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SANTA ROSA COUNTY SCHOOL BOARD Request for Proposal For Group Medical Insurance RFP # 13-10 Proposal Return Date and Time June 27, 2013 3:00 PM Judson C. Crane, CPPB, CPPO, Director of Purchasing and Contract Administration Office of Purchasing

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Page 1: RFP 13-10 Group_Medical_Insurance Santa Rosa€¦  · Web viewSANTA ROSA COUNTY SCHOOL BOARD. Request for Proposal. For. Group Medical Insurance. RFP # 13-10. Proposal Return Date

SANTA ROSA COUNTY SCHOOL BOARD

Request for ProposalFor

Group Medical Insurance

RFP # 13-10

Proposal Return Date and TimeJune 27, 2013 3:00 PM

Judson C. Crane, CPPB, CPPO, Director of Purchasing and Contract Administration

Office of PurchasingSanta Rosa County School Board

6544 Firehouse RoadMilton, FL 32570-6706

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Santa Rosa County School BoardRFP 13-10 Group Medical Insurance

SANTA ROSA COUNTY SCHOOL BOARDTim Wyrosdick, Superintendent of Schools

Purchasing DepartmentJudson C. Crane, CPPB, CPPO, Director of Purchasing & Contract Administration

6544 Firehouse RoadMilton, FL 32570-3411

Phone (850) 983-5130 FAX (850) 983-5133 Suncom 689-5130E-mail: [email protected]

Website: http://www.santarosa.k12.fl.us/purchasing/

The Santa Rosa County School Board solicits a submission as listed in this request for proposal. All terms and conditions below are a part of this proposal request, and no proposals will be accepted unless all these terms and conditions have been met, unless superseded by the proposal specification. Rights are reserved to reject any and all proposals and to waive technicalities. Proposals not submitted in accordance with this proposal request will be rejected.

GENERAL TERMS AND CONDITIONS

1. The purchasing department will be the point of contact for this proposal, unless otherwise noted in the proposal specifications. Under no circumstances are the superintendent of schools, board members, school administrators or any other school board employee to be contacted concerning this proposal until after award. Any such contact may result in proposal disqualification.

2. Price, quality, specifications, payment discounts, warranty, travel time for warranty service, ability to provide service and time of guaranteed delivery will be the determining factors in the awarding of this proposal.

3. Proposal price shall be the delivered and unloaded price to the designated point according to the purchase order. *** Collect shipments will be refused *** No deposits or requests for pre-payment will be allowed.

4. Proposals may be awarded or rejected in whole or item by item, with rights being maintained to make joint awards if in the best interest of the district. The Santa Rosa County School Board will retain all copyright and patent rights that may be created by the contract resulting from this proposal. These rights are to include, but are not to be limited to written works, computer software and mechanical devices that are created as a requirement of this proposal.

5. Enough detail is given in the proposal to describe the item or service being requested although not written, full manufacturer's specifications are implied. Manufacturer's specifications take precedent over information within this proposal if any discrepancy exists. Manufacturer's literature is available from the office of the Purchasing Agent upon request.

6. Any manufacturer's name, trade name, brand name, information and/or catalog numbers listed in a specification are for information only in order to describe and establish general quality levels, not to limit competition. Such references are not intended to be restrictive. Those who are submitting proposals may offer any brand for which authorized to represent, which meets or exceeds the specifications for any and all items. If proposals are based on equivalent products, indicate on the proposal form the manufacturer's name and number and indicate any deviations from the specifications. IMPORTANT NOTE: If proposing an alternate, complete manufacturer's literature, giving full description of the alternate being proposal, must be submitted. Failure to submit manufacturer's descriptive literature when proposing an alternate can result in proposal rejection for failing to comply with proposal instructions. Any proposal lacking written indication of intent to quote an alternate brand will be considered and received as a proposal in complete compliance with the specifications as listed in the proposal. If upon receipt it is found not to meet specifications, payment will not be made and the item will be returned at the proposing companies expense.

7. For Service and Term contracts, the board reserves the right to provide all services internally, and similar goods and services may be procured through a general contractor or other existing contract. The board also reserves the right to separately bid out large purchases of similar goods and services.

8. In the event more than one proposal is submitted for a line item, please indicate the alternate item by inserting "ALT" after the unit price.

9. To be considered all proposals must be submitted on the enclosed proposal form, properly signed by an authorized representative of the company placing the proposal, and delivery date stated.

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10. In the event of an error in extending the total cost of an item, the total price submitted will prevail.11. Sealed proposals must be submitted by hand delivery or mail only as noted in the proposal specifications.

Proposals by telephone, fax or e-mail will not be accepted. Only those submitting a proposal or a proposal marked "NO PROPOSAL" will be retained on the proposal mailing list. No Proposals may be sent via mail, e-mail or fax.

12. The proposal opening shall be public and at the time noted in the proposal specifications. 13. Tie proposals will be awarded to the company who submits the proposal with the earliest postmark or if hand

delivered, the earliest actual time noted or stamped on the envelope. It is the company submitting the proposal responsibility to insure the actual date and time are noted on the envelope. The only exception to this rule is if the tie proposals are between an out of state company and a company headquartered in Florida, the Florida company will prevail.

14. A notice of intended decision will be posted in the office of the Purchasing Director one week prior to award. A notice of intended decision will be furnished only to submitting companies who supply a self addressed, stamped envelope with their proposal or by downloading from the purchasing department internet web site at http://www.santarosa.k12.fl.us/purchasing. All who submit proposals and interested parties may examine the proposal tabulations and files during normal business hours (public record) after proposals have been awarded.

15. Rights are reserved to purchase additional quantities at proposal price.16. Based on School Board Policy 7.70 X, Direct Purchasing, the School District may elect to purchase materials

and equipment included in a contractor’s proposal directly from the supplier.17. Payment will not be made until an order is completed in full.18. The successful company submitting the proposal will allow duly authorized representatives of the board, the

Auditor General of the State of Florida, the Comptroller General of the United States, or other authorized representatives access to any books, documents, papers, and records of the winning proposal company which are directly pertinent to this contract for the purpose of making audits, examinations, excerpts, and transcriptions.

19. When contract is federally funded, retention of all required records for three years after grantees or sub grantees make final payments and all other pending matters are closed.

20. Failure to file a protest within the time prescribed in Section 120.57(3), Florida Statutes, or failure to post the bond or other security required by law within the time allowed for filing a bond shall constitute a waiver of preceedings under Chapter 120, Florida Statutes. All contact in this regard to be made exclusively with the purchasing department. In the event of litigation involving this contract, the venue shall be Santa Rosa County Florida. Arbitration will not be an acceptable means to resolve disputes.

21. When using federal funds the remedies for noncompliance for School District may:(1) Temporarily withhold cash payments pending correction of deficiency in delivery of services.(2) Suspend or terminate the current awarded contract and withhold further awards to the suspended/terminated vendor as found in Title 34,

Section 80.43 code of Federal Regulation.22. When using federal funds the remedies for noncompliance for contracts in excess of simplified threshold of

$100,000 the School District may: (1) Temporarily withhold cash payments pending correction of the deficiency by the grantee or sub grantee. (2) Disallow all or part of the cost of activity or action not in compliance. (3) Wholly or partly suspend or terminate the current award for the grantee or sub grantee’s program.

(4) Withhold further awards for the program or take other remedies that might be available. As found in Title 34, section 80.43, Enforcement Section code of Federal Regulation.

23. (Service proposals only) Insurance required to be carried shall include:A. Insurance

1) The Company shall furnish proof of the following insurance to the Board by Certificate of insurance.

2) The Certificate of Insurance shall state that the School Board, including its agents and employees, are additional insureds under the policy or policies.

3) The Company shall provide Certificates of Insurance to the District’s Risk Manager at 5086 Canal St., Milton, FL, 32570 prior to the start of any work under this contract.

4) The Companies insurers shall provide thirty (30) days advance written notice via certified mail in the event of cancellation of any insurance program required by this contract.

5) All insurance policies shall be issued by companies either of the following qualifications:

6) The company must be (1) authorized by subsisting certificates of authority by the Department of Insurance of the State of Florida or (2) an eligible surplus lines insurer under Florida Statutes. In addition, the insurer must have a Best’s Rating of

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“A-” or better and a Financial Size Category of “VI” or better according to the latest edition of Best’s Key Rating Guide, Published by A.M. Best company. With respect only to Workers’ Compensation insurance, the company must be (1) authorized as a group self-insurer pursuant to Florida Statutes or (2) authorized as a commercial self-insurer fund pursuant to Florida Statutes.

7) Workers’ Compensation Insurance . The Company shall maintain Workers’ Compensation coverage as required by Florida Statute 440, covering all Company employees employed in connection with this contract and Employers Liability Insurance with minimum limits of $1,000,000 per occurrence.

8) Comprehensive General Liability Insurance . The Company shall procure and maintain for the life of the contract/agreement, Comprehensive Liability Insurance, Broad Form, including Products and Completed Operations Liability. This policy shall provide coverage for death, bodily injury, personal injury, or property damage that could arise directly or indirectly form performance of the contract. The coverage must be on an occurrence form basis with minimum limits of $1,000.000 per claim, $2,000,000 per occurrence, combined single limit for bodily injury and property damage liability

9) Business Automobile Liability. The Company shall procure and maintain, for the life of the contract/agreement Business Automobile Liability Insurance with minimum limits of $1,000.000 per claim, $2,000,000 per occurrence, combined single limit for bodily injury liability and property damage liability. This coverage shall be on an “Any Auto” or “Comprehensive Form” policy. The coverage shall be on an occurrence form policy. In the event the Company does not own any vehicles, hired and non-owned coverage shall be provided in the amounts listed above.

B. Indemnification / Hold Harmless1) Company shall indemnify the Santa Rosa County School Board and to the fullest

extent permitted by law, protect, defend, indemnify and hold harmless the Board, its agents, officers, elected officials, employees and volunteers from and against all claims, actions, liabilities, losses (including economic losses), and costs arising out of any actual or alleged;

2) Bodily injury, sickness, disease or death, or injury to or destruction of tangible property including the loss of use resulting there from, or any other damage or loss arising out of, or claimed to have resulted in whole or in part from any actual or alleged act or omission of the company or subcontractor, any directly or indirectly employed by any of them, or anyone for whose acts any of them may be liable in performance of the work; or

3) Violation of law, statute, ordinance, governmental administration order, rule or regulation by the company in the performance of the work; Liens, claims or actions made by the Company or any subcontractor or other party performing the work.

4) The indemnification obligations hereunder shall not be limited to any extent on the amount, type of damages, compensation or benefits payable by or for the company or any subcontractor under workers’ compensation acts, disability benefit acts, other employee benefit acts or any statutory bar.

5) Any cost or expense, including attorney’s fees, incurred by the board to enforce the contract shall be borne by the company.

Direct all insurance inquiries to Risk Management (850) 983-5007.24. Person or persons submitting a proposal or company representative who contends that all or part of the

proposal, (record), is exempt from inspection and copying, shall state the basis of the exemption, (on the proposal/proposal document, in writing), that he or she contends is applicable to the record. This is to include the statutory citation to an exemption created or afforded by statute.

25. Other governmental agencies which qualify under State Board of Education 6A-1.012 may purchase from this proposal if approved by the winning vendor. This is also a joint proposal with the Gulf Coast Purchasing Cooperative whose members may also purchase from the awarded proposal at proposal prices if approved by the winning vendor.

26. In accordance with Florida Statute 1011.14, funding is subject to availability of appropriated funds.27. The Jessica Lunsford Act: The Santa Rosa County School District reserves the right to refuse to

accept services from any personnel deemed by the Santa Rosa County School District to be unqualified, disorderly, or otherwise unable to perform assigned work. This law, effective September 1, 2005, affects your business if you, your employees or your agents will have access to school grounds when students are present, have direct contact with students or have access to or control of school funds. A copy of House Bill 1877, which was approved by the Governor on May

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2, 2005 (Chapter 2005-28, L.O.F., section 21) may be found by accessing the following link on the internet: http://laws.flrules.org/files/Ch_2005-028.pdf. Further information is available at the following website, https://www.santarosa.k12.fl.us/purchasing/Vendor%20Information/Lunford_Act.pdfThe requirements of this new law must be met in order for the School Board to continue working with you. The implementation procedures for this new law, as well as the amendment of July 2007, are posted on our website, at: http://www.santarosa.k12.fl.us/humanresources/Fingerprinting.htmNOTE: Do not return this document with proposal submission.

28. As per Florida Statute 119.071 (Public Records) Sealed bids, proposals or replies received by an agency in response to a competitive solicitation shall be exempt from public inspection or copying until such time as the agency provides notice of an intended decision or until 30 days after opening the bids, proposals or final replies, whichever is earlier.

DRUG FREE WORKPLACESection 287.087 Florida Statutes

Preference shall be given to businesses with drug-free workplace programs. Whenever two or more bids which are equal with respect to price, quality, and service, are received by the State or by any political subdivision for the procurement of commodities or contractual services, a bid received from a business that certifies that it has implemented a drug-free workplace program shall be given preference in the award process.

