COUNTY OF DANE
DEPARTMENT OF ADMINISTRATIONPURCHASING DIVISION
210 Martin Luther King, Jr. Boulevard, Room 426
Madison, Wisconsin 53703
608/266-4109
CHARLES HICKLIN / BONNIE HAMMERSLEY
Controller / Director of Administration
DATE:April 17, 2006
TO:All Proposers
Request For Proposals #106016: Health Insurance
FROM:Charles Hicklin, Controller
SUBJECT:ADDENDUM #2 TO RFP 106016
1. Does the “Plan Document” refer to the benefit schedules or to a Certificate?
Answer: The “Plan Document” refers to the benefit schedule.
2. There are discrepancies between the Dean & Physicians Plus benefit schedules (examples: Mental Health and AODA benefit limits are different. Durable Medical Equipment has a maximum out-of-pocket for the member on one plan, but not on the other). Which benefit schedule should we match? Should we provide for the greater of the two?
Answer: Should match Physician’s Plus’ plan for Mental Health/AODA and Dean’s Plan for Durable Medical Equipment and Supplies
3. In submitting the plan document, is Dane County asking for a Certificate of Coverage or a Plan Benefit Summary?
Answer: Both
4. If a self-funded plan is proposed by GHC, may a provider network other than the Alliance be considered if the network is more comprehensive and provides same or similar pricing (discounts)?
Answer: Yes
5. Section 4.2 c & 4.3: Are reference names and their contact information kept private of is this information available to the general public?
Answer: The County is subject to open records.
6. Section 1.2.3: Open enrollment provisions: clarification: Is this continuous “open” enrollment or at one time (or period of time) during the year?
Answer: Open enrollment occurs only during a new contract period—for ex: this will be a 3- year contract so open enrollment is allowed for 1/1/07. If the County were to extend the contract for an additional year, there would be an open enrollment for year 4. The County does offer an annual choice period for those employees already enrolled in a County health plan.
7. Section 4.4.2 and 7.2: What are the specific provisions for domestic partner coverage? Are there affidavits and/or specific enrollment materials which need to be completed? Will Dane County maintain this enrollment information and notify us of eligibility?
Answer: This material will be added to the website. Dane County will only submit applications for Domestic Partners if they meet the County’s criteria
8. On what date does enrollment begin?
Answer: The County enrollment process will begin approx. in October
9. Can you provide a copy of the Dane County Application Form?
Answer: This will be added to the website
10. Section 5.2.8: What data will Dane County need for the GASB 45 information?
- The name, ID number, sex, date of birth and current plan option for all members of the county’s retiree health and dental groups. If the retiree’s spouse is covered under the plan, we will need the date of birth and sex of the covered spouse as well. It will be important to get this information in an Excel or other electronic format if possible.
- The plan description for both the dental and health plans.
- Is the plan performance given 100% credibility or are rates a blend of actual experience and manual rates? They have also asked if it is possible to breakdown the premiums into pure claims cost and pure administration components.
- A description of how the plan coordinates with Medicare for plan members who are past age 65.
- Claims paid for each health plan, split for actives and retirees and split between medical and drugs. We would just need the total for the entire year.
11. The RFP does not mention plan/vendor’s responsibility for COBRA notification or administration. Does Dane County administer COBRA?
Answer: Yes Dane County administers the COBRA
12. Section 1.2.5 b: Second paragraph, “employees are allowed to ‘escrow’ or leave the County’s plan upon retirement and rejoin within a 10 year period”. How will the carrier know that someone is in this category so that we can administer this correctly? Is there a list the carrier will have access to?
Answer: The County tracks this. It should be seamless for the carrier
13. Section 5.2.4: “…and usual and customary cost comparison”. GHC has usual and customary schedules, but when you use the work “comparison”, what are we to be comparing? Percent of usual and customary covered?
