1 REQUEST FOR PROPOSAL THIRD PARTY ADMINISTRATOR SERVICES City of Los Angeles Civilian Benefits Program Personnel Department - Employee Benefits Division Joint Labor-Management Benefits Committee DATE ISSUED: May 8, 2017 TITLE: THIRD PARTY ADMINISTRATOR SERVICES FOR THE CITY OF LOS ANGELES CIVILIAN BENEFITS PROGRAM CONTRACT TERM: Up to Five (5) Years PRE-PROPOSAL CONFERENCE: May 24, 2017 1:00 p.m. – 2:00 p.m. City Hall 200 North Spring Street, Room 805 Los Angeles, CA 90012 PROPOSAL DELIVERY ADDRESS: City of Los Angeles Attention: Jenny M. Yau City Hall 200 North Spring Street, Room 867 Los Angeles, CA 90012 DEADLINE FOR SUBMITTING PROPOSAL: June 30, 2017 at 3:00 p.m. Pacific Standard Time (PST). DEADLINE FOR OUTREACH TO SUBCONTRACTORS (pursuant to the City’s Business Inclusion Program outreach requirements): June 15, 2017 at 11:59 p.m. PST. RFP ADMINISTRATOR: Jenny M. Yau, Civilian Benefits Program Director Phone: (213) 978-1597 Email: [email protected]
Transcript
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REQUEST FOR PROPOSAL
THIRD PARTY ADMINISTRATOR SERVICES City of Los Angeles Civilian Benefits Program
Personnel Department - Employee Benefits Division Joint Labor-Management Benefits Committee
DATE ISSUED: May 8, 2017 TITLE: THIRD PARTY ADMINISTRATOR SERVICES FOR THE
CITY OF LOS ANGELES CIVILIAN BENEFITS PROGRAM CONTRACT TERM: Up to Five (5) Years PRE-PROPOSAL CONFERENCE: May 24, 2017
1:00 p.m. – 2:00 p.m. City Hall
200 North Spring Street, Room 805 Los Angeles, CA 90012
PROPOSAL DELIVERY ADDRESS:
City of Los Angeles Attention: Jenny M. Yau City Hall 200 North Spring Street, Room 867 Los Angeles, CA 90012 DEADLINE FOR SUBMITTING PROPOSAL: June 30, 2017 at 3:00 p.m. Pacific Standard Time (PST). DEADLINE FOR OUTREACH TO SUBCONTRACTORS (pursuant to the City’s Business Inclusion Program outreach requirements): June 15, 2017 at 11:59 p.m. PST.
RFP ADMINISTRATOR:
Jenny M. Yau, Civilian Benefits Program Director Phone: (213) 978-1597 Email: [email protected]
Section 4: Proposal Format and Submission Requirements __
Section 5: Evaluation of Proposals __
Section 6: General Terms & Conditions __
Attachments A to I – Supplemental Information __
Attachment J – Proposer Declaration Page __
PART B City of Los Angeles General Contracting Requirements (Rev. 1/17)
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SECTION 1 INTRODUCTION/BACKGROUND
1.0 INTRODUCTION
The City of Los Angeles Personnel Department and Joint Labor-Management Benefits Committee (JLMBC) are seeking proposals for a Third Party Administrator for the City of Los Angeles Civilian Benefits Program (“LAwell Program”). The mission of this procurement is to identify the service provider which can best support the LAwell Program by efficiently and effectively administering the recordkeeping, administrative, and communications infrastructure in support of the LAwell Program, its oversight and support staff, and its members. It is the City’s intent to approach this procurement from a “member-based” perspective focused first and foremost on addressing the support services, access to services, and communications efficacy that LAwell members are most concerned with and which directly impact their health and wellbeing. The City presently contracts with Mercer Benefits Administration to provide third-party administration of the LAwell Program, including the following:
Recordkeeping and administration Eligibility management relative to contracted benefits service plan providers Call center communications Member website for self-service benefits elections and ongoing management Plan sponsor website for benefits administration and reporting Affordable Care Act eligibility, compliance, and tax reporting recordkeeping
Segal Consulting (“Segal”) is the JLMBC’s consulting firm providing plan administration consulting services relative to this procurement.
1.1 DEFINITION OF TERMS
The following terms used in the RFP documents shall be defined as follows:
“Agreement” or “Contract” will mean the contract to be entered into between the City and proposer(s).
“Benefits Program” will mean the City of Los Angeles Civilian LAwell Employee Benefits Program.
“Bidder” or “Proposer” will mean the entity that responds to the Request for Proposal.
“CIL” will mean the City’s Cash-in-Lieu monetary benefit for employees satisfying its requirements for opting out of health coverage.
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“City” will mean the City of Los Angeles.
“COBRA” means the Consolidated Omnibus Budget Reconciliation Act of 1985 as it relates to offers of continuation coverage to employees losing benefits coverage due to termination of employment or other reasons.
“Contractor” will mean the individual, partnership, corporation or other entity to which a contract is awarded, and will be synonymous with the term “vendor”.
“Department” will be considered synonymous with the City’s Personnel Department.
“Flexible or Flex Credits” will mean additional dollars provided by the City based on an employee’s benefits elections and/or employee’s job classification per the provisions of an MOU or the Los Angeles Administrative Code.
“LAwell Program” will mean the City of Los Angeles benefits program for its Civilian and other eligible employees.
“JLMBC” will mean the City of Los Angeles Joint Labor-Management Benefits Committee.
“MBC” will mean the City’s current Mercer Benefits Central website for member benefit elections.
“MOU” will mean a Memorandum of Understanding, or collective bargaining agreement, to which an employee labor organization and the City of Los Angeles are both parties.
“New Hire” will mean a newly hired City employee eligible for the Civilian LAwell Benefits Program.
“Non-Represented” will mean an employee who is not represented by a City of Los Angeles employee bargaining unit.
“PEW” will mean a Personal Enrollment Worksheet outlining an employee’s benefit election options at time of new eligibility or pursuant to the annual Open Enrollment Process.
“Represented” will mean an employee who is represented by a City of Los Angeles employee bargaining unit.
“RFP” will mean this Request for Proposal for contracted services issued by the City of Los Angeles.
“Subsidy” will mean monetary assistance provided by the City for an employee eligible for LAwell benefits applied toward the cost of benefits.
“TPA” will mean the Civilian Benefits Program Third-Party-Administrator function that is the subject of this RFP.
1.2 CONTRACT TERM The term of any contract(s) awarded pursuant to this RFP shall be for a period of up to five years from the contract effective date as provided for by the final contract, subject to the termination provisions therein. 1.3 RFP CONTENTS
The contents of this RFP are as follows:
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PART A – Request for Proposal, including the Introduction/Background, Plan Profile & Scope of Service, Proposal Questionnaire, Submission Requirements, Evaluation of Proposals, and General Terms and Conditions. PART B – General Contracting Requirements and Attachments, which includes the City of Los Angeles Standard Provisions for City Contracts (Rev. 1/17) and other general contracting requirements that must be reviewed and completed by proposers as specified in order for a proposal to be deemed responsive.
1.4 RFP CONTACT INFORMATION The Personnel Department and JLMBC are committed to ensuring that all LAwell Benefits business transactions, including procurement processes, are based strictly on integrity, competence, merit, and benefit to LAwell members and their dependents. As a matter of policy and consistent with the City’s ethics rules, JLMBC members and staff will not communicate with current or prospective vendors or their representatives, or any other person or organization, for the purpose or intent of having a particular vendor secure or maintain a contract or business with the LAwell Program, or otherwise realize financial gain from the LAwell Program, whether during or outside of a procurement process. In support of this, and to ensure the transparency and objectivity of this procurement process, all communications and questions regarding or related to the services included in this RFP should be directed as follows:
PART A Contact Information All questions regarding this RFP PART A must be in writing and should be directed to the RFP Administrator as follows:
PART B Contact Information All questions regarding this RFP PART B must be in writing and should be directed to the Personnel Department’s Administrative Services Division staff as follows:
Questions regarding certain General Contracting Requirements may also more appropriately be directed to the City department responsible for the particular requirement, as specified within the Part B materials.
1.5 GENERAL INFORMATION AND PRE-PROPOSAL CONFERENCE The City intends to award a contract, in a form approved by the City Attorney, to the selected proposer. Written proposals submitted to the City shall constitute a legally binding contract offer and shall remain open for twelve (12) months. It is requested that proposals be prepared simply and economically, avoiding the use of unnecessary promotional material. Proposal Timeline The following is the current timeline for the RFP process. The City reserves the right to adjust this schedule. Changes to the timeline, if any, will be posted online as an RFP Addendum.
Target Dates Event
May 8, 2017 Request for Proposal Released
May 16, 2017 Deadline for receiving written questions for the Pre-
Proposal Conference is 4:00 p.m. PST
May 22, 2017 Deadline to register to participate in the Pre-Proposal
Conference by telephone is 4:00 p.m. PST
May 24, 2017
Pre-Proposal Conference at 1:00 p.m. PST
City Hall
200 N. Spring Street, Room 805
Los Angeles, CA 90012
May 31, 2017 General Contracting Requirements Preliminary
Submission Deadline by 3:00 p.m. PST
June 7, 2017
Deadline for vendors to issue written solicitations to
subcontractors via www.labavn.org website. This step
should be completed by 11:59 p.m. PST to avoid
risk of late submission.
June 14, 2017 City Review of General Contracting Document Due to
Vendor by this Date
June 21, 2017 Deadline for receiving written questions regarding the
requirement via www.labavn.org website. All outreach
must be completed by 6/15/17 at 11:59 PM Pacific
Standard Time. No outreach will be allowed or
considered on or after 6/16/17 12:00 AM.
July 1, 2017
Business Inclusion Program (BIP) Summary Sheet
Submission on Los Angeles Business Assistance
Virtual Network (LABAVN) – 4:30 p.m. PST
July – September, 2017 RFP evaluations
August, 2017 Determine qualified proposers that will move on to the
performance testing phase
September, 2017 Complete performance testing of qualified proposers
September - October, 2017
(tentative subject to revision)
City makes selection and begins contract negotiation
with successful proposer
December 31, 2017
or upon contract agreement Target date for executing contract
January 1, 2018 Commencement of Services
Pre-Proposal Conference A Pre-Proposal Conference will be held to provide information regarding the RFP requirements and answer questions from prospective proposers regarding this RFP. The Pre-Proposal Conference will also give proposers and potential subcontractors the opportunity to network. City staff will not provide assistance regarding a proposer’s individual RFP response. The conference has been scheduled pursuant to the schedule noted in the Proposal Timeline. Potential proposers may participate by physically attending or by calling in to the conference. Participants will be asked to identify themselves by name and firm. If you intend to participate by telephone, pre-register by contacting the RFP Administrator by the deadline noted in the Proposal Timeline. The City will provide a call-in number at that time for those interested in participating by telephone. It is to your benefit to bring your own copy of the RFP, particularly the City’s General Contracting requirements, to the conference. No copies will be provided at the conference. Questions Regarding the RFP To maximize the effectiveness of the conference, to the extent possible, proposers should provide questions in writing prior to the Pre-Proposal Conference in accordance
with the deadline noted in the Proposal Timeline. This will enable the City to prepare responses in advance. All questions regarding the RFP should be submitted in writing and sent via e-mail to the RFP Administrator. Please identify the RFP title on the subject line of your message. All questions should identify the RFP section and page number, or the relevant General Contracting provision, for each question submitted. Additional questions may be accepted and addressed at the conference. However, certain responses may be deferred and posted online as addenda to the RFP at a later date. The City will make every effort to respond to all written questions as soon as practical. All questions and responses to questions, or any other changes to or interpretation of the RFP, will be posted online at www.labavn.org. Any such changes or interpretations shall become a part of this RFP and may be incorporated into any Contract awarded pursuant thereto. 1.6 GENERAL CONTRACTING REQUIREMENTS PRE-SUBMISSION OPTION
AND SUBMISSION DEADLINES The City’s General Contracting Requirements are included in Part B, which is attached hereto. Part B contains the Standard Provisions for City Contracts and a variety of documents and forms with which prospective City vendors must demonstrate compliance in order to be awarded a City contract. Within Part B is a list of requirements that must be fully met, including forms to be completed and submitted and details regarding certain processes which must be followed by prospective vendors as part of their RFP response. Failure to meet any of these requirements to the satisfaction of the City by the RFP Proposal Submission Deadline will result in disqualification of the vendor’s proposal as being non-responsive. The City will provide vendors an opportunity to demonstrate responsiveness to the City’s General Contracting Requirements at a date prior to the Proposal Submission Deadline. Vendors are not required to complete and submit their General Contracting Requirements forms/processes by the Preliminary Submission Deadline; however, it may be to their advantage to do so. If a vendor utilizes this option, City staff will identify whether the documents as submitted are or are not responsive to the City’s requirements. If deemed non-responsive, the vendor will have time to demonstrate responsiveness with its proposal at the RFP Proposal Submission Deadline. Following the Proposal Submission Deadline, there will be no further opportunity for demonstrating responsiveness to the City’s General Contracting Requirements. Failure to adequately demonstrate responsiveness to the City’s General Contracting Requirements, or a rejection by the vendor of those requirements or the Standard Provisions for City Contracts, will result in disqualification of the proposal. The relevant dates with respect to this process are included in the Proposal Timeline. 1.7 RFP PROPOSAL SUBMISSION DEADLINE
Responses to this RFP must be submitted on paper and electronic copy must be received by the RFP Administrator by the Proposal Submission Deadline noted on page one of this RFP and the Proposal Timeline. Electronic portions, as specified further in this RFP, must be received no later than this date/time as well. Late responses will not be considered. The City reserves the right to extend the Proposal Submission Deadline should this be in the interest of the City. 1.8 CONSULTANT RESPONSE INFORMATION Responses to this RFP must also be submitted at the same time on paper and electronic copy to the consultant used by the City in the evaluation of responses to this RFP. Delivery should be provided to: Segal Consultants
Attention: Michael Eck HR Technology & Automation Practice Leader 333 West 34th Street New York, NY 10001 [email protected]
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SECTION 2
PLAN PROFILE & SCOPE OF
SERVICES
A. LAwell PROGRAM OVERVIEW
The City of Los Angeles LAwell Benefits Program is offered to eligible full-time and half-time employees of the City of Los Angeles civilian employee population. The City offers its LAwell Civilian Benefits Program (“LAwell”) under Internal Revenue Code (IRC) Section 125. The LAwell Benefits Program includes approximately 24,800 City employees and their 33,000 dependents. In 2016 the LAwell Program spent approximately $297 million in combined employer and employee contributions to health insurance premiums to its medical service providers, along with an additional $41 million on combined premiums for other LAwell service providers (dental, life, disability, & accidental death and dismemberment, also known as AD&D).
B. LAwell PROGRAM GOVERNANCE & CONTRACTING AUTHORITY
The City’s Joint Labor-Management Benefits Committee (JLMBC) and the Personnel Department's Employee Benefits Division administer the LAwell Program for active City civilian employees and their qualified dependents. The JLMBC is composed of five management and five labor representatives and makes recommendations to the General Manager Personnel Department for LAwell Benefits service provider selections. The General Manager Personnel Department is the contracting authority for LAwell Benefits service providers. In accordance with Los Angeles Administrative Code Section 10.5, the Personnel Department may enter into contracts with LAwell Benefits service providers for a period of up to five years. The JLMBC will be reviewing the findings of a designated review panel for this RFP in generating its recommendations to the General Manager Personnel Department.
C. CORE MISSION
The core mission of the LAwell Program is to promote employee health/wellness with competitive benefits at a reasonable level relative to the City's financial capacity. The core mission of the Third Party Administrator is to support the LAwell Program by efficiently and effectively administering the recordkeeping, administrative, and communications infrastructure in support of the LAwell Program, its oversight and support staff, and its members.
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D. KEY SUCCESS METRICS The key metrics for evaluating success in meeting the core mission for the Third Party Administrator include the following:
Reliability and Accuracy in Processing, Recordkeeping, and Data Exchange Responsiveness, Reliability, and Outstanding Customer Service in Call Center
and Other Personalized Member Communications Responsiveness, Reliability, and Outstanding Customer Service in Interactions
with City Staff Member Satisfaction
E. LAwell PROGRAM DESIGN
The LAwell Civilian Benefits Program presently offers employees a menu of medical, dental, vision, life, disability, employee assistance and tax-advantaged savings programs, detailed with incumbent service providers as follows:
MEDICAL
Kaiser Permanente - Statewide Staff-Model HMO
Anthem Blue Cross - Statewide Narrow Network HMO, Statewide Full Network
HMO, Regional HMO, National PPO
DENTAL
Delta Dental - Preventive Only, DHMO, PPO
LIFE INSURANCE
The Standard Insurance Company - Basic life, Supplemental life (1-5 times pay),
Dependent life
DISABILITY INSURANCE
The Standard Insurance Company - Basic disability , Supplemental disability
ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE
The Standard Insurance Company - Voluntary AD&D. Dependent AD&D
TAX-ADVANTAGED SAVINGS ACCOUNTS
Wageworks - Flexible Spending , Dependent Care Reimbursement,
Transportation Saving, Parking Saving
EMPLOYEE ASSISTANCE PROGRAM
Managed Health Network
VISION PROGRAM
EyeMed
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F. SUMMARY DATA Indicative statistical data regarding the City’s benefits eligible population and volume of activity required of the Third Party Administrator to manage is included within Attachment A.
G. ELIGIBILITY
Full-Time Employees – The eligible population for the City’s LAwell Program includes all civilian full-time employees who are contributing members of the City of Los Angeles City Employees’ Retirement System (LACERS) and who are compensated a minimum of 40 hours per pay period1. In addition, eligible employees must also meet at least one of the following requirements:
Eligible for membership within one of the employee representation units where the LAwell Program has been negotiated through a Memorandum of Understanding (MOU).
A “Non-Represented” civilian employee. A Port Police Officer (MOU 27 or MOU 38) and a member of Tiers 5 or 6 of the
Fire & Police Pension System. An elected official of the City of LA or a full-time member of the Board of Public
Works. Half-Time Employees – The eligible population includes all civilian half-time employees who are contributing members of LACERS and who are compensated a minimum of 20 hours per pay period. Employees in part-time, temporary, or seasonal positions who are not LACERS members are not generally eligible for LAwell Benefits unless provided for in the applicable MOU. Employee Family Member Eligibility – LAwell members may also enroll eligible dependents including a spouse, domestic partner, biological or step child, child of a domestic partner, grandchildren for whom the member has legal custody, and grandchildren of children who are up to age 26, unmarried, and financially dependent on the member.
H. THIRD PARTY ADMINISTRATION
The City presently contracts with Mercer Human Resources Services, LLC to provide its third party administrator (TPA) services for the LAwell Civilian Benefits Program. The TPA is responsible for performing a wide range of services related to administering the LAwell Civilian Benefits Program. These services include but are not limited to the following: administering eligibility and benefit elections; participant and dependent enrollment, termination, and life event processing; recordkeeping employee and
1 Or alternate number of hours specified in a Memorandum of Understanding.
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dependent eligibility data; dependent eligibility verification; providing a customized participant enrollment website for members to make benefits elections and report life event changes; providing a dedicated customer service call center Monday to Friday from 8 a.m. to 5 p.m, Pacific Standard Time to answer member questions and process benefits elections and changes; generating enrollment communication notices (e.g. annual and new hire Personal Enrollment Worksheets or PEWs outlining benefits options and related costs) and confirmation statements; communicating election and termination information to LAwell benefits service providers (health, dental, vision, life/disability/accidental death & dismemberment, tax-advantaged savings accounts) electronically on a bi-weekly basis; collecting elections for tax-advantaged savings accounts and calculating and transmitting to the City Controller’s Office the per pay period deduction amount for the employee; coordinating the receipt of information from the LAwell life/disability/accidental death & dismemberment vendor and updating participant elections regarding approval, denial, or non-receipt of life or disability insurance Evidence of Insurability and Medical History Statement forms; computation and verification of employee deductions based on type of benefits plan and coverage level elected; transmitting employee deduction information to the City Controller’s Office to upload into the City’s payroll system (PaySR) on a bi-weekly basis; creating and verifying imputed income amounts for medical and dental plans and supplemental optional benefits (e.g. life, spouse life, and child life insurance, disability, and accidental death and dismemberment insurance); providing support for one Open Enrollment period annually including creation of annual PEWs for all eligible employees, creation and mail fulfillment of confirmation statements after the close of Open Enrollment, and processing of benefits elections (both active and passive enrollment); dual year coverage monitoring and processing support; generating COBRA reports and beneficiary and dependent verification letters; generating monthly invoices and back-up detail rosters to enable the City to make payments to LAwell benefits service providers via self-billing; producing a wide range of reports and data used by staff to monitor eligibility and coverage outcomes (e.g. Open Enrollment activity, call center statistics, demographic reports, family status change report, dual coverage report, direct billing report); and tracking and reporting of ACA eligible employees. Relative to the LAwell benefits service providers, the TPA provides recordkeeping of employee eligibility through a data exchange with the City’s payroll system, as well as employee elections of providers, coverage tiers, dependents, life event changes, etc., as a result of either Open Enrollment (held in October of each year) or life event or employment status changes or new hire events which occur throughout the year. Data updates are provided to the health insurance carriers on a bi-weekly basis.
