ORDER NO.30620 2008 KERB COUNTY HEALTH BENEFITS BIDS Came to be heard this the 14th day of November, 2007, with a motion made by Commissioner Williams, seconded by Commissioner Baldwin. The Court unanimously approved by vote of 4-0-0: That the Kerr County Commissioners' Court refer all proposals received this date for the 2008 Kerr County Employees Health Benefits Plan to Alamo Insurance Group in care of Mr. Gary Looney for review and evaluation and further negotiations so long as all of the rules regarding such review, which have been read into the record, are adhered to, which are the rules adopted by the Court: 1. INS Management Services, Agent-Patrick Sanders, Amarillo, TX 2. TAC, Letter of Notification that they are declining to submit a proposal 3. Bryan Finley & Associates, the agent, Letters of Declination from Cigna, Aetna, United Health Care, Guardian, and a Declination E-mail from TAC for the proposal by Met Life for Life and AD&D Coverage, no bid for HRA Accounts with regard to the cafeteria plan administration, Tab 8 - Prec Management, no bid, Tab 9 - No service proposal for Inroll online enrollment system, Tab 10 is Air Evac Life Team 4. Group & Pension Administrators, Inc., out of Dallas, Agent is Wallace & Associates, bid for 3rd Party Administrator 5. Entrust, out of Houston, TX, for both 3rd Party Administrator and Stop Loss 6. Fara Benefits Services, Inc., out of Mandoville, LA, 3rd Party and Stop Loss 7. Fiserv Health, broker is Wallace & Associates, 3rd Party and Stop Loss 8. Wallace & Associates, submitted by letter from Vanity National referring to prior submission with some revised numbers and a proposal from Colonial Supplemental ~p~-zd ~. ~ COMMISSIONERS' COURT AGENDA REQUEST PLEASE FURNISH ONE ORIGINAL AND TEN (10) COPIES OF THIS REQUEST AND DOCUMENTS TO BE REVIEWED BY THE COURT MADE BY: Judge Tinley OFFICE: County Judge MEETING DATE: November 14, 2007 TIME PREFERRED: SUBJECT: Open proposals received in response to Request for Proposals for 2008 Kerr County Employees Health Benefits Plan and take appropriate action to refer such proposals to Kerr County health benefits and insurance consultant for review and evaluation and further negotiations with proposers. EXECUTIVE SESSION REQUESTED: (PLEASE STATE REASON) NAME OF PERSON ADDRESSING THE COURT: Judge Tinley ESTIMATED LENGTH OF PRESENTATION: IF PERSONNEL MATTER -NAME OF EMPLOYEE: Time for submitting this request for Court to assure that the matter is posted in accordance with Title 5, Chapter 551 and 552, Government Code, is as follows: Meeting scheduled for Mondays THIS REQUEST RECEIVED BY: THIS RQUEST RECEIVED ON: 5:00 PM previous Tuesday @ .M. All Agenda Requests will be screened by the County Judge's Office to determine if adequate information has been prepared for the Court's formal consideration and action at time of Court Meetings. Your cooperation will be appreciated and contribute towards your request being addressed at the earliest opportunity. See Agenda Request Rules Adopted by Commissioners' Court. x o~ oa `L, ~~6 io; ~~ e ~~s a p McFarland, suite 101, Kerrville, TX. The facilities sought, including type and class of station are Non Profit- Educational; power 1.25Kw, transmitter site at 30.03.5.7 N, 099.18.04.4 W and antenna height of 400 ft. 4~=LOST 3 FOUND FOUND: Male Boston Terrier. Call Ada 896-7160 Lost female Beagle Ranchero Rd area. 8 years old. Best friend. -Call 370-7143 LOST Heartshaped Diamond in Ingram or Kerrville. REWARD Call 329-8006 or 329-8008 Lost on 10/22/07: Male; champagne colored Pomeranian. Approx 8yrs old. Answers to Max. Last se8n at Hal Peterson Middle. School. REWARD! Please call 830-739-4537 picture to Special Box Holder, POB 290855, Kerrville, Texas 78029. 9. PETS iE SUPPLIES 4 Dapple Miniature Dachshunds, 2-Black & Tan. 4-M, 2-F. $175/each. 830-992-3307 Angel Fish Sale Very beautiful, large marbled blk/wht/ ornge. Hatched & raised locally $12 $15. Rose Barbs $3.00. Open to the public Oct 27 only. After 10/27 call for appointment. 116 Riverpark Ingram (830)377-0522 Baby Parrots: Conures, Amazons, & Cockatiels melbel@ktc.com 257-3580 Cockatiels Handraised Babies For Sale 377-1473 Dachshund Minia- ture Dapple, Blk/Tan S/W (830)866-3744 FREE! Kittens need good. homes. 257-3841 2. PUBLIC NOTICE 2. PUBLIC NOTICE. County of Kerr Proposal Notice Kerr County is accepting proposals for their Group Medical Claims Administration, Medical Specific and Aggregate Stop Loss insurance, Health Reimbursement Arrangement Administration, Group Term Life Insurance/Accidental Death and Dismemberment Insurance, and Cafeteria Plan Administration. Specifications will be released at 10:00 AM Tuesday October 30, 2007. Requests for Proposals may be obtained at the Kerr County Court House, 700 Main, . Kerrville, Texas 78028. Bids must be presented by the proposal closing date of November 14, 2007 on or before 11:00 AM. that date. Bids must be marked as "Proposal for Kerr County Employee Benefits" and presented to Judge Pat Tinley at 700 Main St., Kerrville. All. pricing will be unit priced. The County shall pay all required premiums monthly. There is no bond required to bid on these contracts. vvg.rnansn~p Positive Training, Obedience, Clicker Training e (830)739-0565 Red Sable Miniature Dachshunds, 10 wks. 2ndshots/ dewormed. 1-M, 2/F. $1.50/each (830)995-3170 "The_greatness of a nation and its moral progress can be judged by the way its animals are treated." Mahatma Gandhi SAVE A LIFE ADOPT A SHELTER ANIMAL KERR CO. ANIMAL CONTROL257-3100 co.ken•.tx.uslanimal FREEMAN FRITTS 257-4144 frnemanfritts.com HUMANE SOCIETY367-7722 humanesociety ofkerrville.org DIAMOND DACHSHUND 367-5741 ddrtx:org UTOPIA RESCUE 830-589-7544 utopiarescue.com D&DK-9 257-0565 11. ANTIQUES 3 FLEA MARIQ:TS ANTIQUE STOFtE CLOSING Mary & Ann's Antique Shop in Comfort is Closing 50% OFF Sale starts Oct. 16th to run through our last day Nov. 30th. We are located at the corner of 8th & High St. in Comfort behind the Comfort Stampede (830)995-4600-info Oak Pedestal Table w/3 leafs & 6 chairs $650; Child's Rolltop Desk $100; Oak , Drafting Chair $75. 830-896-4458 12. QARAGE SALES ANNUALINDOOR COMMUNITY GARAGE SALE Sat. Nov 3rd-8a-1 p Take It Easy Resort Junction Highway FREE PALLETS AVAILABLE IN THE REAR PARKING LOT OF THE KERR- VILLE DAILY TIMES Signs Be Display Attached ' Utility PoIE The City Kerrville Thanks Y For Adher To Thes Rules! 14. WANTED TO BU ABETTER DE Cash for fumii appliances, ec ment-and esta 257-4267 Collector wa to Buy your C and Stam collection. & Silver Scr~ other items 257-2097 DAD'S OL[ SPEAKER: WANTED!! Buy Nice Olt Home Stereo E Working or ni LOOKIN FOR GO USED APPLIAN 830-257-7 Looking for in working i w/remote cc 17. MISC. FOR S $299 Dell Wir Laptops, Desk from $199, Se $375/set i' bunk beds, plete w/mattn Twin mattres springs, $12: Dbl mattres; springs, n. $745/pair, O mattress/box $185/pair. Kin tress/box spi new $275/: 257-4267 Landscape w chips. Firewood For Mesquite & C BBCI Chips 4: (830)377-74 Gage Hill Ma REQUEST FOR PROPOSALS '' gyp) SPECIFICATIONS Specific and Aggregate Stop Loss Insurance Third Party Medical Claims Administration Group Term Life and AD&D Health Reimbursement Arrangement Cafeteria Plan (IRS code 125) Administration Prescription Benefit Management Kerr County Courthouse 700 Main Kerrville, Texas 78028 EFFECTIVE DATE: January 1, 2008 Page 1 of 29 Kerr County ' REQUEST FOR PROPOSAL TABLE OF CONTENTS Page Request for Proposal Legal Notice ............................................................................................... 3 Acknowledgement of Receipt of RFP, Certifications,Con$icx of Interest Questionnaire ................ 4 - 7 Notice to Proposers ..................................................................................................................... 8 General Information, Timetable .................................................................................................. 9 - 13 Background ................................................................................................................................ 