidavit, and a payment is issued by Blue Shield directly to the retiree.
A Retiree Medical Plan that provides eligible retirees and surviving spouses a Retiree Health Grant that is applied as a credit towards the cost of County retiree health premium and/or Medicare Part B premiums. Contractor must be able to calculate and report on imputed income for Domestic Partners.
Health Reimbursement Arrangement (HRA) for specified group(s); grandfathered employees of this group may be eligible for both the HRA and Grant or HRA and 1% cash lump sum benefit.
Eligible retired employees may also receive a pension from the Orange County Employees Retirement System (OCERS).
There are approximately 5,843 retirees currently participating in these plans. The plans are provided or administered by the following carriers/administrators: – Blue Shield of California – claims administrator for the self-funded PPO plans, Wellwise Retiree and Sharewell Retiree – Catamaran Rx - administrator for the self-funded Pharmacy benefit plan for Wellwise Retiree PPO plan – Anthem Blue Cross (non-Medicare HMO, Medicare Advantage HMO and PPOs, and Mixed Enrollment options) – Kaiser (1 fully insured HMO and 1 fully insured Kaiser Senior Advantage Plan) – SCAN HMO (Medicare Advantage Plan)
A Retiree Health Program that provides the following benefits: – For retirees and surviving spouses eligible to receive a Retiree Health Grant, this program provides a monthly benefit (grant) that is applied as a credit to reduce the monthly cost of the County Sponsored health plan and/or to offset the cost of Medicare Parts A and/or B premiums. – The 2015 monthly base Grant amount for an eligible retiree is $21.13 per year of service, to maximum of $528.25 for those who have 25 or more years of service. The amount will be adjusted each year by the average increase or decrease in County health plan premiums, not to exceed three (3) to five (5) percent per year (depending on bargaining unit); Grant subject to further adjustments based on bargaining unit, retirement date, age at retirement and eligibility for Medicare. Once a retiree becomes Medicare Parts A and B eligible, the Grant is reduced by 50%. (If retiree is not eligible for Medicare Part A at no cost and is only eligible for Medicare Part B, there is no Grant reduction. Note: for those who retired prior to this provision being implemented during 2006 and 2007, there is no Grant reduction – dates vary by bargaining unit). Survivor grant is calculated at 50% of deceased retiree’s grant and can subsequently be reduced if the survivor becomes Medicare eligible. Grants for RMR’s are combined, but subject to all adjustment rules above. For employees retiring after the implementation of this provision (date varies by bargaining unit), there is a 7.5% reduction to the Grant for each year pre-60 years of age upon retirement; and a 7.5% increase to the Grant for each year worked after age 60 up to age 70. The 7.5% adjustment does not apply to Peace Officers (or those coded as Safety). Program has a unique setup as it relates to disability retirements.
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Bid 017-201505-BV
There are exceptions to Grant eligibility: AFSCME workers retiring on or after September 30, 2005 are no longer Grant eligible. Peace Officers hired on/after October 12, 2007 are not Grant eligible. Law Enforcement Managers hired on/after June 19, 2009 are not Grant eligible. County attorneys are expected to end participant in the Grant program in the first pay period in July 2016. In no case shall the grant amount exceed the actual cost of the County sponsored health plan and/or Medicare Part B premium. For those retirees who are age 65 and older and do not enroll in a County retiree health plan, the Grant may be used to provide a credit to reimburse Medicare Part B monthly premiums. If an employee retires prior to age 65 and does not enroll in a County retiree health plan, the Grant is forfeited. Employees who terminate their employment or retire from the County and are not eligible to receive the monthly Grant amount, may be eligible to receive a cash benefit equal to the final average hourly compensation times one (1) percent, times their Qualifying hours. The average hourly rate will be calculated based on the employee’s salary over the paid 6,240 eligible work hours preceding the date their grants were frozen. These dates vary by bargaining unit. Qualifying hours are determined based on the number of regular hours worked, excluding overtime, while in an eligible classification. One full year of credited service is the equivalent of 2,080 hours. Maximum grant adjustment amount each year is between 3% and 5% depending on bargaining unit upon retirement. Special coordination with OCERS is required to accurately load eligible buyback amounts as it relates to the Retiree Health Grant. This process includes verifying that the hours provided are correct.