ORGANIZATIONAL STRENGTH, PLAN SPONSOR & RECORDKEEPING
The City will be evaluating each proposer’s organizational experience, stability, financial strength, and experience in providing TPA services, and the degree to which an organization can be a long-term viable partner with the City in executing LAwell and benefits plan missions, goals, and strategies.
(2) External Agency Ratings The City will be evaluating each proposer’s rating agency status (if applicable) as part of assessing overall financial stability.
(3) Client Experience The City will be reviewing the client experience of the proposer, including current governmental plan sponsors who are currently utilizing the provider’s services, as well as recently terminated governmental plan sponsors.
(4) Regulatory and Compliance Services The City will be assessing each proposer’s status relative to any regulatory actions, complaints, administrative challenges, judicial actions, lawsuits, or other material events initiated by or against the vendor that may be relevant to the organization’s reliability as a City of Los Angeles service partner, and as part of ensuring that administrative functions are conducted in accordance with applicable law and regulation.
(5) Health Insurance Portability and Accountability Act (HIPAA) Compliance The City will be assessing each proposer’s compliance with the Health Insurance Portability and Accountability Act (HIPAA).
J. PLAN SPONSOR SERVICES
(6) Plan Sponsor Functions The City is seeking a TPA partner that can provide to City staff the ongoing administration and support services that are required for the successful administration of the LAwell Civilian Benefits Program. This includes an effective account management team that is both proactive in ensuring that the recordkeeping system accurately executes all of its functions and is highly responsive and expeditious in resolving errors. Ongoing services include administering eligibility and termination rules, identifying, reporting on, and creating COBRA notices for terminated employees or those otherwise ineligible for City subsidies, processing life event changes, generating eligibility reporting and invoicing to the City’s benefits service providers, maintaining beneficiary information, administering Open Enrollment and new hire enrollment, providing a call center and member self-service website, generating standard and ad-hoc reports, and participating in meetings as required throughout the year with City staff.
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(7) Plan-Level Website & Access to Plan and Member Records The City provides day to day administrative support of the LAwell Civilian Benefits Program and requires access to real time and historical member benefits data. Employee data comes from the City’s payroll system (PaySR) in a specific file format called a Demographic File. Please see Attachment B for the specific file layout information. The Demographic File is made available and transmitted to the Third Party Administrator biweekly based on the City’s payroll calendar (see Attachment C). Elections and enrollment changes made within the Plan-Level or Member-Level website to member records must be translated into a specifically formatted payroll file containing deductions for coverage elections and then transmitted to the Office of the City Controller (Controller’s Office) to upload into PaySR. Holding historical data of employee election choices (e.g. elections made as a result of either new hire, life event, or employment status changes which occur throughout the year and Open Enrollment (held in October of each year), adequate notes of actions, and details of chronological events within a Plan-level website is imperative for City staff to provide adequate customer service. The TPA is expected to hold and maintain this historical data for the duration of the contract and to transfer those records to the City or to a successor TPA upon termination of the contract in a mutually agreed upon format. To the extent that, due to practical obstacles, records cannot feasibly be transferred to the City or the successful TPA upon contract termination, the TPA must be willing to agree to mutually agreeable terms of retaining and making those records accessible beyond the contract termination date. The City also requires multiple system users with varying levels of system access in compliance with all laws and regulations to access and review confidential content contained within the Plan-level website. The City desires a system that is functional and expandable to the Plan’s growing needs. The system should be very secure, but also adaptable to the City’s needs and versatile. Each proposer will be evaluated for its ability to provide a comprehensive and versatile online system capable of providing the City with the ability to provide day to day administrative support.
K. RECORDKEEPING SERVICES
(8) Systems Architecture, Recordkeeping & Data Management Capabilities The City’s Benefits Program structure provides certain benefits to all of its members on a uniform basis, and certain benefits on a categorical basis. The categories are primarily distinguished by the benefits negotiated in the City’s various Memoranda of Understanding (MOUs). There are approximately 30 MOUs that are eligible to receive benefits from the LAwell program. Additional benefits design features apply to certain populations. The following table provides a high-level summary of the benefits design and rules architecture that must be administered by the TPA:
WageWorks – Dependent Care Spending Account (DCRA)
Anthem Narrow Network
Delta Dental Preventive
The Standard –Child and Spouse Life Insurance
WageWorks – Transit Spending Account (TSA)
Anthem Full Network
WageWorks – Parking Spending Account (PSA)
Anthem Regional Network HMO (Vivity)
Benefits Design Models (Full-Time Employees)*
Full-Time LAwell Plan (no premium contribution up to the Kaiser family premium)
Delta Dental PPO – City subsidy up to 85% of employee-only coverage
All members receive City-paid basic vision insurance. Coverage tier is based on the employee’s medical plan election.
All members receive City-paid $10,000 life insurance benefit
All members receive City-subsidized STD benefits of 50% of pay up to applicable maximum, for up to 2 years
No base benefit
Base benefit provided to all members
All members may participate in any or all of these accounts; one administrative fee applies regardless of the number of accounts
Full-Time LAwell Pay Plan (10% premium contribution)
Delta Dental HMO – City subsidy up to cost of employee-only coverage
Employees enrolled in Cash-in-Lieu are automatically enrolled in employee-only level coverage for vision
Based upon General Manager status or membership in certain MOUs, some employees are eligible to receive supplemental life insurance at 1x annual base pay at no additional cost (City paid benefit)
At employee cost (after-tax), employees may purchase supplemental coverage up to age 65 and 66 2/3% of pay, with cost varying by salary and age
At employee cost (pre-tax), coverage may be purchased in blocks of $50k up to $500k; employee and employee plus family options are available. Coverage options are offered at a flat rate cost regardless of employment status.
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For employees qualifying under the Cash-in-Lieu (CIL) Program, $100 per month is provided in lieu of benefits provided
Delta Dental Preventive – City provides $5 monthly credit
At employee cost (pre-tax), employees can purchase supplemental life insurance coverage up to 5x annual base pay, with cost varying by salary and age.
At employee cost, employees may purchase spouse life insurance (after-tax) from minimum $10,000 to maximum $100,000 of coverage and child life insurance (after-tax) of $5,000 per child. Both coverages are offered at a flat rate cost regardless of employment status.
Approved family or medical leave and certain types of military leave provide continuation of health and dental subsidies
Benefits Protection Plan provides continuation of health, dental, vision, and life insurance subsidies/benefits for those on an approved disability insurance claim
*Employees compensated at least 40 hours per pay period or the number specified in their Memorandum of Understanding.
Benefit Design Models (Half-Time Employees)**
Half-Time LAwell Plan and LAwell Pay Plan – City subsidy up to the employee only Kaiser premium subject to applicable MOU premium-sharing requirements
Half-Time – Delta Dental PPO: City subsidy up to 50% of employee-only coverage; Delta Dental HMO: City subsidy same as Full-Time employee; Delta Dental Preventive: City provides $2.50 monthly credit
Same as Full-Time employee
Half-Time – receive City-paid $5,000 life insurance benefit; supplemental, spouse, and child life insurance options same as Full-Time employee.
Same as Full-Time employee
No base benefit; may also purchase supplemental coverage similar to Full-Time employee
Same as Full-Time employee
Same as Full-Time employee
Approved family or medical leave and certain types of military leave provide continuation of health and dental subsidies
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Benefits Protection Plan provides continuation of health, dental, vision, and life insurance subsidies/benefits for those on an approved disability insurance claim
**Employees compensated at least 20 hours per pay period or the number specified in their Memorandum of Understanding.
Benefits Design Models (Sworn Employees)***
May choose to enroll in LAwell health plans – City subsidy and employee cost, if any is subject to applicable MOU premium-sharing requirements. Employees may also choose to enroll in LAwell CIL program.
May choose to enroll in LAwell dental plans – City subsidy and employee cost, if any is subject to applicable MOU premium-sharing requirements
N/A
N/A
N/A
N/A
N/A
All members may participate in any or all of these accounts; one administrative fee applies regardless of the number of accounts.
***Employees who are members of MOUs 22, 23, 24, and 25.
Additionally, data interfaces are set up between the TPA, the City’s payroll system, PaySR, and LAwell benefits service providers to communicate election and termination information, dependents, coverage tiers, and associated employee cost (i.e. payroll deduction) as a result of elections made due to either new hire, life event, or employment status changes which occur throughout the year and Open Enrollment (held in October of each year). The following table provides a high-level overview of the frequency and number of payroll feeds and carrier file transfers that are required of the TPA:
Vendor Name File Type Frequency
Kaiser Health plan eligibility file from TPA to vendor Bi-weekly/24 feeds per year
Anthem Health plan eligibility file from TPA to vendor Bi-weekly/24 feeds per year
Delta Dental Dental plan eligibility file from TPA to vendor Bi-weekly/24 feeds per year
The Standard Life insurance eligibility file from TPA to vendor Bi-weekly/24 feeds per year
The Standard Disability insurance eligibility file from TPA to vendor Bi-weekly/24 feeds per year
The Standard Accidental death & dismemberment insurance eligibility file from TPA to vendor Bi-weekly/24 feeds per year
WageWorks Tax-advantaged savings accounts (HCFSA, DCRA, TSA, PSA) eligibility file from TPA to vendor Bi-weekly/24 feeds per year
City Controller's Office
Payroll file (subsidy amounts, employee deductions, imputed income) from TPA to vendor; see Attachment H for data layout specifications Bi-weekly/24 feeds per year
City Controller's Office
Demographic file communicating employee data and hours worked to determine benefits eligibility from Controller’s Office to TPA; see Attachment B for data layout specifications Bi-weekly/24 feeds per year
TPA
Annual Open Enrollment payroll test and production file reflecting annual Open Enrollment election and changes for the entire covered population from TPA to City Controller’s Office
Test Payroll File – Early December Full Production File – Mid to Late December
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The TPA is expected to meet or exceed the current level of system function and access experienced by the City and is required to transmit file feeds as displayed in the table above. The TPA’s recordkeeping and systems architecture must further be capable of being highly adaptive to the inherent complexity of the Benefits Program’s design. In addition, the City’s benefits rules, MOU provisions, and plan design construction are subject to frequent change. The City seeks a TPA partner that is adaptive and can participate in and help identify solutions to implementing changes on an ongoing basis in an efficient and cost-effective manner. The complexity of the City’s Benefits Program requires a TPA partner that can invest the necessary level of systems, technical, and support resources to provide effective, accurate, and timely program administration. The City will be evaluating the software systems, information technology staffing resources, and future investment plans of each proposer. The City will further be evaluating capabilities to capture and generate reporting on a range of participant indicative data, both for the purpose of ongoing account administration but also for generating statistical reports on a variety of demographic data points that will assist the City in being able to target its goals and evaluate its success.
(9) Electronic Documents, Imaging & Document Storage The City seeks a TPA capable of generating electronic documents and forms specific to an individual employee’s profile information and benefits elections. The TPA is also responsible for cataloging and retaining other components of member data electronically. Electronic documents and forms include, but are not limited to, personalized benefits statements, confirmation statements, pre-filled enrollment or claim forms, etc. The City will be evaluating the TPA’s ability to generate, process, and/or receive customized member specific documents. The City is seeking to expand the resources available for the Benefits Program to track, maintain, and make available to the City and to its members core documents which pertain to the member’s ongoing management of his/her benefits, including dependent verification documentation. The City seeks a provider capable of imaging and maintaining electronic records of all member records, documents, and forms related to the administration of member accounts. Please note that the current TPA does not image or store electronic documents in the Plan-Level or Member-Level website. The TPA is expected to maintain this data in an electronic format for the duration of the contract and to transfer those records to the City or to a successor TPA upon termination of the contract in a mutually agreed upon format. To the extent that, due to practical obstacles, records cannot feasibly be transferred to the City or the successful TPA upon contract termination, the TPA must be willing to agree to mutually agreeable terms of retaining and making those records accessible beyond the contract termination date.
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(10) Security Protocols, Disaster Recovery & Guarantees The TPA is responsible for maintaining the confidentiality and security of participant records relative to its administration of the service. “Confidential Information” includes participant data, records and personal information such as social security numbers, dates of birth, marital status, home addresses, transaction histories, and other information related to participation in the LAwell Civilian Benefits Program. The provider will need to execute, as part of its contract, a Confidentiality Agreement providing that all confidential information provided to the TPA by or on behalf of City and/or City Personnel, or accessed or reviewed by the TPA during the performance of the Contract, is and will remain the confidential property of the City. The TPA will be required to further agree not to provide or divulge confidential information to any other person or entity except as authorized in writing by the City. The TPA will also be responsible for protecting the confidentiality and maintaining the security of all confidential information in its possession by implementing and maintaining adequate and necessary security systems, along with policies and protocols, to provide the highest reasonable level of safety and security of the confidential information. In the event of a security or data breach, the TPA must have in place an emergency response plan. The TPA must, if there is a breach of its security system and confidential information is accessed or believed to have been accessed, include the information in Civil Code Section 1798.82(d)(3) in the required notification of a breach and indemnify the City against any losses in connection with the data breach. In addition, the TPA will also be required to demonstrate its member protection and remediation plan, including but not limited to the purchase of credit protection services for impacted participants. Finally, the TPA is responsible for establishing contingency plans for emergencies, disasters, and disaster recovery. These plans should include redundant processing centers and plans for activating the necessary participant support services in the event a primary processing center is not available. These plans should also address backup systems and records in the event of damage or disaster impacting the storage and maintenance of the recordkeeping system and its records.
THIRD PARTY ADMINISTRATOR SERVICES
L. Ongoing & Open Enrollment Administration
(11) New Hire Enrollment & Employment Status Changes
Presently, the City’s rules stipulate that a new employee becomes eligible for benefits coverage in the first two-week pay period for which the employee has been compensated for at least 40 hours (full-time employee) or 20 hours (half-time employee). Employees who meet this requirement are identified in the bi-weekly Demographic File (Attachment B) transmitted by the Controller’s Office to the TPA. Currently, the TPA generates a Personal Enrollment Worksheet (PEW) that outlines the benefits options available to the new-hire based on his/her status (e.g. full-time or half-time employee and MOU). The PEW is provided to City staff, who then issues and mails
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the related enrollment informational materials to the employee. The date of eligibility is presently administered as being on or around the employee’s payday for the initial pay period of eligibility. The employee is provided with 60 days from the date of eligibility to make elections for coverage, including the ability to opt out of the health coverage and receive a $100 per-month Cash-in-Lieu (CIL) benefit ($50 per-month for half-time employees) if the alternate coverage meets the City’s requirements. Benefits are effective as of the date the employee enrolls in a benefits program (e.g. health, dental, etc.). If an employee fails to make an election, (s)he will be defaulted to health and dental coverage as determined by the City (presently, the Anthem Narrow Network and DeltaCare DHMO Plan). The employee also receives Basic Life, Disability, and Vision coverage. A confirmation statement is then issued to the employee upon election of coverage or default into coverage. Presently, the confirmation statement is typically issued within two to four weeks of the election date. If an employee has added dependents, the member will have 60 days from the date on the confirmation statement to submit documentation of the dependent’s relationship to the member. If the documentation is not provided, the dependent will be removed from coverage by the TPA and payroll deductions will be adjusted accordingly to reflect the associated benefits coverage level. A final confirmation statement reflecting this cancellation and associated employee payroll deductions per pay period will be generated and provided to the City for City staff to mail to the employee. To improve the member experience, the City will explore vendor capabilities with respect to issuing these communications directly to new-hires, removing City staff from the distribution process. This will involve not only establishing a regular ongoing cycle for normal distributions, but also being able to bypass any data/systems errors or expedite communications in certain situations as necessary.
(12) Life Event, Dependent Verification & Ongoing Affidavit Processing
The City’s LAwell Civilian Benefits Program provides for members to make changes to their benefits elections upon experiencing certain qualifying life events within specified time periods as determined under applicable Federal law/regulation and in accordance with City policy. Please see pages five to six of the “Eligibility, Making Changes & Supplemental Plan Information Guide” (Attachment D) for additional information. Presently, members report a life event change through the TPA by calling the TPA’s call center or accessing their online account on the member self-service web portal to report the life event. The TPA then generates and provides to the City for mail fulfillment a confirmation statement within two to four weeks. Similar to PEW processing, the confirmation statement is provided to City staff, who then issues and mails the confirmation statement and any additional forms (e.g. Evidence of Insurability and Medical History Statement forms) to the employee. The member then has 60 days to submit any applicable supporting documentation such as a marriage or birth certificate, divorce decree, or CIL or domestic partner affidavit to the City. If supporting
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documentation is not received by day 30, the City will send a physical postcard reminder to the employee notifying the employee of the upcoming deadline to submit the documentation, otherwise the dependent will be dropped from coverage on day 61 by the TPA and payroll deductions will be adjusted accordingly to reflect the associated benefits coverage level. No electronic documents are currently provided to the employee. Presently, the City collects supporting documentation via email, fax, or physical hard copy. If received through email, the documentation is printed. All supporting documentation is filed on-site with the City and then sent to an off-site records retention facility after a certain period of time has elapsed. Once the documentation is received and validated by the City, City staff enters a receipt date in the plan sponsor member site. The TPA does not collect supporting documentation and the City does not currently have the ability to upload these documents for electronic storage in the plan sponsor website. The LAwell Civilian Benefits Program also provides employees the ability to purchase additional life insurance of up to five times their annual salary. Generally, buy up options above three times the annual salary require proof of good health. Employees are required to complete and submit an Evidence of Insurability (EOI) form to the City’s life insurance vendor. Additionally, purchasing supplemental disability insurance for the first time during Open Enrollment and future elections requires proof of good health. Employees are required to complete and submit a Medical History Statement to the City’s disability insurance vendor. If any proof of good health is not submitted by March 1 of the calendar year following Open Enrollment or within 60 days of a member’s enrollment as a new hire, the pending coverage amount of the buy up option will be removed from the employee’s account by the TPA. The City and TPA do not collect EOI and Medical History Statement forms as they are provided directly by the employee to the City’s insurance vendor. To create a streamlined and efficient process for dependent verification and proof of good health processing, the City will be evaluating vendor capabilities to provide record keeping services that meet or exceed the current level of service, including: 1) reviewing and validating supporting documentation; 2) imaging and storing supporting documentation electronically; 3) generating dependent verification letters and notices to the member directly via email; 4) providing members the ability to electronically submit EOI and Medical History Statement forms directly to the City’s life and disability insurance vendor; and 5) providing clearly communicated and user-friendly reminders to members regarding outstanding dependent verification documentation, EOI, and Medical History Statement forms due via email. This will improve efficiency, communications, and member outcomes by removing City staff from manually processing and filing supporting documentation, sending physical postcard reminders for documentation due, and establishing a regular ongoing cycle of review and validation of supporting documentation.
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(13) Tax-Advantaged Spending Accounts Administration The LAwell Civilian Benefits Program currently provides four different tax-advantaged savings accounts – 1) Healthcare Flexible Spending Account (HFSA), 2) Dependent Care Reimbursement Account (DCRA), 3) Transit Spending Account (TSA), and Parking Spending Account (PSA) to eligible employees. The HFSA and DCRA are restricted to annual Open Enrollment election processing, while the TSA and PSA provide for election, changes, and cancellations at any time during the year. Participants are permitted to contribute the following minimum and maximum amounts on a pre-tax basis in accordance with Federal law, for each type of account:
HCFSA – A minimum of $300 up to the maximum amount as established by Federal law/regulation.
DCRA – A minimum of $600 up to the maximum amount as established by Federal law/regulation, and consistent with limitations applying when the member is married and a spouse is working.
TSA – A minimum of $10 per payday up to $255 per month (as adjusted pursuant to Federal law/regulation).
PSA – A minimum of $10 per payday up to $255 per month (as adjusted pursuant to Federal law/regulation).
Based on 2016 Open Enrollment information, the number of participants enrolled in the HCFSA and DCRA tax-advantaged savings account and average election amount is provided below:
HCFSA Enrollment – 1,808 Civilian; 465 Sworn; Total 2,273
HCFSA Average Election Amount per Participant – $1,456 Civilian; $1,813 Sworn
DCRA Enrollment – 447 Civilian; 183 Sworn; Total 630
DCRA Average Election Amount per Participant – $3,612 Civilian; $4,057 Sworn
The TPA will be required to collect employee elections for each of these tax-advantaged savings accounts as an annual amount and then calculate the per pay period deduction based on the annual amount divided by the number of pay periods remaining after the day the election is made (per the City’s bi-weekly payroll calendar provided as Attachment C). The per pay period deduction amount is then transmitted to the Controller’s Office to upload into the City’s payroll system on a biweekly basis. Currently, the TPA does not receive actual year-to-date payroll information from the City’s payroll system after each payroll cycle to: 1) reconcile against the payroll deduction amounts it transmits to the City’s tax-advantaged savings accounts vendor; 2) determine if a participant has not contributed enough to meet his or her elected goal amount; and 3) recalculate participant bi-weekly deduction amounts to ensure the participant meets his or her elected goal amount.