Established procedures for processing tie bids will be followed if none of the tied vendors have a drug-free workplace program. In order to have a drug-free workplace program, a business shall:

1. Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition.

2. Inform employees about the dangers of drug abuse in the workplace, the business's policy of maintaining a drug-free workplace, any available drug counseling, rehabilitation, and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations.

3. Give each employee engaged in providing the commodities or contractual services that are under bid a copy of the statement specified in subsection (1).

4. In the statement specified in subsection (1), notify the employees that, as a condition of working on the commodities or contractual services that are under bid, the employees will abide by the terms of the statement and will notify the employer of any conviction of, or plea of guilty or nolo contendere to, any violation of Chapter 893 or of any controlled substance law of the United States or any state, for a violation occurring in the workplace no later than five (5) days after such conviction.

5. Impose a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program if such is available in the employee's community, by an employee who is so convicted.

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6. Make a good faith effort to continue to maintain a drug-free workplace through implementation of this section.

As the person authorized to sign the statement, I certify that this firm complies fully with the above requirements.

Vendor's Signature

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SWORN STATEMENT PURSUANT TO SECTION 287.133 (3)(A),FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES

THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIALS/AUTHORIZED TO ADMINISTER OATHS.

1. This sworn statement is submitted to _______ (print name of public entity)

by (print individual's name and title)

for (print name of entity submitting sworn statement)

whose business address:

And (if applicable its Federal Employer Identification Number (FEIN) is:

(If the entity has no FEIN, include the Social Security Number of the individual signing this sworn statement):

2. I understand that a "public entity crime" as defined in Paragraph 287.33(1)(g), Florida Statutes, means a violation of any state or federal law by a person with respect to and directly related to the transaction of business with any public entity or with an agency or political subdivision or any other state or of the United States. Including, but not limited to, any bid contract for goods or services to be provided to any public entity or an agency or political subdivision of any other state or of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation.

3. I understand that "convicted" or "conviction" as defined in Paragraph 287.133(1) (b), Florida Statutes, means a finding of guilt or a conviction or a public entity crime, with or without an adjudication of guilt, in any federal or state trial court of record relating to charges brought by indictment or information after July 1, 1989, as a result of a jury verdict, nonjury trial, or entry or a plea of guilty or nolo contender.

4. I understand that an "affiliate" as defined in Paragraph 287.133(1)(a), Florida Statutes, means:

a. A predecessor or successor of a person convicted of a public entity crime: or

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b. An entity under the control of any natural person who is active in the management of the entity and who has been convicted of a public entity crime. The term "affiliate" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in the management of an affiliate. The ownership by one person of shares constituting a controlling interest in another person, or a pooling of equipment or income among persons when not for fair market value under an arm's length agreement, shall be a prima facie case that one person controls another person. A person who knowingly enters into a joint venture with a person who has been convicted of a public entity crime in Florida during the preceding 36 months shall be considered an affiliate.

5. I understand that a "person" as defined in Paragraph 287.133(1)(e), Florida Statutes, means any natural person or entity organized under the laws of any state or of the United States with the legal power to enter into a binding contract and which bids or applies to bid on contracts for the provision of goods or services let by a public entity, or which otherwise transacts or applies to transact business with a public entity. The term "person includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in management of an entity.

6. Based on information and belief, the statement which I have marked below, is true in relation to the entity submitting this sworn statement. (Indicate which statement applies.)

Neither the entity submitting this sworn statement, nor any of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, nor any affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989.

The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders, employees, members or agents who are active in the management of the entity, or an affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989.

The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, or an affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989. However, there has been a subsequent proceeding before a Hearing Officer of the State of Florida, Division of Administrative Hearings and the Final Order entered by the Hearing Officer determined that it was not in the public interest to place the entity submitting this sworn statement on the convicted vendor list. (Attach a copy of the final order.)

I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE PUBLIC ENTITY IDENTIFIED IN

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PARAGRAPH 1 (ONE) ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND, THAT THIS FORM IS VALID THROUGH DECEMBER 31 OR THE CALENDAR YEAR IN WHICH IT IS FILED. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECITON 287.017, FLORIDA STATUTES FOR CATEGORY TWO OF ANY CHANGE IN THE INFORMATION CONTAINED IN THIS FORM.

(signature)

Sworn to and subscribed before me this day of , 20 __ .

Personally known: or Produced Identification:

Type of Identification: Notary Public - State of

Notary Signature: Notary Stamp:

Form PUR 7068 (Rev. 06/18/92)

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Information Sheetfor Transactions and Conveyances

Corporation Identification

The following information will be used for incorporation in legal documents. It is, therefore, vital all information is accurate and complete. Please be certain all spelling, capitalization, etc. is exactly as registered with the state or federal government.

(Please Check One)Is this a Florida Corporation?: Yes or No

If not a Florida Corporation,In what state was it created?: _____________________________

What kind of corporation is it?: For Profit or Not for Profit

Is it in good standing?: Yes or No

Authorized to transact business in Florida?: Yes or No

State of Florida Department of State Certificate of Authority DocumentNo.: _______________________________

Does it use a registered fictitious name?: Yes or No

Names of Officers:President: _________________________

Secretary:______________________

Vice President: _____________________Treasurer:______________________

Director: __________________________Director:_______________________

Other: ____________________________Other:_________________________

Name of Corporation (As used in Florida):

________________________________________________________________(Spelled exactly as it is registered with the state or federal government)

Corporate Address:____________________________________________________

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Post Office Box:____________________________________________________

City, State Zip:____________________________________________________

Street Address:____________________________________________________

City, State, Zip:____________________________________________________

(Please provide post office box and street address for mail and/or express delivery)

Federal Identification Number:_________________________________________

Contact person for company:_________________________________________

Telephone Number: _______________Facsimile Number:_______________

Name of individual who will sign the instrument on behalf of the company:

_________________________________________________________(Spelled exactly as it would appear on the instrument)

(Contract must be signed by the President or Vice-President. Any other officer must have permission to sign via a resolution approved by the Board of Directors on behalf of the company. Awarded contractor shall submit a copy of the resolution together with the executed contract to the Office of Purchasing)

Title of the individual named above whom will sign on behalf of the company:

_________________________________________________________

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Santa Rosa County School BoardRFP 13-10 Group Medical

*** PROPOSAL SPECIFICATIONS ***

The Santa Rosa County School Board, Milton Florida, solicits your company to submit a proposal on “RFP 13-10 Group Medical” as listed in this proposal request. All terms and conditions below are a part of this proposal request. No proposals will be accepted unless these terms and conditions have been met. Rights are reserved to reject any and all proposals and to waive technicalities. Proposals which are not submitted in accordance with this proposal request will be rejected.

Term of Contract - The contract resulting from this proposal shall be as follows: Fully Insured Medical/Pharmacy - an initial 12 month period, if funded, beginning January 1,

2014 and ending December 31, 2014. Upon mutual agreement of the School Board and Service Provider(s), coverage/contracts may be extended for four additional one year periods.

Self Funded Medical/Pharmacy Administrative Service Fees – an initial 24 month period, if funded, beginning January 1, 2014 and ending December 31, 2015. Upon mutual agreement of the School Board and Service Provider(s), coverage/contracts may be extended for three additional one year periods.

Self Funded Medical/Pharmacy Stop Loss – an initial 12 month period, if funded, beginning January 1, 2014 and ending December 31, 2014. Upon mutual agreement of the School Board and Service Provider(s), coverage/contracts may be extended for four additional one year periods.

Either party may cancel the contract(s), without reason, with written notification. Cancellation must be in writing and received 120 days prior to December 31st of each contract year. Silence from both parties will be considered as acceptance for another contract year at the same terms and conditions. This condition is not to preclude providing the lowest possible price based on current economic conditions. If economic conditions warrant a change in the conditions or terms of the contract, either party may exercise the cancellation privilege on the next anniversary date without prejudice. The resulting contract from this proposal may be canceled by the Santa Rosa County School Board, at any time, for the contractor’s failure to comply with proposal specifications. Funding for this proposal is subject to availability of appropriated funds. Invoices are to be broken down and detailed as per items listed on proposal form and will be audited for the length of your contract with us.

Evaluation of Proposals - A committee will review and rank proposals based on various factors, including but not limited to company history, qualifications, location, references and price. A list of evaluation criteria is outlined on Page II-4. Presentations may be requested of the top ranked vendors. If necessary the committee will enter into negotiations with the company that receives the number one ranking.

Format for Response to RFP – Responses to the RFP must be in the following format and order. If you are not submitting a proposal for a particular service, include the tab for that section with a “NO BID” response.

Tab 1 – Required Formso Proposal Formo Drug Free Workplace Formo Public Entity Crime Sworn Statemento Certificate of Cost and Pricing Data (TINA) Formo Information Sheet for Transactions and Conveyanceso Proposal Questionnaire

Tab 2 – Fully Insured Medical and Pharmacy Proposalo Include information relative to the scope of services for Section IV – Model Program for

Fully Insured Medical and Prescription Drug Plan. o Prescription Drug coverage should be included in the medical quote.

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Tab 3 – Self Funded Medical and Pharmacy Administrative Service Fees Proposalo Include information relative to the scope of services for Section V – Model Program for

Self Funded Medical Claims Administration. Tab 4 – Self Funded Medical and Pharmacy Stop-Loss Insurance Proposal

o Include information relative to the scope of services for Section VI – Model Program for Self Funded Medical Stop-Loss Insurance

Tab 5 – Sample Documents o Contracts, Explanation of Benefits, plan documents, certificates/booklets, monthly and

annual paid claim reports, high cost claim reports, provider utilization reports, forms and other marketing materials.

Tab 6 – Referenceso Refer to Section II, Page 9, for requirements

Submission of Proposals - One original and 6 copies of the proposal must be filed in the Director of Purchasing and Contract Administrator’s office of the Santa Rosa County School Board, located at 6544 Firehouse Road, Milton Florida prior to 3:00 PM on Thursday, June 27, 2013 and clearly marked “RFP 13-10 Group Medical Insurance.” The sealed proposals will be publicly opened in the Director of Purchasing and Contract Administrator’s office at 8:00 AM, on Friday, June 28, 2013, to be acknowledged and referred to the Purchasing Manager for tabulation. The notice of intended decision will be posted by 4:00 PM, September 5, 2013. The contract award will be at the School Board meeting of Thursday, September 12, 2013, or a later date if additional study is required. Those submitting proposals and interested parties are invited and encouraged to attend both the opening and award. Only the names of the companies submitting a proposal will be called out at the bid opening per Florida Statute 119.071.

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Santa Rosa County School BoardRFP 13-10 Group Medical

*** Proposal Form ***DATE:

COMPANY:

ADDRESS: CITY, STATE & ZIP CODE:

PHONE: TOLL FREE PHONE:

INTERNET WEB SITE (URL): E-MAIL:

FAX:

By: ________________________ TITLE:

(Signature And Print Name)

PAYMENT TERMS:

ACCEPT VISA OR PROCUREMENT CARD FOR PAYMENT: YES NO ADDITIONAL DISCOUNT FOR USE OF VISA CARD:

WARRANTY:

*List additional services your company provides including pricing. You may attach additional pages if needed.