14 RFP Assumptions, Questionnaires, and Submission Forms ......................................................... 15 -27 Attachments: The following files aze also included on CD Claim Experience ................................................................................................................. Summary Plan Documents .................................................................................................... Census .................................................................................................................................. ASO Agreernent ............................................................................................... If you do not have access to an intemet system you may obtain a hard copy of the Request for Proposal from Gary R Looney, 3201 Cherry Ridge Rd Suite D 405, San Antonio, Texas 78230 Ph: 210-930-6665 Page 2 of 29 Kerr County Request for Proposal Specific and Aggregate Stop Loss Insurance Third Party Medical Claims Administration Group Term Life and AD&D Health Reimbursement Arrangement Cafeteria Plan (IItS code 125) Administration Prescription Benefit Management Kerr County will accept sealed proposals for listed items individually or corporately until 11:00 A.M. local time, NOVEMBER 14 2007 County Judge Pat Tinley's office, County Courthouse 700 Main Kerrville, Texas 78028. Proposals will be opened and acknowledged publicly on NOVEMBER 14, 2007. This is a procurement of insurance through the competitive sealed proposal procedure outlined in the Texas Local Government Code 262 including terms and conditions specified in Sections 262.030; 262.025; 262.026; At the proposal opening, only the identity of the proposers will be disclosed by KERB COUNTY. The proposals will be forwarded to KERR COUNTY'S insurance consultant for review, tabulation and analysis. The contents of each proposal will not be disclosed in order to protect the integrity of the negotiation process. To obtain the best final offer(s), revisions by short-listed candidates maybe permitted after original proposal submission, and before the the contract award. All proposals will be later made available to the public for inspection after the contract is awarded. If a proposer indicates and justifies in his proposal(s) that certain information is proprietary, KERB COUNTY will not release the materials for public inspection after the contract award. Clarification of RFP maybe obtained from: Gary R Looney, 3201 Cherry Ridge Rd, Suite D 405, San Antonio, Texas 78230 Ph: 210-930-6665 glooney@alamoinsgrp. coin Please mark on the outside of the submitted envelope/box: "SEALED PROPOSAL FOR KERB COUNTY MEDICAL STOP LOSS, TPA SERVICES, LIFE INSURANCE AND AD&D, NOVEMBER 14 11:00 AM" and send or deliver to the attention of "Kerr County Commissioner's Court, C/O County Judge Pat Tinley County Courthouse 700 Main Kerrville, Texas 78028" KERR COUNTY reserves the right to reject any or all competitive sealed proposals ,waive any irregularities contained therein and to accept any competitive sealed proposals deemed most advantageous to KERB COUNTY. Any competitive sealed proposal received after 11:00 am., local time, NOVEMBER 14, 2007, will be automatically rejected and returned to the proposer unopened. KERB COUNTY will not be responsible in the event that the U.S. Postal Service or any other carrier system fails to deliver the sealed proposal to KERB COUNTY by the given deadline above. Page 3 of 29 Kerr County Specific and Aggregate Stop Loss Insurance Third Party Medical Claims Administration Group Term Life and AD&D Health Reimbursement Arrangement Cafeteria. Plan (IRS code 125) Administration Prescription Benefit Management PLEASE ACKNOWLEDGE RECEIVING THIS RFP BY RETURNING THIS FORM In order to allow a fair and competitive bid process proposer will not be allowed to access markets prior to the release date of this RFP. The official date and time of release is Tuesday October 30, 2007, 10:00 AM. It is your responsibility to return this intent to bid with the proper means of contacting you or your organization. Communicating any questions, answers, or amendments to this RFPwill be made through the process you provide on this form. FAX or Mail TO: Gary Looney xESc Insurance Consultant 3201 Cherry Ridge Dr Suite D 405 San Antonio, Texas 78230 Fax: 210-930-1838 _ WILL RESPOND* WILL NOT RESPOND COMMENTS: AGENT NAME: Agent Phone: Agent Email: Agent Signature COMPANY NAME: Print Agent Name COMPANY FAX COMPANY CONTACT EMAIL: SIGNATURE Page 4 of 29 Company Phone Kerr County Specific and Aggregate Stop Loss Insurance Third Party Medical Claims Administration Group Term Life and AD&D Health Reimbursement Arrangement Cafeteria Plan (IRS code 125) Administration Prescription Benefit Management PLEASE FILL IN THE FOLLOWING INFORMATION NEEDED AND SUBMIT WITH PROPOSAL. The undersigned proposer, by signing and executing this proposal, certifies and represents to Kerr County that proposer has not offered, conferred or agreed to confer any pecuniary benefit, as defined by (1.07 (a) (6) of the Texas Penal Code, or any other thing of value as consideration for the receipt of information or any special treatment of advantage relating to this proposal; the proposer also certifies and represents that the proposer has not offered, conferred or agreed! to confer any pecuniary benefit or other thing of value as consideration for the recipient's decision, opinion, recommendation, vote or other exercise of discretion concerning this proposal, the proposer certifies and represents that proposer has neither coerced nor attempted to influence the exercise of discretion by any officer, trustee, agent or employee of Kerr County concerning this proposal on the basis of any consideration not authorized by law; the proposer also certifies and represents that proposer has not received any information not available to other proposers so as to give the undersigned a preferential advantage with respect to this proposal; the proposer further certifies and represents that proposer has not violated any state, federal, or local law, regulation or ordinance relating to bribery, improper influence, collusion or the like and that proposer will not in the future offer, confer, or agree to confer any pecuniary benefit or other thing of value of any officer, trustee, agent or employee of Kerr County in return for the person having exercised their person's official discretion, power or duty with respect to this proposal; the proposer certifies and represents that it has not now and will not in the future offer, confer, or agree to confer a pecuniary benefit or other thing of value to any officer, trustee, agent, or employee of Kerr County in connection with information regarding this proposal, the submission of this proposal, the awazd of this proposal or the performance, delivery or sale pursuant to this proposal. The Proposer represents that he, his agent(s), nor any corporate employee has contacted any officer, trustee, elected County official or any other County employee with the intent to discuss, influence, or in any manner affect the outcome of the bid process. The proposer shall defend, indemnify, and hold harmless Kerr County, all of its officers, agents and employees from and against all claims, actions, suits, demands, proceeding, costs, damages, and liabilities, arising out of, connected with, or resulting from any acts or omissions of contractor or any agent, employee, subcontractor, or Supplier of contractor in the execution or performance of this RFP. I have read all of the specifications and general proposal requirements and do hereby certify that all items submitted meet specifications. COMPANY: AGENT NAME: AGENT SIGNATURE: ADDRESS: CITY: STATE: ZIP CODE: TELEPHONE: FAX: FIDERAL TIN#: ANID/OR SOCIAL SECURITY #: Page 5 of 29 DEVIATIONS FROM SPECIFICATIONS IF ANY (Attach documents as necessary or state No Deviations): Kerr County Specific and Aggregate Stop Loss InsLUance Third Party Medical Claims Administration Group Term Life and AD&D Health Reimbursement Arrangement Cafeteria Plan (IRS code 125) Administration Prescription Benefit Management CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS Name Of Entity: The prospective participant certifies to the best of its knowledge and belief that it and its principals: a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency: b) Have not within a three year period preceding this proposal been convicted of had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; c) Are not presently indicted for or otherwise criminally or civilly charged by a government entity (Federal, State, Local) with commission of any of the offenses enumerated in paragraph (I) (b) of this certification; and d) Have not within a three year period preceding this application/proposal had one or more public transactions (Federal, State, Local) terminated for cause or default. I understand that a false statement on this certification maybe grounds for rejection of this proposal or terrriination of the award. In addition, under 18 USC Section 1001, a false statement may result in a fine up to a $ 10,000.00 or imprisonment for up to five (5) years, or both. Name and Title of Authorized Representative (Typed) Signature of Authorized Representative Date I am unable to certify to the above statements. My explanation is attached. Page 6 of 29 Conflict of Interest Questionnaire For Vendor or Other Person Doine Business with a Local Government Entitv This questionnaire is being filed in accordance with chapter 176 of the Local Government Code by a person doing business with a government entity. Bylaw this questionnaire must be filed with the records administrator of the local government not later than the 7`~ business day after the date the person becomes aware of the facts that require the statement to be filed. See section 176.006, Local Government Code. A person commits an offense if the person violates Section 176.006, Local Government Code. An offense under this section is a Class C Misdemeanor. l . Name of person doing business with local government entity. 2. ^ Check this box if you are filing an update to a previously filed questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than September 1 of the year for which the activity described in Section 176.006(a) Local Government Code, is pending and not later than the 7°i business day after the originally filed questionnaire becomes incomplete or inaccurate.) 3. Describe each affiliation or business relationship with an employee or contractor of the local government entity who makes recommendations to a local government officer of the local government entity with respect to expenditure of money. 4. Describe each affiliation or business relationship with a person who is a local government officer and who appoints or employs a local government officer of the local government entity that is subject of this questionnaire. 5. Name of local government officer with whom filer has an affiliation or business relationship. (Complete this section only if the answer to A, B or C is YES) This section, item 5 including subparts A, B, C & D must be completed for each officer with whom the filer has affiliation or business relationship. Attach additional s as necessary. A. Is the local government officer named in this section receiving or likely to receive taxable income from the filer of this questionnaire? ^ YES ^ NO B. Is the filer of the questionnaire receiving or likely to receive taxable income from or at the direction of the local government officer named in this section? ^ YES ^ NO C. Is the filer of this questionnaire affiliated with a corporation or other business entity that the local government officer serves as an officer or director or holds an ownership position of 10% or more? ^ YES ^ NO D. Describe each affiliation or business relationship. 6. Describe any other affiliation or business relationship that might cause a conflict of interest. 7. Signatures Signature of person doing business with the Governmental entity Date Page 7 of 29 Kerr County Specific and Aggregate Stop Loss Insurance Third Party Medical Claims Administration Group Term Life and AD&D Health Reimbursement Arrangement Cafeteria Plan (IRS code 125) Administration Prescription Benefit Management NOTICE TO PROPOSER Information provided in these specifications is to be used for purposes of preparing a proposal detailing costs of providing the services and insurance specified. It is further expected that each proposer will read these specifications with caze, since failure to meet each condition or a combination of specified conditions may disqualify proposal. Information provided by Kerr County includes: 1. Current census 2. Plan documents 3. Rate history 4. Standard Loss Information 5. High Claim Losses KERB COUNTY reserves the right to reject any or all proposals or any portion thereof and to accept the proposal deemed most advantageous to KERB COUNTY. Proposer is required to submit quotations on the basis of these specifications. Alternative quotations (for service on a basis different from requested in these specifications) will receive consideration if such alternatives are clearly explained. Any exceptions to coverage requested herein must be cleazly noted in writing and be included as a part of the proposal. KERB COUNTY believes that the data contained in these specifications is sufficient for preparation for a proposal. The information is believed to be accurate and is based upon the latest available information, but it is not to be considered in any way as a warranty. Requests for additional information should be directed in writing to Gary Looney REBC, Insurance Consultant, 3201 Cherry Ridge Drive Suite D 405 San Antonio Texas 78230, Phone (2101930-6665 Fax (210) 930-1838 Email address ~looney~,alamoinsg_rp.com Page 8 of 29 Kerr County Specific and Aggregate Stop Loss Insurance Third Party Medical Claims Administration Group Term Life and AD&D Health Reimbursement Arrangement Cafeteria Plan (IRS code 125) Administration Prescription Benefit Management GENERAL INFORMATION and INSTRUCTIONS 1. The information contained in these specifications is confidential and is to be used only in connection with preparing a proposal for all or part of the following employee benefit plans: Specific and Aggregate Stop Loss Insurance, Third Party Medical Claims Administration, Group Term Life and AD&D, Health Reimbursement Arrangement, Cafeteria Plan (IRS code 125) Administration, Prescription Benefit Management 2. KERB COUNTY reserves the right to accept or reject all or any part of the proposals, waive minor technicalities, and award the proposal to best serve the interest of KERR COUNTY. KERB COUNTY also reserves the right to waive or dispense with any of the formalities contained herein. 3. Proposals are to be submitted on the basis of the specifications contained herein. Alternate proposals will also be considered, if the alternatives are clearly explained. All deviations from the specifications must be clearly identified and explained. 4. The information contained herein is believed to be accurate and up-to-date, but is not intended to be an express or implied warranty. 5. No telephone or fax proposals will be accepted. Proposals will only be accepted if delivered by U.S. Postal Service, contract carriers, hand delivery, etc. KERB COUNTY will not be responsible for missing, lost or late mail. Any proposals received after the deadline will be returned to the proposer unopened. 6. At the proposal opening, only the identity of the proposers will be disclosed by KERB COUNTY. The contents of each proposal will not be disclosed in order to protect the integrity of the negotiation process. 7. To obtain the best final offer(s), revisions by short-listed candidates maybe permitted after original proposal submission, and before contract award. 8. All proposals will later be made available to the public for inspection after the contract is awarded. If a proposer indicates and justifies in his proposal(s) that certain information in the proposal(s) is confidential or a trade secret, KERB COUNTY will review those materials with the proposer prior to releasing the materials for public inspection after the contract award. 