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The City will be evaluating vendor capabilities to provide comprehensive tax-advantaged savings accounts administration including: 1) collecting and processing employee elections and coverage election changes; 2) calculating per pay period deductions based on the participant’s elected goal amount accurately and transmitting this information timely to the Controller’s Office and the City’s tax-advantaged savings account vendor; 3) reconciling payroll deduction amounts against actual year-to-date payroll information received from the City to ensure the employee does not exceed the maximum contribution amount set by plan rules or Federal law/regulation; and 4) recalculating participant deduction amounts to ensure the goal amount is met.
(14) Open Enrollment Administration The LAwell Civilian Benefits Program Open Enrollment period is held annually during the month of October. Benefits elections made during Open Enrollment are effective the following January 1. Qualified benefits eligible employees receive an Open Enrollment Guide (go to http://keepinglawell.com/media/1043/cola-choosewell.pdf to review the 2017 Open Enrollment Guide) along with a Personalized Enrollment Worksheet (PEW). The Open Enrollment Guide and PEW (Attachment E) are mailed to all benefits eligible employees by the City in the last week of September prior to the start of Open Enrollment on October 1 and provides the following information: 1) personal information including date of birth, annual base pay, and zip code; 2) dependent information; 3) current benefits elections; 4) plan options and associated per pay period employee cost and buy-up options for supplemental life, disability, and accidental death and dismemberment insurance for the following year; and 5) specific benefits coverage applicable to certain employees per the provisions of their MOU (e.g. City-paid supplemental life insurance at one times annual salary for employees in certain MOUs). During the Open Enrollment period, employees are able to make changes to existing benefits elections and/or make new benefits elections (e.g. adding new dependents, enrolling into HCFSA and DCRA, purchasing supplemental life insurance) by logging into the TPA member web service portal presently known as Mercer Benefits Central (MBC). Through the MBC, employees are able to review their plan options and premiums, add elections to their shopping cart, and click a checkout feature to complete their enrollment. Employees are also able to make changes and/or enroll in new plans by calling the Benefits Service Center Monday through Friday from 8:00 am to 5:00 pm. If employees do not make an active enrollment, they are automatically re-enrolled into their benefits elections from the prior year (i.e. passive enrollment). Upon the close of the Open Enrollment period, a confirmation statement (see Attachment F) summarizing the employee’s benefits elections and associated per pay period employee cost effective January 1 (i.e. pay period deduction) and beneficiary information is generated and mailed to the employee by the TPA. The confirmation statement is mailed to all employees whether they passively or actively enrolled during the Open Enrollment period. Please note that a separate confirmation statement is generated for sworn employees enrolling into CIL and/or tax-advantaged savings accounts (see Attachment G). The majority of these employees have health and dental coverage through their sworn association.
Employees adding dependents during the Open Enrollment period are required to submit supporting documentation such as a marriage or birth certificate or domestic partner affidavit directly to the City. Employees electing benefits coverage where proof of good health is required must submit an EOI and/or Medical History Statement to the City’s LAwell insurance providers. Lastly, employees electing CIL are required to submit a CIL affidavit directly to the City. Presently, the member self-service web portal does not provide for employees to electronically submit these documents or for the City to provide confirmation or a notification or reminder to the employee of documentation due. If the employee does not submit dependent verification documentation or a CIL affidavit by the deadline established by the City (usually the second week in December), their dependents will be canceled from coverage, CIL will be canceled, and the employee will be defaulted back into their previous health plan option. After the document submission deadline, the TPA provides a list of employees whose dependents have been dropped from coverage and employees whose CIL has been canceled. Additionally, the TPA will provide a final confirmation statement reflecting these cancellations to the City for City staff to issue and mail to the employee. Additionally, the City provides for a silent two-week correction window after the close of the Open Enrollment period on October 31. During the correction window, employees are allowed to make additional changes to their benefits elections or correct any errors that are discovered. A separate confirmation statement is also generated by the TPA reflecting these changes and provided directly to the City for City staff to issue and mail to employees who have made corrections during the correction period. As part of this RFP, the City will be evaluating vendor capabilities to provide Open Enrollment administration which meets or exceeds the current level of service provided as described above including: 1) generating accurate PEWs detailing employee plan options and associated per pay period costs and mailing these PEWs to employees before the start of the Open Enrollment period; 2) providing an alternative method for delivery of PEWs and Open Enrollment Guide(s) that provides members the choice of opting into electronic document delivery; 3) generating accurate confirmation statements and mailing these statements timely to employees immediately after the close of the Open Enrollment and correction periods; 4) providing an alternative method for delivery of confirmation statements electronically via email; 5) ability to customize PEWs and confirmation statements and the amount of time required to program this type of customization during the Open Enrollment window; 6) provide for electronic submission of dependent verification documentation, EOIs, and Medical History Statements; 7) provide confirmation of documentation received and notifications and reminders to members of documentation due; and 8) generating accurate final confirmation statements reflecting cancellation in coverage for employees who did not submit supporting documentation and affidavits timely and providing an alternative method for delivery of these statements electronically via email. Finally, Open Enrollment processing occurs on top of, and in addition to, regular ongoing determination of benefits eligibility due to new hire events and processing of election changes due to life event changes (also known as dual year processing). Presently, for employees who report life event changes in the months of September to
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December and who do not make an active election to change benefits for the following calendar year either online through the MBC or through the call center, prior benefits elections will roll over to the new calendar year. The TPA will be required to maintain and provide support to simultaneous Open Enrollment administration activities and dual year processing. The City will be evaluating vendor capabilities to manage dual year processing and ensure benefits elections are carried forward without interruption or errors.
M. PAYROLL PROCESSING
(15) Data Transmission, Processing Changes & Auditing Functions The City utilizes a fully customized in-house payroll system known as PaySR. PaySR is supported primarily by the City’s Controller’s Office and Information Technology Agency. The TPA will be responsible for transmitting a payroll file in a format specified by the City (Attachment H) and coinciding with the City’s payroll cycle to the Controller’s Office to upload to PaySR biweekly. The payroll file includes: 1) deduction amounts and effective dates of employee benefits plan elections and changes; 2) employer contributions (City subsidy and flex credits) and employee contribution amounts to facilitate W-2 reporting; and 3) imputed income amounts for life insurance and taxable dependent benefits provided by the City. The City will be evaluating vendor capabilities of transmitting a payroll file containing the information outlined above to the Controller’s Office as part of ongoing administration (payroll file includes changes made in an employee’s benefits elections only on a biweekly basis coinciding with the City’s payroll calendar) and at the beginning of each year (one payroll test file and one consolidated payroll production file for the entire covered population reflecting annual Open Enrollment elections and changes) timely and accurately, including the TPA’s auditing functions for ensuring that employee deductions match their benefits elections, validating deductions biweekly with the City’s payroll system, quality assurance standards, and ability to resolve payroll errors with minimal delay.
(16) Direct Billing Process The LAwell Civilian Benefits Program requires that employees maintain a specific number of compensated hours per pay period (40 hours for full-time employees and 20 hours for half-time employees) to remain eligible for the employer subsidy paid towards LAwell program benefits. Employees not meeting this requirement, but who are still employed with the City, may continue receiving LAwell program benefits by paying for the full cost of their benefits through a direct billing process. The TPA will be required to assist in maintaining administration of benefits for employees making payment outside of the City payroll system, including providing a report of direct bill participants, charges, and terminations biweekly and assisting with cancelation and reinstatement of benefits. Additionally, the City will be evaluating vendor capabilities of providing a comprehensive direct billing system, including premium billing and payment collection, issuing billing
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notices and payment reminders to employees, and monitoring and tracking billing and payment activity on a bi-weekly basis.
(17) Eligibility & Premiums Reporting The TPA is responsible for sending election and termination information to the City’s LAwell service providers (health, dental, vision, life/disability/AD&D, tax-advantaged savings accounts) electronically on a bi-weekly basis. Currently, the City’s health plan carriers require transmission of a full eligibility file in EDI 834 format bi-weekly. In addition to transmitting eligibility files bi-weekly, the TPA will also be responsible for transmitting a full eligibility file to reflect all Open Enrollment elections annually. The TPA will review and process carrier eligibility error reports for each file transmission and coordinate with the carrier and the City to correct and resolve these errors on a timely basis.
Currently, the City processes payment monthly to its LAwell service providers on a self-bill basis. The TPA will be responsible for the following to enable the City to self-bill: 1) providing monthly premium reports to the City and its LAwell service providers, including carrier backup reports, premium invoice, including tabs for each vendor and summary tab, adjustment reports, Cash-in-Lieu report, and EAP count report (Attachment I); 2) calculating premium billing amounts and retroactivity based on the billing rules identified by the City; and 3) processing of retroactive premium adjustments. The TPA will also be responsible for premium reconciliation by working with the City’s LAwell service providers to resolve eligibility issues with minimal delay. The City will be evaluating vendor capabilities to: 1) transmit election and termination information timely and accurately to LAwell service providers; 2) provide eligibility and premiums reporting to enable the City to self-bill, and 3) provide eligibility and premiums reconciliation. The City will also be evaluating vendor quality assurance standards for ensuring that monthly premium reports are provided timely and accurately and eligibility and premiums error reports are resolved as soon as possible with minimal delay.
N. OTHER PROCESSES
(18) Specialized Processes The City currently manages certain benefits programs that require specialized processing due to the type of program and employee that is able to participate in the program. Please see below for a description of these programs, the specialized processing required, and the City’s criteria for evaluation of administration of these programs as part of this RFP.
Presently, the City’s LAwell Civilian Benefits Program covers the City’s civilian employees. However, sworn City employees may also choose to participate in the LAwell Civilian Benefits Program by enrolling into LAwell health and/or dental plans, Cash-in-Lieu, and/or tax-advantaged savings accounts. Sworn City employees choosing to participate in LAwell health and/or dental plans are
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currently processed and manually tracked by City staff outside of the plan sponsor website. The City’s TPA does not handle administration for this group of employees (about 15 sworn employees enrolled in a LAwell health plan and 70 sworn employees enrolled in a LAwell dental plan). Sworn City employees choosing to participate in LAwell tax-advantaged savings accounts are administered by the TPA. Sworn City employees may elect participation in these accounts during the Open Enrollment period or due to a life event change. As part of its evaluation, the City will be reviewing vendor capabilities to remove the manual processing and tracking of sworn employees enrolling in LAwell health and/or dental plans by City staff, tracking and reporting on these employees, identifying the types of confirmation statements that are generated and the method by which those confirmation statements are delivered to these employees, and providing tax-advantaged savings account administration for sworn employees.
The City’s Benefits Protection Plan (BPP) provides that employees who are on an approved disability leave may continue LAwell health, dental, vision, and basic life insurance for up to two years of disability. While an employee is covered by BPP, the City subsidy continues, so the employee only pays for the coverage cost they would have paid while an active City employee. Employees who are currently covered under BPP are required to pay their share of the cost through direct billing. The City must manually track these employees separately in its payroll system and subsequently send this information to the TPA. As part of its evaluation, the City will be reviewing vendor capabilities of tracking and reporting on these employees separately from the City’s LAwell civilian population and generating and emailing direct billing notices, payment reminders, and COBRA letters to BPP employees and their dependents.
Employees who are members of the Engineers and Architects Association (MOUs 1, 19, 20, and 21) are eligible to participate in LAwell dental plans or EAA dental plans. Currently, there are approximately 60 EAA employees electing EAA dental coverage. During the City’s annual Open Enrollment period from October 1 to 31, the City manually processes requests from City employees to cancel LAwell dental coverage and elect EAA dental coverage and vice versa. This information is then transmitted to the TPA to update the plan sponsor website to reflect the dental plan elected by the employee. As part of its evaluation, the City will be reviewing vendor capabilities to: 1) remove the manual processing and tracking of EAA employees electing or canceling EAA dental coverage; 2) provide employees the ability to elect EAA dental coverage online during Open Enrollment through the member self-service web portal; 3) identify the types of confirmation statements that are generated and the method by which those confirmation statements are delivered to these employees, and 4) provide tracking and reporting on these employees.
Currently, the City processes disability and life insurance claims manually. Employees complete disability and life insurance claims paperwork and return it to the City for processing. Similar to life event, dependent verification, and ongoing affidavit processing, no electronic documents are provided or uploaded to the plan sponsor website for storage. As part of its evaluation, the City will be reviewing vendor capabilities to: 1) provide for electronic submission of disability
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and life insurance claims; 2) record information such as the date and amount of a life insurance claim paid in the plan sponsor website; 3) provide electronic storage of additional supporting documentation; and 4) generate and email claims forms, confirmation statements, and standard correspondence to employees.
The City provides employees the opportunity to prepare and submit a written appeal if there is a disagreement over benefits eligibility, claims for refunds, or any other matter outside the plan rules. Currently, the City reviews and provides a determination on these appeals. Once the determination on the appeal is made, the written appeal is filed on-site and then sent to an off-site records retention facility after a period of time has elapsed. The plan sponsor website does not currently provide for the electronic storage of appeals and supporting documentation. Additionally, City notes and comments on the decision that is made cannot be recorded in the plan sponsor website. As part of its evaluation, the City will be reviewing vendor capabilities to provide for electronic submission and storage of employee appeals and the ability to record appeals information such as notes and comments for each employee.
O. REPORTING CAPABILITIES
(19) Standard Reporting
Presently, the TPA provides the City with a number of standardized reports on a bi-weekly basis as outlined below. The City has minimal ability to self-generate standard reports and relies heavily on the TPA to accomplish this task. As part of its evaluation, the City will review vendor capabilities to generate and produce the standard reports described below as well as any additional reports that the vendor is able to generate for the City to streamline processing and create efficiency. The City will also evaluate vendor capabilities to allow the City to self-generate these reports on its own, whenever necessary. Lastly, the City requires that the TPA provide standard letters and statements such as beneficiary letters and confirmation statements. The City will evaluate each proposer’s ability and confirmation to provide these documents. Standard Reports:
Benefits Protection Plan (BPP) Employees with 2-Years Limit Report – Identifies BPP employees that have been on disability for two years. The TPA is responsible for terminating the employee’s benefits based on the two year date.
BPP & Hours Report – Identifies those employees that are currently in BPP but have more than zero hours worked.
BPP Employees with Termed Benefits – This report identifies BPP employees with terminated benefits. The City will review the report and notify the TPA if there are any changes.
Carrier Billing (Premium Reporting) – Detailed premium reports including adjustment details and detailed premium rosters that allows the City to self-bill (see additional detail in Section 17).
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Chargeback Report – A report summarizing the City subsidy and employee costs for benefits elections for four City departments – Los Angeles World Airports, Los Angeles City Employee’s Retirement System, Los Angeles Fire and Police Pensions, and Harbor Department. These four departments are responsible for reimbursing the City’s General Fund for these costs.
Death Report – Identifies those employees or dependents that have passed away within a two week period.
Demographic File Drop Report – Identifies those employees who are showing as being active in the plan sponsor website but have dropped off of the bi-weekly Demographic File sent by the Controller’s Office. All active employees should be transmitted on the Demographic File sent to the TPA.
Direct Bill Report – Every other Wednesday, the TPA should provide the City with a report identifying those employees in a direct bill status. There are seven different reports sent based upon the number of hours worked, employment status, and the employee’s MOU.
Employee Dual Coverage Report – Identifies employees who are covering their spouse as a dependent but are also covered under their spouse’s insurance. Either the City or the TPA must contact the employee to resolve the dual coverage.
Dependent Dual Coverage Report – Identifies dependents that are covered under both parent’s insurance. Either the City or the TPA must contact the employee to resolve the dual coverage.
Pending Family Status Change Report – Identifies those employees who have initiated family status changes that are pending through the MBC or in the service center. The City will contact these employees to remind them to call the service center to complete their family status change.
Move Report – Identifies those employees who have experienced a move life event based on information that has been received via the Demographic File. The City will contact those employees if their change in zip code affects their current dental coverage so that the employee can make new selections. Please note that there is no zip code restriction on health plans.
Multiple Life Event Report – Identifies employees who have had multiple life events run within the same two week period that the report is run and both life events require verification documentation to be returned to the City.
New Hire Report – Identifies those employees who have come over on the Demographic File as new hires. This report is used by the City to determine if the employee is eligible to receive a new hire packet.
No Documentation Received Report – Identifies employees who have not returned the necessary documentation within the 60 day time period. If documentation is not received on the 61st day, the TPA will cancel the employee’s new benefits elections and adjust the employee’s payroll deductions accordingly to reflect the associated benefits coverage level.
No Documentation Received/30 Days Report – Identifies those employees who have 30 more days to return the necessary verification documentation to the City before their new elections will be canceled if not received on the 61st day. The City sends these employees a reminder postcard.
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Rehires and Reinstate Report – Identifies employees who have been rehired or reinstated to City service based on the Demographic File. The City reviews the report and gives instruction to the TPA on the effective date of the reinstatement or rehire to determine benefits eligibility.
Reject Report – Identifies employees who were not able to be loaded in the plan sponsor website due to various issues with their data on the Demographic File. The City investigates these employees and ensures that the information is corrected before the next Demographic File is sent.
Status 07 or Benefits Ineligible Report – Identifies intermittent/part-time employees who are not eligible for benefits under the LAwell Civilian Benefits Program but who are showing active with benefits. The City reviews this report and informs the TPA when benefits should be terminated.
Status 09 Report – Identifies employees who have been terminated from City service (e.g. retirement, resignation, etc.). The City reviews this report and confirms if the employee has been terminated from City service. COBRA letters are then generated for these employees.
Term Dependent Age 26 Report – Identifies dependents who have reached the age of 26. The TPA is responsible for removing the dependent from coverage; the effective date of the coverage termination is the birth date of the dependent.
65/70 Report – Identifies employees who are or will be 65 or 70 in the current month but have not yet experienced age reduced benefits. The TPA is responsible for reducing these employees’ life insurance amounts based on the first of the month that the employee turns age 65 or 70.
Standard Letters and Statements:
Beneficiary Letters – Letters generated for employees who have made changes to their beneficiaries within the two week payroll processing calendar. These letters contain employee and new beneficiary information.
COBRA Sheets – Identifies employees and dependents whose health and/or dental coverage has been terminated in the previous two weeks.
Confirmation Statements – Letters showing changes an employee has made to their benefits elections in the previous two weeks. The letters are presently sent to the City and mailed to the employee’s address on file by City staff.
Personal Enrollment Worksheets (PEWs) – Letters generated for new hires and rehires who are eligible for benefits. The PEWs contain employee information specific to the employee, benefits options available to the employee, and associated cost. The PEWs are sent to the City and presently mailed to the employee’s address on file by City staff.
(20) Open Enrollment Reporting
Similar to standard reporting, the TPA provides the City with annual Open Enrollment reports during Open Enrollment and following the close of Open Enrollment. The City has no ability to self-generate standard Open Enrollment reports. As part of its evaluation, the City will be reviewing vendor capabilities for generating reports
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summarizing Open Enrollment activity both during Open Enrollment and following the close of Open Enrollment, including any additional reports that the vendor is able to generate for the City to best capture and summarize Open Enrollment activity. The City will also evaluate vendor capabilities to allow the City to self-generate Open Enrollment reports on its own, whenever necessary and to customize Open Enrollment reports to meet the City’s reporting needs.
(21) Customized Reporting The City will be evaluating vendor capabilities for generating customized reports as requested by the City in a timely and accurate manner.
P. LEGAL COMPLIANCE
(22) Legal and Special Administrative Services The City will be evaluating the TPA’s plan sponsor regulatory interpretive and oversight services and ability to provide legal analysis and interpretations of laws, regulations, and other matters pertaining to employee benefit plan information.
(23) COBRA and CalCOBRA Administration Currently, City staff administers Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) notification and enrollment requirements. This includes receiving a list of terminated employees from the TPA, with the City then confirming that the employee has been terminated in its payroll system, mailing out COBRA notices and election forms to the employee and/or dependents, collecting the election form from the employee and/or dependents, and sending the appropriate plan information and enrollment forms to the employee and/or dependents. The City will be evaluating the capabilities of each proposer in providing comprehensive COBRA administration, including generating COBRA notices for terminated employees and/or dependents, delivering these notices via mail or electronically directly to the employee and/or dependents, processing COBRA enrollment election forms, and communicating enrollments and terminations directly to the City’s LAwell health plan carriers. This will involve removing City staff from manual COBRA administration and establishing a regular ongoing cycle of processing and distribution of COBRA notices and election forms.