Additional General Information
Active employee deductions for the cost of County sponsored health and welfare benefits are currently through the County’s CAPS+ system. Retiree and surviving spouse deductions are through OCERS.
All County employees, retirees and eligible dependents who are enrolled under the County sponsored health plans or dental plan are eligible for continuation of benefits under COBRA. The Contractor is expected to provide COBRA administration services.
All County employees who become disabled, are on Family Medical Leave or other types of leave of absence and continue to qualify for health and welfare benefits will be direct billed by the Contractor for premiums that these employees have to pay for.
Many County employees receive benefits through their bargaining unit/union: – County employees classified as “Peace Officers” or “Law Enforcement Managers” have their health plan through their bargaining unit. The bargaining unit will provide enrollment information to the Contractor. Based on this information, the Contractor will calculate payroll deductions and pass the information back to the County through payroll feed. There are six health plans offered with three rate tiers for each plan. – County employees in the “Craft and Plant” unit are provided Life, AD&D, Short Term Disability and Long Term disability benefits through the County. They are provided vision and dental benefits through their union. – All other general employees (non-management, non-attorney) are provided Life, AD&D, Short Term Disability/Long Term Disability, vision and dental benefits through their unions. Peace Officers and Probation Safety are provided are provided Life, Short Term Disability/Long Term Disability, vision and dental benefits through their unions; AD&D is provided by the County. – These benefits are not included in the Contractor’s services, except that the Contractor needs to know that these plans are available to be able to refer employees to the appropriate phone number to call.
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County employees are eligible for unemployment benefits. This program is currently self-funded with claims administration performed by Equifax. The Contractor is not expected to perform any administration services related to this program but must know that the program exists, establish a web link from its web site, and where to refer employees who call the Contractor about this benefit.
The County currently has the following plans: 1.62 457 plan and 1.62 401(a) plan for employees in the “1.62@65” OCERS pension formula, 401(a) for specific units (mostly Executive level), 3121 Extra Help Defined Contribution, 1.62 Defined Contribution, and 457 Defined Contribution plans that are separately administered by the County’s Defined Contribution vendor, Empower Retirement. The Contractor is not expected to include these plans as part of its services, except establish a web link from its web site and know where to direct the employees for plan information.
The County and its employees do not pay into FICA nor do they pay into SDI.
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EXHIBIT 4 ACTIVE EMPLOYEE ELIGIBILITY MATRIX (To print and view this exhibit, please use the landscape and legal paper settings)
Group
Bargaining Unit
Attorneys
Status
Health (inc. Wellness Credit
FT
Vol AD&D
S T D
L T D
H C R A
Extra Add’l Dep Basic Life Life AD&D Attorneys
Dental
Basic Life
Add’l Life
PT
FT
PT
D C O R B A P
AT
Attorneys at Superior Court
AX
Judge’s Medical Premium Reimb Plan
Judge’s PERS Claims Reimb Plan
1% Retiree Health Contribution Plan
Retiree Health 1% Cash Lump Sum Benefit (6)
Craft & Plant Unit Craft & Plant Unit
FT
PT
CP
Elected Officials Elected Officials
E1
FT
Orange County Employee Association (OCEA)
Basic Employees
Court Employees
CF, CL, CS, CY, GE, HP, PM, PS, SL, SM, SO
CC, CI, GC, SC, SG, SS
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FT
PT
FT
PT
(1)
(1 & 5)
105
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County of Orange
Group
Bargaining Unit
Status
JS, JX (4)
FT
Judges
Health (inc. Wellness Credit
Dental
Basic Life
Add’l Life
Extra Add’l Life
Dep Life Judges
Bid 017-201505-BV
Basic AD&D
Vol AD& D
H S L C T T R D D A
D C R OB A P
Judge’s Medical Premium Reimb Plan
Judge’s PERS Claims Reimb Plan
1% Retiree Health Contribution Plan
Retiree Health 1% Cash Lump Sum Benefit (6) (3)
Management Court Executive Mgt.
E5, E6, E7
Executive Mgt.
E0, E2, E3, E9
Admin. Mgt. Law Enforcement Mgt.
Court Mgt.
Probation Admin. Mgt. Probation Executive Mgt.