9. Gary R Looney REBC is the independent insurance consulting agent providing technical assistance to Kerr County during the RFP process. Gary R Looney is compensated by KERB COUNTY on a fee basis, and is not compensated by the service provider. 10. Vendors are cordially invited to the proposal opening, but are not required to attend. Page 9 of 29 Kerr County Specific and Aggregate Stop Loss Insurance Third Party Medical Claims Administration Group Term Life and AD&D Health Reimbursement Arrangement Cafeteria Plan (IRS code 125) Administration Prescription Benefit Management TIMETABLE 1. These specifications are to be released for action at 10:00 am October 30, 2007. 2. One original and two (2) copies of the proposals are to be delivered or mailed to Kerr County Courthouse, C/O Judge Pat Tinley, 700 Main, Kerrville, Texas 78028 to arrive by NOVEMBER 14, 2007, 11:00 am. 3. Consideration and action on the Proposals will be presented to the Commissioner's Court on or about November 19, 2007. 4. The successful proposer will be notified on or about November 19, 2007. 5. Coverage is to be effective January 1, 2008. 6. Policies or contracts aze to be provided to KERB COUNTY no later than 30 days after such effective date. 7. The contract term desired is three years with yeazs two and three subject to County Commissioner's Court approval. PREPARATION OF PROPOSAL The proposer shall prepare their proposal in one original and two (2) copies on the attached proposal form with attachments as necessary to fulfill the specifications contained herein. Unless otherwise stated, all blank spaces on the proposal or as applicable to the subject specification, must be correctly filled. A unit price must be stated for each item, either typed in or written in ink. Any exceptions or deviations from the requested services must be clearly indicated in writing and submitted with and form a part of the proposal form. Failure to follow these instructions will be grounds for disqualifications of a proposal. Complete and sign all documents provided including the Conflict of Interest Questionnaire (CIQ) which is included in the information you have received. Page 10 of 29 Kerr County Specific and Aggregate Stop Loss Insurance Third Party Medical Claims Administration Group Term Life and AD&D Health Reimbursement Arrangement Cafeteria Plan (IRS code 125) Administration Prescription Benefit Management WITHDRAWAL OF PROPOSAL Proposers may withdraw their proposals anytime up to the time specified as the closing time for acceptance of proposals. However, no proposer shall withdraw or cancel their proposal for a period of 60 days after said closing date for acceptance of proposal nor shall the successful proposer withdraw or cancel or modify their proposal, except at the request of KERR COUNTY, after having been notified that KERR COUNTY has accepted the said proposal. Withdrawal or cancellation of a proposal after the closing date for acceptance of proposals shall result in the forfeiture of the bid security. CRITERIA USED IN EVALUATING PROPOSALS 1. No insurance proposals will be accepted from insurers without a Best's Rating, of at least an "A--" in the most recent edition of BEST'S KEY RATING GUIDE FOR LIFE/IIEALTH,. 2. Any insurers, agents or third party administrators shall be duly licensed by the state of Texas, and comply with all applicable state insurance laws and requirements or duly constituted applicable insurance regulatory authorities. A local government self-insurance pool organized under the Texas Interlocal Cooperation Act or other state law shall also be an acceptable provider. 3. The proposal must be in easily understood format with coverage clearly outlined. 4. Proposals will be first evaluated on technical factors other than cost, including but not limited to coverage, benefits, services and financial stability. After a preliminary evaluation of the technical criteria, cost will be included in the evaluation process. Cost will be evaluated on an equal basis with the technical criteria. For the evaluation of cost, fixed administrative cost for athree-year period will be considered first; followed by total first year cost for stop loss insurance premiums and maximum claim cost. For aggregate stop loss insurance maximum claim cost, additional specific deductibles (lasers) will be added to maximum claim cost, if not an allowable claim expense for aggregate maximum claim cost. Page 11 of 29 Kerr County Specific and Aggregate Stop boss Insurance Third Party Medical Claims Administration Group Term Life and AD&D Health Reimbursement Arrangement Cafeteria Plan (IRS code 125) Administration Prescription Benefit Management QUALIFICATION OF COMPANIES AND AGENTS SUBMITTING PROPOSALS. All companies and agents submitting proposals must be licensed by the state of Texas and have demonstrated level of good performance with municipalities, school district or other public entities in Texas. The company or agent must have an Errors and Omissions (E&O) policy with a minimum limit of $1,000,000. An agent submitting a proposal must maintain a fully staffed office for the servicing of the program. The agent must have been in business for at least five years and must assign a minimum of one qualified account representative to service KERR COUNTY to include assisting with enrollment responsibilities. This representative must have a minimum of five years experience in employee benefits, or hold the CLU, CEBS and or RHU designation. DEVIATION FROM SPECIFIED COVERAGE OR SERVICE Proposals are to be submitted on the basis of the specifications contained herein. Proposer MUST include the RFP Submission Forms with its proposal. All costs to be incurred and billed to KERR COUNTY will be firm and included in these forms. Alternative proposals will also be considered, provided the alternatives are clearly explained. All deviations from the specifications must be clearly identified and explained. UNDERWRITING DATA KERR COUNTY has assembled the underwriting exposure, and loss data included in these specifications. While every effort has been made to ensure the accuracy of this information, it cannot be guaranteed. It shall be the responsibility of the successful proposer to review this information and work with KERR COUNTY on an ongoing basis to ensure all relevant exposures are included in KERR COUNTY'S program. If it becomes necessary to revise any part of this proposal, a written addendum will be provided to-all proposers who have submitted an "Intent to Bid Form". KERR COUNTY is not bound by any oral representation, classifications, or changes made in the written specifications by KERR COUNTY employees, unless such classification or change is provided to proposers in a written addendum from an authorized representative of KERR COUNTY or KERR COUNTY'S insurance consultant. COMPLIANCE WITH LAWS All proposers involved shall observe and comply with all regulations, laws ordinances, etc., of local, state, and federal government as they apply to this proposal process Page 12 of 29 Kerr County Specific and Aggregate Stop Loss Insurance Third Party Medical Clairns Administration Group Term Life and AD&D Health Reimbursement Arrangement Cafeteria Plan (IRS code 125) Administration Prescription Benefit Management TERM OF CONTRACT AND EXTENSION/RENEWAL RIGHTS The term of the contract for insurances or service shall be for not less than one year, subject to earlier termination as provided by the law and by the terms of the contract. In addition, unless otherwise specified in the proposal, the award of this proposal shall include the right at the option of KERR COUNTY, and contingent upon the agreement by both parties, to any change in premium costs or benefits to renew and extend this contract on a year to year basis as may be permitted by applicable law and Commissioner's Court approval as may be in the best interest of KERR COUNTY; if the maximum term of this contract and all renewals of it shall be not more than three years before such contract must again be offered for competitive bidding. AUTHORIZED SIGNATURE All proposal forms must be signed by persons