(24) Affordable Care Act (ACA) Compliance As part of its compliance requirements with the ACA, the City worked with its current TPA to develop a payroll/benefits analytics program called the Employer Shared Responsibility (ESR) tracking tool. The ESR tracking tool exchanges information between the City’s payroll system and the TPA recordkeeping system and is designed to track hours, make eligibility determinations based on the look back and stability period determined by the City, predict future enrollment volume, and conduct trend analysis. The City utilizes the ESR tracking tool to: 1) identify those City employees who
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are not currently eligible for a City health subsidy under the LAwell Civilian Benefits Program but who qualify for health-care eligibility under the ACA and 2) provide annual summary data required to meet the tax reporting requirements of the ACA. The ESR tracking tool provides monthly and annual reports indicating employees who are trending as ACA-eligible based on the look back and stability period and makes final ACA eligibility determinations for the existing workforce and new hires. Additionally, the TPA provides the City with a separate reporting solution known as a Minimum Essential Coverage (MEC) report. The MEC report provides enrollment information of employees and covered individuals such as employees’ spouses and dependents who were covered by minimum essential coverage. The MEC enables the City to meet its obligation under the ACA requiring certain employers and insurance carriers to report on offers of health insurance coverage made to full-time employees during the calendar year. The City utilizes both the ESR tool and MEC report to coordinate the preparation of Form 1095-C for civilian and sworn employees and Form 1095-B for some sworn members and their dependents who participate in a self-insured plan. As the City does not administer the health plans provided to sworn employees, the City is required to facilitate and coordinate the exchange of health coverage information between the City and sworn associations to complete Form 1095-C for sworn employees. For the 2015 and 2016 calendar years, the City utilized an external tax reporting vendor to translate the ESR and MEC information provided by the TPA and sworn associations into the data required to populate and produce Forms 1095-C and 1095-B. The third party tax reporting vendor was also responsible for tax forms mail fulfillment. Under the assumption that the current ACA employer mandate and reporting requirements continue to be in effect on a go-forward basis, in order to refine and streamline its ACA tax reporting responsibilities, the City is seeking to partner with its TPA to develop a comprehensive ACA tracking hours and MEC coverage reporting solution, IRS tax forms completion, and tax forms mail fulfillment services. As such, the City will be evaluating vendor capabilities of providing comprehensive employee monitoring and tax reporting services to enable the City to comply with its ACA obligations or any similar health care regulation passed by the State or Federal government during the full term of the agreement.
(25) Centers of Medicare and Medicaid Services (CMS) Data Match Occasionally, the City is required to report to CMS information regarding health plan coverage information for former or current City employees to identify potential dual Medicare and City plan coverage. Currently, the City works with its TPA to gather the information necessary to complete a CMS data match. This process is often lengthy and requires a significant amount of staff time to reconcile the information provided by the TPA. To improve the City’s ability to respond to CMS, the City will explore vendor capabilities with respect to completing data match questionnaires from CMS on behalf of the City, thereby removing City staff from this process.
The City’s LAwell Civilian Benefits Program is highly focused on providing the highest levels of customer service and responsiveness to its members. Part of that involves working with its TPA to communicate clearly and effectively via its website and other communication venues/materials. The City will look for processes that the TPA has in place to prevent recordkeeping and communication errors which lead to participant complaints; the processes used by the TPA in managing situations wherein a communication or recordkeeping error has occurred; and processes used by the TPA to ensure quality control relative to its communications to members, particularly in prioritizing effective communication relative to recordkeeping systems limitations, workflow processes, and disclosure requirements. Members currently utilize the MBC member website to: 1) access member-specific benefits information, 2) make benefits elections during Open Enrollment or due to a New Hire event, and 3) report life event changes and make associated benefits election changes. The portal is available 24 hours a day, seven days a week with registered user access and system troubleshooting options with security access (see following screen shot).
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The City’s objective for its TPA is to create a member-level website that is user-friendly, responsive and accessible over multiple electronic devices, and fully secure. The website must also incorporate flexibility and customizable features and options which provide the opportunity to evolve its benefits program design and features. The website must be ADA compliant. Members typically access the current portal only during Open Enrollment. The City would like to consider ways to expand the resources available on the website to help promote active member engagement with their benefits throughout the calendar year. These resources include, but are not limited to, access to historical data, enhanced educational information, personalized communication, access to other benefits information that is not part of the LAwell Civilian Benefits Program, etc. The City will evaluate each proposer’s member level website and evaluate its capabilities and usability to accommodate the LAwell Civilian Benefits Program design and features.
(27) Website News/Messaging/Interactive Capabilities The City’s current MBC website has functionality to post general information news pieces after an employee has logged into his/her account on the member portal. The City is interested in enhancing pre-login content, interactive media, direct customized emails, reminder notifications (email and account based), and other customizable content. The City will evaluate each proposer’s capabilities in providing information through its online and other electronic media resources including, but not limited to, the Member-Level website.
(28) Website Customization Capabilities & Resources The City will review the TPA’s capabilities for customizing the website consistent with the City’s ongoing needs to refine and evolve its capabilities to create an effective and user-friendly member experience.
(29) Planned Enhancements The City will evaluate the TPA’s "web vision," including the foundation, principals and philosophy that guide the standard site and form the foundation for future evolution, and enhancements planned over the next 3-5 years. Access to, and delivery of, benefits information is expected to remain current with industry standards. The City will evaluate each proposers’ planned online enhancements.
(30) Media Technology: Video, Mobile Apps & Other Media The City is interested in reviewing other communications media technology that vendors may offer such as videos, mobile applications, social media tools, etc. The City is additionally interested in mass e-mail capability, with options to send communications to segments of the population.
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An important value for the City is ensuring that the TPA is able to communicate a high-level, simple and coherent framework for participants to conceptualize the most fundamental tasks and features of the member’s benefits selection and management process. The City strives to be innovative and effective, and seeks a TPA that has the resources, institutional commitment, creativity, facility, responsiveness, and innovative mind-set to support the City’s ambitious communications objectives.
R. PARTICIPANT CALL CENTER & REPRESENTATIVES
(31) Call Center Location, Hours & Languages The TPA will be responsible for providing a call center team of dedicated representatives who are fully trained and capable of answering questions and providing detailed information about the City’s benefits, which can vary depending on each employee’s MOU membership, employment type, working status, etc. The current call center is available five (5) days a week, Monday through Friday, from 8:00 am to 5:00 pm Pacific Standard Time and is accessible through a toll free 800 number or through online chat. During the Open Enrollment period, which takes place during the entire month of October, the hours of operation are extended to a 12-hour period during the last few days of the Open Enrollment period. Spanish language speakers are also available during regular and extended hours. The City desires to enhance and improve the efficiency of its call center. Proposers will be evaluated on their capabilities in providing a call center that is capable of handling a high call volume and is versatile to meet the operational needs of a diverse population.
(32) Staffing & Training
The LAwell Civilian Benefits Program is governed by applicable law/regulation, multiple Memorandums of Understanding, and other governing documents. The call center representatives must be capable of competently and proficiently mastering this complexity in order to effectively assist the membership. The TPA will be required to provide adequate training and utilize ongoing quality control mechanisms to ensure that call center staff provide the highest level of competent service. The City requires dedicated call center staff resources that can become familiar with the unique aspects of the City’s program and will evaluate each firm’s abilities and options in providing sufficient resources.
(33) Metrics & Standards, Case Management, Call Monitoring & Reporting
Capabilities, & Call Center Customization Capabilities & Resources Currently, the TPA provides for a call monitoring and tracking system known as Siebel separate from the plan sponsor website. Call center representatives document all calls and City staff utilizes Siebel to review the representatives’ summary of the call and any additional notes. City staff is also able to record their own notes regarding a case in Siebel. If a case requires an action be made to correct eligibility information or member
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data, City staff must use a secondary website to submit an “e-room” request to the TPA to make the change in the plan sponsor website. As such, City staff currently uses three separate systems – Siebel to review and record member call information, eRoom to request the TPA to correct member data, and the plan sponsor website to review the member’s official record. As part of its evaluation, the City will review vendor capabilities for providing a single, integrated system for managing member data and call information. The City will also assess vendor capabilities to foster call center accountability through proposed response standards, including measuring responsiveness and timely resolution of member issues, metrics, call monitoring, and other tools. The TPA will be required to provide regular reporting on its results.
S. PARTICIPANT CALL CENTER (AUTOMATED)
(34) Structure, Script, Time & Languages
The TPA will be responsible for providing an automated call system that is available to provide benefits information and access to member specific information 24 hours a day, seven days a week.
The City desires an automated system that can provide generic benefits information, such as health plan options and contact information, to individuals calling at any time into the system. The City also desires an automated system that can allow for City employees to log in to their account through the phone and process member transactions or request verification of information on their account. The current automated system does not provide for this functionality.
(35) Email, Fax & Mail Capabilities
The City wishes to partner with a TPA that can provide services to assist in automated communication processes for member transactions, such as mailing or emailing a confirmation receipt after a member changes information on his/her account. Proposers will be evaluated on their ability to provide mass mailing, specialized mailing, and other automated or manual fulfillment services.
T. MEMBER SATISFACTION
(36) Complaint Resolution & Website, Participant & Automated Call Center Member Satisfaction
The City seeks to provide the highest level of customer service to its members and requires that member complaints be addressed promptly and in a responsive, professional, and customer-friendly manner. The TPA will be required to maintain a system of monitoring and tracking complaints and improving its processes as warranted based on recurring or systemic service issues. The City will evaluate each proposer's protocols and disciplines in effective complaint management.
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The City’s LAwell Civilian Benefits Program is highly focused on providing the highest levels of customer service and responsiveness, and will evaluate each firm’s method of determining and maintaining member satisfaction with the self-service website, participant, and automated call center.
U. MEMBER COMMUNICATIONS & COUNSELING SERVICES
(37) Communications Philosophy & Resources The LAwell Civilian Benefits Program seeks a TPA that has the resources, institutional commitment, creativity, facility, responsiveness, and innovative mind-set to support the City’s evolving communications objectives. The City's Plan is looking for ways to expand the intellectual resources devoted to its communications efforts, and looks to its TPA as providing a primary opportunity for partnership in this endeavor. The City will assess whether proposers would have the resources for, pursuant to this contract, establishing a Senior Communications Development staff resource that would be available to work closely with the City and exercise a leadership role in producing innovative, outcomes-based communications educational content, materials, and initiatives, and coordinate the execution of communication functions involving the City’s benefit service providers. This resource would be separate and distinct from any resources required for the management and oversight of ongoing communications production efforts (e.g. for newsletters, quarterly statements, marketing material updates, etc.).
(38) Enrollment Guide The City produces a printed enrollment guide book (guide) detailing benefits options and associated costs for all eligible civilian employees, as described in the Open Enrollment Administration section of this RFP. The printed guide information is posted electronically on the MBC website with personalized information post-login on each member account and is also available as a generic PDF on the www.keepingLAwell.com site. In addition to the standard guide, the City currently produces two alternate versions: 1) a New Hire guide for civilian new hires which is used generally from mid-December to September, and 2) a Sworn guide which is intended for distribution to a select number of sworn employees (estimated around 500) during Open Enrollment.
Civilian Open Enrollment Guide Civilian New Hire Guide Sworn Open Enrollment Guide
The three guides are currently fully developed by City staff and communications consulting resources, and utilize City publishing resources for mail fulfillment. The guides serve as the primary and principal communication piece produced by the City that reaches all of its members. In connection with its objectives for improving its communications resources, the City will assess vendor capabilities to develop, maintain, and refine its primary communication materials, including and most especially its enrollment guides.
The TPA currently produces a Personal Enrollment Worksheet (PEW), as described in the Open Enrollment Administration section of this RFP, at one time each year for all eligible employees during Open Enrollment, and also every two weeks (payroll cycle) throughout the year for New Hire eligible employees. The PEWs contain detailed benefits election options and corresponding cost information for the employee specific to the individual’s MOU, employment status, and salary. The PEWs are created from payroll information transmitted via the Demographic File (Attachment B) by the Controller’s Office to the TPA biweekly. Based on the information provided in the Demographic File, the employee’s employment status (e.g. full-time or half-time) and MOU provide different benefits options and varying employee costs, with some (not all) of those costs determined as a percentage of the employee’s salary. Eligibility for these benefits options is determined by the hours worked and employment status. Eligibility can change from pay period to pay period and New Hire employees receiving a PEW – an offer of coverage – are given 60 days to make an election. The offer of coverage is at least two weeks old when the offer package is mailed via United States Postal Service to the employee. Once an election is made, a confirmation statement is generated biweekly on a pay period schedule and mailed by City staff to the employee. The confirmation statement identifies and confirms elections choices made (or defaulted option if no election was made) by the employee and outlines the supporting documents required for certain benefits choices, including the deadline to submit these documents to retain the benefits elections. Employee benefits elections are canceled by the TPA and payroll deductions
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will be adjusted accordingly to reflect the associated benefits coverage level if the proper supporting documentation is not received. See below examples of a PEW and confirmation statement.
Personal Enrollment Worksheet (6 pages) Confirmation Statement (4 pages)
The City will be assessing each vendor’s ability to enhance and customize the content of the Personal Enrollment Worksheet and Confirmation Statements to ensure that benefits information, options, expectations, deadlines, and consequences are clearly communicated. This will necessarily require flexibility on the part of the TPA in designing where certain content is located, how prominently certain pieces of information are displayed, and other factors which contribute to communications efficacy.
(40) Onsite Member Advocate & Local Counseling Services
The City maintains a public counter in its Benefits Office located in Room 867 of Los Angeles City Hall and provides in-person service hours Monday to Friday, 8:00 am to 4:00 pm Pacific Standard Time. City staff and health plan representatives are available at the public counter to answer questions and assist members in understanding their benefits options, assist with accessing services, and resolve member issues. In order to expand its customer service resources, the City will be assessing vendor capabilities to provide onsite benefits management member advocate services. A member advocate would assist members and City staff in navigating the TPA’s resources, resolving issues that may arise in administration of the TPA’s website and recordkeeping system, and/or address issues relating to employee status, eligibility, benefits coverage, and related issues.
FEES & GUARANTEES
(41) Fees & Charges The City values proposals that include reasonable, cost-effective, and competitive fees to perform the services described in this RFP. All proposers must submit a
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comprehensive list of all proposed fees, including but not limited to per-member, transactional fees, programming fees, and the costs of communications specialist and/or member advocate staffing. All fees that the TPA will or may apply are required to be disclosed. The City values proposals which provide the highest degree of clarity for the City in planning for and projecting its future costs. As such, the City welcomes fixed fee proposals which are inclusive to the highest degree possible of all actual or potential costs, and do not include a high risk of fee inflation due to ongoing programming, web design, communications, and other services which are part of the ongoing evolution and improvement of the City’s program. The proposed fees submitted by the proposer for providing the services described in this RFP shall constitute a firm and fixed offer to the City that will remain open and valid for a minimum of 12 months from the submission deadline.
(42) Processing Standards & Performance Guarantees The City requires that the TPA identify its quality standards for performance with respect to processing various types of transactions related to benefits eligibility and enrollment, life event changes, and generation and delivery of PEWs and confirmation statements as part of Open Enrollment and ongoing administration. The City will evaluate each proposer’s ability to provide accurate and timely processing of transactions and generation and delivery of PEWs and confirmation statements, error prevention, data validation, processes for resolution of errors without delay, and adaptability in addressing unusual situations in a timely and accurate manner.
The City will also be considering the vendor’s proposed performance guarantees, with a focus on those that are meaningful, measurable, and relate to the core mission and customer service quality objectives that have been identified in this RFP.
(43) Additional Information
Any other data the proposer considers essential to the evaluation of its proposal shall be clearly stated in this section. If there is no additional information the proposer wishes to present, the proposer should state, “There is no additional information we are presenting pursuant to this Request for Proposal.”
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SECTION 3
PROPOSAL QUESTIONNAIRE QUESTIONNAIRE INTRODUCTION AND INSTRUCTIONS i. Introduction The RFP questions included in this RFP are intended to solicit important background information about your firm and fully disclose the data points upon which proposers will be evaluated. The City is not evaluating firms using any information other than what is outlined within this RFP. Responses to this section along with documents required to be submitted pursuant to Part B of this RFP are necessary for the proposal to be considered responsive. ii. Instructions
Do not alter the questions or question numbering. Complete all appropriate sections of the questionnaire. To obtain an electronic version of the questionnaire, please contact the RFP
Administrator. Provide an answer to each question even if the answer is “not applicable” or
“unknown.” Answer the question as directly as possible.
o If the questions asks “How many…” provide a number. o If the question asks, “Do you…” indicate Yes or No followed by any
additional brief narrative explanation to clarify. Be concise in your response. Use bullet points as appropriate. Consider how
to word any response that exceeds 200 words in length so that the response contains the most important points you want displayed.
Referring the reader to attachments for further information should be avoided or used on a limited basis. Any response that does not directly address the question, but only contains marketing information, will be considered non-responsive.
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A. ORGANIZATIONAL BACKGROUND Responses to the following are required in order for your proposal to be considered responsive but will not be rated.
1. Cover Letter and Proposal Declaration - Provide a cover letter and Proposal Declaration to
include the following:
Title “City of Los Angeles Third Party Administrator Services RFP” and submission date
Contact name of person authorized to bind the proposer to the proposal
Contact Name/Title:
Mailing Address:
Location of Business (if different from mailing address):
Type of legal entity (corporation, Limited Liability Company, joint venture, partnership, etc.)
A short description of your organization, the businesses in which it engages, and the services it provides.
Telephone Numbers (Office, Cell, and 24-hour lines):
Fax Number:
E-mail Address:
Date entity was established and location of entity when established
Location of headquarters (full address) and, if your firm has more than one office location, which of your firm’s offices will service this account.
Annual revenues
Total number of employees
Total number of employees in the City of Los Angeles
Total number of employees in the County of Los Angeles
Number of employees reported in whose exclusive, primary work location is in the County of Los Angeles
Number of employees providing services for this contract
The following statement:
“The undersigned hereby offers and agrees to furnish the goods and/or routine services in compliance with all the service level requirements, instructions, specifications, and any amendments contained in this RFP document and any written exceptions in the offer accepted by the City. This proposal is genuine, and not sham or collusive, nor made in the interest or in behalf of any person not herein named; the proposer has not directly or indirectly induced or solicited any other proposer to put in a sham proposal, or any other person, firm or corporation to refrain from submitting a proposal; and the proposer has not in any manner sought by collusion to secure for itself an advantage over any other proposer.”
A signature submitted on behalf of the proposer by an officer authorized to bind the proposer to the proposal, acknowledging: i. Receipt of and agreeing the submitted Proposal is based on the RFP and any identified
addenda. ii. Failure to indicate receipt of addenda may result in the proposal being rejected as non-
responsive. iii. To constitute a responsive proposal, all pages of the proposal questionnaire and
required forms must be submitted. iv. Under penalty of perjury under the laws of the State of California that the proposal is
true and correct and the proposer agrees to the terms and conditions in the proposal.
2. City Business License Number or Vendor Registration Number - Indicate your City Business License Number or Vendor Registration Number if available. A license or registration
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number is not required for your proposal but will be required prior to execution of a contract. To obtain a Business Tax Registration Certificate (BTRC) or Vendor Registration Number call the Office of Finance at (213) 473-5901 and pay the respective business taxes. The address is as follows: City of Los Angeles, City Hall - Office of Finance, 201 North Main Street, Room 101, Los Angeles, CA 90012 – http://www.lacity.org/finance/).
3. State of California Board of Equalization Permit - Indicate your company’s State of California Board of Equalization permit number. If you do not have this permit, please make a statement to this effect.
4. California Revenue and Taxation Code - Fill out and submit the appropriate California Revenue and Taxation Code form, if applicable (for out of state vendors).
5. Compliance with Standard Provisions - Provide a statement indicating that your firm will comply with the City of Los Angeles General Contracting Provisions attached to this RFP in Part B, including the Standard Provisions for City Contracts (Rev. 1/17). Please note that your statement does not relieve you from providing all of the documents required pursuant to the “Proposal Response Checklist.”
6. Insurance - The City is estimating that the following insurance coverage types will apply to this contract:
Workers Compensation: $ 1,000,000 General Liability: $ 1,000,000 Professional Liability: $10,000,000 Please verify that you will be able to meet the required coverage levels and that you will submit proof of such pursuant to Part B, “General Contracting Requirements - Insurance Requirements,” as a condition of execution of any final contract (see Part B, “Standard Provisions – Insurance Requirements” for further details). Note that if the proposer is a sole owner company with no employees, the proposer can sign the City’s waiver of workers compensation. General Liability can also be obtained through the City’s SPARTA program for small contractors. Links to the City’s waiver form and SPARTA program from the City’s Risk Management website are provided as follows:
7. Lobbyist Disclosure - Disclose any (1) arrangements your company has with any lobbyists and/or agents representing your company, and (2) any arrangements your company has with an unrelated individual or entity with respect to the sharing of any compensation, fees, or profit received from or in relation to the proposing company being awarded a Contract with the City. If any such arrangements exist, describe the nature of the relationship and the manner in which compensation or fees would be shared.
8. Endorsement Disclosure - Disclose any financial relationship your company has with any union, organization, or association in conjunction with an endorsement. Provide details regarding the relationship, including any benefit that will be recognized by the union, organization, or association in the event your company is awarded a Contract with the City.
