Burleigh County Human Resources. Request for Proposals for Self-Funded Health Insurance

Transcription

1 Burleigh County Human Resources Request for Proposals for Self-Funded Health Insurance Issue Date: April 23, 2018 Due Date: May 14,

2 Table of Contents Table of Contents... 2 A. General Questions... 4 B. Plan Design... 4 C. Pharmacy... 5 D. Wellness/prevention... 5 E. Customer Service... 5 F. Additional Company Information... 6 G. Account Team... 6 H. Claims... 6 I. Reporting... 6 J. Eligibility/Enrollment... 7 K. HIPAA/Privacy... 7 L. Website... 7 P. References... 7 Q. Attachments

3 PROPOSAL PROCESS 1. Schedule The anticipated schedule for the proposal process is outlined below: Issuance of RFP April 23, 2018 Proposal Submission May 14, 2018, 5:00pm Proposal Review Completed June 2018 In-Person Meetings with Finalists June 2018 Notification to Bidders July 2018 Implementation Beginning January 01, Proposal Submission Proposals must be delivered directly to the Burleigh County Human Resources Department no later than 5:00pm, May 14, Late submissions or proposals delivered via fax will not be accepted. Please an electronic version of the proposal to Tammy Terras, HR Director AND deliver three (3) hard copies to the following address: Burleigh County Human Resources Department Attn: Tammy Terras Health Insurance RFP 221 N 5 th St PO Box 5518 Bismarck, ND General Information: The County currently offers its estimated 343 employees, Single or Family coverage on the NDPERS Sanford Health Plan. The employer currently contributes 95% of the employee s plan premium. Contributions are subject to change at the County s discretion. Current Medical Rates Plan Single Family NDPERS Sanford Health Plan $ $ PARTICIPANT BREAKDOWN Plan Single Family Total NDPERS Attachments: 1. Current Plan Design 3

4 A. General Questions 1. Please indicate if any benefit or eligibility limitations will apply to new members who have any pre-existing medical conditions. If so, what are the extent and duration of these limitations? 2. Can an employee be denied coverage for any reason? 3. Describe how you transition care for those with existing health conditions. 4. How are employees able to access care out of state? Out of the country? 5. Describe any applicable pre-authorization requests for in-network and out-ofnetwork hospital admittance. 6. Include a description of your organization's major short term strategic initiatives and your long term strategic business plan. Specifically address cost containment efforts. 7. Describe how your organization differentiates itself from your competitors. Specifically, what makes your organization the best partner for Burleigh County? 8. Identify all services that are currently outsourced or subcontracted, the name of the vendor/partner, and the length of the relationship. Please identify any additional costs associated with this. Describe how you ensure quality customer service and timely and effective issue resolution. 9. Please describe your standard (or proposed) financial arrangements with Burleigh County under a self-funded arrangement including but not limited to: account requirements and process for claim payment, frequency of reimbursement to the administrator for claims paid, the name of any third party administrators, methodology for funds transfers, required reserves in claim account, etc. 10. Identify and describe your national preferred provider organization. 11. Provide your estimate of discounts from paid charges in North Dakota. Please break this down by Institutional, Professional, and Prescription Drug. B. Plan Design Burleigh County is covered under the North Dakota Public Employees Retirement System (NDPERS) health plan. We are requesting a self-funded proposal and wish that the proposal includes the following details: The plan mirrors the existing NDPERS plan in design. Explain if the contract is incurred or paid. If it is a paid contract, please explain the details. How are administrative fees paid (pmpm, percentage of claims, other)? What services, if any, are included with the administrative fees? Explain how the aggregate is settled? What specific stop-loss levels can you provide? 4

5 When will stop-loss coverage be administered? Do you laser claims in your self-funded arrangement? Please explain all other fees that are not included in the administrative fee, or if they are in addition to. What other value adds do you offer and explain any additional cost. Please list any other items Burleigh County should consider with selffunding. C. Pharmacy 1. Do you use a formulary? If yes, describe what type, how frequently it is updated and the process for additions/deletions. 2. What Pharmacy Benefit Manager (PBM) firm(s) do you use most often? Why? 3. What type of reporting is available? 4. What is the rebate structure? 5. What is the pricing structure, including all administrative fees and dispensing fees? 6. Have you negotiated transparency pricing with any of the Pharmacy Benefit Managers you work with? 7. Describe your mail-order drug program. 8. Provide details on how prescription rebates would be reimbursed to the plan. D. Wellness/prevention 1. Describe your company s experience in providing wellness services. 2. Fully describe your wellness services. 3. How many employees do you have in your in-house wellness department? 4. What are your key wellness initiatives for this year? 5. Do you offer rebates based on participation in wellness services? 6. Do you offer onsite health screenings? What is the cost? 7. Are preventive services a standard offering? If yes, describe how they re integrated into your plans. 8. Are preventive services capped? If yes, at what dollar amount? E. Customer Service 1. Where is the call center that will service our account located? 5

6 2. What are your customer service hours of operation? 3. Can employees submit questions via ? If yes, what is the normal response time? Are the s secured? F. Additional Company Information 1. Provide your company s name, address, phone number and address. 2. List your company s regional offices in North Dakota and where most of the work on the contract will be done. 3. Provide a contact name and information for the person to whom we can direct questions. 4. Briefly describe your company s history. 5. What is your company s ownership structure? 6. What is your company s tax status? 7. Are you NCQA accredited? If so, what is your current status? 8. Provide your key 2017 HEDIS results. G. Account Team Provide an overview of how the Burleigh County relationship will be managed, both strategically and on a day-to-day basis: 1. The key individuals on your proposed implementation team Employer Services. 2. The key individual assigned to overall contract management. 3. The key dedicated individual or team members responsible for day-to-day account management and service. H. Claims 1. Where is your claims processing center located? 2. Explain when and how are claims paid? 3. What is your current claim backlog (in days) at the designated claim office? 4. Confirm your organization will assume full fiduciary responsibility for claim determination. I. Reporting 1. Are you capable of producing ad hoc reports? If yes, what is the turnaround time? Is there a charge? 6

7 J. Eligibility/Enrollment 1. If desired, can Burleigh County update and maintain eligibility and check employee claim status online? Are there any special charges for access to and use of these tools? 2. Do you have representatives who can be on site to assist with enrollment? 3. Following the receipt of complete enrollment information, when will ID cards be available for new members? 4. Please describe how you handle manual eligibility updates and the turnaround/timing of such updates. 5. How frequently can eligibility information be updated? 6. Is online enrollment available? K. HIPAA/Privacy 1. Confirm that your company meets all federal requirements and HIPAA regulations on data standards, code sets and Protected Health Information (PHI) for non-routine disclosures and authorized releases of PHI. 2. Do you have a contingency/disaster plan in place to prevent unauthorized access to Protected Health Information? L. Website 1. What services and information can employees access online? 2. Can employees set up personalized accounts? 3. What online tools are available for employer use? 4. Is training available to our staff? P. References 1. Please supply three references from former/current clients, preferably counties. Q. Attachments Your proposal must also include: Service area map Description of provider network and hospitals Description of referral process Description of grievance/complaint procedure 7