who have legal authority to bind the insurer and administrator to the services proposed. DISQUALIFICATION AND REJECTION OF PROPOSALS Failure to comply with the requirements or the procedures set forth herein, or to satisfy the insurance and servicing criteria as set forth in the specifications, may result in disqualification. It is not intended that exceptions to the specification will, in and of themselves, result in disqualification. CONTINUITY OF COVERAGE All employees, retirees and dependents covered by the current plan are to receive immediate coverage under the new plan. Continuity of coverage for current participants is to be on a "no loss no gain" basis for all insurance coverage. In addition, proposers must waive the actively at-work provisions. In fulfilling the Continuity of Coverage requirement fair credit must be allowed for all or any part of health insurance deductibles or co-insurance satisfied, and accumulated lifetime maximum amounts before the contract effective date. Page 13 of 29 Kerr County Specific and Aggregate Stop Loss Insurance Third Party Medical Claims Administration Crroup Term Life and AD&D Health Reimbursement Arrangement Cafeteria Plan (IRS code 125) Administration Prescription Benefit Management Background Information Kerr County is located North West of San Antonio in the Texas Hill Country. The majority of the 200+ insured employees, retirees and COBRA participants participating in KERB County's self-funded health benefit plan use the services of providers located in Kerr County and San Antonio. Mutual of Omaha has provided Administrative Claim Services, COBRA, HIPAA administration, HRA administration for the Health Plan since January of 2005. The plan has been self-insured for several years. In 2005 the County instituted an HRA plan for all employees, changed the previous three option plan to two options both with HRA accumulation accounts. In 2007 the plan options were offered however, no employees enrolled in the $1,500 deductible plan. The HRA account expenses are not included in the losses attributed to the specific or aggregate insurance coverage. The County is very interested in providing a proactive wellness program for their employees. Be certain to provide a description of a wellness plan that you feel would impact the employees of Kerr County. The basic group term life insurance amount is $20,000 per employee and includes accidental death and dismemberment. A copy of the plan of benefits is included in the attachments. The rate is $.20/$1,000 for basic life coverage and $.02/$1,000 for accidental death and dismemberment. KERB COUNTY desires to receive proposals for continuation of the self-funded health plan based on duplication of existing Plan of Benefits unless other specified. KERR COUNTY currently provides medical plan benefits for retirees. The current retirees will be grandfathered for coverage. Future Retirees will be provided with a limited plan of benefits not to exceed the level of the Specific Deductible. Retirees are shown on census as Class R001. Page 14 of 29 Kerr County Specific and Aggregate Stop Loss Insurance Third Party Medical Claims Administration Group Term Life and AD&D Health Reimbursement Arrangement Cafeteria Plan (IRS code 125) Administration Prescription Benefit Management Individual Stop Loss Insurance (ISL)/Aggregate Stop Loss Insurance (ASL) Request for Proposal Submission Form RFP ASSUMPTIONS: 1. Proposal is to be based on the duplication of the existing Plan of Benefits, unless otherwise specified, Any deviations must be clearly identified and explained. All proposals will be assumed to have been submitted without any deviations unless clearly noted. 2. Proposal is to be based on the provided census. 3. Contract effective date is to be January 1, 2008. All participants enrolled in the insurance plan as of December 31, 2007 are to be covered on a "no loss/no gain" basis. "No loss/no gain" for participants are to include credit/debit for accumulated deductible, coinsurance, and lifetime maximum benefits. 4. KERR COUNTY desires to receive proposals for a three (3) year period on one of the following basis: • Fixed price for the three (3) year period, or • Two annual renewal adjustments determined by formula at the time the contract is awarded, or • One (1) year contract with two annual renewal options for rate and premiums deemed to be favorable to KERR COUNTY. Renewal rates are to be provided to KERR COUNTY by October 1 (90 days prior to anniversary date). 5. KERR COUNTY will only consider stop loss insurance policies meeting the following: a Specific and Group Aggregate Policy on a 15/12; paid/12; 24/12 or paid /15 basis for Medical and Drug (Rx). We do not wish to see an aggregating specific. b. Medical and Drug (RX) Specific Coverage with $40,000; $50,000; $60,000 Stop loss. c. Medical and Drug Aggregate Coverage at 120% and 125% of expected claims d Final determination on all lasers, if any, including deductible amounts and conditional lasers should be clearly identified and provided with RFP response based on provided claims data e. Insurance Company Quotation Document with all terms clearly listed f. Waive Actively at Work Provisions 6. Renewal rate must be received by ICERR COUNTY at least 90 days prior to date of rate change. 7. Any estimated savings, performance or other guarantees should be specific, quantifiable and should include a method for validation. QUESTIONS: 1. Describe the business entity submitting the proposal: a. Insurance Company Name: b. Address: c. Contact Person: d. Telephone Number: e. Year Founded (Ins. Co): Kerr County Page 15 of 29 Specific and Aggregate Stop Loss Insurance f. What percentage of overall business is Health related? g. Managing Underwriter's Name: h. Year Founded (Managing Underwriter): i. Number of Years for Representing Insurance Company: 2. Describe Financial Stability of Insurance Company offering stop loss coverage: a. Financial Rating Service Current Rating Prior Year Rating A.M. Best Standard & Poors Moody's b. Is Insurance Company authorized to do business in Texas? 3. Provide three (3) Texas client references (preferably public entities): Company Name: Company Contact information: Name Company Name: Company Contact information: Name Company Name: Company Contact infornation: Name 4. Describe the business entity submitting the proposal: a Name of Business Entity: b. Current Business Address: a Mailing Address: d Contact Person: e. Telephone Number: f. Type of Business Entity: Corporation -General Partnership _ Sole Proprietorship Registered Limited Liability Partnership Limited Liability Company 5. a. Has the business entity been a defendant in any lawsuit in any state or federal court during the preceding five (5) years? _ Yes No If yes, identify each lawsuit by party, case number, court, subject matter, and disposition: b. Does the business entity have any claims filed against it which are unresolved and presently pending before any State of Texas Administrative agency? .Yes No If yes, please provide a full description of the charges 6. Financial Information: Phone Number Phone Number Phone Number Page 16 of 29 a. Has the business entity filed a voluntary or involuntary petition in bankruptcy, obtained an order for relief, or received a discharge on any debt under the U.S. Bankruptcy laws during the preceding seven (7) years? _ Yes No If yes, please describe: b. Has any owner, member, or partner of the business entity filed a petition in banla uptcy, obtained an order for relief, or received a discharge on any debt under the U.S. Bankruptcy laws during the preceding seven (7) years? Yes No If yes, please describe: 7. Describe insurance coverage (include copy of Insurance Certificate): a. The business entity must provide satisfactory evidence of existing insurance coverage in the amount of $1,000,000.00 for Errors and Omissions or other fiduciary liability. If the business entity is selected to provide services it must provide evidence that such coverage will be in effect for the duration of the agreement. 