9. Subcontracting - If any portion of the Contract is to be subcontracted, it must be clearly set forth as to the part(s) to be subcontracted, the reasons for the subcontracting, and a listing of subcontractors. For each subcontractor proposed, provide the following information:
i. The specific service being subcontracted ii. Name of Subcontractor
iii. Subcontractor’s Contact Name iv. Contact Title v. Contact Phone Number vi. Mailing Address vii. Location of Business (if different from mailing address) viii. Business Telephone Number ix. Subcontractor’s registration # and/or license #, if applicable x. Description of Work to be Subcontracted xi. Reason for Subcontracting xii. Percent of Total Contract to be Subcontracted & Dollar Amount xiii. Relevant work experience in years and level of responsibility xiv. Experience in number of years that your firm has worked with the Subcontractor
providing these services xv. If subcontractor is a MBE, WBE, LBE, SBE, EBE, or OBE xvi. If subcontractors will not be utilized, so indicate here.
B. QUALIFICATIONS
The questions in the following section will be rated.
QUESTIONNAIRE
# Question Response
ORGANIZATIONAL STRENGTH, PLAN SPONSOR & RECORDKEEPING SERVICES
Please provide an overview of your organization and organizational structure, to include the name of your parent company (if you have one), the nature of its business, the name of your company, the length of time your firm has been providing the broad range of services included within this procurement, headquarters, number of clients and members, and geographic service area.
2
Please provide your organization’s revenues and net profits for the last three calendar years.
3 Please provide your organization's revenues and net profits for providing the range of services (i.e. health and welfare) included in this procurement for the last three calendar years.
4
Is your company a subsidiary or affiliate of another company? If yes, describe the nature of the business of the parent firm. Provide full disclosure of all direct or indirect ownership. Indicate what percentage of the total company revenues your company represents for each of the last three calendar years.
5
What is the last date when your organization had a change in its business structure, whether through an acquisition or divestiture or through an alliance arrangement? If applicable, how did this change in business affect the recordkeeping business?
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6
Describe any pending agreements to merge or sell your company or any portion thereof, or your parent company; or any pending or anticipated plans to reorganize your company within itself or as part of the larger organization of which your company is a part.
7 Describe any change in senior management (including CEO, CFO, CIO, or other executive management) in the last five years. Indicate the average tenure (in years) of senior management.
8
Please provide a summary of your organization's strategic plan, including how you control/manage the growth of your business.
9
What percentage of your services solicited in this RFP would be outsourced to other firms or sub-contracted? For services representing more than 5% of the total fee proposed for this RFP, identify all providers and their functions.
10
What percentage of your services solicited in this RFP would be outsourced or subcontracted to U.S. and non-U.S. service providers? Identify all U.S. and non-U.S. providers, their functions, and the percentage of work that would be performed by them under this contract.
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How many proposals have you submitted in the last three years in response to public sector RFPs for Third Party Administrator services? How many of these resulted in your selection to provide services?
12
Provide a comprehensive list of your company office locations in order of the following: 1) Los Angeles area offices, 2) California area offices, 3) United States offices, and 4) offices abroad. Identify which locations will be used to manage services under this contract, and the extent of services to be performed at each location.
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Indicate the total number of employees in your firm as of 12/31/16, 12/31/15, and 12/31/14.
14
Provide the name, position, resume, employment date(s) with your organization, geographic location, and a description of duties for each employee who is expected to work on this contract during its duration. Please also provide the expected availability and number of hours per day, month, and year each employee will be assigned to work on this contract and organization chart.
15
Describe any changes in direct management - the day-to-day staff who provide the administrative, information technology, and other direct management of the account - over the last two years. For the work unit(s) that you would propose servicing the City's Plan, what was the total staff turnover for 2016, 2015, and 2014? Provide the number of full-time employees and percent of staff turnover.
16 Please complete the following applicable membership profile/client base information for calendar year 2016:
Total (Public and
Private Sector Plans)
Public Sector Plans
Clients
Private Sector Plans
Clients
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a) Benefit programs under administration as of 12/31/16
b) Total number of employee members under administration as of 12/31/16
c) Total number of employee and dependent members under administration as of 12/31/16
d) Client retention (as a percentage of total plans) for plans under administration as of one, three, and five years ending 12/31/16
e) Number of client relationships as of 12/31/16, 12/31/15, 12/31/14 and 12/31/13
f) Percentage of your total plan clients that have retained your firm as of 12/31/16, 12/31/15, 12/31/14, and 12/31/13
g) Number of plans gained as of 12/31/16, 12/31/15, 12/31/14, and 12/31/13
h) Number of plans lost as of 12/31/16, 12/31/15, 12/31/14, and 12/31/13
i) Average client relationship (in years) as of 12/31/16, 12/31/15, 12/31/14, and 12/31/13
17 Indicate the following plan clients by asset size and member base as follows:
Member Base
Public Sector Plan
Clients
Private Sector Plan
Clients
Under 5,000
5,001 – 10,000
10,001 – 25,000
25,001 – 50,000
50,001+
Total
18 Indicate the following governmental group plan clients by asset size and member base as follows:
Member Base
Under 5,000
5,001 – 10,000
10,001 – 25,000
25,001 – 50,000
50,001+
Total
External Agency Ratings
19 Please provide the most recent ratings for your company by the following:
a) Standard and Poor's
b) Duff and Phelps
c) A.M. Best
d) Moody's
If your firm is not rated, submit documentation of a similar nature which attests to your firm's financial stability.
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20 Has there been any change in your ratings in the last two years? If yes, please explain the nature and reason(s) for the change.
Client Experience
21 Please provide your three largest current public sector plan clients in the following format:
Client name:
Contact name:
Address:
E-mail address:
Phone number:
Number of employees covered:
Contract start date:
Contract end date:
Short description of services provided:
22 Please provide your three former public sector plan clients that most recently discontinued services in the following format:
Client name:
Contact name:
Address:
E-mail address:
Phone number:
Number of employees covered:
Contract start date:
Contract end date:
Short description of services provided:
23 Please provide your three public sector plan clients that most recently retained your services in the following format:
Client name:
Contact name:
Address:
E-mail address:
Phone number:
Number of employees covered:
Contract start date:
Contract renewal date:
Contract end date:
Short description of services provided:
Regulatory and Compliance Services
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Has your company been the subject of any complaint filed with any state or federal regulatory agency or office in the past five years? Has your company ever had a license to do business, an agent/broker license or any other insurance license revoked or suspended? Has your company ever been reprimanded or otherwise cited by a licensing agency? If any of these apply, please describe fully.
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25
Are there any outstanding legal actions pending against your organization? If so, please explain the nature and current status of the action(s) to the extent possible. What guarantees can you provide that these actions will not disrupt your business operations or impact the City’s account if you were awarded a contract?
26
Identify and describe any past, pending or threatened judicial or administrative litigation (including lawsuits or protests) in which you have litigated against a client or prospective client, within the past five years, related to the type of services you are proposing. Indicate the reasons for the lawsuit/protest and the outcome. Provide contact information for the entity sued or challenged.
27
Describe any incident within the past ten years in which your business has had a contract terminated for default. Termination for default is defined as notice to stop performance due to your organization's non-performance or poor performance and the issue was either not litigated, or litigated and such litigation determined your organization to be in default. Submit full details of all termination for default experienced by your firm during the past five years including the other party’s name, address, telephone number and your firm’s position on the matter. The City will evaluate the facts and may, at its sole discretion, reject your firm’s proposal if the facts discovered indicate that completion of a contract resulting from this RFP may be jeopardized by selection of your firm. If your firm has experienced no termination for default in the past ten years, so indicate.
28
Has your company or its subsidiaries ever filed or been petitioned into bankruptcy or insolvency or has your company ever made any assignment for the benefit of your creditors? If so, provide complete details.
29
Describe what procedures and policies you have in place to protect against, and provide disclosure of, any potential or perceived conflict of interest involving relationships your firm may have with service providers for which you may also be asked to conduct performance reviews or otherwise evaluate for the City's Plan. To what extent and under what circumstances do the individuals who would be directly servicing the City's account personally meet with service providers that could be actual or potential City clients?
Health Insurance Portability and Accountability Act (HIPAA) Compliance
30
Describe your Health Insurance Portability and Accountability Act (HIPAA) compliance plan and policies. Include policies and procedures used by your organization to react to a data breach, including but not limited to any policy relating to HIPAA Breach Notification Rule, 45 CFR §§ 164.400-414. Also, Identify if you are a "Covered Entity" or "Business Associate" under HIPAA.
50
31 Do you have a website that details information about your policies and procedures for accepting and sending Electronic Data Interchange (EDI) transactions? If so, please indicate the website.
32 Where does the copy of your Companion Guide for HIPAA EDI transactions reside?
PLAN SPONSOR SERVICES
Plan Sponsor Functions
33 By checking each box, verify that you will provide the following. If there are any exceptions, do not check the box and explain the deviations.
a) Account management team/manager for addressing administrative and client relationship issues
☐
b) Receive data in a format and frequency specified by the City and load the data to support administration of the City's benefits plans
☐
c) Upon receipt of data from the City, determine new hire and rehire benefits eligibility based on the City's requirements, create a personalized benefits enrollment worksheet and confirmation statements, and post new hire elections
☐
d) Upon receipt of a termination event through the data exchange from the City, terminate the employee's benefits based on the City's requirements and create confirmation statements for terminated employees
☐
e) Calculate employee deductions, including imputed income amounts for life insurance and taxable dependent benefits and employer subsidies based on benefits elections and transmit this information to the City's payroll processing system in a format required by the City on a bi-weekly basis
☐
f) Process bi-weekly cancellation and monthly retirement report provided by the City
☐
g) Create COBRA notices for terminated City employees ☐
h) Process employee life event changes and benefits elections throughout the year, determine eligibility, recalculate and process payroll deductions based on life event and eligibility changes, and create ongoing confirmation statements for these types of events
☐
i) Receive evidence of insurability (EOI) forms received from the City's life insurance and disability carrier(s) and process elections and required payroll deductions based on the approved coverage amount
☐
j) Report benefits eligibility (e.g. new hire elections, coverage changes, and terminations) to the City's benefits carriers (health, dental, vision, life/disability/accidental death and dismemberment insurance, and flexible spending accounts) electronically on a bi-weekly basis
☐
k) Record and track dependent verification documents and affidavits (e.g. birth/adoption certificates, marriage certificates, divorce decrees, court orders, gain/loss of insurance, Cash-in-Lieu Affidavits), generate bi-weekly reports to identify if no documentation has been received, and process election coverage changes due to no documents received
☐
51
l) Resolve discrepancy and error reports received from the City's benefits carriers on a bi-weekly basis within 48 to 72 hours of receipt of the report from the benefits carrier
☐
m) Create premium reports to enable the City to generate self-invoices for payment to its benefits carriers
☐
n) Designate participant's primary and contingent beneficiaries online and through the Benefits Service Center at any time during the year and create beneficiary designation letters when a beneficiary is designated and/or changes are made to beneficiaries
☐
o) Provide forms fulfillment as requested by the City during the annual Open Enrollment period, during the plan year, and due to special projects such as a dependent verification audit
☐
p) Provide support for one Open Enrollment period annually including an unadvertised silent correction period of up to two additional calendar weeks as described below:
1. Lead one enrollment planning/kick-off session annually ☐
2. Make annual changes to the benefits management system proposed to provide the services as described in this RFP, including updates to, and testing of, plan premiums, employee deductions, flexible spending account contribution limits, benefits and/or plan additions and/or deletions, website enhancements, etc.
☐
3. Creation of annual personal enrollment worksheet for all eligible employees
☐
4. Creation and mailing of confirmation statements after the close of the Open Enrollment and correction periods
☐
5. Drop dependents and stop Cash-in-Lieu (CIL) coverage that was added during the Open Enrollment period and where verification documents and a CIL affidavit were not received timely. Additionally, create and mail a confirmation statement to affected employees whose dependents were removed from coverage and whose CIL coverage was stopped
☐
6. Provide automated default processing for all participants who did not enroll (i.e. passive enrollment)
☐
7. Provide sworn employees the ability to elect Cash-in-Lieu and enroll in flexible spending accounts and generate and mail confirmation statements after the close of the Open Enrollment and correction periods for these employees
☐
q) Support dual year processing which includes processing new hire elections and elections due to life event changes that occur during the Open Enrollment period, ensuring Open Enrollment elections are updated, and producing files and reports for the current years and Open Enrollment during the open enrollment period
☐
r) Provide a confidential and secure member self-service website incorporating the City logo and color scheme and providing plan comparison information and documents to allow participants to:
1. Create a user id and password ☐
2. Review personal and dependent information and make changes as needed
☐
52
3. View prior, current, and Open Enrollment coverage information including personal enrollment worksheets and confirmations statements
☐
4. Make benefits elections (new hires, rehires/reinstates) ☐
5. Report life events and make related benefits changes ☐
6. Elect and change beneficiary designation(s) ☐
7. Manage participation in the transit and parking spending accounts at any time during the calendar year (e.g. enroll, make changes, cancel)
☐
s) Track and report on participant sessions and maintain activity logs on the member self-service website
☐
t) Provide a Benefits Service Center Monday through Friday with hours minimally from 8:00 a.m. to 5:00 p.m. PST with online real-time chat functionality throughout the year, including during the annual Open Enrollment and correction periods, to allow participants to call in and speak to a live member representative, make benefits elections and changes, report life event changes, change beneficiary designation(s), and answer employee questions about benefits plans and eligibility
☐
u) Provide Spanish-speaking representatives to support Spanish-speaking callers, a service to support other non-English speaking callers, and accept and handle calls from hearing impaired participants
☐
v) Provide extended hours and additional call center representatives for peak volume periods such as the annual Open Enrollment period
☐
w) Digitally record and retain copies of all incoming and outgoing participant calls received at the Benefits Service Center and provide the City access to retrieve recorded calls at any time during the year
☐
x) Provide a case management system to track and document all participant calls and provide City staff systems access to the case management system to view recorded notes, chat transcripts, and make updates to call notes
☐
y) Monitor calls monthly and provide for continued development and coaching of Benefits Service Center representatives
☐
z) Provide standard monthly reporting on call volume, call type, call abandonment rate, and other criteria requested by the City
☐
aa) Survey participants satisfaction with the Benefits Service Center and member self-service website and report results to the City monthly
☐
bb) Provide direct billing administration including providing a report of employees whose status no longer qualifies for benefits as determined by the City's plan rules, processing terminations, reinstating coverage, and creating direct billing notices
☐
cc) Provide a procedure for activating, processing, administering, and terminating an employee's participation in the City's Benefits Protection Plan
☐
dd) Track and report on enrollment trends as requested by the City ☐
53
ee) Provide City staff systems access to the primary benefits management system proposed to be used to provide the services proposed
☐
ff) Notify the City immediately if your firm loses any accreditation, license, or liability insurance coverage
☐
34
Do you agree to participate in City management meetings during the year, as requested, including providing for (at your own cost) attendance and presentation materials for an annual performance review with the City's Joint Labor-Management Benefits Committee?
Plan-Level Website & Access to Plan and Member Records
35 By checking each box, verify that you will provide the following. If there are exceptions, do not check the box and explain the deviations.
a) Plan sponsor website allowing the City to view member and plan data
☐
b) Ability to review member demographic data (name, address, age, etc.)
☐
c) Ability to review member benefit plan enrollment/election information - including current, past, and pending elections
☐
d) Ability to review beneficiary designations (current and historical)
☐
e) Ability to review imaged documents recorded in the member's online file
☐
f) Ability to search for employee's by SSN, name, or employee ID (if latter is maintained in your system)
☐
g) Ability to generate reports of member data for custom time periods and custom parameters (e.g. Open Enrollment elections)
☐
h) Ability to review participant sessions and activity logs ☐
i) Ability to extract member data into a text delimited, MS Excel, or similar spreadsheet format
☐
j) Ability to review member web portal access and call center history records
☐
k) Ability to see copies of TPA generated correspondence (USPS mail and email) sent to members
☐
36 Describe your plan sponsor online resources. Provide an Internet address and instructions on how to access a demonstration of your Internet capabilities for the plan sponsor site.
37 Describe any systems enhancements you are planning for your plan sponsor online resources.
38 Describe any efforts you have made to solicit feedback from plan sponsors as to the structure and content of your plan sponsor online resources.
39
Provide a full description of what member account information is available to view on-line. Describe what types of member data the City can update electronically (e.g. address, beneficiary designation, etc.). Confirm the plan sponsor will have access to real-time plan data.
54
40
Describe how and what is required of plan sponsors to establish online access to their Plan-level accounts, and what is required of the plan sponsor to obtain access when they have lost a username/password.
RECORDKEEPING SERVICES
Systems Architecture, Recordkeeping & Data Management Capabilities
41
Please describe the systems architecture you expect to use to provide the services proposed, including your primary benefits management system. a) When were these systems implemented? b) How often are they updated? c) Are they proprietary or purchased from an outside provider? d) What is the associated fee for customization and how is the fee determined?
42 What are the hardware and software requirements needed to run your software?
43
Regarding the information technology staffing resources, including programming staff that will provide systems support for the services proposed, please describe the following: a) Provide the position, work experience, employment date(s) with your organization, geographic location, and a short description of the duties performed for each of the information technology staff expected to work on this contract during its duration. b) Please provide the expected availability and number of hours per day, month, and year each employee will be assigned to work on this contract and organization chart. c) Do you have a dedicated programming staff? d) If so, how many programmers are on staff full-time? Part-time?
44 What remote site capabilities does the City have including remote report writing and query capabilities? Please describe.
45
a) Would you allow the City to enter changes to employee records on-line? b) Do you routinely provide your other clients with this capability? c) What are your restrictions to employer access?
46 What is your future systems direction and strategy?
47 What additional systems functions and/or features would you suggest the City consider for managing its benefits programs?
48
a) Is there a limit on the number of concurrent users that are allowed to use the system? b) If so, what is the limitation and is there a fee associated with adding additional users? c) If applicable, what is the fee and how is it determined?
55
49
Describe your recordkeeping software system including: a) What software do you currently use and when was your recordkeeping system first put into place b) Whether the software was developed internally, leased, or purchased from another provider and if the system is leased or subcontracted, provide details of the arrangement c) Who has the ultimate responsibility/authority to make sure the software remains current with respect to laws, regulations, and client needs
50 Describe how you monitor system capacity and plan for future expansion.
51 Are you going through any system conversions or major changes/enhancements now or in the next three years? If so, please describe and give the schedule.
52 When was the last major system enhancement and what was the nature of the enhancement?
53
Describe the integration among your voice response, on-line, and recordkeeping systems. What messaging do members see or hear if he/she makes a duplicate request or attempts to change a pending transaction?
54 How many hours of scheduled maintenance do you have scheduled for 2017? For 2016, how many of the scheduled hours were used?
55 Do you foresee any specific problems incorporating the City’s processing requirements and plan features into your system? If so, describe in detail.
56
Indicate whether your recordkeeping system accommodates these data fields, if you can add as a data field, and if so, if you can identify any inconsistencies or errors upon the transmission of a data file.
Accept? Could accept as additional data field?
Identify Gaps or
Inconsistencies
a) Social Security Number ☐ ☐
b) Non-SSN member ID (employer provided or generated by your system)
☐ ☐
c) Last Name, First Name, Middle Initial ☐ ☐
d) Mailing Address ☐ ☐
e) Mailing Address Effective Date ☐ ☐
f) Home Phone ☐ ☐
g) Cell Phone ☐ ☐
h) Work Phone ☐ ☐
i) E-mail Address ☐ ☐
j) Birth Date ☐ ☐
k) Death Date ☐ ☐
l) Gender ☐ ☐
m) Marital Status ☐ ☐
n) Marital Status Effective Date ☐ ☐
o) City Original Hire Date ☐ ☐
p) City Most Recent Hire Date ☐ ☐
q) Date of Benefit Plan(s) Elections Enrollment ☐ ☐
r) Date of Benefit Plan(s) Life Event Change(s) ☐ ☐
56
s) City Termination Date ☐ ☐
t) Employment Legacy Status Code (active vs. terminated) ☐ ☐
u) Department Code ☐ ☐
v) MOU (Bargaining Unit) Code ☐ ☐
w) Job Classification ☐ ☐
x) Annual Salary and/or Hourly/Biweekly Rate of Pay ☐ ☐
y) Hours Worked per Pay Period ☐ ☐
z) City subsidy ☐ ☐
aa) Employee Contribution ☐ ☐
bb) Imputed Income ☐ ☐
cc) Date of Communications Sent ☐ ☐
dd) Date of Verification Documents Received ☐ ☐
ee) Dates of Appeal Received, Denied, Granted ☐ ☐
ff) Client Staff Notes and Comments ☐ ☐
gg) Dependent Designation (Spouse) ☐ ☐
hh) Dependent Designation (Domestic Partner) ☐ ☐
ii) Dependent Designation (Children) ☐ ☐
jj) Dependent Effective Date ☐ ☐
kk) Dependent Birthdate ☐ ☐
ll) Dependent SSN ☐ ☐
mm) Dependent Relationship ☐ ☐
nn) Dependent Address ☐ ☐
oo) Dependent Telephone Number ☐ ☐
pp) Dependent E-mail Address ☐ ☐
qq) Beneficiary Name(s) (Life Insurance) ☐ ☐
rr) Beneficiary Percentage (Life Insurance) ☐ ☐
ss) If you can accommodate additional data fields beyond those identified in this question, please provide list of full data fields supported.
