ATTACHMENT 1

Lake County rfp Worksheet

General Information

1. Provide the following information about your company:

Company Name
Primary Contact for RFP
Contact Person Address
E-mail Address
Telephone

2. List the personnel your company will assign to help administer the Lake County Enrollment System.

Name / Location / Years with Company / Current Work Load
Account Service Representative
Implementation Manager

3. References

Current Clients (1,000+ Subscribers) / Contact Name / Contact Title / Contact Telephone / Years as Client
Current Clients
1.
2.
3.
Former Clients
1.
2.
A. Required Services

Please confirm or provide any deviations in your Response to the Services outlined below:

Service / Confirm (yes or no) / Deviations / Enhancements /
1.  Confirm the System will provide a secure, end-user friendly website with on-line enrollment capability, HIPAA compliant and available 24/7 via a secure login.
2.  Confirm the System will provide an on-line employee access tool that facilitates all aspects of the benefit selection process. This access should be available on all PC or mobile devices.
3.  Confirm the System will able the ability to interface with a variety of third party vendors, with the ability to send and receive weekly dates feeds and biweekly payroll data feeds to /from the carriers.
4.  Confirm the System’s ability to support information into payroll systems that are on different payroll schedules and have unique deduction codes (payroll codes). Even entities who share payroll systems have unique processes and payroll codes.
5.  Confirm the selected System will remain compatible with County/Affiliate network and updated versions of Microsoft Office, Adobe, and comment browser tools.
6.  Confirm the System’s ability to support the County’s business rules regarding issues such as benefits eligibility, waiting periods and leaves of absence.
7.  Confirm the System will identify employee and their unique benefit eligibility along with plan pricing (note: each agency has its own unique premium plan – (example: premiums for BOCC employee HMO plan are different from Tax Collector premiums).
8.  Confirm the System will determine dependent eligibility for each benefit by taking employee through a series of eligibility questions.
9.  Confirm the System will display all benefit options that employee is eligible to enroll in along with per pay period pricing
10.  Confirm the System will present to employee only those forms needed to complete open enrollment (rather than a list of all forms that they must choose from).
11.  Confirm the System will allow for employee ability to electronically complete forms and submit to HR to eliminate the need for paper forms.
12.  Confirm the System will allow employee to upload any required documentation for example marriage certificate to add a spouse mid-year.
13.  Confirm the System will administer enrollment in specific plans based on defined salary thresholds.
14.  Confirm the System can assign each benefit selection must be able to have unique start/effective dates.
15.  Confirm the System has the capability for benefit amounts to be able to be capped by dollar limits (ex. Supplemental Life) and must be able to calculate dynamically based on salary and age.
16.  Confirm the System allows updates to employee demographic information to be imported to payroll system – even if no changes in benefits is taking place
17.  Confirm the System will display projected total per pay period deduction (premium) calculations for employee review throughout the enrollment process.
18.  Confirm the System allows for the addition of dependents into selected plan.
19.  Confirm the System’s ability to receive dependent data such as Name, DOB, SSN, Gender, and relationship to employee.
20.  Confirm the System provides education support for participants through the use of file downloads and relevant linked content.
21.  Confirm the System will have the ability for the County and/or the vendor to add, change or delete announcements, forms and plan documents on the enrollment website.
22.  Confirm the System will manage enrollment into benefits that may require evidence of insurability and subject to guaranteed issue limits.
23.  Confirm the System has the ability to assign default plans and track affirmative waivers to be in compliance with the Affordable Care Act.
24.  Confirm the System has the ability for the County staff to add, change or delete website links on the enrollment website.
25.  Confirm the System has the ability to provide customization options to include logo and custom messaging and links to County resources and required notices
26.  Confirm the System has reporting and statistical capabilities that provide common data retrieval, and ad-hoc reporting capabilities that provide for selective reporting by entity, member, dependent provider, plan, option, and/or cost.
27.  Confirm the System provides customized reports and file downloads based on the reporting needs of the County.
28.  Confirm the County will have the ability to pull an open enrollment participation report.
29.  Confirm the System has secure notification l capability.
30.  Confirm the System will support two factor authentication option which will be mandatory for super-user logins.
31.  Confirm the County will have a dedicated account representative.
32.  Confirm there will be dedicated technology support during normal work hours and emergency support capability during non-working hours, weekends and holidays.
33.  Confirm the System’s ability to set-up agency specific plans and eligibility criteria; report on each agency or as a total group; and restrict access to other agency information with the exception of the "super administrators" at the County offices.
34.  Confirm the System will limit enrollment of any individual to only those benefits eligible to enroll and should calculate premiums based on specific employee, retiree or dependent demographics (such as age).
35.  Assistance in conducting dependent eligibility audits
36.  System shall be user friendly and include a "save and return" feature.
37.  Confirm the System will allow the administrator and any designees must have access to reporting portal to generate ad hoc eligibility, enrollment, census, and other reports necessary to manage the benefit plans.
38.  Confirm the System’s ability to provide employees with a confirmation statement following enrollment summarizing their elections and payroll deductions, including electronic signature. Sample statement to be included with proposal submission.
39.  Confirm the flexibility to interface with a variety of payroll systems that may include MUNIS, UltiPro, CHPS, Financial Edge.
40.  Confirm the System’s ability to provide reports on enrollment selections, changes in enrollment, and premium information on a group and individual basis.
41.  Confirm the System’s ability to provide exporting report capabilities using payroll codes.
42.  Confirm the System’s has ad hoc and customization reporting capabilities.
43.  Confirm the Employees will be able to access the site using the following major browsers: Internet Explorer, Google Chrome, Safari and Firefox.
44.  Confirm a project timeline has been provided under Tab 6.
45. 
B. Desired Administrative Services
Service / Response
1.  Describe any enhanced services such as information sharing to members via email, website infomercials, Facebook, and other social media.
2.  Describe employee education and communication tools to compare plan options side-by-side; estimate out­of-pocket costs for each plan; customize targeted messages to specific groups of employees; post reminders and videos to explain important details or instructions.
3.  Describe the System’s ability to offer a new hire training portal providing mandatory notices, important messages, videos, forms and policies, including employee acknowledgements and electronic signatures.
4.  Describe the System’s ability to split benefit deductions into pre- or post-tax categories based on defined parameters (e.g. an overage dependent not eligible for a pre-tax deduction).
5.  Describe the System’s ability to create total compensation statement available for employee to view at any time customized for each entity.
6.  Describe the System’s ability to provide benefit overview query at employee level so that they can see benefit that they are enrolled in (required) and the beneficiaries (desired) that are also included in the plan.
7.  Describe the System’s ability to create Super-user access (unlimited) that manages, maintains and administers system; provide additional accounts for inquiry only so that local HR representatives can query on specific employee account.
8.  Describe the ability for administrator to initiate a qualifying event for both participant completion as well as to update the system (ex. Dependent who age out of eligibility).
9.  Describe the System’s ability for the employee to initiate a qualifying event and have the event pend until administrator approval.
10.  Describe the System’s ability to allow administrator to update benefit information once approvals or changes have occurred.
11.  Describe how employees will login to the site. Is active directory integration supported?
12.  The County has several different agencies that each have their own active Directory, can the system support a separate active Directory integration for each agency?
13.  How will initial user accounts be populated?
14.  How do accounts get removed when employees leave employement
E. Cost and Performance Guarantees