8. Describe ISL and ASL claim payment: a. Where will claims be paid? b. What is the definition of "paid claim" to be eligible for reimbursement? c. Can KERB County's HR Director and consultant speak directly to claim examiner for questions related to payment of claim? Yes No Comment: d. What is the normal processing time for ISL claim? e. What is normal processing time for ASL claim? f. What expenses related to investigation of claim are eligible for reimbursement (e.g. hospital audit, medical records, etc) by the stop loss carrier? g. If KERB COUNTY has negotiated with providers, will these discounts be accepted, in lieu of doing a hospital or other audit? Yes No h. Describe documentation needed for ISL claim reimbursement: 9. Describe Underwriting: a Will any claimants be excluded or assigned a higher deductible (lasered)? _ Yes No If so, please describe: 10. Did you provide a Specimen Stop Loss Contract? Yes No 11. Does your Stop Loss insurance contract have any exclusions or limitations that are more restrictive than those used in Page 17 of 29 KERB County's booklet? If so, please describe: _ 12. Are the active-at-work and disabled dependent provisions waived for the effective date of the contract? _ Yes _ No 13. If Centers of Excellence are used for your transplant coverage, please provide specific information for facilities cost and procedures to be used: Please attach a schedule with complete information: 14. Please state any variations to the Request for Proposal Assumptions or other qualifications for your quote: 15. After the ISL deductible is reached will the stop loss carrier pay claims directly to vendor or require Kerr County to pay claim and be reimbursed? If reimbursed what is turnaround time? 16. For what period of time are quoted rates guaranteed? 17. Is a longer rale guarantee available? If so, please describe: 18. Are quoted rates net of agent commission? If no, please describe: 19. Do quoted rates include advance funding for: a. Specific Claims? If no, additional cost to provide: b. Aggregate Claims? If no, additional cost to provide: 20. Is the quote based on the services of a specific provider network? 21. Please give rate differential to use the following networks: Specific Aggregate a. PHCS _ b. Healthsmart _ c. BC/BS _ d. CNN e. Beechstreet _ f. Texas True Choice Yes No Yes No Yes No Yes No Yes No Yes No Page 18 of 29 21. The following rate exhibit maybe used for rate submission however included with the CD or available by Internet is an Excel Spreadsheet titled, "Self Funded Quote Spreadsheet". Complete this spreadsheet as it will be used for bid analysis. BASIC PLAN $ Specific Deductible Basis for Deductible: Incurred Paid Number of Rates Monthly Premium Annual Premium Partici ants Specific Premium: Single Family Com osite Aggregate Premium Com osite Aggregate Attachment Pts. Single Family HIGH PLAN $ Specific Deductible Basis for Deductible: Incurred Paid Number of Rates Monthly Premium Annual Premium Partici ants Specific Premium: Single Family Com osite Aggregate Premium Com osite Aggregate Attachment Pts. Single Family Page 19 of 29 Kerr County Third Party Administration Questionnaire TPA Organization 1. Name, Address, City, State, Zip Code and Telephone Number of Firm. 2. Is your firm owned or operated by a parent company? If yes, please identify the parent and its primary business. 3. How long has your firm been in business? How long have you done claims administration? 4. Who are the principal officers in your firm? How long have they been in their positions? 5. Is this a branch facility? If so, please identify the main office location. 6. How many claim processors are Full Time employees in your firm? 6a. How many claim processors will be appointed to service this account? 6b. Of those approximately how many years of experience does each have with medical claims processing? 7. Do you have bilingual claims personnel available to plan participants who call your office for customer service and/or claims processing? 8. How many clients do you perform claim administration services for? What is the average size? 9. Do you carry Errors & Omissions coverage? Provide a copy of your current policy. Claims Administration 1. What are your claim office performance standards for claim accuracy and turnaround time? 2. What is your average turnaround time? 3. What is your current per day production minimum expected of your claims processor? 4. What are your internal audit procedures? 5. What edits and controls are used to avoid duplicate payments? 6. What safeguards exist to protect against claims abuse and fraud? 7. What program do you use to unbundle claims? 8. What coordination of benefits (COB) procedures do you follow? 9. What database do you use to determine Reasonable and Customary fee allowances? How frequently do you update your R&C screens? 10. Describe your procedures for professional Medical claims review? 11. Explain your hospital bill audit procedures. 12. Describe your procedures for tracking and reporting excess claims? 13. Explain how you handle subrogation and third party disbursements? 14. List the excess carriers which you are approved with for claims administration? 15. Do you provide a toll free number for claim inquiries? If yes, what is the cost? Page 20 of 29 16. What are your normal hours of operation to answer calls for claim inquiries? 17. Describe your customer service process when an employee calls with a claim inquiry. 18. If you have a separate customer service unit, what are your standards for: Answer Time: Abandon Rate: 19. What submission rate has been assumed when calculating your fee? 20. Does your fee assume a first year claim lag? If so, what is the cost to purchase mature claim year administration? 21. Does your fee assume any excess loss carrier overrides? Eligibility System 1. How is an insured's eligibility assigned and maintained? 2. How often can eligibility information be updated? 3. Do you maintain information on each of the family members separately, as well as the employee? 4. What is your accuracy standard and turnaround time for loading new groups, updates, and changes? System Capabilities 1. Is your claim processing system completely automated? 2. Are there any significant manual activities required to process claims? 3. Describe your claims payment system, including hardware and software? 4. Do you own or rent your claim payment system software? 5. How is a person's claim history tracked? 6. How many benefit components (IE -separate deductible, totals, lifetime benefits, etc.) can be maintained by the system? 7. Can the system track number of visits by procedure? 8. Can the system handle different benefit levels for PPOs? 9. How many PPOs can the system handle for one client? 10. Can your system accept Electronic Data interchange claim submissions? 11. What percentage of your claims is currently accepted on an electronic basis? Banking Arrangements 1. Do you require the use of a specific bank for claim accounts? If so, please provide the name, address, and phone number of the bank. 2. Is an initial claims payment deposit required to establish banking arrangements? 3. Will you perform bank account reconciliations? Page 21 of 29 4. Are there any additional costs to the banking? (LE.: -EFT charges, monthly charges, etc.) 5. What is the cost of the check stock you provide? 6. How many checks are provided in your cost assumptions? Utilization Review 1. What U.R. services are performed in-house? 2. What outside U.R. services do you use? How long have you used them? 3. Indicate which U.R. services you have assumed in your proposal? Pre Notification Preadmission Review Concurrent Review - On Site or Off Site Retrospective Review Large Case Management Discharge Planning 4. Can you accommodate Pre-Notification for the following? Specialty Care referrals Home Health Care Ancillary Services Inpatient Surgical procedures Outpatient Surgical procedures Lab & X-ray procedures Inpatient Mental Health and Substance Abuse Outpatient Mental Health and Substance Abuse Preferred Provider Organizations 1. Do you have capabilities to process PPO discounts in-house? 2. Which PPOs do you have access to processing in-house? 