County of Orange RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
MA, MB, MR, MX, MY, ST
FT
PT
FT
PT
FT
PT
FT
(7)
PT
(7)
FT
PT
FT
PT
FT
PT
ML
MS, CX
MP
E4, E8
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County of Orange
Group
Bargaining Unit
Peace Officers
Status
Health (inc. Wellness Credit
FT
(7)
PT
(7)
Dental
PO, SP
Basic Life
Add’l Life
Extra Add’l Dep Basic Life Life AD&D Peace Officers (2)
Bid 017-201505-BV
Vol AD&D
1% Retiree Health Contribution Plan
Retiree Health 1% Cash Lump Sum Benefit (6)
H S L C T T R D D A
Judge’s D Medical C O Premium R B Reimb A P Plan
Judge’s PERS Claims Reimb Plan
Eligibility Workers Unit Eligibility Workers Unit
FT
PT
EW
Special Districts Law Library (Non-Mgt) Cemetery District (Non-Mgt)
FT
PT
FT
PT
FT
PT
ZL
ZC
Operations & Service Maintenance Ops. & Service Maintenance
OS
Footnotes: (1) Gang & Posse, Special Officers and Coroners. Full-time Probation Unit (Barg Unit=PM, PS). (2) Air Support, Air Support Alternates, Bomb Squad, Bomb Squad Alternates and Sheriffs. (3) Only if prior County service before becoming a Judge. (4) JX – Active Judges that are also eligible for Retiree Benefits – Retiree group code is assigned. (5) Part-time Probation Unit (Barg Unit=PM & PS) including Gang & Posse. (6) Eligibility Workers who were termed prior to 09/30/2005 are still eligible for this Lump Sum payout. Most other groups (non-Eligibility Workers) are eligible if hired prior to 06/23/06 or 12/21/06 (7) ML and PO are covered under and elections taken by AOCDS Health Plans. Only health plan deductions are administered by Contractor. Groups do not receive Wellness Credit..
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EXHIBIT 5 RETIREE – HEALTH & HEALTH GRANT ELIGIBILITY MATRIX
Status
Age Requirement (when separated)
Less than 50
Retiree – Health & Health Grant Eligibility Matrix Lapse in Separated with OCERS Health Health Pension Eligible Coverage Coverage Activated to Defer Permitted (5) (4) (3) Retirement Y N(7) Y Y N/A N N Y N Y N Y Y Less than 10 years N N Y N Service Requirement (RMIP + eligible buy back) (6)
50+ 10+ years (6)
Eligible for Health (2)
Health Grant Eligible
Y N Y N
N(7) N N N
Y
Y
Y
Y
Y
Y
N
N
Y
N
N
N
Y
Y
Y
Y
Y
Y
N
N
Y
N
N
N
Y
Y
Y
Y
Y
Y
N
N
Y
N
N
N
Grant Calculation
N/A N/A N/A N/A See Grant Calculation N/A
Normal Retiree N/A
N/A
20+ years (Safety Unit Only)
30+ years
Retiree – Service Disability
Retiree – Non Service Disability
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N/A
N/A
N/A
Y
Y
Y
Y
Y
N/A
5+ years (6)
N/A
Y
Y
Y
Y
Y
See Grant Calculation N/A See Grant Calculation N/A See Grant Calculation (Automatically given Service = 10 years or actual, whichever is greater) See Grant Calculation
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Status
Survivor – Service Disability Survivor – NonService Disability
Age Requirement (when separated)
Service Requirement (RMIP + eligible buy back) (6)
N/A
N/A
Retiree – Health & Health Grant Eligibility Matrix Lapse in Separated with OCERS Health Health Pension Eligible Coverage Coverage Activated to Defer Permitted (5) (4) (3) Death of an Active Employee Y
Y
Y
Y
Eligible for Health (2)
Health Grant Eligible
Y(1)
Y
Grant Calculation
50% of Grant Calculation N/A
5+ years (6)
Y
Y Survivor Retiree
Bid 017-201505-BV
N/A
N/A
Y Death of a Retiree N
Y
Y
Y(1)
Y
Y
N
Y(1)
Y
50% of Grant Calculation N/A