COMMENTS (if any):
57 If your system supports custom field(s), please indicate the following:
a) Can the custom field(s) be added anywhere in the application?
b) Can the custom field(s) be labeled by the client and reported upon with that label?
c) Can the custom field(s) only be visible by certain users?
58 Indicate whether your recordkeeping system can identify the following inconsistencies from the client's data file every pay period and which party is accountable for resolving the issue.
Identify Inconsistencies
?
Resolved by TPA
Resolved by Plan Sponsor
Illogical Data:
a) Duplicate records ☐ ☐ ☐
b) Missing information such as employee name, date of birth, id number, and/or SSN
☐ ☐ ☐
c) Missing or invalid zip code ☐ ☐ ☐
d) Missing or invalid MOU ☐ ☐ ☐
e) Employees with same SSN ☐ ☐ ☐
57
f) Employees with same demographic values on at least five fields: first name, last name, SSN, date of birth, gender
☐ ☐ ☐
COMMENTS (if any):
Electronic Documents, Imaging & Document Storage
59
a) Describe whether your system can issue electronic documents to employees for the annual Open Enrollment period and related to ongoing life event changes such as an enrollment worksheet, confirmation statements, correspondence, etc. b) If so, is your system capable of emailing these documents to employees? c) Please describe this process and any limitations such as file size and type, frequency, and systems requirements.
60
Please describe if your system is capable of the following related to electronic forms: a) Storing and emailing pre-filled electronic forms (e.g. life, disability, COBRA forms) to employees b) Allowing employees to complete the forms online and submit them electronically for your firm and/or for the City to review and approve c) Any limitations or restrictions in storing, emailing, or submitting electronic forms Provide sample electronic forms of your clients
61
a) The City wishes to encourage City employees to receive communications and documents electronically. Does your system provide the ability to record an employee's choice to opt out of print communications and instead receive electronic communications via email? b) If so, describe the types of documents (e.g. booklets, pamphlets, brochures, newsletters, etc.) that can be emailed or otherwise made available to employees electronically and if there are any limitations on file size and type, frequency, and systems requirements.
62
Describe your document storage capabilities from a member perspective: e.g. enrollment worksheets, confirmation statements, dependent verification documents (birth and marriage certificates), forms (life, disability, accidental death and dismemberment claims), correspondence (letters, appeals), etc.
63 By checking each box, verify that you will provide the following. If there are exceptions, do not check the box and explain the deviations.
a) Image all forms and documents related to a member's account including, enrollment worksheets, confirmation statements, dependent verification documents (birth and marriage certificates), forms (life, disability, accidental death and dismemberment claims), correspondence (letters, appeals), etc.
☐
b) Store all documents on your system for the duration of your firm's contractual relationship with the City
☐
c) Transmit to a subsequent provider or otherwise turn over to the City all imaged documents related to the member's account
☐
58
64
What imaged documentation are you capable of receiving and storing from a prior administrator? Identify any documents that you are not capable of receiving and storing. Please describe any limitations.
65 Provide the most recent copy of your last independently conducted application audit SSAE-16 (if available).
66 Please describe your incident response process for managing virus/worm outbreaks or network intrusions.
67 Describe all elements of your data protection/privacy policy.
68 Does your data protection/privacy policy prevent the sale or distribution of collected data?
69 Are you in compliance with HIPAA security guidelines? When did you complete your last assessment and what was the outcome?
70 Are all server rooms physically secured? Are only authorized personnel allowed into them? Please describe.
71 Describe what type of single sign-on your system can support.
72 What percent of your clients have successfully implemented single sign-on with their carriers/vendors?
73
Please describe how passwords are communicated to the plan sponsor users. a) Are passwords communicated back to users securely when a password is first set up or reset (e.g. sent back to the user via email or voice mail)? b) Are users forced to change new and reset passwords upon their next logon? c) What are your format guidelines for password construction? d) Do passwords expire after a predetermined amount of time (e.g. every 60 days)? e) Are passwords encrypted at all times, including during transmission and storage?
74 What kind of encryption software do you use?
75 What methods are employed to encrypt and protect confidential or sensitive information (e.g. passwords, SSNs, personal information) as it transmits from browser to server and back?
76 Is encryption used to protect sensitive files and databases on servers and on proprietary or confidential attachments to email messages sent?
77 Does your system record all unauthorized or unsuccessful attempts to log on to the system? Can these unsuccessful attempts be viewed by the client?
78 Describe the type of audit functionality that exists, particularly around data changes.
79 Are the audit logs independently reviewed to confirm only appropriately authorized use of the application? If so, how often are they reviewed?
80 Does the system lock out user ids after a predetermined number of invalid logon attempts? Please describe.
81 Does the system log users off or require re-authentication after a predetermined period of inactivity?
59
82 Does your system prevent the browser from caching sensitive information?
83 By checking each box, verify that you will provide the following. If there are exceptions, do not check the box and explain the deviations.
a) Confidentially maintain member data, records and personal information such as social security numbers, dates of birth, marital status, home addresses, transaction histories, and other information related to participation in the Plan.
☐
b) Indemnification to the City for any liability associated with security breaches of your recordkeeping system.
☐
84
Describe in detail your procedures and safeguards used to protect the confidentiality of member accounts, including security for your hardware and facility, authorized access to data, encryption and confidentiality of data, and security for hard-copy documents.
85 Describe your response plan in the event of a data security breach. Include in your response if your plan provides notifications to affected individuals in the event of a security breach.
86 Describe what credit protection and other services you provide to members who may be impacted by a data security breach.
87 Describe your disaster planning/prevention resources and plans, including the frequency with which your data is backed up and redundant processing centers.
88 Describe your disaster recovery resources and plans; indicate how often you test your recovery system.
89
How many hours of scheduled and unscheduled downtime occurred over the last three calendar years? Describe each incident and explain: a) The cause of the down time b) The impact on members, including any losses c) How the incident was handled d) Whether there are any pending claims related to any of these outages
90 With regard to your recordkeeping systems, please describe your record retention and destruction policy, including how long records are retained.
THIRD PARTY ADMINISTRATOR SERVICES
ONGOING & OPEN ENROLLMENT ADMINISTRATION
New Hire Enrollment & Employment Status Changes
91 Will your system generate a personal enrollment worksheet (PEW) outlining benefit plans options and costs for new hires?
92
Presently, the TPA generates PEWs for new hires and provides them to the City to package with enrollment materials and issue to employees via U.S. mail. The City is interested in having the TPA perform this distribution function. Please indicate whether you can do so. If so, please describe how you would perform this function.
93 If you have an email address for certain employees, is your system capable of emailing the PEW and related communication materials to those specific employees?
60
94
Describe how your system typically captures, validates, and processes new hires. Indicate whether you can accommodate the City's biweekly process of passing eligibility data for the purpose of processing new hire enrollment. Describe your timing to issue the PEW and how new hires are identified and tracked within your system.
95 Describe your process from a member's perspective for enrolling into benefits either through the member self-service website or via telephone through the Benefits Service Center.
96
Describe how your system processes benefits elections made by a new hire through the member self-service website or via telephone through the Benefits Service Center. Provide a description of the timing required to: (1) process the enrollment, (2) transmit corresponding payroll deductions to the City's payroll system, and (3) transmit coverage information to the City's benefits carriers. How is the effective date of the benefits coverage determined? Provide a sample processing timeline based on the process outline described in the Plan Profile & Scope of Services.
97
Describe how your system will process adjustments to employee benefits information resulting from employment status changes (e.g. employees who are (1) returning from a leave of absence, (2) moving from full-time to half-time status and vice versa, (3) changing job classifications and/or pay grades, (4) rehired in the same calendar year) received from the City's HR data file that includes data for all covered populations biweekly. Based on the type of change, does your system generate a PEW or confirmation statement? How does your system recalculate and process payroll deductions based on the employment status change?
Life Event, Dependent Verification & Ongoing Affidavit Processing
98
a) Please describe how your system processes life event changes, including the availability of benefit plan options and recalculation of employee payroll deductions based on the type of life event change. b) How does your system process multiple life event changes that occur during the same time period? c) How are life event changes transferred to the City's payroll system to ensure accurate payroll processing and deductions?
99
a) Please describe the type of confirmation that your system provides to the employee upon the completion of processing a life event change. b) Is your system able to auto-generate confirmation statements? c) If so, can these confirmation statements be emailed to the employee? d) How do you ensure the accuracy of the information that is provided on the confirmation statement? e) Please provide a sample confirmation statement.
100
Describe the type of life event changes that can be processed through the member self-service website. Is there a limitation on the type of life event(s) that can be processed online? If yes, please describe the limitations.
61
101
a) Describe your dependent verification audit process (i.e. how dependents are added and dropped from coverage) including ongoing verification and during Open Enrollment. b) Do you validate documentation received and confirm the eligibility of newly added dependents? c) Are employees able to upload dependent verification documentation through the member web self-service website? d) Are City staff able to upload and save dependent verification documents in your system?
102 Does your system auto-generate dependent verification letters and email the employee directly upon the employee adding/removing a dependent on to/from coverage?
103
Regarding the dependent verification process, please respond to the following. a) Is your system capable of generating and sending emails to remind employees to submit dependent verification documentation? b) If email communication is not possible, do you send hard-copy dependent verification letters to employees? c) Provide samples of dependent verification letters.
104
Currently, the City performs the dependent verification process (i.e. collecting and verifying receipt of supporting documentation such as birth and marriage certificates from employees and recording this information into the plan sponsor site). The City is interested in having the TPA perform the dependent verification process. a) Please describe your capability of providing this service including whether the service will be subcontracted. b) If subcontracted, please provide the name and location of the subcontractor. How long have you had this subcontractor relationship? c) What is the associated fee, if any, for providing dependent verification services? d) Please fully outline what is or is not included in the fee structure.
105
Does your system allow for dependent verification audits? If so, please describe this process. What is the associated fee, if any, for performing this type of audit? If applicable, how is the fee determined?
106
Regarding the processing of Evidence of Insurability (EOI) forms, please respond to the following: a) How does your system process EOI forms? b) Does the system suspend or allow partial coverage until an EOI is approved? c) How long can an EOI remain outstanding in your system? d) Describe how the system will process an election based on the coverage amount once the EOI has been approved by the City's benefits carrier.
62
107
a) What types of reports are available to capture information on members with outstanding EOI forms? b) Can the City generate these reports directly from your system? c) How often can these reports be generated? d) Is there a fee associated with generating these reports? If so, how is the fee determined? e) Provide a sample of these types of reports.
108 What is your follow-up system for alerting members of outstanding documentation or actions (e.g. EOI form or dependent verification documents needed?)
Tax-Advantaged Spending Accounts Administration
109
Please describe if and how your system will collect and process elections for civilian and sworn employees for the following types of tax-advantaged spending accounts: Healthcare, Dependent Care, Transit, and Parking Accounts, including the transfer of election amounts to the City's payroll system biweekly.
110
Please describe how your system calculates tax-advantaged savings accounts employee contributions based on the benefits election date and the annual limits set by IRS rules. How and when is the contribution amount adjusted if the participant has not contributed enough to meet his or her annual goal amount (e.g. participant is on a leave of absence)?
111
a) Does your system collect year to date contribution amounts per participant? b) If so, does your system recalculate the contribution amount to enable the participant to meet their goal amount? c) Does your system generate and send emails to notify participants that contributions have been recalculated to enable the participant to meet their goal amount? d) How is the recalculated contribution amount transmitted to the City's payroll system?
112
a) Do you audit your system to ensure that participant contributions and goal amounts match the tax-advantaged savings account vendor's files (i.e. reconciliation of accounts)? b) If so, how often is this review/audit performed? c) What actions do you take to resolve discrepancies between the two files (e.g. performing negative and positive adjustments)? How quickly can the discrepancies resolved?
113
Transit and Parking spending accounts may be updated by our participants on a bi-weekly basis throughout the year; describe the portal through which such changes could be made using your system, and provide sample screen shots to illustrate how this functionality would appear to the participant making mid-year changes.
63
114
Because Transit and Parking spending accounts can be updated throughout the year, can you create a separate portal for just these accounts (removing them from the portal for other benefit elections, whether during Open Enrollment or throughout the year) and administer them as a unique file exchange with the City's payroll system and the City's tax-advantaged spending account provider? Please describe.
Open Enrollment Administration
115
The length of the City's Open Enrollment period is one month. Additionally, the City provides for a "silent" two-week correction period to make changes. What is the average length of Open Enrollment and correction period for your clients?
116
Please describe the work you perform to prepare for Open Enrollment, including leading a preparation/kick-off session annually, amount of time required to prepare for Open Enrollment, and activities that need to be performed annually prior to the start of Open Enrollment.
117
a) Describe the work required, and the amount of time needed, to program changes in an employee's benefits deductions, the City's subsidy contribution, benefits service providers, and the level and types of benefits provided by the City which would be effective at the start of the next plan year. b) What is the associated fee, if any, for programming these types of changes in your system? If applicable, how is the fee determined? c) How quickly can these changes be programmed in your system and what is the average length of time to program these types of changes prior to Open Enrollment?
118
a) Please describe how your system manages dual year processing (i.e. processing elections for life events that occur during the Open Enrollment period). b) How do you process these transactions and ensure prior elections roll over to the new plan year? c) How does your system ensure that dual year processing does not interfere with Open Enrollment activities? d) Please describe the files and reports that are produced for dual year processing.
119 The City requires a personalized enrollment worksheet (PEW) be provided to all eligible employees prior to the start of Open Enrollment.
a) Please describe your process, including timing required to process formatting and text changes, for preparing a PEW to be sent to all eligible employees.
b) How much time is required to prepare PEWs for each eligible employee?
c) How soon could PEWs be generated before the start of the City's Open Enrollment period in October?
d) Confirm that the PEW can be provided via hard-copy, electronically, or both.
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e) Is your system capable of emailing the PEW directly to employees?
f) Can the PEW be customized?
g) What is the associated fee, if any, for programming changes to the PEW?
h) How much lead time is required to program changes to the PEW to ensure delivery to the employee before the start of the City's Open Enrollment period on October 1?
120
The City requires a confirmation statement be provided to all eligible employees (including for employees that did not make any changes, i.e., passive enrollment) outlining any changes to benefits elections that were made during the Open Enrollment and correction periods.
a) Please describe your process for closing out all elections after the end of the Open Enrollment and correction periods, including timing required to process formatting and text changes, for preparing a confirmation statement to be sent to all eligible employees.
b) How much time is required to close out these elections and prepare confirmation statements?
c) How soon could confirmation statements be produced after Open Enrollment closes?
d) How soon could confirmation statements be produced after the end of the correction period?
e) How will the confirmation statement be provided - hard copy, email, or both? Is your system capable of emailing the confirmation statement directly to employees?
f) Can the confirmation statement be customized?
g) What is the associated fee, if any for programming changes to the confirmation statement?
h) How much lead time is required to program changes to the confirmation statement to ensure delivery to the employee immediately after the close of the City's Open Enrollment and corrections periods?
121
The City also requires a confirmation statement be provided to all employees whose newly added dependents were dropped from coverage or CIL canceled because the employee did not submit verification documents to the City by the established deadline (usually the second week in December).
a) Please describe your process for closing out all elections after the City's verification documentation deadline, including timing required to process formatting and text changes, for preparing a confirmation statement to be sent to employees whose dependents were dropped from coverage or CIL was canceled.
b) How much time is required to close out these elections and prepare confirmation statements?
c) How soon could confirmation statements be produced after the verification documentation deadline?
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d) How will the confirmation statement be provided - hard copy, email, or both? Is your system capable of emailing the confirmation statement directly to employees?
e) Can the confirmation statement be customized?
f) What is the associated fee, if any for programming changes to the confirmation statement?
g) How much lead time is required to program changes to the confirmation statement to ensure delivery to the employee immediately after the verification documentation deadline?
122
A majority of employees do not make any changes during the Open Enrollment period (i.e. passive enrollment). a) Please describe how your system handles passive enrollment to ensure prior benefits elections are rolled over to the new plan year, including any life event changes that are made during the Open Enrollment period (i.e. dual year processing). b) Are there any systems limitations that may prevent prior benefits elections from rolling over to the new plan year? If so, please describe those limitations.
123
a) Do you provide mail fulfillment services during Open Enrollment? b) If so, is the fulfillment service provided directly by you or a subcontractor? c) If provided by a subcontractor, please provide the name and location of the subcontractor. d) How long have you had this subcontractor relationship? e) What is the associated fee for providing mail fulfillment services and how is the fee determined?
124
The City's Open Enrollment period is October 1 to 31 with a "silent" two week correction period immediately following the close of Open Enrollment. a) How soon could mail fulfillment services for PEWs be provided to ensure they are delivered to members prior to October 1? b) How soon could mail fulfillment services for confirmation statements be provided after the close of the Open Enrollment and correction periods?
125 Regarding the dependent verification process for adding dependents during Open Enrollment, please respond to the following:
a) Do you review and process dependent verification documentation for your clients as part of the Open Enrollment process?
b) If so, please describe this process, including any communications and documents that are provided to members.
c) What is the associated fee, if any, for you to perform this function? If applicable, how is the fee determined?
d) If you do not provide this service, please describe how your system is set up to enable City staff to review and process dependent verification documents that are received from members adding dependents during Open Enrollment.
PAYROLL PROCESSING
Data Transmission, Processing Changes & Auditing Functions
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126
Describe how your system will interface with the City's payroll system, PaySR including: a) How data will be transferred between the two systems b) How employee data will be reported and maintained securely and accurately in your system c) How the system will be able to handle changes as a result of City labor negotiations that may affect an employee's benefits deductions and/or the City's subsidy contribution
127
Describe how your system will calculate the biweekly amount of an employee's payroll deductions based on the employee's benefits elections and how this information will be transferred to the City's payroll system.
128
Describe your process for ensuring accurate employee payroll deductions based upon an employee's MOU, benefit plan elections, and coverage level. What quality control measures are in place to ensure accuracy and monitor and resolve discrepancies?
129
Describe your process for ensuring the appropriate calculation of flexible credits for each employee based on the employee's status and MOU. What quality control measures are in place to ensure accuracy and monitor and resolve discrepancies?
130
a) Please describe how payroll data is validated and what safeguards are in place to ensure data is valid and correct? b) Do you review and audit payroll records to ensure accuracy and discover any variances, discrepancies, or errors? c) If so, how often is this review performed? d) If variances, discrepancies, or errors are discovered, please outline the process for resolving the problem. e) What is the average amount of time to resolve any variance, discrepancy, or error? f) How do you ensure these problems do not recur and are resolved in their entirety? g) Can the City request additional programming changes be implemented to validate payroll data and what is the average time for implementing these changes? What is the associated fee, if any, for programming changes and how is the fee determined?
131
Describe the payroll process that is performed at the beginning of each plan year, including the activities performed by you to stop all active benefits deductions and start new benefits deductions based on participant elections made during the Open Enrollment period and prior benefits elections rolling over to the new plan year due to dual year processing.
132
a) Is your system capable of calculating and processing retroactive adjustments to an employee's deduction and employer subsidy amounts? b) If so, please describe this process, including how the calculation is computed and how the retroactive adjustment is transferred to the City's payroll system. c) What quality control measures are in place to ensure accuracy of the calculation and timely transmission of the information to the City's payroll system?
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133
a) Is your system capable of calculating imputed income amounts for life insurance and taxable dependent benefits? b) If so, please describe this process, including how the calculation is computed, for who and under which dependents (if any) it applies, and how the amount is transferred to the City's payroll system. c) What quality control measures are in place to ensure accuracy of the calculation and timely transmission of the information to the City's payroll system?
134
a) Please describe how your system will calculate and report total employer and employee contributions on a calendar/tax year basis. b) If a retroactive adjustment is required to a participant's record to correct an error, please describe the process for correcting the record to ensure accurate calendar/tax year reporting. c) What quality control measures are in place to ensure accuracy of the calculation and timely transmission of the information to the City's payroll system?
Direct Billing Process
135
Every pay period, the City bills members who become benefits ineligible (e.g. insufficient hours worked, leave without pay status) and do not qualify for the City's subsidy. a) Describe your direct billing capabilities. b) Do you have a direct billing system that can generate direct billing notices and payment reminders? c) Can these notices and reminders be emailed to employees?
136
If applicable, does your direct billing system allow employees to create an online account and make payment for outstanding deductions or premiums due? If so, please also describe payment capabilities and methods of payment accepted, where you would propose the funds be deposited, and how those funds would flow back to the City.
137 If you offer a direct billing system but cannot actually receive the funds, would the City be able to post and record payments received in the direct billing system?
138
If applicable, is your direct billing system capable of generating reports? If so, please describe the types of reports that can be generated, frequency, and who can generate the reports (TPA and/or City staff). Please provide sample reports.