*List systems and equipment your company does not support

**THIS PROPOSAL FORM MUST BE THE FIRST PAGE OF YOUR PROPOSAL**

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TABLE OF CONTENTSPage Number

SECTION I - INTRODUCTIONScope of Request for Proposal...................................................................................... I-1Profile of Santa Rosa County School Board................................................................. I-1Current Plans................................................................................................................. I-2Separation and Distribution .......................................................................................... I-2

SECTION II - GENERAL CONDITIONSProposal Submission and Withdrawal ..........................................................................II-1Proposal or Public Opening ..........................................................................................II-1Proposal Questions........................................................................................................II-2Addenda to This RFP....................................................................................................II-2Minimum Qualifications of Proposer ...........................................................................II-2Negotiations of Proposals .............................................................................................II-3Conduct of Proposers.....................................................................................................II-3Evaluation Criteria ........................................................................................................II-4Cost of Preparation .......................................................................................................II-5Conflict of Interest ........................................................................................................II-5 Legal Requirements ......................................................................................................II-5Liability..........................................................................................................................II-5Public Record Law ........................................................................................................II-6Audit Records ................................................................................................................II-6Anti-Discrimination Clause ...........................................................................................II-6Retention of Records .....................................................................................................II-6Discriminatory Vendor’s List ........................................................................................II-7State Licensing Requirement .........................................................................................II-7Severability of Contracts ................................................................................................II-7Information Sheet for Transactions & Conveyances .....................................................II-7Use of Proposal Forms ...................................................................................................II-8Irrevocability of Proposal................................................................................................II-8Contract Awards .............................................................................................................II-8Compliance with Laws, Rules, and Regulations.............................................................II-8References ...................................................................................................................... II-9Deviations from Model Program.....................................................................................II-9Acceptance of Electronic Enrollment………………………………………………......II-9Certificate of Current Cost and Pricing Data ................................................................II-10

SECTION III – COMMON CONTRACT PROVISIONSProvisions Incorporated by Reference.….......................................................................III-1Prohibition of Warranty Endorsement …...................................................................... III-1Sole Agent Endorsement............................................................................................... III-1Hold Harmless/Indemnification Provision.................................................................... III-1Termination and Non-Renewal Endorsement............................................................... III-2Rerating Endorsement................................................................................................... III-3Provision of Legal Defense……………………………………………………………III-3

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SECTION IV – MODEL PROGRAM FOR FULLY INSURED MEDICAL andPHARMACY

Provisions Incorporated by Reference ......................................................................... IV-1Contract Period ............................................................................................................. IV-1Rate Guarantee Period .................................................................................................. IV-1Commissions..................................................................................................................IV-1Ownership of Claim Data …......................................................................................... IV-1Audit Requirement........................................................................................................ IV-2Eligibility & Enrollment ................................................................................................IV-2Continuity of Coverage (No Loss/No Gain Provision)................................................. IV-2Scope of Coverage ….................................................................................................... IV-2Pooling Point................................................................................................................. IV-2Scope of Services…...................................................................................................... IV-3Managed Care Services................................................................................................. IV-3Administrative Services ................................................................................................IV-8Additional Services..................................................................................................... IV-12Wellness Program and Disease Management Services .............................................. IV-13 Performance Guarantees ............................................................................................. IV-13

SECTION V – MODEL PROGRAM FOR SELF FUNDED MEDICAL and PHARMACY ADMINISTRATIVE SERVICE FEES

Provisions Incorporated by Reference .......................................................................... V-1Contract Period ............................................................................................................. V-1Rate Guarantee Period ................................................................................................... V-1Commissions.................................................................................................................. V-1Access to Claim Files..................................................................................................... V-1Ownership of Claim Files .............................................................................................. V-2Audit Requirement.......................................................................................................... V-2Eligibility & Enrollment ................................................................................................ V-2Continuity of Coverage (No Loss/No Gain Provision).................................................. V-2Scope of Coverage ......................................................................................................... V-3Scope of Services............................................................................................................ V-3Managed Care Services...................................................................................................V-3Administrative Services ................................................................................................. V-8Additional Services....................................................................................................... V-12Wellness Program and Disease Management Services................................................ V-13Performance Guarantees .............................................................................................. V-13

SECTION VI – MODEL PROGRAM FOR SELF FUNDED MEDICAL and PHARMACY - STOP-LOSS INSURANCE

Provisions Incorporated by Reference .........................................................................VI-1Scope of Coverage ........................................................................................................VI-1Continuity of Coverage (No Loss/No Gain Provision)..................................................VI-1Current Rates ................................................................................................................VI-2Claims History ..............................................................................................................VI-2

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Large Dollar Claims.......................................................................................................VI-2COBRA Participants......................................................................................................VI-2Contract Period ............................................................................................................. VI-2Rate Guarantee Period .................................................................................................. VI-2Remuneration................................................................................................................ VI-2

SECTION VII – GROUP BENEFITS PROPOSAL SUMMARYProposal Questionnaire…………..………………......................................................VII-1

SECTION VIII – EXPOSURE, LOSS DATA & APPENDICESSource of Information .................................................................................................VIII-1Appendices………………………………………………………………………......VIII-2

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SANTA ROSA COUNTYSCHOOL BOARD

_______________________________________

Section I

Introduction

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SECTION I

INTRODUCTION

SCOPE OF REQUEST FOR PROPOSAL

Santa Rosa County School Board, is requesting information for one or more of the following coverages/services as further described in this Request for Proposal (RFP):

Section IV of the RFP: Fully Insured Medical and Pharmacy Coverage

Section V of the RFP: Self Funded Medical and Pharmacy Administrative Service Fees. Proposals should include network access for the proposed plans, medical claims management, utilization review services and the ability to use the School Board’s choice of stop-loss insurance vendors.

Section VI of the RFP: Self Funded Medical and Pharmacy - Stop-Loss Insurance

Proposers have the ability to propose on one or all of the above requested coverages.Please see Section II, page 7 for Severability of Contracts.

It is the intent of the Santa Rosa County School Board to continue the current relationship with Fisher Brown Bottrell Insurance and Michael Carraway as the named agent of record.

PROFILE OF SANTA ROSA COUNTY SCHOOL BOARDThe Santa Rosa County School Board is located in Milton, Florida and is the School Board’s principal city.

Section I – Page 1

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CURRENT PLANS

Medical and RX Plans: A total of approximately 3,650 employees, retirees and their eligible dependents participate in five Florida Blue plans:

1. BlueOptions PPO 05773 – 5/60/100 RX 2. BlueOptions PPO 05301 – 10 Generic Only3. BlueOptions HDHP/HSA 05181/82 – 10/50/80 RX after CYD 4. BlueOptions HDHP/HSA 05192/93 – 20% RX after CYD 5. Blue Medicare PPO – 5/35/65 RX

The group medical plans currently include pharmacy coverage. For this RFP, the pharmacy coverage should also be included.

The group medical plans we currently offer have four plan tier options available:1. Employee/Retiree Only2. Employee/Retiree + Spouse3. Employee/Retiree + Child(ren)4. Employee/Retiree + Family

SEPARATION AND DISTRIBUTION

This RFP has been designed for transmittal as a complete document to interested parties. It is recommended that it not be separated; however, it may be reproduced in its entirety as additional distribution might dictate.

The School Board will utilize the BidNet System for distribution of RFP 13-10 Group Medical Insurance and Vendors must register and quotes will be issued at: http://www.govbids.com/scripts/panhandle/public/home1.asp OR contact BidNet at 1-800-677-1997.

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Section I – Page 2

SANTA ROSA COUNTYSCHOOL BOARD

_______________________________________

Section II

GeneralConditions

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SECTION II

GENERAL CONDITIONS

PROPOSAL SUBMISSION AND WITHDRAWALAll proposal sheets and forms must be executed and submitted in a sealed envelope.Seven completed responses to this RFP (one original and six copies) shall be submitted to the Purchasing Office at Santa Rosa County School Board in a sealed envelope marked "RFP 13-10 Group Medical Insurance.” All proposals are subject to the conditions specified herein. Those which do not comply with these conditions are subject to rejection. It is the sole responsibility of the Proposer to deliver the proposal to the address contained herein on, or before, the closing hour and date indicated. The School Board Purchasing Department will not be responsible for the inadvertent opening of a proposal not properly sealed, addressed or identified.

Proposals properly labeled in sealed envelopes will be received at:

Santa Rosa County School BoardPurchasing Manager, Judson C. Crane CPPB, CPPO,

Director of Purchasing & Contract AdministrationOffice of Purchasing6544 Firehouse Road

Milton, Florida 32570-6706

Proposals are due by 3:00 PM on June 27, 2013

Proposals, once received, become the property of the School Board, cannot be withdrawn, and will not be returned to the Proposers. Upon opening, proposals become subject to public disclosure in accordance with Chapter 119, Florida Statutes.

PROPOSAL OR PUBLIC OPENINGThe proposal opening shall be public, at the address indicated on the Request forProposal document, on the date and at the time specified. It is the Proposer’s responsibility to assure that the proposal is delivered at the proper time to the place of the opening. Proposals received after the date and time will be rejected and returned unopened to the offeror. Proposals by fax or telephone will not be accepted.

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Section II – Page 1

PROPOSAL QUESTIONSQuestions concerning any portion of this RFP shall be directed in writing to the below named individual who shall be the official point of contact for questions. Questions must be received before June 17, 2013. Questions will not be accepted after this date. Mark cover page, email subject or envelope(s) “Questions on RFP 13-10 Group Medical Insurance” and send to:

Karen L. RetherfordHuman Resource Services Manager

5086 Canal StreetMilton, FL 32570

Fax: [email protected]

Questions deemed material and requiring written clarification will be addressed in the form of an addendum and posted to the Purchasing Department website: www.santarosa.k12.fl.us/purchasing under Bids and Proposals.

ADDENDA TO THIS RFPPrior to submitting the proposal, it will be the sole responsibility of each Proposer to review the School Board’s website to determine if addenda were issued and, if so, to obtain such addenda for attachment to the proposal.

MINIMUM QUALIFICATIONS OF PROPOSERProposals will be accepted from financially sound insurers authorized to do business in the state of Florida. A.M. Best rating of “A” or better is required for each insurer responding to this RFP.

If claims administration services are to be provided by an organization not rated by A.M. Best or another nationally recognized rating firm, proposals will only be accepted if the organization providing the services:

1. Has, as of the proposal return date specified in the RFP, been successfully operating as a medical claims administrator for a minimum of five consecutive years; and

2. Submits with its proposal, its last audited financial statement issued by a certified public accountant, dated no earlier than 18 months prior to the proposal date specified in this RFP.

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Section II – Page 2

NEGOTIATIONS OF PROPOSALSBased on the written proposals, pursuant to Florida Statute 112.08, the School Board may elect to enter into negotiations with one or more of the proposers.

CONDUCT OF PROPOSERSAll submitters or individuals acting on behalf of submitters are hereby prohibited from lobbying or otherwise attempting to persuade or influence any member of the Santa Rosa County School Board or any member of the Selection Committee at any time during the course of the solicitation process. Failure to comply with this procedure will result in rejection/disqualification of said submittal without exception.

All submitters or individuals acting on behalf of submitters are further prohibited from contacting or otherwise attempting to communicate with any member of the Selection Committee regarding the pending solicitation or its outcome until after the Committee has arrived at a recommendation of the most qualified submitters. Until such recommendation is disclosed, any contact with the Selection Committee shall be channeled through the Office of Purchasing. Failure to comply with this procedure will result in rejection/disqualification of said submittal without exception.

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Section II – Page 3EVALUATION CRITERIAThe proposal review committee will select one or more proposer(s) based upon the evaluation criterion below for the medical plans. The Committee will select the group it deems most qualified as finalists and will conduct simultaneous negotiations with each vendor regarding cost, coverage, quality and service and will recommend award of the contract to the School Board to the vendor that provides the most responsive and responsible proposal that is most advantageous to the School Board.

MEDICAL PLANSCRITERION________________________________________________________________________Cost - Although cost will be a major consideration in evaluating proposals, it will not be the only consideration. Cost will include (but not be limited to) disclosure of rates/premiums, services cost and claims cost, cost guarantees. For self-insured options, cost will include stop loss terms, administration fees and other cost components.__________________________________________________________________________________Coverage - The amounts and breadth of coverage and extent of deductibles, co-payments, coinsurance, restrictions or exclusions._____________________________________________________________________________Providers – The number and types of providers. The provider network discounts. For medical benefits, the hospitals and number of physicians under contract and the number of contracted physicians who will accept new patients and the match-up between current top providers and the network providers proposed. For pharmacies, the extensiveness of the pharmacy network. ______________________________________________________________________________Service/Customer Service - The administration capabilities and experience of Proposers. This includes such items as enrollment assistance, service responsiveness, communication with the School Board staff on program administration, quality of billings and experience reports, Internet website, attendance at District Insurance Committee and School Board meetings/events, willingness to engage in at-risk performance guarantees, etc.__________________________________________________________________________________Wellness and Disease Management Programs. This includes such items as breadth of wellnessand disease management program and predictive modeling capabilities, bio-metric screenings, health risk assessment and self-help tools, health coaching, Internet website, attendance at wellness meetings/events. Experience in developing and administering programs, including use of incentives and other methods to encourage participation. Premium credit or wellness funds to support school district wellness initiatives. _________________________________________________________________________________Reporting Services – Monthly and annual reports of paid claims, high cost claim reports, provider utilization reports, quality of experience reports, developing adhoc reports, extent and quality of reports on wellness/disease management, etc.__________________________________________________________________________________Stability - Financial stability of the Proposer, A.M. Best ratings (if applicable), the number of years in business, etc.______________________________________________________________________________

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References – The input received from references contacted and the relevant experience such references display.______________________________________________________________________________Presentations – Presentations may be requested of the top ranked vendors. The quality of the presentation and the information provided about the proposal and expectations for service to the School Board.

Section II – Page 4COST OF PREPARATIONThe School Board will not reimburse any Proposer for any costs associated with the preparation and submittal of any proposal, or for any travel and per diem costs that are incurred by any Proposer in the preparation and submittal of any proposal.

CONFLICT OF INTERESTThe award hereunder is subject to the provisions of Chapter 112, Florida Statutes. All Proposers must disclose with their proposal the name of any officer, director, or agent who is also an employee of the School Board. Further, all proposers must disclose the name of any employee who owns, directly or indirectly, an interest in the proposer’s firm or any of its branches. The proposer shall not compensate, in any manner, directly or indirectly, any officer, agent, or employee of the School Board for any act or service that he/she may do, or perform for, or on behalf of any officer, agent or employee of the Proposer. No officer, agent, or employee of the School Board shall have any interest, directly or indirectly, in any contract or purchase made, or authorized to be made by anyone for, or on behalf of the School Board. The proposer shall have no interest and shall not acquire any interest that shall conflict in any manner or degree with the performance of the services required under this RFP.