Y N N(8) N Y(1) N Grant Calculation: Annual Grant Allowance x RMIP Service Hrs/2,080 (rounded down to the next whole year -including eligible non-extra help buy backs) = Annual Grant. (This calculation is only for retirees who retired with Grant prior to adoption date for Retiree Grant Restructuring in 2006.) Maximum Service years per person is 25 years. Footnotes: (1) Surviving Child(ren) – must be eligible to receive an OCERS Pension check in order to be eligible for health coverage. Exception: OCERS dependent age requirements (age 18/22) is inconsistent with plan age requirements. Surviving child will receive Direct Bill for coverage once OCERS check ends until the ageout of plan eligibility. Incapacitated children not eligible for pension check but eligible for health plan can remain on the plan as long as they remain incapacitated. (2) Must enroll in Health within 30 days of activating OCERS pension check. (3) If yes, Health effective date is 1st of the month following 30 days from the notification from OCERS that the pension was activated. Pre-existing conditions will apply for the PPO plans. (4) If not OCERS pension eligible, Retirees/survivors are not eligible for a Health or Health Grant. (5) These rules apply to deferrals after 2003. Pre-2003 deferrals are being governed by OCERS. (6) Eligible buy backs are applied to service first, then up to 1 year Extra Help buy back is permitted, if the 1 year qualifies the employee for minimum eligibility. (7) Frozen Group - these employees were not age 50 when they deferred, but were age 50 and had 10 years as of 8/1/1993, when the Grant program was established. These employees are eligible for Health coverage and the Health Grant. Currently, these individuals self-identify and The County contacts OCERS to verify age 50 and years of service as of 8/1/93. A list of these deferrals is not available. (8) Surviving spouses that are not eligible to receive a pension check, but are eligible for health. (Direct Billing will be required).
The Retiree Health Program provides the following benefits: – For retirees and surviving spouses eligible to receive a Retiree Health Grant, this program provides a monthly benefit (grant) that is applied as a credit to reduce the monthly cost of the County Sponsored health plan and/or to offset the cost of Medicare Parts A and/or B premiums. – The 2015 monthly base Grant amount for an eligible retiree is $21.13 per year of service, to maximum of $528.25 for those who have 25 or more years of service. The amount will be adjusted each year by the average increase or decrease in County health plan premiums, not to exceed three (3) to five (5) percent per year (depending on bargaining unit); Grant subject to further adjustments based on bargaining unit, retirement date, age at retirement and eligibility for Medicare. County of Orange RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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Once a retiree becomes Medicare Parts A and B eligible, the Grant is reduced by 50%. (If retiree is not eligible for Medicare Part A at no cost and is only eligible for Medicare Part B, there is no Grant reduction. Note: for those who retired prior to this provision being implemented during 2006 and 2007, there is no Grant reduction – dates vary by bargaining unit). Survivor grant is calculated at 50% of deceased retiree’s grant and can subsequently be reduced if the survivor becomes Medicare eligible. Grants for RMR’s are combined, but subject to all adjustment rules above. For employees retiring after the implementation of this provision (date varies by bargaining unit), there is a 7.5% reduction to the Grant for each year pre-60 years of age upon retirement; and a 7.5% increase to the Grant for each year worked after age 60 up to age 70. The 7.5% adjustment does not apply to Peace Officers (or those coded as Safety). Program has a unique setup as it relates to disability retirements.