3. Can you install PPO discounts for Direct contracts with providers? If so, what is the charge? 4. How many different PPOs do you interface with currently? Who are they? 5. Which PPOs are you currently using? (attach directory or website access) Reporting 1. Provide a list of reports available in your standard reporting package. What is the cost of these reports? 2. Can you generate customized reports? Are reports available through Internet? What is the charge? 3. How are paid claims reported? 4. How does your firm report claims to Excess Loss carriers? 5. Can you report on PPO savings? Page 22 of 29 General 1. What is the cost for producing a plan document? Is it included in your cost assumptions? 2. What is the cost for producing a Summary Plan Description? Is it included in your cost assumptions? 3. What is the cost of having the Plan Document and SPDs changed due to regulatory changes? Is it included in your cost assumptions? 4. What is the cost of printing the 500 Summary Plan Descriptions for the plan participants? Is it included in your cost assumptions? 5. What is the cost for printing 1000 ID cards? Is it included in your cost assumptions? 6. What is the cost of Explanation of Benefits: Is it included in you cost assumptions? If so, how many do you assume? 7. Is there an initial set-up fee charged for the installation of our plan? 8. Please disclose any additional fees or expenses that are borne by the client including but not limited to any contractual reimbursements, capitated fees or other fees paid to the TPA , e.g. Rx reimbursements . 9. Do you offer assistance in the administration of COBRA benefits? HIPPA Certificates? Please explain the type of assistance and/or administration duties you provide. HRA Questionnaire 1. Do you offer HRA administration in conjunction with your claims administration? 2. How often do you reimburse a claimant for expenses incurred that are filed on a paper claim form? 3. Do you provide a debit card for all participants? 4. Do you require the use of a specific banking institution? 5. Is there a minimum funding requirement? If so what? 6. Please describe your HRA administration in relationship to your medical claims administration. 7. Identify all costs associated with your HRA administration package to include all costs and services provided. 8. Do you include access to accounts via the intemet? At what additional cost if any? Prescription Benefit Manager Questionnaire Please fmd the current prescription drug plan design in the medical plan summary attachment. 1. Please describe your retail pharmacy network (number of independents and number of chains; are all chains in the network?) including its relationship to you (e.g. owned or leased). 2. Please confirm that prescription drugs prescribed by any licensed health care provider, including dentists, will be covered by the pharmacy program. 3. Is the use of a formulary mandatory? Please attach a copy of the formulary for review. 4. Does the retail brand discount include savings from formulary, network spread, clinical savings, DUR savings? 5. Is the brand discount a hard discount? Page 23 of 29 6. Is the brand discount an average? Is it based on 11 digits NDC? 7. Is the brand discount at mail order based on 100 units or actual acquisition NDC? 8. Is the mail discount based on 11 digit NDC? 9. Is pricing for retail brand and overall generic effective rate guaranteed? 10. Your quote MUST include a traditional pricing model and a transparency full pass-thru model. Is the pricing guaranteed? 11. What is the discount for specialty drugs? What is the dispensing fee? Is the specialty drug program apass-thru under a transparency model? Are supplies included in the pricing? 12. Please provide your definition of "generic". Also provide a defmition of the generic included in the overall generic guarantee. 13. What quantity is an AWP based on for mail order? 14. How are manufacturer rebates handled? Will KERR COUNTY share in the rebates? If so, what percentage? 15. Do rebates have a minimum guarantee per claim? Per brand? 16. Are rebates paid quarterly? If not, when? 17. Under transparency pricing model, are rebates a 100% pass thru of Gross? 18. Will coverage of OTC impact rebates? If so, how much? 19. Do rebates survive termination? When are they paid after termination? 20. Are rebates paid on specialty drugs? 21. Do you contract directly with manufacturers for formulary rebates or do you use another PBM? If yes, who handles? 22. Please describe how the drugs for the formulary are selected, and who is responsible for the selection. 23. Do you own your own mail service? If not, who do you sub-contract with and do you retain revenue? 24. Do you own your own Specialty Pharmacy? Or subcontract? If yes, who handles specialty pharmacy? 25. What is the average turnaround time for mail order pharmacy? 26. Can mail order pharmacy be ordered on-line? 27. Does the PBM allow 90-day fills at retail in addition to mail order? If so, what contracted pharmacies participate? What is the discount to KERR COUNTY fora 90-day network? What plan design is used? 28. Do you offer alternatives in the pharmacy program that can help control or reduce the plan costs? If so, please provide details and approximate savings for each feature. 29. Please explain your Drug Utilization Review process for these programs: a. Prospective b. Concurrent c. Retrospective 30. Please submit a sample of your standard reporting package. Attach samples of your standard reporting package that is included in your quote. Please note if your paid claims numbers are based on paid or incurred claims figures. Page 24 of 29 31. Include in your response a PPI report, a specialty drug report, and a net cost per day for mail or retail report w/ specialty and acute meds removed. 32. How do you propose getting members to look at alternative brands that have generics available and do your manufacturer contracts preclude you from providing this type of information to members? 33. What financial advantage would KERR COUNTY gain if we limited the pharmacy network to several large chains? Could exceptions be made in outlying areas? 34. Is electronic billing available? Reports on line? Is an interactive website available? Can members compare pricing of drugs on line? 35. Will the PBM provide assistance with developing a communication piece? 36. Provide all materials used in marketing your product. 37. Do your administration fees include the following: a. Postage (in D below) b. Claim forms c. ID cards, (medicaUrx combo cards?) d. Mailing to participants homes e. Participating provider directories f. Customer service representatives specific to KERR COUNTY. g. Mail order forms h. 1 - 800 number to call center i. Standard report packages 38. Does your plan currently offer on-line access to claims and eligibility information for employees? Is there a separate charge for this to the plan? 39. Will any revenue be paid to a third party administrator for services, fees, disease state management or other vendor services by the PBM? Will all compensation to third parties be disclosed? Is an implementation allowance paid to the payor? If so, how much per member or head of household? 40. Will you audit the pharmacy data? Specifically, as a payor, what independent source will audit claims? What are the fees associated with an independent audit? 41. Will you provide consultative modeling and forecasting annually? 42. Will atrue-up of guarantees be performed annually? If so, when can KERR COUNTY expect payment of true-ups above guarantees under transparency model? 43. Will the mail service provider provide to KERR COUNTY copies of their suppliers (wholesaler or manufacturer) invoices showing net invoice for medications? 44. Will your firm detail its total revenue from all sources for administering the KERR COUNTY pharmacy benefit plan and allow an independent audit by the KERR COUNTY? 45. The 3 fmalist will be required to make a presentation to KERR COUNTY and answer questions to fully explain the specifics of the program offered. 