LEGAL REQUIREMENTSApplicable provision of all Federal, State, county and local laws, and of all ordinances, rules, and regulations shall govern development, submittal and evaluation of all proposals received in response hereto and shall govern any and all claims and disputes that may arise between person(s) submitting a response to RFP hereto and the School Board by and through its officers, employees and authorized representatives, or any other person, natural or otherwise; and lack of knowledge by any bidder shall not constitute a cognizable defense against the legal effect thereof.

LIABILITYThe supplier shall hold and save the School Board, its members, its officials, officers, agents and employees harmless from liability of any kind in the performance of the contract resulting from this RFP.

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Section II – Page 5

PUBLIC RECORD LAWAny material submitted in response to this RFP will become a public document pursuant to Section 119.07, F.S. This includes material which the responding Proposer might consider to be confidential or a trade secret. Any claim of confidentiality is waived upon submission, effective after opening pursuant to Section 119.07. Contractor’s refusal to comply with this provision shall constitute sufficient cause for termination of the contract resulting from this RFP.

AUDIT RECORDSThe contractor agrees to maintain books, records, and documents (including electronic storage media) in accordance with generally accepted accounting procedures and practices which sufficiently and properly reflect all revenues and expenditure of funds provided by the School Board under any contract resulting from the RFP, and agrees to provide a financial and compliance audit to the School Board or to the Office of the Auditor General and to ensure that all related party transactions are disclosed to the auditor. The contractor agrees to include all record keeping requirements on all subcontracts and assignments related to the contract resulting from this RFP.

ANTI-DISCRIMINATION CLAUSEThe non-discrimination clause contained in Section 202, Executive Order 11246, as amended by Executive Order 11375, relative to Equal Employment Opportunity for all persons without regard to race, color, religion, sex or national origin, and the implementing rules and regulations provided by the Secretary of Labor are incorporated herein.

RETENTION OF RECORDSContractor agrees to retain all client records, financial records, supporting documents, statistical records, and any other documents (including electronic storage media) pertaining to any contract resulting from this RFP for a period of five (5) years. Copies of all records shall be made available to the School Board upon request. All invoices and documentation must be clear and legible for audit purposes. Documents must be retained by contractor within the State of Florida at an address to be provided, in writing, to the School Board within 30 days of the contract execution. Any records not available at thetime of an audit will be deemed unavailable for audit purposes. The contractor will cooperate with the School Board to facilitate the duplication and transfer of any said records or documents during the required retention period. The contractor shall inform the School Board of the location of all records pertaining to the contract resulting from this RFP and shall notify the School Board by certified mail within ten (10) days if/when the records have been moved to a new location.

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Section II – Page 6

DISCRIMINATORY VENDOR’S LISTAny entity or affiliate who has been placed on the Discriminatory Vendors List may not submit a proposal to provide goods or services to a public entity, may not be awarded a contract or perform work as a contractor, supplier, subcontractor, or consultant under contract with any public entity and may not transact business with any public entity.

STATE LICENSING REQUIREMENTAll entities defined under Chapters 607, 608, 617 or 620, Florida Statutes, seeking to do business with the School Board shall be on file and in good standing with the State Of Florida’s Department of Insurance.

The offeror shall have, prior to making this offer, met the license, certification, and any other requirements of the state, county, city and/or other agency of authority with jurisdiction in such matters and should provide copies of documentation which evidence such qualifications with your response to this solicitation; and, that the offeror shall provide follow-up evidence that the contractor maintains such credentials throughout the period of the agreement.

A copy of a current certificate of authority from the Secretary of State authorizing your company to do business in the State of Florida; or other evidence of legal authority to do business in the state, county, city and/or any other agency of authority should be provided with your response to this solicitation; however, the School Board may allow this responsiveness issue to be cured after submission of your offer within a reasonable period of time and prior to any recommendation for award. Information concerning certification with the Secretary of State can be obtained at http://ccfcorp.dos.state.fl.us/index.html.Failure to provide evidence of current licensure, certification or other evidence of legal authority to do business in the matters of this solicitation may render your offer non-responsive.

SEVERABILITY OF CONTRACTSThis RFP solicits proposals for multiple coverages/services. Each proposal received will be severable unless the Proposal indicates that the coverages/services are required to be purchased together. It is the Proposer’s responsibility to explain such details in the proposal.

INFORMATION SHEET FOR TRANSACTIONS AND CONVEYANCESThe Information Sheet for Transactions and Conveyances Corporation Identification should be completed and submitted with offer. Information as provided may be verified through the Department.

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Section II – Page 7

USE OF PROPOSAL QUESTONNAIRE AND PROPOSAL FORMProposers should complete the Proposal Questionnaire and Proposal Form included in Section VII of this RFP. All blanks on the Proposal Forms should be completed. If a question or confirmation is not applicable, it should be answered with an "N/A.”

Supplemental information may be attached to the Proposal Questionnaire and Proposal Form. Failure to fully complete the Proposal Questionnaire and Proposal Form may result in disqualification of your proposal.

If additional space for a response is required, attach an additional page to the page on which the question is stated. Clearly identify the number of the question to which the response is attached.

The signature on the Proposer's Warranty(ies) must be that of an officer, partner or a sole practitioner of the company making the proposal. The original proposal, and each copy submitted, should contain an original signature on the Proposer's Warranty contained in the Proposal Form.

IRREVOCABILITY OF PROPOSALEach Proposer agrees that proposals shall remain open until the effective date of coverage, January 1, 2014, not subject to revocation, and shall be subject to the School Board’s acceptance.

CONTRACT AWARDSThe School Board anticipates entering into a contract with the Proposer or Proposers who submit the proposals judged by the School Board to be most advantageous.

The Proposer understands that this RFP does not constitute an agreement or a contract with the Proposer. An official contract or agreement is not binding until proposals are reviewed and accepted by the School Board and executed by all parties.

The School Board reserves the right to reject all proposals, to waive any informality, to negotiate with vendors, and to solicit and re-advertise for other proposals.

COMPLIANCE WITH LAWS, RULES, AND REGULATIONSEach Proposer is responsible for full and complete compliance with all laws, rules, and regulations that may be applicable.

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Section II - Page 8

REFERENCESProposers should provide at least five references for whom similar coverage/services have been provided in the past three years. References from the School Board’s general geographic area and from similarly sized Florida counties, municipalities and/or other governments are preferred.

DEVIATIONS FROM MODEL PROGRAMThe contract terms and conditions stipulated in this RFP are those desired by the School Board, and preference will be given to those proposals in full or substantial compliance with them. All deviations from the model program must be clearly identified and stated in the proposal.

ACCEPTANCE OF ELECTRONIC ENROLLMENT Successful Proposer must have the capability of accepting electronic enrollment data and working cooperatively with Benefit Help, the School Board’s current vendor who provides on-line benefits administration and enrollment services. Proposer must be willing to accept weekly files from Benefit Help with membership updates.

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Section II – Page 9

CERTIFICATE OF CURRENT COST AND PRICING DATATruth in Negotiations Act (TINA)

This is to certify that, to the best of my knowledge and belief, the cost or pricing datasubmitted, either actually or by specific identification in writing, to the Santa Rosa County School Board, Office of Purchasing’s representative in support of Request for Proposal for Group Medical Insurance 13-10 is accurate, complete, and current as of _______________________*.

This certification includes the cost or pricing data supporting any advance agreements and forward pricing rate agreements between the offeror and Santa Rosa County School Board that are part of the proposal.

Firm:_____________________________________________________________

Signature:__________________________________________________________

Name:_____________________________________________________________

Title:______________________________________________________________

* Insert the date: day, month, and year, when price negotiations were concluded and price agreement was reached, or, if applicable, an earlier date agreed upon between the parties that are as close as practicable to the date of agreement on price.

THIS FORM MUST BE RETURNED WITH THE PROPOSAL.

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Section II – Page 10

SANTA ROSA COUNTYSCHOOL BOARD

_______________________________________

Section III

Common Contract Provisions

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SECTION III

COMMON CONTRACT PROVISIONS

PROVISIONS INCORPORATED BY REFERENCEThis Section III contains requirements and endorsements, which are common to more than one coverage or service. The contract requirements and endorsements set forth in this Section III are incorporated by reference in such sections. Those provisions, which are identified as endorsements, are to be included verbatim in the insurance policy or contract.

PROHIBITION OF WARRANTY ENDORSEMENTThe Company acknowledges that the School Board has made a reasonable attempt to provide the Company with relevant and appropriate rating exposures and loss data. The Company therefore waives any right of denial of coverage or voidance of the contract based upon any expressed or implied warranty or representation (whether written or oral) that the rating exposures and loss data provided disclose all exposures or data known to exist.

SOLE AGENT ENDORSEMENTIt is agreed that the School Board shall be the Sole Agent with respect to payment, cancellation, and notice with respect to the Contract between the School Board and the successful Proposer(s). Any notice with respect to the foregoing shall be sent in writing to:

Karen RetherfordHuman Resource Services ManagerSanta Rosa County School Board

5086 Canal StreetMilton, Florida 32570

HOLD HARMLESS/INDEMNIFICATION PROVISIONThe successful Proposer shall hold harmless, indemnify and defend the School Board, its members, officials, officers and employees against any claim, action, loss, damage, injury, liability, cost and expense of whatsoever kind or nature (including, but not by way of limitation, attorneys' fees and court costs) arising out of or incidental to the performance of the contract or work performed hereunder, whether or not due to or caused by negligence of the School Board, its members, officials, officers or employees,

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excluding only the sole negligence of the School Board, its members, officials, officers and employees.

Section III – Page 1

TERMINATION AND NON-RENEWAL ENDORSEMENTNotwithstanding any provision in this Contract to the contrary, except with respect to cancellation of this Contract for non-payment (for which at least sixty (60) days’ written notice shall be provided), the Company may not cancel, non-renew, restrict coverage, or restrict the Company's contractual obligations with respect to this Contract except:

A. as of the end of the 12 or 24 month anniversary of the Contract, whichever is applicable; and

B. then only when such action is to be effective at least one hundred and twenty (120) days after receipt by School Board, of valid written notice from the Company of the Company's intention with respect to such cancellation, nonrenewal, restriction of coverage, or restriction of the Company's contractual obligations.

The Company may not effect cancellation of this Contract for non-payment of premium until at least sixty (60) days after receipt by the School Board, of valid written notice from the Company of the Company's intention with respect to such cancellation.

The written notice of any cancellation, non-renewal or restriction of the Company's contractual obligations shall be delivered by certified mail to:

Karen RetherfordHuman Resource Services ManagerSanta Rosa County School Board

5086 Canal StreetMilton, Florida 32570

This Contract may be canceled at any time at the request of the School Board, by written notice to the Company stating when thereafter cancellation is to be effective. If the School District is required to provide advance notice to the Proposer of cancellation or non-renewal, the required notice should not exceed 60 days. In the event of termination of this Contract, for whatever reason, the earned fees or other consideration shall be computed on a pro rata basis without penalty, and the Company shall refund the excess of paid fees or other consideration to the School Board, within thirty (30) days from the date of termination.

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Section III – Page 2

RERATING ENDORSEMENTNotwithstanding any provision in this Contract to the contrary, the Company may not effect any increase of rates or other consideration applicable to this Contract except:

A. as of the end of the 12 or 24 month anniversary of this Contract, whichever is applicable; and

B. then only when such increase is to be effective at least ninety (90) days after receipt by the School Board, of valid written notice from the Company, stating specifically the amount of change proposed. Mere notice that a change in rates or consideration is proposed, without stating clearly the exact amount and the effect of the proposed change on the overall consideration of this Contract, shall not constitute a valid notice.

The written notice of any change in rates or other change in consideration shall be delivered by certified mail to:

Karen RetherfordHuman Resource Services ManagerSanta Rosa County School Board

5086 Canal StreetMilton, Florida 32570

PROVISION OF LEGAL DEFENSEPlease indicate the extent to which the Proposer will provide a legal defense and/or pay claims in the event of suits by plan participants.

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Section III – Page 3

SANTA ROSA COUNTYSCHOOL BOARD

_______________________________________

Section IV

Model ProgramFor

Fully Insured Medical andPharmacy Plan

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SECTION IV

MODEL PROGRAM FORFULLY INSURED MEDICAL AND PHARMACY PLAN

PROVISIONS INCORPORATED BY REFERENCEThe following provisions of this RFP are incorporated by reference into thisSECTION IV – MODEL PROGRAM FOR FULLY INSURED MEDICAL AND PHARMACY PLAN.

SECTION II - GENERAL REQUIREMENTS - All the provisions of SectionII are specifically incorporated by reference.

SECTION III – COMMON CONTRACT PROVISIONS – All provisions of Section III are specifically incorporated by reference.

CONTRACT PERIODFor fully insured services, an initial twelve (12) month contract from January 1, 2014, through and including December 31, 2014, is required with the option of the School Board to renew the program for four (4) additional plan years thereafter. Renewal guarantees are encouraged and will be considered favorably.