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EXHIBIT 6 Below is the County current files type and format transfer between vendors From County to Offeror - bi-weekly transmission Indicative Data DPOL ( all valid Deduction Policy Codes) GRADE (all valid Grades) MGMT-GRADE (Management valid grades) REPUNITS (all valid Rep-Units) STTL (all valid Sub-Titles) TITLE (all valid Titles) FSA Actuals (from payroll) PO Health File from Brown Insurance (including HCRA & DCRA, changes only) Deduction Detail Bi-weekly Missed Deductions Over 30 Day Report
Format EBSCIDC (IBM mainframe format) Text (ASCII fixed format) Text (ASCII fixed format) Text (ASCII fixed format) Text (ASCII fixed format) Text (ASCII fixed format) Text (ASCII fixed format) Text (ASCII fixed format)
Text (ASCII fixed format) Text (ASCII fixed format)
From Offeror to County - bi-weekly transmission MISC 1PAY 1DED EADJ (Imputed Income, including Domestic Partner)
Text (ASCII fixed format) Text (ASCII fixed format) Text (ASCII fixed format) Text (ASCII fixed format)
From Offeror to County - bi-weekly Edit Reports Indicative Data File Edits Detail Indicative Data File Edits Summary Indicative Data File Edits Summary
Excel Excel Word
From Offeror to County Missing Address Adjustments OCERS Intent to Retire Edits Active Census File Retiree Census File FSA Quarterly Audit
Excel Excel Excel Excel Excel Excel
Other files involving Offeror OCERS to Offeror Intent to Retire - Twice Monthly Offeror to OCERS Medical Retiree Interface - Monthly Offeror to OCERS Medical Retiree Adjustment file Monthly
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Text (ASCII fixed format) Text (ASCII fixed format) Excel
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Health Vendor Interfaces - weekly unless otherwise noted. Anthem Blue Cross - eligibility ANSI 834 Blue Shield of California - eligibility ANSI 834 Cigna HMO - eligibility ANSI 834 Catamaran Rx No files currently being sent Kaiser - eligibility ANSI 834 Kaiser to Offeror - KPSA/CMS enrollment discrepancies Excel SCAN HMO - eligibility ANSI 834 Annual W-2 Box 12 – Offeror to County
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Text (ASCII fixed format)
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EXHIBIT 7 ELIGIBILITY DEFINITIONS AND REQUIRED DOCUMENTATION Dependents Spouse
Eligibility Definition A member of the opposite sex or same sex to whom you are legally married.
Documentation Required Photocopy of marriage certificate AND if married longer than 6 months A copy of the front page of the subscriber’s most recent federal tax return that includes this spouse (you may black out all financial information).
Domestic Partner
A Domestic Partner must be a person of the same sex or opposite sex if one or both persons are over the age of sixty-two (62) and meet the eligibility criteria under Title II of Social Security Act as defined in 42 U.S.C. section 402 (a) for old age insurance benefits of Title XVI of the Social Security Act as defined in 42 U.S.C. section 1381 for aged individuals. Domestic Partner must be at least 18 years of age. Note: You are not eligible to enroll as a Domestic Partner if either you or the subscriber 1) has previously filed a Declaration of Domestic Partnership with the Secretary of State pursuant to Division 2.5 of the Family code that has not been terminated under Section 299 of the Family Code; or 2) is currently legally married to another person; or have any other Domestic Partner, spouse or spouse equivalent of the same or opposite sex.
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Note: if you do not have joint tax documents, you may provide documents showing current joint debt such as a joint bank account, a joint loan, any billings in both names at the same address. For domestic partnership – proof that subscriber is registered as a Domestic Partner as California requires [Declaration of Domestic Partnership filed with Secretary of State (or similar registry from other state)] or a notarized affidavit, signed jointly with subscriber, stating domestic partnership relationship, shared permanent residency, and that subscriber and Domestic Partner are not blood relatives, AND if union is longer than 6 months AND EITHER (1) or (2) from the options below: 1. Proof of financial interdependence by providing two (2) of the following: Common ownership of real property or a common leasehold interest, common ownership of motor vehicle, Joint Bank or Credit Account, Designated as beneficiary for Life Insurance or Retirement Benefits or under subscriber’s Last Will and Testament, Power of Attorney, etc. OR 2. Copy of the top half of the State Tax Return that includes this person (you may black-out all financial information).
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Dependents Child(ren)
Eligibility Definition For Health Coverage Children under age 26 including step children, foster children, children placed for adoption, legally adopted children, and children of domestic partners. Income may be imputed for children of domestic partners if you cannot claim them as your dependent. The term “children” shall not include any legally married spouse or domestic partner or children of your dependent child, i.e. you may not enroll your dependent’s children (your grandchildren) or spouse.
Child (Student)
Incapacitated children age 26 and over that are dependent upon the participant for support and were incapacitated prior to their 26th birthday. See details below under ‘Dependent Children with Disabilities’ For Dental Coverage (if available): Unmarried children under age 19 including step children, foster children, children placed for adoption, legally adopted children, and children of Domestic Partners, that are legally dependent upon subscriber for support and reside in service area, unless court ordered. Unmarried Children who are full-time students over the age of 19 through 25, for dental plan, are fully registered in an accredited college or secondary school in or outside coverage area and must be dependent on you for financial support to continue to be covered. Full Time Student is considered a minimum of 12 Units.