46. Will your firm contractually guarantee that the amount you reimburse to pharmacy providers is the exact same amount that is billed to the plan sponsor? ATTACH A SAMPLE DRAFT OF THE PBM CONTRACT Page 25 of 29 Cafeteria Plan Administration 1. Name, address, city, state, zip code and telephone number of home office of firm. Branch office location(s), if any. 2. Is your company awholly-owned subsidiary or a division of another company? If so, please identify the company name and address. In addition, please list all owners (if not publicly owned), and all affiliated companies. 3. Have any principals of the firm ever been named in a lawsuit dealing with the management/administration of a Section 125 Cafeteria Plan? 4. How many clients are currently served? Please provide the largest group, the smallest group and the number of employees covered. 5. What is the maximum processing time that will occur between receipt of claims and reimbursements to the members? 6. What guarantee will you provide to Kerr County that this function will be completed within this time frame? 7. What is the size of your staff? 8. List staff experience of the employees that will be handling Kerr County's account. 9. List the office location intended to service Kerr County. 10. Is there a toll free number for employees and/or Kerr County to speak to a customer service representative? If so, what are the hours? 11. Does your firm perform discrimination studies as to eligibility, contributions and benefits under the plan? If so, how frequently? 12. Does your company offer debit card services? If so, please explain in detail. ADMII~TISTRATION 1. Describe the computerized system used to collect, assimilate and integrate the data of the program. 2. Provide a sample of your Administrative Service Agreement. 3. Provide a sample of your Plan Document. 4. Describe your capabilities for Direct Deposit. 5. Provide samples of worksheets and/or any materials that will be provided to Kerr County for educational purposes. 6. Describe your process for entering enrollment information into your system. 7. What electronic or Web-based services does your company offer? Can claims be filed via fax or through other electronic means? Do you charge additional fees for this service? 8. Does your firm provide monthly, quarterly, or annual account statements directly to the participating employees? If so, please explain in detail the process and if there are any additional fees associated with Employee Account Status statements. Page 26 of 29 9. Provide a sample of Section 125 reports generated for employees and Kerr County. Provide a sample of any other reports that you believe maybe useful to Kerr County on a regular basis. Please provide sample reports that would be utilized for bank reconciliation. ORGANIZATION STRUCTURE 1. Any Administrator must have filed and be approved with the State of Texas. If a TPA is later rejected by the State, it will be considered grounds for dismissal. 2. Is your organization for profit or non-profit? 3. Are you an affiliate of an insurance carrier or independently owned and managed? 4. If you are a multiple site organization, are certain services delegated to specific locations or are all services available at any location? LIABILITY PROTECTION & BANKING REFERENCE 1. Please disclose the amount of liability insurance protection currently in force. The selected Administrator must provide confirmation of coverage. 2. Is the company and all employees bonded? If so, please provide details. 3. Are employees covered by workers compensation insurance while performing services on site at Kerr County? a. { }Yes { }No PRICES/FEES 1. Provide schedules of fees for each Plan. Indicate whether fees or services are contingent upon the sale of any products to Kerr County and the conditions under which the products would be sold. 2. Are the fees due payable on the first of the month, quarterly, annually or combination of these? 3. Is a fee structure available that incorporates various levels of participation? 4. Do you intend to receive any commissions from the vendors servicing Kerr County? 5. Explain any methods to be utilized to control expense. 6. Provide a fee for administering the Medical and Dependent Care Spending Accounts with and without a Debit Card option. HISTORY 1. Briefly explain the development of your organization and your corporate business objectives. 2. Explain how long you have been in business and how long you have been providing Section 125 Administration services. UNIQUE CHARACTERISTICS 1. What do you feel is unique about your firm that will offer the best value to Kerr County for Section 125 Administration services? 2. Please comment on any other characteristics of your organization that are considered unique in the industry. Page 27 of 29 WELLNESS AND PREVENTION QUESTIONNAIRE: 1. Provide an executive summary of the wellness services you provide. 2. Are wellness and prevention medical services your main line of business? If not, please explain in detail where and how wellness fits into your business plan. HEALTH RISK ASSESSMENT (HRA) SERVICES: 1. Describe the Health Risk Assessment (HRA) tool your organization offers. Please attach a sample. 2. In what languages are your HRA, website, and employee materials available? 3. What is the average participation rate for your clients? 4. Explain your experience designing incentive systems to drive participation, including your most successfully designed incentive program. 5. Please complete the grid below with a checkmark or specific answer if your HRA includes the feature described. 6. How often do you recommend that the members have an HRA? 7. Please describe turnaround time for each of the following areas: a. Providing the HRA results to individuals. b. Contacting individuals for possible interventions. c. Providing Kerr County with a summary report of the initial HRA results. 8. Please describe how your company would communicate with individuals to assist them in understanding how to utilize the HRA and how to interpret the results. 9. Describe how your company will set and reach HRA participation goals? 10. Do you recommend using incentives? If so, please describe sample incentives your company might recommend. 11. How is the individual's HRA record updated in working with the disease management staff? 12. Do you monitor and report individual HRA changes from year to year? .. Page 28 of 29 HRA PRODUCT FEATURE Included? Web-based HRA Paper-based HRA Biometric clinic based Provides information on confidentialit Provides information on how data will be used DATA COLLECTED Health status Chronic conditions Famil health history Medications Lifestyle risks Safet Preventive exams Immunizations Biometrics Readiness to char e INDIVIDUAL RESULTS High-risk clinical situations are identified and appropriate steps can be taken for immediate intervention. Score communicated Focus/ riori of individual's health/lifestyle areas are communicated Health im rovement recommendations are made Action ste s rovided Can o to s ecific to ics within web site Summ re ort is available online Summ re ort can be tinted Links to additional health information are available Provides information or links to risk reduction ro ams Employer can customize messages on their URL to include references and links to internal ro rams or other vendors EMPLO~'ER REPORTS Web-based/electronic re orts available Re orts can be tinted Lifestyle risks are re orted Health status are re orted Chronic conditions are re orted IMPLEMENTATION & COMMUNICATION STRATEGY: 1. Please provide a proposed communication plan for introducing an onsite wellness program and reference the ongoing communication process. Outline your company's responsibilities in these processes. Please include copies of your educational materials and timelines for distribution. 2. How can employees communicate with the medical team? 3. Discuss the frequency and type of communications that eligible persons will receive throughout the program period. 4. Provide your web address and any access codes needed to explore your services. 5. How would you suggest reaching spouses? Page 29 of 29