RATE GUARANTEE PERIODRegardless of actual enrollment, the initial rates shall be guaranteed for 12 months from the effective date of the contract. Changes after the initial 12 month period shall be subject to the Rerating Endorsement.

COMMISSIONSThe Proposer must identify any agents, brokers or intermediaries who will be receiving commissions or other similar compensation. Any commissions or other similar compensation must be shown separately including the commission basis and the estimated annual commission amounts. Commission arrangements, if any, will be between the School Board, the successful Proposer and any agent, broker or other intermediary representing the successful Proposer.

OWNERSHIP OF CLAIM DATAThe School Board shall have all right, title, interest and ownership to all loss statistics created as a result of the services to be provided by the successful Proposer. Further, at

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the sole option of the School Board, and upon fourteen (14) calendar days’ written notice, the successful Proposer shall provide such data to the School Board.

At the termination of the contract, the successful Proposer shall provide the School Board with computer tapes or other computer media containing all of the data required to facilitate a smooth transition. Such data shall be made available within 30 days of written request, in a format generally importable into a commonly recognized database for loss statistics.

Section IV – Page 1

AUDIT REQUIREMENTAt the sole option of the School Board, the successful Proposer shall submit to an audit by, or on behalf of, the School Board of the successful Proposer's files and procedures as they relate to the School Board.

ELIGIBILITY & ENROLLMENTCoverage must match the School Board’s current eligibility requirements, including coverage for retirees, as outlined in the School Board’s current plan documents, found in the Exposure Section of this RFP.

Proposers should be aware that it is impossible to predict how many employees will elect each plan design and monthly premiums rates for each plan design must be honored as proposed even if there is a substantial change in plan design choices at enrollment.

CONTINUITY OF COVERAGE (NO LOSS/NO GAIN PROVISION)Notwithstanding any actively at work, waiting period, pre-existing condition, or other provision or limitation in the proposed plan to the contrary, if, but for the replacement of the current plan with the proposed plan, an insured would have been covered by the current plan, the insured shall be entitled to the lesser of:

(1) the benefits which would have been payable had the current plan been continued; or

(2) the benefits which would be payable under the proposed plan without the application of any actively at work, waiting period, pre-existing condition, or other provision or limitation in the proposed plan.

SCOPE OF COVERAGEThe School Board is interested in proposals for plan designs that most closely match theSchool Board’s current plan designs: High Option PPO 05773, Low Option PPO 05301, High Option HDHP/HSA 05181/82, Low Option HDHP/HSA 05192/93 and Blue Medicare PPO.

In addition to proposals for four plan designs that most closely match the School Board’s current plan designs, the School Board is also requesting proposals for only two plans, the High Option PPO 05773 and the Low Option HDHP/HSA 5192/93.

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The School Board reserves the right to negotiate with proposer finalist(s) on alternative designs.

POOLING POINTProposers are requested to provide details regarding the pooling point and pooling charges included in premium calculations. Current pooling is at $255,000.

Section IV – Page 2

SCOPE OF SERVICESThe successful Proposer shall perform all services indicated below, includingManaged Care Services, Administrative Services, Prescription Benefit Services and Additional Services. Proposals must include claims administration, network access and utilization review services. Any sub-contracted services to be provided in connection with these requirements must be identified in the proposal.

Fully insured and self funded proposals should include prescription drug coverage.

All proposals should include copies of any contract which the School Board will be required to execute. All proposals should include copies of standard communication materials that are sent to members, such as explanation of benefit (EOB) type forms.

MANAGED CARE SERVICESProposer should maintain a provider managed care network consisting of hospitals, physicians, allied and ancillary services, and durable medical equipment. This arrangement should:

1. Provide services with reasonable promptness with respect to geographical location, hours of operation, and after hours care; including emergency care available 24 hours a day, 7 days a week.

2. Contract with network physicians that:

a. Hold appropriate occupational and professional licenses;

b. Hold active and unrestricted privileges in their specialty;

c. Have a valid Drug Enforcement and Administration (DEA) number and hold unrestricted prescribing privileges (except chiropractors);

d. Have hospital privileges at participating hospitals;

e. Have not been convicted of a felony or greater crime;

f. Are specialty board certified (80% or greater); and

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g. Have not been suspended, placed on probation or limited from any hospital privileges or restricted from receiving payments from Medicare, Medicaid, or other third party programs during the last five years

Section IV – Page 3

3. Contract with network hospitals that:

a. Hold current Joint Commission on Accreditation of Hospitals (JCAH) accreditation without conditions and licensure;

b. Have at least 80% of staff physicians with full admitting privileges board certified;

c. Are free from disciplinary action for the last five years;

d. Are Medicare certified; and

e. Hold current accreditation with one of the following (in lieu of JCAH), if hospital is primarily of a rehabilitative nature and lacks surgical facilities:

(1) American Osteopathic Hospital Association; or(2) Commission on the Accreditation of Rehabilitative Facilities

4. Provide a network(s) consisting of providers that have the capacity to provide treatment throughout the State of Florida. a. The School Board desires the network to include the following most

utilized hospitals: (1) Baptist Health Care Systems (including Gulf Breeze and Jay

Hospitals)(2) Sacred Heart Hospital(3) Santa Rosa Medical Center(4) West Florida Hospital

Proposers should include a detailed list that includes all participating hospitals in the following counties: Escambia, Santa Rosa and Okaloosa.

In addition, include a detailed list of all national specialty facilities that are considered in network under your proposed plans. Examples include M.D. Anderson, Mayo Clinic, UAB, Shands, Ochsners, etc.

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b. The School Board desires that the hospitals in the network(s), collectively, should offer the following services:(1) Anesthesia(2) Audiology(3) Day Surgery(4) Diagnostic, X-Ray, and Laboratory Services(5) Emergency Services(6) Medical/Surgical Intensive and Acute Care

Section IV – Page 4Services continued:(7) Neo-natal Care(8) Neurology Services(9) Obstetrical Care and High-Risk Obstetrical Care(10) Pediatric Care(11) Psychiatric Care(12) Respiratory Care(13) Social Service & Discharge Planning(14) Speech Pathology(15) Substance Abuse Treatment(16) Therapies - Physical, Respiratory, Occupational(17) Trauma Care

c. The School Board desires that the network(s) include the following providers:

(1) Primary care physicians who include physicians practicing in the field of General Practice, Family Practice, Internal Medicine, OB/GYN, and Pediatrics.

(2) Specialty physicians in the network(s), collectively, should provide the following medical practice areas:- Allergy/Immunology- Anesthesiology- Cardiology- Chiropractic Medicine- Endocrinology- Dermatology- Gastroenterology- Internal Medicine- Neurology- Obstetrics/Gynecology- Oncology- Ophthalmology- Orthopedic Medicine- Otolaryngology

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- Pediatrics- Physical and Occupational Therapy- Podiatry- Pulmonary Medicine- Radiology- Rheumatology- Speech Pathology and Audiology- Urology Section

IV – Page 55. Include ancillary providers in the network(s) that are properly licensed and

credentialed, and provide the following services: imaging centers, diagnostic x-ray and laboratory facilities, durable medical goods, home health care, skilled nursing facility, birth centers, and hospices.

6. Provide the School Board with information relative to network discounts that the Proposer receives from local providers including inpatient hospital discounts, outpatient hospital discounts and physician discounts.

7. Provide employees with on-line access to current directory information and printed copies upon request.

8. Require that network providers hold the employees/dependents and the School Board harmless from any fees for services which are rendered that are plan eligible charges (except deductibles, co-payments and coinsurance), regardless of the reason for non-payment.

9. Prohibit network providers from balance billing the patient for any excess of contracted amount, except for deductibles, co-payments and coinsurance.

10. Provide Medical Case Management that:

a. Uses Florida Registered Nurses and vocational counselors to provide all the services described below. Refer more complicated cases and/or disputes with providers to physician consultants who are licensed and are board certified in their specialty.

b. Performs specific services that coordinate the provision of care and the management of benefits in cases of catastrophic illness or injury. Such a program should strive to ensure that patients receive the most appropriate, cost-effective care and derive maximum advantage from available plan benefits. It may require covering expenses not normally covered by the plan (e.g., air conditioners, wheelchair ramps, etc.) in exceptional situations, to return a patient to a productive life.

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c. Follows specific medical/disability criteria to determine which claims may need medical/disability management intervention to include, but not be limited to, the following:(1) Spinal cord injury(2) Burns (third and fourth degree)(3) Amputations(4) Traumatic brain injury(5) Renal failure(6) Neo-natal single or multiple births

Section IV – Page 6Medical/disability criteria continued:(7) Neoplasm of brain, bone, pancreas, liver(8) At risk pregnancy(9) Accidents involving multiple family members with multiple injuries(10) All claims exceeding a $25,000 threshold(11) Organ transplants

d. Coordinates with Utilization Review and claims processing for effectiveness and efficiency.

e. Provides quarterly medical case management reports on all claims expected to exceed $10,000 or otherwise identified as being the type of claim which will benefit from medical case management, in addition to reports that identify current and past case loads, prognoses and savings realized through case management.

10. Provide Utilization Review that:

a. Uses Florida licensed Registered Nurses to provide all the services described below. Refer more complicated cases and/or disputes with providers to physician consultants who are licensed and are board certified in their specialty.

b. Includes the following specific services:(1) Pre-admission certification for medical admissions, and

determination of medical necessity;

(2) Continued stay review by telephone of all hospitalizations. Certification of the need for additional days beyond the initial precertification. Medical necessity of treatment and length of stay to be strictly observed. No benefits are to be payable if the treatment is not medically necessary;

(3) Concurrent Review of selected hospitalizations via personal visit by a Registered Nurse (RN) where conditions indicate the need;

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(4) Retrospective Utilization Review (after delivery of service, but prior to payment) of all unusual claims plus all claims over 25,000; and

(5) Discharge planning for medical/surgical patients.

c. Provides quarterly statistics on the effectiveness of Utilization Review.

Section IV – Page 7d. Coordinates with Medical Case Management for effectiveness and

efficiency.

ADMINISTRATIVE SERVICESExcept for the collection of premium to the successful Proposer and, as except otherwise noted in this RFP, the successful Proposer shall be totally responsible for the administration of the plan. These activities should include, but are not limited to, the following:

1. Subject to the exercise of professional judgment, the successful Proposer shallaccept and settle or deny all reported claims. Successful Proposer will also be responsible for adjudication of claims appeals.

2. Furnish an electronic version of the certificates/booklets for the School Board to use on their website.

3. Issue ID cards within three (3) calendar weeks (plus four (4) days’ mailing time) after completion of open enrollment periods or after new hire electronic enrollment records are received. ID cards will be mailed directly to members.

4. Establish claims reporting procedures that are compatible with the needs and organizational structure of the School Board.

5 Provide enrollment assistance, including educational materials pre-approved by the School Board in advance of distribution, to the School Board during open enrollment period on an annual basis. These tasks should include, but not be limited to, requiring Proposer representatives to attend all scheduled benefit/enrollment meetings.

6. Assign a staff person as the School Board’s account representative.

7. Meet with the District Insurance Committee as needed to discuss the status of the plan, performance, audits, reports, and planning.

8. Attend meetings, if requested by the School Board.

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9. Verify claimant’s eligibility for benefits based on eligibility requirements furnished by the School Board.

10. Maintain covered dependent information by dependent’s name, date of birth, gender, and relationship to insured and social security number.

11. Prepare a monthly report on any covered dependents (excluding dependents who are mentally and physically handicapped) who will be turning age 30 the

Section IV – Page 8following month. Provide a copy of this report to the School Board within five (5) working days from the end of the reporting period.

12. The Patient Protection and Affordable Care Act (PPACA) requires benefit plans that provide coverage for dependents to cover adult children to age 26*. This applies to all group health plans and issuers of group or individual insurance, including fully insured and self funded plans. In general, coverage must be allowed to continue until the child reaches the age of 26. The obligation to make dependent coverage available to children ends the day before the child’s 26th* birthday.

*Although PPACA only requires coverage up to age 26, the School Board desires to continue coverage up to age 30.

13. Use fully automated online clinically-oriented claims adjudication and auditing system that analyzes coded claims data to ensure correct identification.

14. Screen for and deny workers’ compensation claims.

15. Target (flag) the following types of claims for supervisory review*:

a. Service required precertification, but certification not obtained;

b. Actual length of stay or level of service does not match the approved length of stay or level of service;

c. Dollar amount or diagnoses warrants potential referral to medical casemanagement; or

d. Any one bill that exceeds $10,000.

*Supervisory review shall include, as appropriate, at a minimum, review of itemization of invoices exceeding $10,000 and review of case management notes.

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16. Identify and maintain separate COB information for each applicable claimant, as well as distinguish between the various types of COB.

17. Maintain the confidentiality requirements of Florida law by having adequate systems security features.

18. Turnaround 95% of all "clean" claims within ten (10) working days and 100% of all claims within thirty (30) working days. A “clean” claim is a claim submitted with all needed information for proper processing and adjudication.