Bid 017-201505-BV
Documentation Required For Natural Child(ren) – Photocopy of child’s birth certificate showing subscriber’s name. For Step Child(ren) – Photocopy of child’s birth certificate showing subscriber’s spouse/Domestic Partner’s name; and a copy of marriage certificate showing the subscriber and parent’s name. For Domestic Partner child, include proof that subscriber is registered as a Domestic Partner as the state requires, showing the subscriber and parent’s name. For Legal Guardian, Adoption, Grandchild(ren) or Foster Child(ren) – Photocopy of Affidavits of Dependency, Final Court Order with presiding judge’s signature and seal or Adoption Final Decree with presiding judge’s signature and seal.
If you are adding a Child to Dental Coverage for the first time, you need to provide: Documentation as noted for the “Child” dependent type: if Natural Child(ren) – Photocopy of child’s birth certificate showing subscriber’s name. If Step Child(ren) – Photocopy of child’s birth certificate showing subscriber’s spouse/Domestic Partner’s name; and a copy of marriage certificate showing the subscriber and parent’s name. For Domestic Partner child, include proof that subscriber is registered as a Domestic Partner as the state requires, showing the subscriber and parent’s name; OR If Legal Guardian, Adoption, Grandchild(ren) or Foster Child(ren) – Photocopy of Affidavits of Dependency, Final Court Order with presiding judge’s signature and seal or Adoption Final Decree with presiding judge’s signature and seal. For a Child over the age of 19 through 25 on Dental Coverage, you must provide annually: Documentation of full-time student status, such as any one of the following: transcript, roster, bill from school, copy of cashed check payable to school for upcoming semester, any documentation from school indicating that student is enrolled or expected to be at school in upcoming semester, Certification Form for Full-time Student Status. Documentation should include School name and show total units being taken.
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County of Orange
Dependents Dependent Children with Disabilities
Eligibility Definition For Health Coverage Incapacitated children of any age who are dependent on the participant for support and were incapacitated prior to their 26th birthday. The child did not have to be covered by a County of Orange health plan at the point they became incapacitated if the event was prior to their 26th birthday. For Dental Coverage (if available) Unmarried, incapacitated children of any age who are dependent on the participant for support and were incapacitated prior to their 19th birthday. The child did not have to be covered by a County of Orange health plan at the point they became incapacitated if the event was prior to their 19th birthday.
Bid 017-201505-BV
Documentation Required Documentation as noted for the “Child” dependent type: if Natural Child(ren) – Photocopy of child’s birth certificate showing subscriber’s name. if Step Child(ren) – Photocopy of child’s birth certificate showing subscriber’s spouse/Domestic Partner’s name; and a copy of marriage certificate showing the subscriber and parent’s name. For Domestic Partner child, include proof that subscriber is registered as a Domestic Partner as the state requires, showing the subscriber and parent’s name; or if Legal Guardian, Adoption, Grandchild(ren) or Foster Child(ren) – Photocopy of Affidavits of Dependency, Final Court Order with presiding judge’s signature and seal or Adoption Final Decree with presiding judge’s signature and seal. AND A copy of the front page of the subscriber’s most recent federal tax return that includes this child (you may black out financial information), AND If a Social Security disability award has been awarded, or is currently pending, please include this information in the documentation submitted. Please note that this eligibility verification is only verifying the child’s eligibility as a dependent. Your health plan determines the disability status of the child.
Copies of the above documentation can typically be obtained via these websites: www.vitalrec.com www.studentclearinghouse.org
County of Orange RFP 017-201505-BV File Folder C001686 7/22/2015 12:24 PM
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County of Orange
Question and Answers for Bid #017-201505-BV - Benefits Administration Outsourcing Services
Bid 017-201505-BV
5
Overall Bid Questions There are no questions associated with this bid. Question Deadline: Aug 4, 2015 4:00:00 PM PDT
6 7/22/2015 12:24 PM
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