Page 1 RFP 12-14-2017 Amendment One

Page 1 – RFP 12-14-2017 Amendment One

November 21, 2017

RE:Amendment One – Request for Proposal (RFP) 12-14-2017

Medical/Pharmacy (Fully Insured/Bundled Self-Funded); Employee Assistance Plan; Dental PPO; Prepaid Dental; HSAand COBRA Administration.

Below are questions and answers and additional information for the above referenced RFP. All other terms and conditions remain the same.

General Information:

Please provide the agent name on this group? Please provide the census? How many employees are on the plan?

In regards to your questions, on page 23, item 10, Gallagher Benefit Services is the current consultant for the District. The number of employees can be found in the purpose section on page 18. The census is included in the RFP as an embedded document. The census is located under exhibit 8, page 38.

In reference to Page 2 of the RFP, General Information: May prospective offerors submit Best and Final Offers with the initial responses, on December 14, 2017?

No, they may not. Best and Final Offer requests will be determined by the District Evaluation Committee after the initial evaluation has been completed.

In reference to Page 5 of the RFP, Instructions to Offerors, Section 1, Inquiries, and Paragraph B: Please specify how amendments will be “published”? Will the District distribute amendments to those identified Offerors via email? If the District will post amendments to a specific website, please provide the website address.

Amendments will be published in the same format as the RFP. Prospective Offerors will be sent an email with the link to the Amendment.

In reference to Page 5 of the RFP, Instructions of Offerors, Section 2, Offer Preparation, Paragraph D, Page 18 of the RFP, Special Terms and Conditions, Section 3, Award Basis, Third Paragraph, and page 24 of the RFP, Proposal Formatting Requirements, Tab 4 of the Instructions:

Please confirm that submission of the Offeror’s preprinted or standard terms will not be the cause of an immediate bid rejection.

Confirmed, however, the District’s Legal Department will review all exceptions to the District’s standard terms.

Please confirm that the District may consider allowing for a period of negotiation, during which time specific terms and conditions of the District’s contract provisions, which are relevant and mutually acceptable, may be included with an Offeror’s standard contract documents in any final agreement.

See page 18 of the RFP document.

Page 24, Proposal Formatting Requirements, Tab 5 Instructions only call for Flash Drives to be used for the transmission of electronic copies. However, Page 1, General Information, first paragraph also allows for the use of CDs. Please confirm which media may be utilized for electronic submissions.

Please submit your electronic submissions utilizing a flash drive only. CDs are no longer acceptable as many newer computers do not have a device to read a CD.

On Page 2, General Information, it states that the electronic copies are being requested to comply with Public Record requests. Should this be redacted?

No.

On Page 22, first paragraph, it lists that we need to provide 1 original and 4 copies, but then the next bullet states, “A copy of the actual proposal from your company that you are referencing in any of your responses to the RFP”. Does that mean we need to provide 1 original and 5 copies? What exactly do you mean by this statement?

To clarify, please provide one original labeled “ORIGINAL”. Then provide four additional copies labeled “COPY”. Total of five copies. Additionally, provide 4 electronic copies in the form of a Flash Drive.

On Page 24, under the Proposal Format Requirement, may we provide a 6th tab for additional information?

Yes, you may.

On Page 24, Paragraph Tab 2 of the RFP, it states that we need to provide a “Request for Taxpayer ID” however a form was not provided. Please provide the requested form.

The Request for Taxpayer ID is located on page 42 of the RFP.

On Page 24, Tab 5 of the RFP, it states that we cannot provide anything in Adobe. However, some of our samples, Geo Access Reports and scanned copy of original signature documents will be in PDF. Is this acceptable?

Yes, however, we are requesting that the questionnaire responses be provided in a Word document and that any document that is designed in Excel from the exhibits be returned in an Excel format. There are no exceptions to this.

On page 5, under 2, Offer Preparation Item C, Can you please confirm where and how many exceptions to the terms & conditions should be presented? Should it follow on letter in Tab 1?

Confirmed, however, the District’s Legal Department will review all exceptions to the District’s standard terms.

On page 24, for Tab 1 – is here a specific order you would like the responses forms in? For example, do you want all the evaluation forms first?

We did not identify a specific order, however, usually the questionnaires are first, and then the Excel documents follow grouped by coverage.

Would the stop loss form also go in Tab 2?

No, please place in Tab 1.

Is it acceptable to submit on the flash drive any large files rather than printing them out?

No, this is not acceptable.

Medical Questions and Answers:

Is the District currently fully insured or do they have a stop loss contract through Meritain? The current contract I saw did not have any indication of being self-insured or fully insured. Is there specific only coverage? If so, are you able to forward rates and factors for this?

The District is fully insured through the ASBAIT Trust. The claims, premium and enrollment is managed by Meritian, a Third Party Administrator. Because it operates as a fully insured plan, information regarding actual stop loss is not available.

Please provide the name of the current provider network being used by Meritain for the self-funded medical plan?

The current network being used within the state of Arizona is Blue Cross Blue Shield. Effective July 1, 2018, ASBAIT will be utilizing the Aetna network. For claims incurred out of state, the network is Aetna.