Section IV – Page 9

19. Issue EOBs (print or electronic version) to the claimant within five working days of processing claims.

20. Prepare and furnish the School Board with monthly exposure and loss data statistics. Exposure data should include census data, such as zip code, date of birth and employment status. Loss data reports should include, but not be limited to, the following information: (Data subject to compliance with HIPAA privacy guidelines.)

a. Claims data should be provided monthly (within 30 days after the end of the month) with cumulative totals for the plan year, separately for participants in each plan offered, preferably in a format that will provide data separately for employees and their dependents, retirees and their dependents and COBRA and their dependents, and total for all participants and all dependents. The desire for separate premium/claims experience for employees, retirees, COBRA and dependents is to permit the School Board to determine if the rates being charged are equitable. Claim reports should be provided additionally for 12 months after plan termination or until there are no run-out and/or extension of benefits claims.

b. Claims data should be provided monthly detailing all claims where more than $50,000 has been paid in the current plan year. Data should include amount paid, type of plan participant (employee, dependent, retiree, etc.), diagnosis, prognosis and status of the claim (active, expired, etc.).

21. Cooperate with the managed care organizations and the UR firm in resolving discrepancies for proper payment of benefits when compliance dictates the use of one or both of these programs.

22. Conduct semi-annual internal audits for claim accuracy and occurrence ofmispayments. Report results to the School Board within ten (10) working days from the end of the reporting period.

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23. Identify and pursue claims that should be properly payable through automobile insurance and/or coordination of benefits (COB). Additionally, report on the savings produced.

24. Provide COBRA and HIPAA administration and pay COBRA beneficiary claims.

25. Establish and maintain a toll-free line for employees. This line should be operational from at least 8 a.m. to 6 p.m. (Central Standard Time). A voice mail system or equivalent system should be available to take off-hour or weekend calls.

Section IV – Page 10

26. Maintain access to a Medical Director to evaluate appealed claims.

27. Administer the plan on a detail billing remittance basis by division, separated by active employee, retiree and COBRA beneficiary.

28. Conform accounting procedures and practices to generally accepted accounting principles.

29. Maintain proper records for tax reporting purposes; e.g., 1099s.

30. Retain medical claims history online for minimum of 24 months.

31. Provide benefits to employees/dependents that are referred to an out-of-network specialist due to the lack of in-network providers in that specialty, at the network benefit level.

32. Prepare, maintain, and file with any applicable federal, state or local governmental agencies, any forms or reports as may be required from time to time by law; e.g., Form 5500, COBRA, etc.

33. Provide assistance with regard to: (1) problems arising in connection with insurance laws, (2) tax aspects of the Plan, (3) litigation arising out of the administration of the Plan, and (4) any other legal matters that may arise in the course of the operation of the Plan.

34. Establish claim denial and grievance procedures which are clearly communicated to members. Grievance procedures should be consistent with all applicable federal and state laws, rules and regulations. Proposer will be responsible for adjudication of claims appeals/grievances.

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Section IV – Page 11

ADDITIONAL SERVICES1. Supply all postage required to service the School Board’s account.

2. Provide an EOB that meets the School Board's approval and uses a format and terminology such that a person not of a medical or insurance background can easily understand the content.

3. Send correspondence using School Board approved pre-formatted letters to the claimant or provider. The content of these letters must be easily understandable by a person not of a medical or insurance background.

4. The School Board will have first review and pre-approval of any correspondence that will be sent to claimants or providers that includes changes/amendments to the plan.

5. Maintain all records of business transacted in accordance with this RFP. At the end of the contract period, all documents, papers, records, canceled checks and claims history shall be captured in such a manner for media storage and delivered to the School Board.

6. Provide access to archived data within ten (10) working days of a request by the School Board.

7. Provide reports inclusive of data elements specified by the School Board, and in mutually agreed upon formats. The required standard reports include, but are not limited to, the following:

a. Monthly reports are due on the 15th workday following the end of the "report" month. These reports should include paid claims summaries (separated by employee, dependent, retiree, and COBRA beneficiary).

b. Quarterly and Year-to-Date Reports are due on the 15th working day following the "report" quarter. These reports should include: benefit

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payment summaries, inpatient (utilization) reports, paid claims by coverage and diagnosis types, COB savings, and service inquiries.

Section IV – Page 12

WELLNESS PROGRAM AND DISEASE MANAGEMENT SERVICESThe School Board received $450,000 in wellness funds from Florida Blue in 2012 and $100,000 in wellness funds in 2013 to help support district wellness program initiatives that have been in place since October of 2009. In order to maintain such a program, Proposers that include a wellness fund contribution in their proposal will be favored.

The School Board is interested in proactive wellness and disease management initiatives, including participation incentives, including but not limited to health screenings, flu shot programs, health risk assessments and health fairs. Please provide details in your proposal of all current program offerings including, if applicable, any additional cost. Proposals should detail the support staff and other assistance that will be provided. Additionally, please outline any wellness services that you feel would be advantageous to the School Board and why.

PERFORMANCE GUARANTEESProposers should confirm that they are willing to offer performance guarantees and that they are willing to permit the School Board access to claims offices, personnel and files to conduct audits necessary to verification of performance standards. Performance may be evaluated on a variety of issues, such as:

Timely delivery of finalized contracts for the selected program. Timely delivery of identification cards, at and subsequent to initial enrollment. Timely delivery of plan documents. Claims turnaround time. Accuracy of claims coding and payments. Telephone response time and abandonments. Quality of service to plan participants, as measured by periodic surveys. Quality and timeliness of claims experience reports. Network provider participation, with penalties for drops below pre-specified

levels.

Rate of provider turnovers. Access to standards of care.

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Collection or other threats to participants by providers not paid by the insurer.

Please confirm your firm’s willingness to enter into such an agreement and to negotiate appropriate terms, and recommend appropriate incentives or disincentives (meaningful penalties) to make the performance guarantee practical.

Section IV – Page 13

SANTA ROSA COUNTYSCHOOL BOARD

_______________________________________

Section V

Model Program

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ForSelf Funded Medical and Pharmacy

Administrative Services Fees

SECTION VMODEL PROGRAM FOR

SELF FUNDED MEDICAL and PHARMACY – ADMINISTRATIVE SERVICE FEES

PROVISIONS INCORPORATED BY REFERENCEThe following provisions of this RFP are incorporated by reference into thisSECTION V – MODEL PROGRAM FOR SELF FUNDED MEDICAL and PHARMACY ADMINISTRATIVE SERVICE FEES.

SECTION II - GENERAL REQUIREMENTS - All the provisions of Section II are specifically incorporated by reference.

SECTION III – COMMON CONTRACT PROVISIONS – All the provisions of Section III are specifically incorporated by reference.

CONTRACT PERIODAn initial Third Party Administrator (TPA) Services contract from January 1, 2014 through and including December 31, 2015, a period of twenty four (24) months, is required with Santa Rosa County, having the option of renewing the program for three (3) additional plan years thereafter.

Proposals are requested to provide pre-determined fees for run-out claims administration charges in the event of cancellation/non-renewal of the plan.

RATE GUARANTEE PERIODRegardless of actual enrollment, the initial ASO rates shall be guaranteed for 24 months.Changes after the initial 24 month period shall be subject to the Rerating Endorsement.

COMMISSIONS

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Any commissions or other similar compensation must be shown separately including the commission basis and the estimated annual commission amounts. Commission arrangements, if any, will be between the School Board, the successful Proposer and any agent, broker or other intermediary representing the successful Proposer.

ACCESS TO CLAIM FILESThe proposer agrees that the School Board shall have reasonable access to all claimfiles created as a result of the claims services to be provided by the successful Proposer. For the purpose of this provision, reasonable access shall include making available, upon receipt of five (5) days advance written notice, all claim files for review by the School Board. Further, upon written request of the School Board, the successful Proposer shall make available to the School Board at the School Board’s offices and within ten (10) days after the written request, a complete copy of selected files identified by the School Board.

Section V – Page 1

OWNERSHIP OF CLAIM FILESThe School Board shall have all right, title, interest and ownership to all loss statistics and claim files created as a result of the services to be provided by the successful Proposer. Further, at the sole option of the School Board, and upon fourteen (14) calendar days’ written notice, the successful Proposer shall furnish such files to the School Board.

At the termination of the contract, the successful Proposer shall provide the School Board with computer tapes or other computer media containing all of the data required to facilitate a smooth transition. Such data shall be made available within 30 days of written request, in a format generally importable into a commonly recognized database for loss statistics.

AUDIT REQUIREMENTAt the sole option of the School Board, the successful Proposer shall submit to an audit by, or on behalf of, the School Board of the successful Proposer's files and procedures as they relate to the School Board.

ELIGIBILITY & ENROLLMENTCoverage must match the School Board’s current eligibility requirements, including for retirees, as outlined in the School Board’s current plan documents, found in the Exposure Section of this RFP.

Proposers should be aware that it is impossible to predict how many employees will elect each plan design and monthly premium rates for each plan design must be honored as proposed even if there is a substantial change in plan design choices at enrollment.

CONTINUITY OF COVERAGE (NO LOSS/NO GAIN PROVISION)Notwithstanding any actively at work, waiting period, pre-existing condition, or other provision or limitation in the proposed plan to the contrary, if, but for the replacement of

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the current plan with the proposed plan, an insured would have been covered by the current plan, the insured shall be entitled to the lesser of:

(1) the benefits which would have been payable had the current plan been continued; or

(2) the benefits which would be payable under the proposed plan without the application of any actively at work, waiting period, pre-existing condition, or other provision or limitation in the proposed plan.

Section V – Page 2SCOPE OF COVERAGEThe School Board is interested in proposals for plan designs that most closely match theSchool Board’s current plan designs: High Option PPO 05773, Low Option PPO 05301, High Option HDHP/HSA 05181/82 and Low Option HDHP/HSA 05192/93 and Blue Medicare PPO.

In addition to proposals for four plan designs that most closely match the School Board’s current plan designs, the School Board is also requesting proposals for only two plans, the High Option PPO 05773 and the Low Option HDHP/HSA 5192/93.

The School Board reserves the right to negotiate with proposer finalist(s) on alternative plan designs.

All proposals should include copies of any contract which the School Board will be required to execute. All proposals should include copies of standard communication materials that are sent to members, such as explanation of benefit (EOB) type forms.

SCOPE OF SERVICESThe School Board is seeking proposals for claims administrative services from a qualifiedThird Party Administrator (TPA) to support the School Board's group plan.

The School Board recognizes that as a public entity, it is subject to Florida Statute 112.08 requiring procurement of actuarial services for self-insured plans to assure that funding levels are set to cover current and future liability of the benefits plan. Actuarial services (actuarial certification) will be separately procured by the School Board.

The successful Proposer shall perform all services indicated below, including Managed Care Services, Administrative Services, and Additional Services. Proposals must include claims administration, network access and utilization review services. The School Board expects to contract with a vendor which may sub-contract with various necessary

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vendors, such as a provider network. Such sub-contracted vendors must be identified in the proposal.

MANAGED CARE SERVICESProposer should maintain a provider managed care network consisting of hospitals, physicians, allied and ancillary services, and durable medical equipment. This arrangement should:

1. Provide services with reasonable promptness with respect to geographical location, hours of operation, and after hours care; including emergency care available 24 hours a day, 7 days a week.

2. Contract with network physicians that:a. Hold appropriate occupational and professional licenses;

Section V – Page 3b. Hold active and unrestricted privileges in their specialty;

c. Have a valid Drug Enforcement and Administration (DEA) number and hold unrestricted prescribing privileges (except chiropractors);

d. Have hospital privileges at participating hospitals;

e. Have not been convicted of a felony or greater crime;

f. Are specialty board certified (80% or greater); and

g. Have not been suspended, placed on probation or limited from any hospital privileges or restricted from receiving payments from Medicare, Medicaid, or other third party programs during the last five years.

3. Contract with network hospitals that:a. Hold current Joint Commission on Accreditation of Hospitals (JCAH)

accreditation without conditions and licensure;

b. Have at least 80% of staff physicians with full admitting privileges board certified;

c. Are free from disciplinary action for the last five years;

d. Are Medicare certified; and

e. Hold current accreditation with one of the following (in lieu of JCAH), if hospital is primarily of a rehabilitative nature and lacks surgical

facilities:

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(1) American Osteopathic Hospital Association; or

(2) Commission on the Accreditation of Rehabilitative Facilities

4. Provide a network(s) consisting of providers that have the capacity to provide treatment throughout the State of Florida.a. The School Board desires the network to include the following most

utilized hospitals:(1) Baptist Health Care Systems (including Gulf Breeze and Jay Hospitals)(2) Sacred Heart Hospital(3) West Florida Hospital(4) Santa Rosa Medical Center

Proposers should also include a detailed list that includes all participating hospitals in the following counties: Escambia, Santa Rosa and Okaloosa.