Indicate below fee for the Plan Years listed. Use the “Subscriber” count and a composite fee for Employees, Retirees and COBRA participants to calculate the monthly fee.

Initial Contract Term / 1st of 3 renewals / 2nd of 3 renewals / 3rd and final renewal
2017-2020 / 2020-2021 / 2021-2022 / 2022 - 2023
Subscribers / 1,300 / 1,340 / 1,360 / 1.380
Subscriber Monthly Rate (PSPM) / $ / $ / $
Total Monthly Premium
Total Annual Premium
Confirm all costs that the County may be subject to incur as part of year 1, 2 and 3 implementation and ongoing maintenance. Costs should include proposed Per Subscriber Per Month (PSPM) fees. Other fees such as, initial set-up, annual renewal, new vendor set-up, hourly rate for ad hoc reporting, etc. should be listed separately.
List the limitations and assumptions.

Complete the chart below indicating whether the service is included in the proposed fees. If the service is not included in your proposed fees, list the additional proposed fee.

Cost of Services
Services/Fees / Included / Additional Fee
Start Up costs
Data interface for all current vendors of THE COUNTY
List of provided reports
Ad hoc reports
Changes in vendors in the future
Additions of vendors in the future
Changes of file feeds of existing vendors
Midyear changes
List others if applicable

List the Performance Guarantees your Company has included in your proposal.

Issue/Service / Performance Standard / Financial Guarantee
1.  Each annual enrollment must be completed with no interruption in online service, with less than 1% dissatisfaction from members, and with an accuracy rate of 99.5%.
2.  An annual evaluation of: the Enrollment System; the company personnel assigned to the County; and the overall satisfaction of members will be completed by the County. On a scale of 1 to 5, the company evaluation score must be no less than 4.5.

As an officer of the Company, I certify that the information contained in our proposal worksheet is accurate, and our company will be bound by the contents of our proposal.

Signature: ______Date: ______

Name: ______Title: ______

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