139
If providing direct billing services as described above, please indicate if the service is provided a subcontractor. a) If so, please provide the name and location of the subcontractor. b) How long have you had this subcontractor relationship? c) What is the fee for providing direct billing services and how is the fee determined?
Eligibility & Premiums Reporting
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140
The TPA will transfer eligibility data (e.g. elections, terminations, changes) electronically to each of the City’s benefits carriers biweekly. Please provide a list of the benefits carriers/vendors you have interfaced with for your clients from 2012-2017.
141 Please describe your process for sending election and termination information to benefits carriers electronically. How do you ensure that the information is transmitted securely and timely?
142
a) Do you review and process carrier eligibility error reports for each file transmission? b) If so, please describe your review process to reconcile the error report with the carrier and Plan Sponsor. c) What is the average amount of time to reconcile and process these error reports?
143
a) Is your system capable of calculating premium billing amounts and retroactivity based on the billing rules identified by the City? b) If so, please describe how this process is performed. c) Up to how many days can you perform retroactive premium adjustments?
144
The TPA will be required to provide monthly premium reports to allow the City to generate self-invoices for payment to its benefits carriers and vendors. a) Please describe the types of reports the TPA provides to enable the City to self-bill. b) How often can these reports be generated and by whom (TPA and/or City staff)? c) Please provide sample reports.
145
Proprietary City departments (Los Angeles World Airports, Harbor Department, Fire and Police Pensions, LACERS) are primarily special funded and reimburse the City for benefits costs of its employees. a) Is your system able to create monthly premium reports that break down employee and employer costs for proprietary departments to enable the City's Personnel Department to invoice proprietary departments? b) If so, how often can this report be generated and by whom (e.g. .TPA and/or City staff)? c) Please provide sample reports.
146
Please describe your premium reconciliation process, if any. How do you work with the carriers to resolve any eligibility issues that are discovered? After reconciliation, please describe the process for ensuring that the monthly premium billing reports provided to the City include any required adjustments due to the reconciliation of eligibility information.
OTHER PROCESSES
Specialized Processes
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147
The LAwell Civilian Benefits Program primarily covers civilian City employees. However, sworn City employees may also choose to participate in the LAwell Civilian Benefits Program by enrolling into the health and/or dental plans, Cash-in-Lieu, and/or tax-advantaged savings accounts. Sworn City employees choosing to participate in LAwell health and/or dental plans have a different pay/contribution structure than civilian employees.
a) Describe how your system will handle processing benefits elections for these two different membership groups.
b) Include a description of how your system will process the election and life event changes from beginning to end, including the types of confirmation statements that are generated.
c) Are there are any limitations that would prevent administration of both groups in your system? If so, please describe those limitations.
148
Please describe how your system will handle specialized City processes such as the Benefits Protection Plan which allows employees who are on an approved disability leave to continue to receive benefits.
a) Is your system able to process and track these employees separately?
b) What types of reports are available to track and report the status of these employees?
c) Is your system able to generate and email direct billing notices to these employees and track payment due dates and payments received?
d) Can BPP COBRA notices be generated by the system for terminated employees and their dependents?
e) Are there any limitations that would prevent administration of this group of employees in your system? If so, please describe those limitations.
149
Employees who are members of the Engineers and Architects Association (EAA) are eligible to participate in LAwell dental plans or EAA dental plans. During the City’s annual Open Enrollment period from October 1 to 31, the City manually processes requests from City employees to cancel LAwell dental coverage and elect EAA dental coverage and vice versa. This information is then transmitted to the TPA to update the plan sponsor member site to reflect the dental plan elected by the employee.
a) Please describe how your system will handle processing EAA dental coverage requests for this group of employees.
b) Does your system provide employees the ability to elect EAA dental coverage through the Open Enrollment member self-service portal?
c) What types of reports are available to track and report the status of these employees?
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d) Include a description of how your system will process the election change from enrolling into and/or cancelling EAA dental coverage, including the types of confirmation statements that are generated.
e) Are there are any limitations that would prevent administration of this group of employees in your system? If so, please describe those limitations.
150 Please describe your system's capabilities in the administration of disability and life insurance claims processing. Does your system provide City staff the ability to:
a) Upload and store documents such as disability claim employer statements and life insurance claims documents per employee?
b) Record information in the plan sponsor member site such as the date a life insurance claim has been paid, amount, and documents that are received per employee?
c) Generate and email claims forms to employees to complete and return?
d) Generate and email confirmation statements to employees to confirm receipt of information and documents received?
e) Generate and email standard correspondence to employees?
151
Does your system provide City staff the ability to upload and store appeals filed by employees and other documents related to the appeal process such as research notes and correspondence that is sent to the employee? If so, please describe this function.
152 Does your system provide a centralized email inbox that City staff can receive emails from and send emails to employees?
REPORTING CAPABILITIES
Standard Reporting
153 Please describe in detail the capability and timing to produce system generated reports for, at a minimum, the following:
a) Employee status (e.g. full-time, half-time, direct bill) breakdown
b) Employee status (e.g. full-time, half-time, direct bill) breakdown by MOU
c) Employee gender, age, and salary breakdown by employee status and MOU
d) Dependent type (e.g. spouse, domestic partner, child) breakdown
e) Medical and dental plan breakdown by employee status (e.g. full-time, half-time, direct bill)
f) Medical and dental plan breakdown by MOU
g) Addition of dependents by employee status and MOU
h) Tax-advantaged savings account enrollment by employee status, MOU, age, salary, gender, and election amount
i) Supplemental insurance benefits enrollment by employee status, MOU, age, salary, gender, and election amount
j) Can City staff generate these reports at any time?
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k) If not, please describe the process and timing required to generate these reports by your system and any systems limitations with generating these types of reports.
l) What is the frequency in which these reports can be generated?
m) Please provide a copy of sample reports provided to clients.
154
a) Are you able to provide a report at the end of the year aggregating the total amount of employer and employee contributions for each participant on a calendar/tax year basis? b) If so, please describe the process for generating this type of report. c) What is the associated fee, if any, for producing this type of report? d) If applicable, how is the fee determined? e) Please provide sample reports.
155
Please review the below listed reports as described in the Plan Profile & Scope of Services. By checking each box, verify that you will are able to create the report on a biweekly basis. If there are any exceptions, do not check the box and explain the deviations.
Standard Reports:
a) Benefits Protection Plan (BPP) Employees with 2-Years Limit Report
☐
b) BPP & Hours Report ☐
c) BPP Employees with Termed Benefits ☐
d) Carrier Billing (Premium Reporting) ☐
e) Chargeback Report ☐
f) Death Report ☐
g) Demographic File Drop Report ☐
h) Direct Bill Report ☐
i) Employee Dual Coverage Report ☐
j) Dependent Dual Coverage Report ☐
k) Pending Family Status Change Report ☐
l) Move Report ☐
m) Multiple Life Event Report ☐
n) No Documentation Received Report ☐
o) No Documentation Received/30 Days Report ☐
p) Rehire and Reinstate Report ☐
q) Reject Report ☐
r) Status Code 09 Report ☐
s) Term Dependent Age 26 Report ☐
t) 65/70 Report ☐
Standard Letters and Statements:
u) Beneficiary Letters ☐
v) COBRA Sheets ☐
w) Confirmation Statements (Open Enrollment, Ongoing for New Hires, and Life Event Changes)
☐
x) Personal Enrollment Worksheets (Open Enrollment, Ongoing for New Hires, and Life Event Changes)
☐
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156
a) Does your system provide City staff the capability of generating the reports listed in questions 160 and 162 at any time? b) If not, please describe the process and timing required to generate these reports by your system and any systems limitations with generating these types of reports. c) Please provide a sample calendar in which these reports would be ready on a biweekly basis.
157
The City will require regular activity and statistical reports. a) Provide a copy of your standard activity and statistical reports that would be most representative of the type of data you typically provide to your clients. b) What other types of standard reporting can you provide that you believe will assist the City in administering the LAwell Civilian Benefits Program efficiently?
158
a) Please describe the type of review and audit measures in place to ensure accurate and timely reporting. Include the frequency of the review and indicate the staff, including job title that is tasked with performing the review. b) How do you ensure the accuracy and timeliness of the reports that are provided?
Open Enrollment Reporting
159 Please describe in detail the capability and timing to produce system generated reports for, at a minimum, the following:
a) Active versus default changes during Open Enrollment and the correction window and comparison across years
b) Employee status (e.g. full-time, half-time, direct bill) breakdown and comparison across years
c) Employee status breakdown by MOU and comparison across years
d) Gender, age, and salary breakdown and comparison across years
e) Dependent type breakdown and comparison across years
f) Tax-advantaged savings accounts enrollment by employee status, age, salary, and gender and comparison across years
g) Medical and dental plan breakdown and comparison across years
h) Medical and dental plan breakdown by employee status and MOU and comparison across years
i) Medical and dental plan migration between plans and comparison across years
j) Addition of dependents and comparison across years
k) Supplemental insurance benefits enrollment by employee status, MOU, age, salary, gender, and election amount and comparison across years
l) Pending EOI report
m) Can City staff generate these reports at any time?
n) If not, please describe the process and timing required to generate these reports by your system and any systems limitations with generating these types of reports.
o) What is the frequency in which these reports can be generated?
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p) Please provide a copy of sample reports provided to clients.
160
a) Please describe the types of reports that are provided to summarize Open Enrollment activity. b) What type of information is provided in these reports? c) How often will the reports be generated during or after the Open Enrollment period? d) What is the associated fee, if any, for producing these types of reports? e) If applicable, how is the fee determined? Please provide sample reports.
161
a) Please indicate if you will be able to provide a report of participants who have passively enrolled at the end of the Open Enrollment period. b) What is the associated fee, if any, for producing this type of report? c) If applicable, how is the fee determined?
162 What other types of Open Enrollment reporting can you provide that you believe will assist the City in administering the LAwell Civilian Benefits Program efficiently?
Customized Reporting
163
a) Please describe the process including timing and staff resources needed to create a customized report requested by the City. b) What is the average time to create a customized report? c) What is the associated fee, if any, for producing ad hoc reports? d) If applicable, how is the fee determined?
164
a) Please describe your ability to collect, analyze data, and report on the LAwell Civilian Benefits Program in comparison to industry standards, marketplace competitors, and best practices. b) Include a description of the staffing levels, skills, and team structure available for data collection, analysis, and reporting. c) Please provide sample reports.
165
a) Please describe the type of review and audit measures in place to ensure accurate and timely reporting. b) How do you ensure the accuracy and timeliness of the standard, Open Enrollment, and customized reports that are provided?
LEGAL COMPLIANCE
Legal and Special Administrative Services
166
Please describe your plan sponsor client relationship team that will be assigned to the City. Fully describe their roles, their experience, the approximate percentage of their time that will be allocated to the City's plan, and what is distinctive about this proposed team.
167
a) How do you ensure that your recordkeeping system is in compliance with all applicable federal and state statutes, rules and regulations, the City's plan document, and contract? b) What safeguards are in place to ensure clients are in compliance?
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168
What resources do you have to provide your clients with legal analysis, interpretations of laws, regulations, and other matters on legislative and regulatory matters pertaining to employee benefit plan information?
169
a) Does your organization provide written updates to clients on legislative/regulatory changes? b) If yes, how frequently? c) Provide a recent sample.
COBRA and CalCOBRA Administration
170
Please describe your experience and capabilities in COBRA and CalCOBRA administration including sending timely COBRA notices to members upon termination, communicating enrollments and terminations to the health plan carrier, generating billing letters, and receiving and tracking member payments. Describe any limitations in this area.
171
a) Does your system generate an "Offer of COBRA Coverage Notice" to terminated employees and/or dropped dependents? If so, provide a sample notice. b) How soon could this notice be generated after receipt of termination information from the City? c) Can your system email this notice? d) If not, please describe your mail fulfillment services for COBRA notices and any applicable fees.
172
If providing COBRA and CalCOBRA administration services as described above, please indicate if the service is provided a subcontractor. a) If so, please provide the name and location of the subcontractor. b) How long have you had this subcontractor relationship? c) What is the fee for providing COBRA and CalCOBRA administration services? d) If applicable, how is the fee determined?
Affordable Care Act (ACA) Compliance
173
Under the assumption that the current ACA employer mandate and reporting requirements continue to be in effect on a go-forward basis, the City is seeking TPA services to assist with the Employer Shared Responsibility (ESR) requirements of the ACA. a) Please describe your ESR administration services including analysis, reporting, and your systems capability to perform eligibility determinations based on aggregation of hours of service data from the City's payroll system. b) What is the associated fee for this service? c) If applicable, how is the fee determined?
174
a) What software and/or services do you provide for Affordable Care Act reporting compliance? How do you track hours to determine "full time" status? b) What type of audit or review is performed to ensure accurate reporting? c) Please provide a sample of your ACA software and reporting.
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175
a) Please detail your ability to produce IRS Forms 1094-B, 1094-C, 1095-B, and 1095-C. b) Do you currently provide this service for your clients? c) If so, please describe the process from beginning to end for generating these forms, including how your system analyzes data to generate the forms, timing required to produce the forms to meet IRS deadlines, and fulfillment services.
176
If providing ACA compliance services as described above in questions 180 to 182, please indicate if the service is provided a subcontractor. a) If so, please provide the name and location of the subcontractor. b) How long have you had this subcontractor relationship? c) What is the fee for providing tracking of ACA eligible employees and tax reporting services and how is the fee determined?
Centers of Medicare and Medicaid Services (CMS)
177 Please describe your experience and capabilities in providing a response to CMS, including Data Match services, notices, and other demands required by CMS.
178
a) Have you completed CMS Data Match reports for your clients? b) If so, please describe your experience in this area including the quantity completed and average amount of turnaround time to complete a CMS Data Match. c) What is the associated fee for performing a CMS Data Match and how is the fee determined?
179
a) Describe your experience with the Voluntary Data Sharing Agreement option offered by CMS (https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/EmployerServices/Voluntary-Data-Sharing-Agreement.html). b) Do any of your other clients have a VDSA with Medicare? c) If so, please describe your experience in this area.
180
If providing CMS data match services, please indicate if the service is provided a subcontractor. a) If so, please provide the name and location of the subcontractor. b) How long have you had this subcontractor relationship? c) What is the fee for providing CMS data match services and how is the fee determined?
r) If you can accommodate additional data fields beyond those identified in this question, please provide list of full data fields supported.
COMMENTS (if any):
182 If your system supports custom field(s), please indicate the following:
a) Can the custom field(s) be added anywhere in the member self-service website?
b) If so, are the custom field(s) also available within any mobile application?
c) Can the custom field(s) be labeled by the client and reported upon with that label?
183 Provide an Internet address and instructions on how to access a demo site for your Internet capabilities for the member self-service site (both pre-login and post-login).
184
Review the City's current Member Benefits Central website. Describe how your member web-interface differs from the City's current design and where you see gaps (both positive and negative).
185 Describe how and what is required of members to establish online access to their accounts, and what is required of members to obtain access when they have lost a username/password.
186 Describe what is required of current members when you transition a new account with respect to re-establishing online account access.
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187
Indicate whether language services other than English are available for your website and whether your website has been reviewed as compliant with applicable laws/regulations for disabled member access.
188 Provide the volume for your internet site for the last eight quarters (quarters ending 3/31/15 through 12/31/16).
189 Indicate if your member level website is available as a mobile optimized site or as an App, and on which platforms it operates. If applicable, provide a website address and/or the name of the App.
190 What is the number of concurrent users that the website can support?
191
a) When is maintenance performed on the web self-service system? b) How long is the system down? c) What message will members see during this down time?
192 What security methods do you use to ensure the confidentiality of member information (social security number, address, etc.)?
Website News/Messaging/Interactive Capabilities
193 Describe your website's capabilities for posting news, updates, and other information from your organization or from the City.
194
Describe your website's capabilities for pre and post login: 1) communication (e.g. chat, email, etc.), 2) interactive functions (e.g. games, surveys, polls, etc.), and 3) other multimedia items (e.g. videos).
195 Describe your website's capabilities for notifications pre and post login specific to a member's account.
196
a) Describe your website's capabilities for sending reminder emails and messages to members who have recorded email addresses in your system. b) Can messaging be targeted to specific groups of members?
197 Describe your website's capabilities for members to upload documents and forms for the City to review and validate.
198 Describe your review/approval process for posting content from other entities, such as from the City's contracted wellness vendors.
199 a) Describe your interactive support tools available to members. B) What kind of information is available to members and how would they access it?
200
Describe what resources, if any, your organization devotes to generating fresh website content, and provide examples of fresh content (no more than two pages in length your organization has generated in the three-month period ending 12/31/16) as an attachment.
Website Customization Capabilities & Resources
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201
a) Describe your organization's ability to customize or not customize the structure and content of your website. b) Fully describe what can be customized for the City. c) Describe how you will work with the City to customize the site and the resources you will make available to launch and maintain the customized components of the site.
202
a) Describe the timing and staffing resources needed to customize your website for Open Enrollment and throughout the year. b) Describe if there are any limitations in customizing the website. c) What is the average amount of time to customize components of the website? d) Indicate whether and under what conditions or within what parameters you charge your clients for customization. e) If applicable, how is the fee determined?
203
a) Please describe your staffing resources to build, customize, and maintain the website on an ongoing basis. b) Is a content management system incorporated into the website design? Please describe.
204 Describe whether your website can accommodate co-branding with the City's LAwell Civilian Benefits Program and Wellness Program.
Planned Enhancements
205
a) Provide your firm's "web vision." This should include the foundation, principals, and philosophy that guide your current site and form the foundation for future evolution, and enhancements you are preparing for over the next three to five years. b) Describe how this vision differentiates you from your competitors.
206
a) What three recent enhancements/innovations have you implemented over the last few years that best reflect this vision? b) Comment on how these innovations are relevant to the City and its mission for the LAwell Civilian Benefits Program.
207
How do your electronic capabilities compare to those in place at other organizations in terms of (a) security controls (e.g. use of and access to SSNs, touch/fingerprint access to self-identify on a mobile app, etc.); and (b) interactivity and responsiveness (e.g. use of a message center and emails/texts to communicate confirmation of transactions)?
Media Technology: Video, Mobile Apps & Other Media
208
a) Describe your organization's video educational and marketing content. b) What specific video content do you make available and is it applicable to governmental plan sponsors of employee benefit plans? c) Does this material require or does it not require customization for the City's Plan? d) Indicate whether you charge your governmental plan sponsors for the use of this material in their plans or for customization. e) If applicable, what is the fee for customization and how is the fee determined?
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209
Provide samples of any videos you've developed that could be used by a governmental plan sponsor for marketing or educational purposes applicable to governmental plan sponsors of employee benefit plans, if you have produced them.
210
a) Indicate if you have a mobile application or mobile optimized website. b) What features does it include or may it be limited compared to the regular member website? c) What information (if any) can be customized by the plan sponsor? d) If you offer one, provide information regarding how to access your mobile application. e) Indicate whether and how you maintain consistency between your mobile application and website.
211 Describe any other media or technology your firm could bring to enhance the City's benefits program specifically and/or benefits/wellness programs more broadly.
PARTICIPANT CALL CENTER & REPRESENTATIVES
Call Center Location, Hours & Languages
212
Describe the following characteristics of the call center that will be assigned to the City's account. If there are multiple facilities or groups serving the account, please answer each question for each facility and/or group.
a) Location and hours of operation of the call center including location of primary and backup centers
b) Total Call Center Representatives (CSRs) employed on a year-round basis
c) Proposed staffing plan including number of CSRs and a description of the types of personnel to be involved, and the roles and responsibilities of staff
d) Back-up call center operational readiness in the event of a natural disaster, etc.
213 By checking each box, verify that you will provide the following. If there are exceptions, do not check the box and explain the deviations.
a) Customer service representative call center ☐
b) Operating hours Monday through Friday minimally from 8:00 am to 5:00 pm Pacific Standard Time
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c) Expanded hours during the last two weekdays of the Open Enrollment period
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d) Spanish speaking customer service reps available during Open Enrollment and standard operating hours
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e) Automated voice response system with voice mail feature if members are calling after hours
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f) Digital call recording and call tracking ☐
g) Case management system for tracking and documenting all participant calls and providing City staff systems access to the case management system to view recorded notes, chat transcripts, and make updates to call notes
☐
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214 List the holidays for which the call center is typically closed.
215
a) What language services other than English are available? b) What languages do you currently support? c) How are these services provided? d) Confirm your ability to provide Spanish language services and hearing-impaired access services during all hours of telephone customer service availability and during Open Enrollment.
216
The City typically experiences high call volume during the last week and especially during the last two days of Open Enrollment. a) How many lines will you use to handle the anticipated Open Enrollment call volume? b) How many during ongoing administration? c) What steps are taken if call volumes exceed anticipated levels both during Open Enrollment and during ongoing administration?
217
Describe the investments that your firm has made in call center technology, apart from any website enhancements, over the past three years that have enhanced customer service and member satisfaction.
Staffing & Training
218 Indicate the relationship of your CSRs: employees or outside contractors. If contractors or a combination, include the percentage of each and duration of the subcontractor agreement.