Section V – Page 4

In addition, include a detailed list of all national specialty facilities in network, i.e. M.D. Anderson, Mayo Clinic, UAB, Shands, Ochsners, etc.

b. The School Board desires that the hospitals in the network(s), collectively, should offer, the following services:(1) Anesthesia(2) Audiology(3) Day Surgery(4) Diagnostic, X-Ray, and Laboratory Services(5) Emergency Services(6) Medical/Surgical Intensive and Acute Care(7) Neo-natal Care(8) Neurology Services(9) Obstetrical Care and High-Risk Obstetrical Care(10) Pediatric Care(11) Psychiatric Care(12) Respiratory Care(13) Social Service & Discharge Planning(14) Speech Pathology(15) Substance Abuse Treatment(16) Therapies - Physical, Respiratory, Occupational(17) Trauma Care

c. The School Board desires that the network(s) include the following providers:(1) Primary care physicians who include physicians practicing in the

field of General Practice, Family Practice, Internal Medicine, OB/GYN, and Pediatrics.

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(2) Specialty physicians in the network(s), collectively, should provide the following medical practice areas:- Allergy/Immunology- Anesthesiology- Cardiology- Chiropractic Medicine- Endocrinology- Dermatology- Gastroenterology- Internal Medicine- Neurology- Obstetrics/Gynecology- Oncology- Ophthalmology

Section V – Page 5Specialty physicians continued:- Orthopedic Medicine- Otolaryngology- Pediatrics- Physical and Occupational Therapy- Podiatry- Pulmonary Medicine- Radiology- Rheumatology- Speech Pathology and Audiology- Urology

5. Include ancillary providers in the network(s) that are properly licensed and credentialed, and provide the following services: imaging centers, diagnostic x-ray and laboratory facilities, durable medical goods, home health care, skilled nursing facility, birth centers, and hospices.

6. Provide employees with on-line access to current directory information and printed copies upon request.

7. Provide the School Board with information relative to network discounts that the Proposer receives from local providers including inpatient hospital discounts, outpatient hospital discounts and physician discounts.

8. Require that network providers hold the employees/dependents and the School Board harmless from any fees for services which are rendered that are plan eligible charges (except deductibles, co-payments and coinsurance), regardless of the reason for non-payment.

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9. Prohibit network providers from balance billing the patient for any excess of contracted amount, except for deductibles, co-payments, and coinsurance.

10. Provide Medical Case Management that:a. Uses Florida Registered Nurses and vocational counselors to provide all

the services described under (c). Refer more complicated cases and/or disputes with providers to physician consultants who are licensed and are board certified in their specialty.

b. Performs specific services that coordinate the provision of care and the management of benefits in cases of catastrophic illness or injury. Such a program should strive to ensure that patients receive the most appropriate, cost-effective care and derive maximum advantage from available plan benefits. It may require covering expenses not normally covered by the

Section V – Page 6plan (e.g., air conditioners, wheelchair ramps, etc.) in exceptional situations, to return a patient to a productive life.

c. Follows specific medical/disability criteria to determine which claims may need medical/disability management intervention to include, but not be limited to, the following:

(1) Spinal cord injury(2) Burns (third and fourth degree)(3) Amputations(4) Traumatic brain injury(5) Renal failure(6) Neo-natal single or multiple births(7) Neoplasm of brain, bone, pancreas, liver(8) At risk pregnancy(9) Accidents involving multiple family members with

multiple injuries (10) All claims exceeding a $25,000 threshold(11) Organ transplants

d. Coordinates with Utilization Review and claims processing for effectiveness and efficiency.

e. Provides quarterly medical case management reports on all claims expected to exceed $10,000 or otherwise identified as being the type of claim which will benefit from medical case management, in addition to reports that identify current and past case loads, prognoses and savings realized through case management.

11. Provide Utilization Review that:

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a. Uses Florida licensed Registered Nurses to provide all the services described below under (c). Refer more complicated cases and/or disputes with providers to physician consultants who are licensed and are board certified in their specialty.

b. Includes the following specific services:(1) Pre-admission certification for medical admissions, and

determination of medical necessity;

(2) Continued stay review by telephone of all hospitalizations. Certification of the need for additional days beyond the initial certification. Medical necessity of treatment and length of stay to be strictly observed. No benefits are to be payable if the treatment is not medically necessary;

Section V – Page 7(3) Concurrent Review of selected hospitalizations via personal visit

by a Registered Nurse (RN) where conditions indicate the need for such;

(4) Retrospective Utilization Review (after delivery of service, but

prior to payment) of all unusual claims plus all claims over $25,000; and

(5) Discharge planning for medical/surgical patients.

c. Provides quarterly statistics on the effectiveness of Utilization Review.

d. Coordinates with Medical Case Management for effectiveness and efficiency.

ADMINISTRATIVE SERVICESExcept for the collection of premium to the successful Proposer and, as except otherwise noted in this RFP, the successful Proposer shall be totally responsible for the administration of the plan. These activities should include, but are not limited to, the following:

1. Subject to the exercise of professional judgment, the successful Proposer shall accept and settle or deny all reported claims. Successful Proposer will also be responsible for adjudication of claims appeals.

2. Furnish an electronic version of the certificates/booklets for the School Board to use on their website.

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3. Issue ID cards within three (3) calendar weeks (plus four (4) days’ mailing time) after completion of open enrollment periods or after new hire electronic enrollment records are received. ID cards will be mailed directly to members.

4. Establish claims reporting procedures that are compatible with the needs and organizational structure of the School Board.

5. Provide enrollment assistance, including educational materials pre-approved bythe School Board in advance of distribution, to the School Board during open enrollment period on an annual basis. These tasks should include, but not be limited to, requiring Proposer representatives to attend all scheduled benefit/enrollment meetings.

6. Assign a staff person as the School Board’s account representative.

7. Meet with the District Insurance Committee as needed to discuss the status of the

Section V – Page 8

plan, performance, audits, reports, and planning.

8. Attend meetings, if requested by the School Board.

9. Verify claimant’s eligibility for benefits based on eligibility requirements furnished by the School Board.

10. Maintain covered dependent information by dependent’s name, date of birth, gender, and relationship to insured and social security number.

11. The Patient Protection and Affordable Care Act (PPACA) requires benefit plans that provide coverage for dependents to cover adult children to age 30*. This applies to all group health plans and issuers of group or individual insurance, including fully insured and self funded plans. In general, coverage must be allowed to continue until the child reaches the age of 30. The obligation to make dependent coverage available to children ends the day before the child’s 30th* birthday.

*Although PPACA only requires coverage up to age 26, the School Board desires to continue coverage up to age 30.

12. Use fully automated online clinically-oriented claims adjudication and auditing system that analyzes coded claims data to ensure correct identification.

13. Screen for and deny workers’ compensation claims.

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14. Target (flag) the following types of claims for supervisory review*: a. Service required pre-certification, but certification not obtained;

b. Actual length of stay or level of service does not match the approved length of stay or level of service;

c. Dollar amount or diagnoses warrants potential referral to medical case management; or

d. Any one bill that exceeds $10,000.

*Supervisory review shall include, as appropriate, at a minimum, review of itemization of invoices exceeding $10,000 and review of case management notes.

15. Identify and maintain separate COB information for each applicable claimant, as well as distinguish between the various types of COB.

Section V – Page 9

16. Maintain the confidentiality requirements of Florida law by having adequate systems security features.

17. Turnaround 95% of all "clean" claims within ten (10) working days and 100% of all claims within thirty (30) working days. A “clean” claim is a claim submitted with all needed information for proper processing and adjudication.

18. Release benefit checks within 48 hours of fund transfers.

19. Issue EOBs (print or electronic version) to the claimant within five (5) working days after final action of the claims.

20. Prepare and furnish the School Board with monthly exposure and loss data statistics. Exposure data should include census data, such as zip code, date of birth and employment status. Sample loss data reports should be included in proposal. These loss data reports should include, but not be limited to, the following information: (Data subject to compliance with HIPAA privacy guidelines.)

a. Claims data should be provided monthly (within 30 days after the end of the month) with cumulative totals for the plan year, separately for participants in each plan offered, preferably in a format that will provide data separately for employees and their dependents, retirees and their dependents and COBRA and their dependents, and total for all participants and all dependents.

The desire for separate premium/claims experience for employees, retirees, COBRA and dependents is to permit the client to determine if the rates being charged are equitable. Claim reports should be provided

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additionally for 12 months after plan termination or until there are no run-out and/or extension of benefits claims.

b. Claims data should be provided monthly detailing all claims where more than $25,000 has been paid in the current plan year. Data should include amount paid, type of plan participant (employee, dependent, retiree, etc.), diagnosis, prognosis and status of the claim (active, expired, etc.).

21. Cooperate with the managed care organizations and the UR firm in resolving discrepancies for proper payment of benefits when compliance dictates the use of one or both of these programs.

22. Conduct semi-annual internal audits for claim accuracy and occurrence ofmispayments. Report results to the School Board within ten (10) working days from the end of the reporting period.

Section V – Page 10

23. Identify and pursue claims that should be properly payable through automobile insurance and/or coordination of benefits (COB). Additionally, report on the savings produced.

24. Provide COBRA and HIPAA Administration and pay COBRA beneficiary claims.

25. Establish and maintain a toll-free line for employees. This line should be operational from at least 8 a.m. to 6 p.m. (Central Standard Time). A voice mail system or equivalent system should be available to take off-hour or weekend calls.

26. Maintain access to a Medical Director to evaluate appealed claims.

27. Administer the plan on a detail billing remittance basis by division, by active employee, retiree and COBRA beneficiary.

28. Conform accounting procedures and practices to generally accepted accounting principles.

29. Maintain proper records for tax reporting purposes; e.g., 1099s.

30. Retain medical claims history online for minimum of 24 months.

31. Provide benefits to employees/dependents that are referred to an out-of-network specialist due to the lack of in-network providers in that specialty, at the in-network benefit level.

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32. Prepare, maintain, and file with any applicable federal, state or local governmental agencies, any forms or reports as may be required from time to time by law; e.g., Form 5500, COBRA, etc.

33. Provide assistance with regard to: (1) problems arising in connection with insurance laws, (2) tax aspects of the Plan, (3) litigation arising out of the administration of the Plan, and (4) any other legal matters that may arise in the course of the operation of the Plan.

34. Establish claim denial and grievance procedures which are clearly communicated to members. Grievance procedures should be consistent with all applicable federal and state laws, rules and regulations.

Section V – Page 11ADDITIONAL SERVICES1. Supply all postage required to service the School Board account.

2. Provide an EOB that meets the School Board's approval and uses a format and terminology such that a person not of a medical or insurance background can easily understand the content.

3. Report claims to the School Board's stop-loss insurer in accordance with the requirements of said insurer. Provide a copy of this report to the School Board on the same day as the insurer is notified.

4. Send correspondence using School Board approved pre-formatted letters to the claimant or provider. The content of these letters must be easily understandable by a person not of a medical or insurance background.

5. The School Board will have first review and pre-approval of any correspondence that will be sent to claimants or providers that includes changes/amendments to the plan.

6. Outline the claims payment checking account arrangement for the School Board, to be utilized in making authorized payment of benefits under the plan.

7. Fax a check register to the School Board two times per month.

8. Reconcile the statements of the payment account on a monthly basis and maintain canceled checks, unclaimed check detail, and other records relating to bank reconciliation. Prepare an unclaimed check report for presentation to the State of Florida.

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9. Provide the School Board, on a monthly basis, a copy of the statement accompanied by a copy of the completed reconciliation within five (5) working days from receipt of bank statement.

10. Maintain all records of business transacted in accordance with this RFP. At the end of the contract period, all documents, papers, records, canceled checks, and claims history shall be captured in such a manner for media storage and delivered to the School Board.

11. Provide access to archived data within ten (10) working days of a request by the School Board.

Section V – Page 1212. Provide reports inclusive of data elements specified by the School Board, and in

mutually agreed upon formats. The required standard reports include, but are not limited to, the following:a. Monthly reports are due on the 15th working day following the end of the

"report" month. These reports should include: check stop-pay listing, check registers, paid claims summaries (separated by employee, dependent, retiree, and COBRA beneficiary).

b. Quarterly and Year-to-Date Reports are due on the 15th working day following the "report" quarter. These reports should include: claim lag, benefit payment summaries, inpatient (utilization) reports, paid claims by coverage and diagnosis types, COB savings, claims that exceed $50,000 (to flag for specific claims), and service inquiries.

WELLNESS PROGRAM AND DISEASE MANAGEMENT SERVICESThe School Board received $450,000 in wellness funds from Florida Blue in 2012 and $100,000 in wellness funds in 2013 to help support district wellness program initiatives that have been in place since October of 2009. In order to maintain such a program, Proposers that include a wellness fund contribution in their proposal will be favored.

The School Board is interested in proactive wellness and disease management initiatives, including participation incentives, including but not limited to health screenings, flu shot programs, health risk assessments and health fairs. Please provide details in your proposal of all current program offerings including, if applicable, any additional cost. Proposals should detail the support staff and other assistance that will be provided. Additionally, please outline any wellness services that you feel would be advantageous to the School Board and why.