Please provide updated experience.

Please see the embedded document below with experience through 09/30/2017:

Updated Self-Funded Evaluation embedded below with correction to tiers:

Question 1.20 on the Medical Questionnaire is the only confirmation question regarding confirmation of payment or credit for maintaining current or alternative benefit enrollment systems. Can you please define your currently monthly costs, and should that be included in rates quoted for Amphitheater Public Schools?

The preference is No commissions. If you are including broker compensation that is built into the rate, please disclose that information with your response to the RFP. Currently, there is broker compensation of $8,155 in consulting fees that covers the cost of broker compensation and the online enrollment system included in the medical rates.

Can you please explain any fees for consulting services or enrollment systems included in existing rates?

Please see the response to the above question.

If costs for consulting or enrollment systems are NOT to be included in the rates being bid, will you confirm if rates should be quoted net of any compensation or reimbursement?

Yes, if you are able to do so, please quote rates net of commissions.

If costs for consulting or enrollment systems were included in existing rates, can you please provide the current employer contribution amounts net of any costs for consulting, enrollment systems, or reimbursements?

Currently, there is broker compensation of $8,155 in consulting fees that covers the cost of broker compensation and the online enrollment system included in the medical rates. Current contributions are listed on page 23 of the RFP.

In order to be able to complete “Top Drugs and Tier Match” exhibit accurately we will need 11 NDCs instead of the 9 Digits provided. Please provide this exhibit with 11 Digit NDCs.

ASBAIT provides Top Drugs aggregated by the first nine digits of the NDC code. We are unable to provide an aggregated top drug file with the additional two codes which indicate quantity or box size. The information provided is the data available for schools pooled within the ASBAIT Trust.

Please confirm the following benefits for the HDHP plan: do they have a non-embedded deductible with an embedded Out of Pocket Maximum; regarding hospital inpatient services, does the deductible apply after the $250 copay and then 20% coinsurance; regarding the urgent care, does the deductible apply with the $50 copay then 20% coinsurance?

The HDHP plan has a non-embedded deductible.

All other information can be found on pages 26 and 27 of the RFP.

Please confirm the following benefits for the $500 Plan: please confirm coverage for minor lab and x-ray; please confirm coverage for major diagnostic.

Please refer to the plan document located on page 26.

Please confirm the following benefits for the $300 Plan: please confirm coverage for minor lab and x-ray; please confirm coverage for major diagnostic.

Please refer to the plan document on page 26.

Is Bariatric coverage or infertility coverage included? Is so, please provide summary of current coverage.

Bariatric Coverage: This can be found under morbid obesity on the Amphitheater/ASBAIT plan document (see below):

Surgical treatment for Morbid Obesity is limited to one Surgical Procedure per Lifetime andwill only be covered if all the following conditions are met:

(a)The Covered Person has been covered under the Plan for a minimum of 12 months prior to the date ofthe procedure.

(b) The Covered Person has either (1) a body mass index (BMI of 40 or greater or (2) a BMI of 35 or greaterin conjunction with a severe co-morbidity, such as obesity hypoventilation, sleep apnea, diabetes,hypertension, cardiomyopathy, or musculoskeletal dysfunction.

(c) The Covered Person has at least a 24 month year history of Morbid Obesity as documented in suchperson’s medical records.

(d) The Covered Person does not have an underlying diagnosed medical condition that would cause MorbidObesity (e.g., an endocrine disorder) that can be corrected by means other than surgical treatment.13623 – 7/1/2017 90 v.042017

(e) The Covered Person has completed full growth (18 years old or supporting documentation of completebone growth).

(f) The Covered Person has failed to achieve and maintain significant weight loss and such person hasparticipated in a Physician-supervised nutrition and exercise program for at least 6 months (occurringwithin the 24-month period prior to the proposed surgical treatment) and such participation isdocumented in his or her medical records.

(g) The Covered Person must be evaluated by a licensed professional counselor, psychologist or psychiatristwithin 12 months prior to the proposed surgical treatment. The evaluation should document the following:

(i) That there is no significant psychological problem that would limit the ability of the Covered Personto understand the procedure and comply with any medical and/or surgical recommendations;

(ii) Any psychological co-morbidities that may be contributing to the Covered Person’s inability to loseweight or a diagnosed eating disorder; and

(iii) The Covered Person’s willingness to comply with the preoperative and postoperative treatmentplans.

Includes coverage for one year of post-operative visits.

The following surgery will not be eligible as treatment of Morbid Obesity under the Plan:

(a) Loop gastric bypass;(b) Gastroplasty, more commonly known as "stomach stapling" (not to be confused with vertical bandgastroplasty); and(c) Mini gastric bypass.

Eligible expenses will be payable as shown in the Medical Schedule of Benefits.

Infertility: See page 100 under general exclusions, also noted below:

Infertility: Expenses for confinement, treatment or services related to infertility (the inability to conceive) or the

Promotion of conception will not be considered eligible, except diagnosis and testing of infertility as specified

under Eligible Medical Expenses.