Answer: Yes we are asking for your UCR percentage
14. Within what timeframe or how often does Dane County notify us of employee terminations?
Answer: During the next billing period
15. How often does Dane County supply a reconciliation report?
Answer: Monthly
16. Section 5.2.1 #1: What is Dane County expecting when asking for a report by “Department”? Are you asking for claims by specialty?
Answer: Remove #1 from 5.2.1—no longer required
17. Section 5.2.1 #3: What is Dane County expecting when asking for a report on “coordination of benefits”? Are you asking for a report of how much is saved by coordination of benefits?
Answer: Yes
18. General Pharmacy questions:
- May an HMO use their own standard formulary, or must they match a formulary created and defined by Dane County?
Answer: Use your own formulary
- Is the HMO allowed to cover selected OTC medications on formulary?
Answer: Yes
- Which drugs, if any, for infertility must be covered?
Answer: Use the standard per your formulary up to the amount available per the schedule of benefits
- Are there any annual lifetime benefit maximum limits that apply to drugs?
Answer: No maximums
- If a patient requests a brand name drug when a generic is available, may the brand name not be covered due to non-formulary status?
Answer: If the doctor writes a script for a brand name, the patient is entitled to the brand name.
- If a patient requests a brand name drug when a generic is available, may they have the brand if they pay the difference in cost over the generic?
Answer: There would be no cost difference to the member ($6 generic, $10 brand) if they use a brand name when a generic is available as long as the Dr. has requested that the patient use the brand.
- Are prescriptions limited to a 30 or 34-day supply?
Answer: 34 day supply
- If a “90-day” or “maintenance drug” program is offered, are there specific requirements or parameters defined by the county or the plan?
Answer: 2 month co-pay for a 3-month supply
- Are “zero co-pay” drugs required, and if so are they defined by the county or the plan?
Answer: No, defined by the plan
- Are quantity limits for specific drugs (irrespective of days supply) defined by the county or the plan?
Answer: The plan
19. Do you have full SPD or plan booklet available?
Answer: See each carrier’s website
20. Have there been any plan changes in the past 24 months (Since 3/1/2004)?
Answer: Prior to 1/1/04 there was a $20,000 max on drugs. There is no longer a max on drugs.
21. Do you have monthly premium that corresponds with claims/lives data in the Management Report?
Answer: No, but if available, would be ideal
22. What are the Retiree rates? What are current E+1 rates for retirees as well as rate history?
Answer: E+1= 2 singles for actives & retirees
23. What is R&C percentile?
Answer: Delta Standard contract & Health is 90%
24. Lives: There is a large discrepancy in the last 2 months of data experience, Jan & Feb 2006. Specifically a large decrease being show in the Single lives. Also the Total Lives do not equal Single + Family for those two specific months. They state the following and I show the actual. This is a 12.5% decrease and I need clarification as to why/what is happening here.
Answer: Effective 1/1/06 the retirees were put on a 4-tier structure through Delta Dental and the actives remained on a 2 tier structure. Therefore there is not a decrease in enrollment the population has just been shifted to a different tiering system and the reporting we have is only able to represent the active population. The retiree census represents the most current enrollment so please refer to that document for the most accurate count.
25. RFP Section 2.6 Multiple Proposals—What constitutes a separate proposal? Can all fully insured arrangements (i.e. dual choice and sole carrier) be offered under one proposal? Would a self-funded offering be a separate proposal from a fully insured offering?
Answer: A self-funded and fully insured proposal would be considered 2 separate proposals. A dual choice and sole carrier fully insured proposal would be considered 1 proposal with different pricing.
26. RFP Section 4.4.4—Must be able to provide ID cards without using Social Security numbers. To be compliant, is a plan of action acceptable or must this be in place by January 1, 2007?
Answer: Preference may be given to those that have it in place upon 1/1/07.
27. RFP Section 5.2.2—Provide necessary forms and instructions for use. We provide Coordination of Benefit, Full Time Student, and Medicare Questionnaire. Are there any other types of forms that need to be included in the RFP response?