PERFORMANCE GUARANTEES

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Proposers should confirm that they are willing to offer performance guarantees and that they are willing to permit the School Board access to claims offices, personnel and files to conduct audits necessary to verification of performance standards. Performance may be evaluated on a variety of issues, such as:

Timely delivery of finalized contracts for the selected program. Timely delivery of identification cards, at and subsequent to initial enrollment. Timely delivery of plan documents. Claims turnaround time. Accuracy of claims coding and payments. Telephone response time and abandonments. Quality of service to plan participants, as measured by periodic surveys. Quality and timeliness of claims experience reports. Network provider participation, with penalties for drops below pre-specified

levels. Rate of provider turnovers.

Section V – Page 13 Access to standards of care. Collection or other threats to participants by providers not paid by the insurer.

Please confirm your firm’s willingness to enter into such an agreement and to negotiate appropriate terms, and recommend appropriate incentives or disincentives (meaningful penalties) to make the performance guarantee practical.

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Section V – Page 14

SANTA ROSA COUNTYSCHOOL BOARD

_______________________________________

Section VI

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Model ProgramFor

Self Funded Medical and Pharmacy – Stop Loss Insurance

SECTION VI

MODEL PROGRAM FORSELF FUNDED MEDICAL and PHARMACY

STOP-LOSS INSURANCE

PROVISIONS INCORPORATED BY REFERENCEThe following provisions of this RFP are incorporated by reference into thisSECTION VI - MODEL PROGRAM FOR SELF FUNDED MEDICAL and PHARMACY STOP LOSS INSURANCE.

SECTION II - GENERAL REQUIREMENTS - All the provisions of SectionII are specifically incorporated by reference.

SECTION III – COMMON CONTRACT PROVISIONS – All provisions of Section III are specifically incorporated by reference.

SCOPE OF COVERAGEThe School Board is interested in proposals for stop-loss insurance for plan designs that most closely match the School Board’s current plan designs: High Option PPO 05773, Low Option PPO 05301, High Option HDHP/HSA 05181/82, Low Option HDHP/HSA 05192/93 and Blue Medicare PPO. The School Board reserves the right to negotiate with proposer finalist(s) on alternative plan designs. In addition to proposals for four plan designs that most closely match the School Board’s current plan designs, the School Board is also requesting proposals for only two plans, the High Option PPO 05773 and the Low Option HDHP/HSA 5192/93.

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Stop-loss proposals should be on a 12/15 contract basis with a specific limit of$5,000,000 and a retention of $250,000. Coverage should include specific and aggregate coverage for medical and prescriptions. The aggregate limit should be $1,000,000 and the attachment point should be at 125% of expected claims.

Proposals with enhancements to the contract basis, aggregate limit and/or attachment point will be favored. If your proposal is contingent upon use of a specific administrator and/or network, please make sure this is clearly stated.

All proposals should include copies of any contract which the School Board will be required to execute.

CONTINUITY OF COVERAGE (NO LOSS/NO GAIN PROVISION)Notwithstanding any actively at work, waiting period, pre-existing condition, or other provision or limitation in the proposed plan to the contrary, if, but for the replacement of

Section VI – Page 1

the current plan with the proposed plan, an insured would have been covered by the current plan, the insured shall be entitled to the lesser of:

(1) the benefits which would have been payable had the current plan been continued;or

(2) the benefits which would be payable under the proposed plan without the application of any actively at work, waiting period, pre-existing condition, or other provision or limitation in the proposed plan.

CURRENT RATESThe School Board does not currently purchase stop-loss insurance because we purchase fully-insured coverage.

CLAIMS HISTORYRefer to the Exposure Section of the RFP.

LARGE DOLLAR CLAIMSRefer to the Exposure Section of the RFP.

COBRA PARTICIPANTSRefer to the Census contained in the Exposure Section of this RFP.

CONTRACT PERIODFor Stop-Loss Insurance (specific and aggregate), an initial twelve (12) month contract from January 1, 2014, through and including December 31, 2014, is required, with the

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School Board having the option of renewing the program for four (4) additional plan years thereafter. (Note, above contract period dates do not include run-out period.)

RATE GUARANTEE PERIODRegardless of actual enrollment, the initial rates shall be guaranteed for 12 months. Changes after the initial 12 month period shall be subject to the Rerating Endorsement.

REMUNERATIONAny remuneration or other similar compensation included must be shown separately.Remuneration arrangements, if any, will be between the School Board, the successful Proposer, and any agent, broker or other intermediary representing the successful Proposer.

Section VI – Page 2

SANTA ROSA COUNTYSCHOOL BOARD

_______________________________________

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Section VII

Group Medical Proposal Summary

SECTION VII

GROUP MEDICAL PROPOSAL QUESTIONNAIRE

Please complete Proposal Questionnaire as the information applies. Type or hand write the responses in ink; corrections should be typed or in ink and initialed. Do not leave any question blank. If it does not apply, type or write in “NA.” It is suggested that these forms be photocopied for work copies prior to final completion of all information.

GENERAL INFORMATION

1. Insurer/TPA/PPO/HDHP/HMO:_________________________________________

2. A.M. Best’s Rating:______________________________________________________

3. Insurer/TPA/PPO/HDHP/HMO authorized to do business in Florida?________________

4. Proposer_______________________________Toll Free Telephone:_________________

Contact Name:______________________________Telephone #:___________________

Fax #:____________________________Location:_______________________________

5. Insurer approved in accordance with Florida Statutes; documentation provided?________

6. One original and six copies of proposal submitted and valid until (WHEN)?__________

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7. Are sample contracts, forms, riders provided for analysis?_________________________

8. Will you provide 120 days notice of non-renewal and rate/cost change?______________

9. Will 60 days notice of termination by the Santa Rosa County School Board be acceptable?______________________________________________________________

10. Will you, in addition to providing mandated COBRA benefits, make conversion benefits available to participants entitled to continue similar coverage without evidence of insurability, as prescribed by Florida law?______________________________________

11. Are there any services desired in this RFP for which you do not have the “in-house” capability to perform work and for which you will subcontract?_____________________

Explain:_________________________________________________________________________________________________________________________________________________________________________________________________________________

________________________________________________________________________

Section VII – Page 1

_ Yes No12. Does your proposed program comply with all applicable Florida and

Federal Statutes regarding insurance of group benefits, PPOs, HMOs, and HDHP’s and will you assure future compliance? _______ ______

13. Will you provide general administration services as requested for the benefits plan? _______ ______

14. Have you enclosed your proposed administrative contract? _______ ______

15. Are you agreeable to negotiation to contract terms? _______ ______

16. Will you assist in the enrollment process and conduct employeebenefit meetings, including presentation of cost containment explanations and instructions? _______ ______

17. Will you provide a plan document, and certificates or booklets, and any other appropriate literature to describe the benefits to employees? _______ ______

18. Will the literature be distributed to employees in layman’s terms, and be subject to approval by the Santa Rosa County School Board? _______ ______

19. Will you perform the claims service requested by the Santa RosaCounty School Board? _______ ______

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20. Will you make a toll-free telephone number available to Santa RosaCounty School Board and plan participants to call you regardingproblems, questions, etc.? _______ ______

21. If the answer to the above question is no, will Santa Rosa County School Board and plan participants be allowed to call you collect? _______ ______

22. Will you provide for direct payment to medical care providers upon assignment by employees? _______ ______

23. Will you provide for coordination of benefits with all other availablesources, so long as not prohibited by law? _______ ______

24. Have you provided a sample of your claims forms and a sample of the Explanation of Benefits (EOB) form you send to participants and their providers? _______ ______

25. Are the above forms available electronically? _______ ______

Section VII – Page 2

Yes No

26. Will you provide separate details on claimant (employee, retiree,COBRA or dependent), the nature of claim, current status and paid and incurred costs for claims which exceed $50,000? _______ ______

27. Have you submitted a listing and sample copies of the variety ofclaims reports and other management reporting systems available to the Santa Rosa County School Board? _______ ______

28. Have you stated which of the available claims reports and othermanagement reporting systems you are including within the costs of your proposal? _______ ______

29. Have you provided specifics about your capability and cost to modifyexisting report formats to comply with the Santa Rosa County School Board desires for premium/claims experience information? _______ ______

30. Have you provided evidence of your Comprehensive General Liability, Business Automobile Liability and Worker’s Compensation insurance in the required limits? _______ ______

31. Have you stated all differences to the existing plans? _______ ______

32. Do you agree to waive the actively at work provision for the coverage(s)you are quoting? _______ ______

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33. Do you agree to waive non-confinement provisions for dependents? _______ ______If not, please explain provision.______________________________________________________________________________________________________________________

34. Will your stop loss renewal contracts automatically provide 24/12 coverage? ______ ______

35. Do you agree not to carve out or laser out individual insureds in the future renewal years? ______ ______

36. Please confirm you would provide stop loss coverage should a carrier be selected as the claims payor under administrationservices contract? ______ ______

37. Please advise your current in force block of specific stop lossloss and aggregate coverage? ______ ______

38. Please state the amount or percentage of stop loss levels retainedin-house. ______ ______

Section VII - Page 3

39. If secondary layers of stop loss coverage are secured as part of your proposal, identify all reinsurers’ participation in this risk, the amounts of exposure each reinsurance will retain, and the ratings and size of their reinsurance block of each carrier.________________________________________________________________________________________________________________________________________________

40. As a cost containment measure, do you agree to provide wellness, education, medical management and clinical services? ___________________________________

41. Will you agree to provide a 50% profit return to the group each year that the earned premium is greater than the sum of the incurred claims and that you will retain any deficit with no carry over to the next year’s accounting? _______________________________

42. What is the location and staffing of the claims office that will serve Santa Rosa County School Board? ___________________________________________________________

43. What will be your frequency of claims payment?_______________________________________________________________________________________________________

44. What is the approximate time service that may be expected for claims payments?___________________________________________________________________________________________________________________________________________________________________________________________________________________________

45. State and define your claim turn around time._____________________________________________________________________________________________________________

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_________________________________________________________________________

46. List here the name(s) of any Santa Rosa County School Board employees or Board members who own, directly or indirectly, an interest of five percent (5%) or more in the proposer’s firm or any of its branches.________________________________________________________________________________________________________________________________________________

47. List here the name(s) of any officer, director or agent who is also an employee of the Santa Rosa County School Board.__________________________________________________________________________________________________________________________________________________________________________________________________

48. Identify the earliest date you will accept a disclosure statement for a binding agreement ofcoverage? ___________________________________________________________ ___________________________________________________________________

49. Identify your requirement for claims data for a binding reinsurance agreement? ___________________________________________________________________

Section VII – Page 4

50. Please provide group name and contact numbers for two terminated groups in our area that your company serviced within the previous two-year period? ____________________________________________________________________________________________________________________________________________

51. Please provide the group name (county), total members, contact name and phone number for all School Boards in Florida that your company currently insures. Please specify those located in the Florida panhandle area? _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

52. Explain your pharmacy utilization management programs. Disclose formulary and non-formulary medications and any drugs that are specifically excluded from coverage. .

_________________________________________________________________________________________________________________________________________________________________________________________________________

53. Will your proposal permit for medical to be a “stand alone”?_________________________

54. Does your proposal provide information relative to provider network discounts?_________

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Section VII – Page 5

SANTA ROSA COUNTYSCHOOL BOARD

_______________________________________

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Section VIII

Exposure, Loss Data,and Appendices

SECTION VIII

EXPOSURE AND LOSS DATA

SOURCE OF INFORMATION

Santa Rosa County School Board, and current vendors and carriers supplied all data and statistical information. In some instances, data was retyped for clarity. If there are omissions, additional data is not readily available.

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Section VIII – Page 1

APPENDICESAppendices can be found online at https://www.santarosa.k12.fl.us/purchasing/bids/2013/RFP%201310%20groupmedicalinsurance/RFP%201310GroupMedicalInsurance.htm

Appendix 1: PPO Plan Summary Descriptions:a) Blue Options PPO 05773 – High Option plan b) Blue Options PPO 05301 – Low Option plan

Appendix 2: HDHP/HSA Plan Summary Descriptions:a) BlueOptions HDHP/HSA 05181/82 – High Option plan b) BlueOptions HDHP/HSA 05192/93 – Low Option plan

Appendix 3: Blue Medicare PPO Plan Summary Description

Appendix 4: Medical Claims Experience Reports 2010-2013

Appendix 5: Medical High Cost Claims Report 2010-2013

Appendix 6: Top Utilized Facilities 2010-2013

Appendix 7: Medical Rates by Plan and Monthly Contributions by School Board and Employees

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Appendix 8: Rate History Report 2011-2013

Appendix 9: Medical Census Report 2013

Appendix 10: Blue Medicare Census Report 2013

Appendix 11: COBRA Enrollment Report 2011-2013

Appendix 12: Retiree Enrollment Report 2011-2013

Appendix 13: Prescription Utilization Report 2010-2013

Appendix 14: Top 25 Physicians by Paid Date 2010-2013

Section VIII – Page 2