Nothing in this section is intended to exclude coverage for any infertility counseling or treatment required to be

covered (if any) as a preventive service under the guidelines published by the Health Resources and Services

Administration on August 1, 2011 (or any applicable subsequent guidelines).

Please provide monthly membership (not subscriber) enrollment to match up with claims provided. If unable, please confirm average contract size.

Embedded below is the monthly membership from 08.2016 through 09.2017. We are unable to provide prior data.

Please confirm if this will be net of commission or if we are to include any commissions/service fees. If so, please confirm the amount to be included.

This should be quoted net of commissions.

Please confirm we should include our Performance Rewards. Since Public Sector groups have more budget constraints, we can run into issues on the renewal side. For example, group earns a credit of $300k in year one…the city/board then sets the budgets off of premium paid that includes the credit and makes the assumption that they will earn the credit annually when in many times they earn it only once which leads to budgeting shortfalls and issues at renewal. We can absolutely include it but do not want to cause issues.

Please use your judgement and the District will consider all options.

Would the school be open to a wellness quote as a separate line item rather than as part of the fee?

Please use your judgement and the District will consider all options.

Do you want commissions built into the stop loss?

No commissions.

In regards to contract basis, we do not offer 12/24 nor 12/15. Would a 12/12 with TL work? It is similar to 12/15.

Please use your judgement and be specific in your proposal.

For the out of network reimbursement, please confirm what to quote: MNRP 110%, 140%, or UCR 80%.

Please use your judgement and be specific in your proposal.

On page 29, Embedded Medical Questionnaire, General Information section, Question 1.7, the following Language appears: “Your Company’s assumption of liability on a no-loss, no-gain basis. Regarding assumption of liability, you understand that the extended liability, if any, under the present carrier would offset in determining the benefits payable. Verify.”

We are requesting that all members be accepted immediately with no pre-existing limitations.

Can you please clarify the meaning of “no-loss, no-gain basis” in this context?

See response to the above question.

On page 27, item 3 and item 4, there is a reference to Aggregate Stop Loss at 110%,” but no reference to the desired term. Can you please clarify/specify?

Please quote a 110% aggregate stop loss benefit. Please be specific as to what your firm quotes.

Exhibit #3: Medical/Pharmacy/EAP (Page 26 of 46). The 2017/2018 Adobe Rate Exhibits on the Classic Gold, Classic Silver, and HDHP, there is a note in the rates that the Teladoc fee of $2.05 included in the medical rates, but not included in the above rates. And off to the side there is a fee of $2.90. I think this is a typo and the Teladoc Fee for 2017/2018 Rates should be $2.90 since the Teladoc Rates in the 2016/2017 policy year shows $2.05 and $2.05 consistent fees.

The 2017/2018 rate for Teladoc is $2.90. The $2.05 should have been updated to reflect that amount. The $2.90 is separate from the medical rates.

The Large Claims report that is included in the RFP provides a high level diagnosis for example:

Endocrine (other), immune and metabolic (non sex gland) = $139,697

Neurology: hereditary and degenerative conditions of the nervous system = $118,818

Dermatology/subcutaneous: all = $74,052

Infections disease agents: excluding HIV and TB = $70,463

Do you have a more detailed Large Claims report that can give us specific diagnosis information? For example:

Malignant Neoplasm, Skin = $xxx,xxx

Septicemia = $xxx,xxx

Inflammatory Bowel Disease = $xxx,xxx

Lupus = $xxx,xxx

What was provided is all that is available.

Dental PPO and Prepaid Dental Questions and Answers:

Can you please confirm if the current PPO dental is self-funded or fully-insured and also confirm if we should quote self-funded or fully-insured?

The ASBAIT PPO Dental plan is fully insured. We are requesting that carriers provide fully-insured quotes.

Can you confirm that our pricing fees will reflect net of commissions? If not, please confirm the percentage of commissions to be included.

No Commissions are to be included in the dental products.

Can you confirm what network is being used for in-network claims in the attachment 2017-2018 PPO Dental Summary through Meritain?

The dental network is through Blue Cross Blue Shield. However, participants may go to any dental provider as there is no difference between in and out-of-network benefits. It is a “true” indemnity dental plan.

On Page 23, Item 7 of the RFP, it indicates that the employer pays 100% of the employee only DHMO premium, yet the census indicates that 28% of the employees are not covered. Please explain why so many are not taking the “free” coverage.

Employees are not required to select dental coverage even though the employer is paying 100% of the cost for the Employee.

In what capacity are you using Meritain for the Experience Information on Page 31?

Meritain is a Third Party Administrator for the ASBAIT Trust and manages claims, premium and enrollment for the Trust.

On Page 31, Attachment 17 PPO Dental Summary from BKB, are the Dental PPO Administration Fees currently Self-Funded. If so, is there any Broker Fee?

The PPO Dental is not self-funded, but it is managed by the ASBAIT Trust currently. No there are no broker fees.

Please provide the Dental Summary Plan Description (Page 31, Rates and Benefits).

Please note that on Page 31 of the RFP, the very last two embedded documents are the benefit summary documents from ASBAIT and EDS.