Answer: Any standard form that the carrier sends out
28. RFP Section 5.2 Claims Services—Report should include: 1. Department Currently enrollment information is not segmented by department. Would the County be able to being submitting enrollment in this manner in order to comply with this request?
Answer: This is no longer required
29. RFP Section 6.0—Pricing must include a breakout for Family, Single, Retiree + Spouse, plus a breakout for Medicare eligible retirees and their dependents. Please confirm whether this mirrors the current tier structure or whether the County is looking for 3 tier rates for both the actives and retirees.
Answer: Current
30. RFP Section 7.1 Payment Regulations—What is the County’s ability for electronic payments and reconciliations?
Answer: The County has the ability to process electronic payments and reconciliations. This would be worked out with the successful vendor(s).
31. Please advise whether the scoring and weighting methodology is the same as for the 2004 RFP. If not, what is the weighting for each of the RFP sections?
Answer: Same as 2004
32. Insurance Questionnaire Question 22—We view a PPO or a POS plan as a freedom of choice plan. Was there a different plan option that you are requesting?
Answer: No
33. Can you please provide additional experience information? The bid included, Dean’s experience through August 05 – P+ through November 05. We would like additional experience through 2/28/06 or 3/31/06, 3 years of rate history by plan ie: Dean, P+ and by enrollment status ie: single, limited family, two party and full family.
Answer: Additional experience Not available. Rate Info:
2004: Dean HMO—Single $293.05, Family $688.67, 1 over 65 $205.13, 2 over 65 $410.26, 1 over, 1 under 65 $498.18, 1 over, 2 under 65 $594.89 and 2 over, 1 under 65 $506.98. Dean POE—Single $494.23, Family $1,161.44, 1 over 65 $345.96, 2 over 65 $691.92, 1 over, 1 under 65 $840.19, 1 over, 2 under 65 $1,003.28 and 2 over, 1 under 65 $855.02.
2004: P+ HMO—Single $292.04, Family $686.24, 1 over 65 $208.71, 2 over 65 $471.43, 1 over, 1 under 65 $500.74, 1 over, 2 under 65 $602.93 and 2 over, 1 under 65 $519.62
2005: Dean HMO—Single $328.22, Family $583.19, 1 over 65 $229.76, 2 over 65 $459.52, 1 over, 1 under 65 $557.98, 1 over, 2 under 65 $666.29 and 2 over, 1 under 65 $519.62
Dean POE—Single $771.32, Family $1,370.49, 1 over 65 $408.23, 2 over 65 $816.46, 1 over, 1 under 65 $991.41, 1 over, 2 under 65 $1,183.87 and 2 over, 1 under 65 $1,008.91.
2005: P+ HMO—Single $338.74, Family $796.04, 1 over 65 $242.10, 2 over 65 $484.22, 1 over, 1 under 65 $580.86, 1 over, 2 under 65 $602.76 and 2 over, 1 under 65 $699.40
34. Need an employee census including gender, DOB, coverage status (s/f) and plan participation (HMO, Indemnity, PPO), COBRA and Retiree Status, and zip codes.
Answer: See RFP
35. Name of current carrier/administrator and how long has the County been with them.
Answer: See RFP - With Dean Health Plan since 1996 and with Physician’s Plus since 2004
36. Schedule of all plan benefits
Answer: See RFP
37. How is Dane County currently handling Medicare Part D for its retirees?
Answer: Current wrap plan for Medicare eligible members is offered with Dean Health but not Physician’s Plus
38. Describe the Medicare Part D Wrap Around option that the County is requesting. (The reason for this question is that with all of the options and degree of confusion that exists around Medicare Part D, we simply want to ensure that the product/services included in our proposal meet the needs of the County).
Answer: Retirees pay Dane County co-pay only of $6 & $10. Part D discounts come back to the County
39. Please provide further explanation of “negative billing” and how / if this would apply to payment of self-funded prescription claim – as compared to fully insured premiums.
Answer: Rates would be set either way and premiums paid based on County’s enrollment