219
a) Do you assign CSRs to specific accounts? b) If yes, how many would be assigned to the City? c) How many are primary vs. secondary? d) How many CSRs would be dedicated to the City during Open Enrollment and during ongoing months?
220
Regarding the CSRs in your organization, please describe the following: a) What is the average age and tenure (in years)? b) What is the current turnover rate of CSRs? What is the turnover rate of CSRs in the previous three years ending 12/31/16, 12/31/15, and 12/31/14? c) What percentage of CSRs who leave that job stay within your organization? d) What are the qualifications and average years of experience of the CSRs that will be assigned to the City's account?
221 Describe the minimum licensing, degrees, or training required to hold the position of CSR.
222 Regarding the CSRs in your organization, please describe the following:
a) The training provided for CSRs including how they will be trained on this account prior to go-live and on an on-going basis
b) How your CSRs are trained and able to solve problems on a client’s behalf efficiently and quickly
c) Any continuing education program in place for your CSRs to stay current with program changes and changes in the law and health benefits administration
223 Please describe the procedures for monitoring and ensuring the quality of services provided by CSRs and customer satisfaction.
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224
a) How often are CSR calls monitored to ensure continued development and coaching? b) Describe your plan is to promote continued development and coaching to increase member satisfaction.
225
a) In staffing CSRs, how many employees do you assume a single CSR can cover? b) How many calls per day can a CSR cover? c) What is the average length of a call that a CSR typically handles as part of ongoing administration and during Open Enrollment?
226 Explain if/how calls are assigned within your system to different processing groups.
227
a) Describe what is required of employees and/or dependents to self-identify when they are interacting directly with a CSR. b) Describe what access CSRs have to sensitive information such as the SSN when pulling up an employee's account. c) How is the confidentiality of the employee and/or dependent maintained?
Metrics & Standards
228 Provide the actual results for the previous three years for the following key measurements of the call center to be assigned to the City's account:
a) Call volume per month
b) Average volume for the calls received by CSR
c) Number of CSRs
d) Number of members served by your call center
e) Total number of calls received by CSRs in 2016
f) Average number of calls received annually per CSR
g) Percent of calls answered within 30 seconds
h) Average speed of answer
i) Average length of calls with CSR
j) Quality standard for number of seconds on hold while call transfers to CSR
k) Average actual number of seconds on hold while call transfers to CSR
l) Quality standards for call abandonment rate
m) Actual call abandonment rate
n) Percentage of calls requiring calls back
o) Quality standard for amount of time to call back with status on issue
p) Average actual amount of time to call back with status on issue
q) Quality standard for amount of time to handle issue resolution
r) Actual average amount of time to handle issue resolution
s) Average number of calls monitored by supervisor on a monthly basis
Case Management, Call Monitoring & Reporting Capabilities
229 Describe your case management system for tracking and documenting all participant calls.
a) What types of notes and comments do CSRs typically document in this system?
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b) Is the case management system separate from, or a part of, the plan sponsor website?
c) If a case requires City staff to request the TPA to correct a member's eligibility or information, please describe this process including how City staff notifies the TPA and average number of days from notification by City staff to full resolution.
d) Is City staff able to enter its own notes in the case management system?
e) Please provide sample call center scripts and transcripts.
230 Is there a limit on the number of City users that can have access to the case management system? If so, please describe.
231 Please describe any limitations of the case management system.
232 Do you monitor/track member calls for quality control? In what manner and how frequently? How are calls logged and tracked and who has access to that information?
233 Regarding phone calls received by the call center, please respond to the following:
a) Are all phone conversations recorded?
b) How long do you maintain the records of conversations?
c) If yes, can City staff listen to these recordings?
d) Do you have any restrictions or limitations on City staff’s ability to listen to those recordings?
e) Will City staff be able to retrieve and review the calls themselves?
f) If so, what is the amount of time needed to retrieve a call?
g) If City staff cannot directly retrieve the call, please describe the process for requesting retrieval of a call, including the timing needed to retrieve the call.
234
a) How long does it take to pull up a recorded conversation for calls less than one year old; one to five years; more than five years? b) Will City staff be able to retrieve and review the calls? c) If so, what is the amount of time needed to retrieve a call?
235
a) Describe the records CSRs have direct access to when handling a telephonic inquiry. b) Do they have access to imaged documents and/or the employee's self-service account? c) What type of transactions is the CSR able to complete online to assist the employee? d) How quickly is the recordkeeping system updated after transactions are performed?
236 a) If a call must be transferred from one CSR to another or to a supervisor, can data and the call be transferred simultaneously? b) If no, how is the transfer accomplished?
237 Describe the workflow tools used to track member processing by the administration team.
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238
a) What types of management reports are available for reporting CSR service (e.g. call volume by day, types of transactions, call abandonment rate)? b) How often are these reports made available either during Open Enrollment or during ongoing administration? c) Please provide sample of standard reports.
Call Center Customization Capabilities & Resources
239 Describe how your call center controls the accuracy of, and accountability around, communicating Plan-specific information to a Plan's member population.
240
a) Describe the ability to customize scripts of the automated member call center based on the City's needs. b) If applicable, what is the associated fee for customization and how is the fee determined?
241
a) Describe the flexibility of the call center to handle fluctuations in call volume, its scalability, and the proportion of its capacity currently in used. b) If applicable, what is the associated fee for scalability and how is the fee determined?
PARTICIPANT CALL CENTER (AUTOMATED)
Structure, Script, Time & Languages
242 Provide an overview of your organization's automated call center features, including whether it is voice-responsive, number-responsive or both, and hours of accessibility.
243
Describe the process used to design the automated call center script and call logic. Include: a) Roles and responsibilities of City staff and your organization b) A sample of a system-generated call logic flow diagram and script c) Define the testing process used to ensure system accuracy. Include any roles and responsibilities of City staff and your organization
244 a) Provide a sample script of the phone "tree" and, if possible, a dummy line to call for the City to call and test. b) If phones should go down, what message will callers hear?
245
a) How much lead time is needed to make and implement changes to the call center script and call logic, if needed? b) If applicable, what is the associated fee for programming this change and how is the fee determined?
246
a) What type of maintenance is performed on the automated call center system? b) How often is maintenance performed? c) How long is the system down? d) What message will callers hear during this down time?
247
a) Describe your voice response system. b) Does it include a voice mail feature that allows callers to leave messages if calling after hours? c) If yes, when are these messages retrieved, logged, and answered?
84
248 Describe what efforts, if any, your organization uses to establish and test the user-friendliness of your system, in particular the ease of access to opt out to speak to a customer service representative.
249
a) What information must be provided by the member to access his/her account? b) Is the login information the same or different than that required for the website?
250 Provide a list of transactions that can be processed through the automated system (i.e., PIN changes, address changes, etc.).
251 How quickly is the recordkeeping system updated after transactions are performed?
252 How does the automated line accommodate hearing/speech impaired members?
Email, Fax & Mail Capabilities
253 Indicate whether your system has the ability to send group emails to members who have recorded email addresses within your system and what limitations exist in establishing the groups.
254 Indicate your capabilities to produce mass mailings.
255 Indicate your capabilities to receive items through mail, such as supporting documentation.
256 Describe your process for warehousing and updating member forms, who would be responsible for managing this, and at what frequency of review/updating?
257 Describe your organization's ability and development process/resources for generating communications content in other languages.
MEMBER SATISFACTION
Complaint Resolution
258 By checking each box, verify that you will provide the following. If there are exceptions, do not check the box and explain the deviations.
a) An electronic monitoring system for complaints and inquiries ☐
b) Tracking of the type of complaint/inquiry ☐
c) Tracking of response times ☐
d) Tracking of all contacts from the member regarding the complaint
☐
259 Provide your firm's complaint resolution statistics for the last year, including the types/natures of these complaints by category:
a) % of complaints resolved same day:
b) % of complaints resolved the next day:
c) % of complaints resolved within 3-5 days:
d) % of complaints resolved within 5-21 days:
e) % of complaints resolved after 21 days:
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260
Describe your complaint resolution process, including: a) How can the complaint be submitted? b) What steps are taken after it is received? c) Discuss the process, including timing for each step of escalation, for member complaints submitted through the call center, website, written correspondence or other.
261 How do you respond to feedback (from the member and City staff) to improve call quality?
262 a) What is the follow-up procedure and remediation for complaints about CSRs? b) How do you work with the City to resolve the complaint?
263
What is the process and timing for notifying (1) the City of any errors, mistakes, or unforeseeable circumstances committed by CSRs that affect the service provided to the City's employees and (2) resolution of these matters?
Website, Participant & Automated Call Center Member Satisfaction
264
Describe if, how, and the frequency with which you will assess member satisfaction with the following: a) Member self-service website b) Participant call center c) Automated call center
265
Indicate if you have tools to assess satisfaction at point of contact and/or as a general member satisfaction survey with the following: a) Member self-service website b) Participant call center c) Automated call center
266
If you have collected member satisfaction survey data, indicate your 2016 results for both your full client base as well as your three largest governmental clients with the following: a) Member self-service website b) Participant call center c) Automated call center
267
Please describe the tools you use and your plan for increasing member satisfaction with the following: a) Member self-service website b) Participant call center c) Automated call center
MEMBER COMMUNICATIONS & COUNSELING SERVICES
Communications Philosophy & Resources
268
A key objective of this RFP is to identify the firm that has the resources, institutional commitment, creativity, facility, responsiveness, and innovative mind-set to support the City’s ambitious communications objectives. Describe your proposed approach to creating a strategy for coordinating and integrating your firm's plan education and communication activities and materials into a communications program that represents and coordinates with the City's core mission and values.
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269
a) Please identify all primary members of the communications team that would work with the City. This should include ancillary team members such as graphic design, print/production and coordination resources. b) Please indicate approximately what percentage of time the primary team members would be expected be allocated to the City's account.
270
As indicated in the Plan Profile & Scope of Services, the City's Plan is looking for ways to expand the intellectual resources devoted to its communications efforts, and looks to its Third Party Administrator as providing an opportunity for partnership in this endeavor.
a) Indicate whether you would be willing to establish a Senior Communications Development staff resource that would be available to work closely with the City and exercise a leadership role in producing innovative, outcomes-based communications educational content (including Open Enrollment materials), materials, and initiatives, and coordinate the execution of local and headquartered communications functions.
b) If you have such a resource, indicate who this individual would be, their qualifications for responsibilities at this level, the percentage of that person's time that would be devoted to the City's account, and whether (s)he would be locally or headquarters based.
271
By checking each box, indicate which of the following ongoing communications development/production is included in your base price. If there are exceptions, do not check the box, explain any deviations, and discuss how you would address the pricing.
a) Enrollment worksheets and benefit guides (print or electronic) for all plan members for the duration of the contract
☐
b) All paper forms for all plan members for the duration of the contract
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c) All informational flyers for all plan members for the duration of the contract
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d) All website updates and general content development, exclusive of highly specialized programming projects that involve substantial resources, for the duration of the contract
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e) All mobile application development and updates for the duration of the contract
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f) All educational programs, including content customization, for the duration of the contract
☐
Enrollment Guide
272 By checking each box, indicate if you can provide the following. If there are exceptions, do not check the box and explain the deviations.
a) A custom Civilian Open Enrollment guide in both print and electronic formats
☐
b) A custom Civilian New Hire guide in both print and electronic formats
☐
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c) A custom Sworn Open Enrollment guide in both print and electronic formats
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d) Maintain and control the inventory and production of all related enrollment materials that are to be included in the enrollment guides, including but not limited to marketing materials, a Q&A, and other plan information
☐
273
Provide a sample of what you would regard as one of the best enrollment guides you have developed (excluding any material previously developed for the City) for a governmental employee benefits program.
274 Describe your standard communication materials for a client's Open Enrollment period and during ongoing administration.
Enrollment Worksheets & Confirmation Statements
275
a) Is the City able to customize the structure, language or other features of personal enrollment worksheets or confirmation statements? b) Indicate the average amount of time required to process changes and whether there are any costs or limitations provided on personal enrollment worksheet and confirmation statement customization. c) Provide samples of a personal enrollment worksheet.
276
a) For which services or transactions are confirmation statements generated? b) Is your system able to email confirmation statements to members? c) Does your system retain historical confirmation statements in member accounts? d) Provide samples of confirmation statements.
277
a) Describe your forms fulfillment capabilities including the type of services you provide to clients for Open Enrollment and during ongoing administration. b) What is the associated fee for forms fulfillment services and how is the fee determined?
Onsite Member Advocate & Local Counseling Services
278 Indicate if you would be willing to provide an on-site member advocate as described in the Plan Profile & Scope of Services.
279
Indicate whether your call center representatives can be located onsite with the City and whether they can provide multiple roles of benefits counseling, administrative processing with the recordkeeping system, and member advocacy for problem resolution.
280
What is the associated fee on a per-representative basis for you to provide and on-site member advocate (assume a representative is full-time at 40 hours per week), and whether the City could expand these resources on a per-representative basis at its option over the duration of the contract.
281 Describe the licensing, certification, and/or training that you would provide to a member advocate representative.
FEES & GUARANTEES
Fees & Charges
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282
Provide the per-member fee that you would propose for administration of this contract exclusive of communications development and distribution/mailing costs, and indicate whether that fee would be guaranteed for the five-year term of the contract. To the extent possible, base proposed fees on the statistical data provided in Attachment A of the RFP.
283
Describe the assumptions that you have made in developing your per member unit cost including the amount of any increase or decrease in the number of member accounts over the contract period and any other factors relevant to the development of your proposed per member account fee. To the extent possible, base proposed fees on the statistical data provided in Attachment A of the RFP.
284
Provide a comprehensive breakdown of all transactional fees outside of the per-member fee that the City may be subject to. Include all assumptions used in the development of your proposed fee(s).
a) Dependent verification processing (on-going and Open Enrollment)
b) Dependent verification audit
c) Mail fulfillment services
d) Direct billing
e) COBRA and CalCOBRA administration
f) Tracking of ACA eligible employees and tax reporting services
g) Member communication and education
h) Member self-service website media and mobile enhancements
i) Senior Communications Development staff resource
j) On-site member advocate
k) Communications content development and distribution services
l) Other
285 Are you proposing to charge for system modifications required by legislative changes or by changes created by policy or labor agreements? If so, indicate the anticipated fees.
286 Are you proposing to charge for programming and operational enhancements? What controls or guarantees you can offer which will help the City to manage its costs.
287
a) Indicate if you are willing to propose a flat annual (not to exceed) fee for customization costs (required by legislation and/or requested by the City) in order to allow the City to more effectively anticipate and manage ongoing budgeting for TPA services. To the extent possible, base proposed fees on the statistical data provided in Attachment A of the RFP. b) Indicate what that annual fee would be and if it would be guaranteed for the life of the contract.
288
Indicate what portion, if any, of your per-member fee, represents any implementation costs associated with administering the City's Plan that may be amortized over the term of this contract.
289 Indicate if there is an additional fee for implementation/conversion and if so, please fully outline the fee structure.
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290
Describe how and when fees will be billed and collected, when the invoice is due, grace periods, and the process for late payment charges. Include the interest rate credited to early payment, if any, and interest rate charged for late payments.
291 Indicate whether the City's payment options include electronic fund transfer, manual invoicing, or both.
Processing Standards & Performance Guarantees
292
List your quality standards for performance and your average actual performance (in business days) for the following processing standards. Assume all data, wires or other requests are received in reasonably good order and before your cutoff time for the day, and that any required employer approvals have been received. Check each box for which you would agree to put compensation at risk for the transaction:
f) Generation of Confirmation Statements (Open Enrollment, Ongoing for New Hires, and Life Event Changes)
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g) Mail Fulfillment of Confirmation Statements (Open Enrollment, Ongoing for New Hires, and Life Event Changes)
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h) Personal Enrollment Worksheets (Open Enrollment, Ongoing for New Hires, and Life Event Changes)
☐
i) Errors in Personal Enrollment Worksheets and/or Confirmation Statements (Open Enrollment and Ongoing for New Hires)
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j) Errors in Confirmation Statements (Open Enrollment, Ongoing for New Hires, and Life Event Changes)
☐
k) Processing of urgent City requests affecting an employee's benefits (e.g. life insurance, benefits enrollment, etc.)
☐
l) Processing of City requests to modify/correct an employee's benefits elections (e.g. stop tax-advantaged savings account contributions, cancel benefit, etc.)
☐
m) Processing of the City's rehire and reinstates list ☐
293
List your quality standards for performance and your average actual performance (in business days) for the following processing standards. Assume all data and other requests are received in reasonably good condition and before your cutoff time for the day, and that any required employer approvals have been received and check the box if you would agree to put compensation at risk for the transaction:
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Performance Standard
Quality Standard
(# of Business Days)
Average Actual
Performance (# of Business
Days)
Compensation at Risk?
(Check box if you agree)
a) Transfer of payroll information to the City bi-weekly ☐
b) Payroll processing errors affecting employee's payroll deductions
☐
c) Payroll processing errors affecting City subsidy amount ☐
d) Payroll processing errors affecting imputed income amount ☐
f) Missing payroll information affecting an employee's payroll deductions, City subsidy amount, imputed income, pre and post-tax contributions
☐
294
List your quality standards for performance and your average actual performance (in business days) for the following processing standards. Assume all data and other requests are received in reasonably good condition and before your cutoff time for the day, and that any required employer approvals have been received and check the box if you would agree to put compensation at risk for the transaction:
Performance Standard
Quality Standard
(# of Business Days)
Average Actual
Performance (# of Business
Days)
Compensation at Risk?
(Check box if you agree)
a) Transmission of election and termination information to the City's benefits carriers and vendors
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b) Creation and transmission of monthly premium billing reports to the City and the City's benefits carriers and vendors
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c) Creation and transmission of monthly premium billing reports for proprietary departments to the City
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d) Reconciliation of eligibility error reports with the City's benefits carriers and vendors
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e) Reconciliation of premium and eligibility information with the City's benefits carriers and vendors
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295 Please describe in detail the staffing levels, skills, and team structure available for data collection, reporting, analysis, and application of problem solving and process improvement.
296 How are errors handled through your system? Describe any error corrections that cannot be handled by the system.
297
What is the process and timing for: 1) notifying the City of any errors, mistakes, or unforeseeable circumstances committed by your staff and/or system that affect the service provided to the City's employees 2) resolution of these matters, including the capacity to provide staff resources to ensure timely resolution of these matters?
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298 Confirm that if an error is due to your company’s error, you will make the employee whole for any financial loss at your company’s (and not the City’s) expense.
299 Indicate what performance guarantees you would provide and any associated financial penalties associated with some or all of them.
300 Please provide samples of your standard service agreement for providing health and welfare third party administration services.
301 Please provide samples of performance agreements you have implemented with your clients.
302
a) How will you measure the City's member satisfaction with the call center, web enrollment process, and ongoing services? b) How often will this satisfaction be measured? c) Are you willing to incorporate member feedback and satisfaction survey results into the performance agreement? d) What fees, if any, are you willing to put at risk for member satisfaction falling below 90 percent?
303
a) What type of guarantee can you make to the City on meeting its implementation date? b) What fees, if any, are you willing to put at risk if the implementation date is not met?
304
Are you willing to negotiate performance guarantees with the City that place a portion of your fees at risk should you fail to meet agreed upon performance standards? For each performance standard noted below, please check the boxes for which you are willing to put compensation at risk for the transaction, how the compensation will be determined, and explain any deviations or alternative fee-at-risk structure.
Performance Standard
Compensation at Risk?
(Check box if you agree)
How Compensation
is Determined?
a) Generation and delivery to the City of Personal Enrollment Worksheets (PEWs) for new hires benefits eligibility determination on a biweekly basis - delay of two business days or more from due date before final sign off and approval by the City
☐
b) Generation and delivery to the City of confirmation statements for life event changes on a biweekly basis - delay of two business days or more from due date before final sign off and approval by the City
☐
c) Generation and delivery to the City of Open Enrollment PEWs - delay of two business days or more from due date before final sign off and approval by the City
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d) Generation and delivery to the City of Open Enrollment confirmation statements - delay of two business days or more from due date before final sign off and approval by the City
☐
e) Transmission of payroll file to the City on a biweekly basis - delay of 8 hours or more from due date to the City
☐
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f) Transmission of benefits elections and cancellations to City's benefits carriers on a biweekly basis - delay of 8 hours or more from due date to the City's benefits carriers
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g) Transmission of annual Open Enrollment payroll test file to the City - delay of three business days or more from due date before final sign off and approval by the City
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h) Transmission of annual Open Enrollment payroll file to the City by the third week in December of the calendar year - delay of 8 hours or more from due date to the City
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i) Errors in payroll file delivered to the City on a biweekly basis - error rate of more than five percent of the number of records on payroll file
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j) Processing City requests to a member's benefits elections - delay of two business days or more from date requested by the City and close out of the request
☐
k) Call abandonment rate (on-going and during Open Enrollment) - exceeds five percent on three or more days during the month or at least two days during Open Enrollment
☐
l) Member satisfaction rate as measured through call center and web surveys - satisfaction rate of less than 90 percent on a monthly basis
☐
m) Average time callers wait to speak with a Customer Service Representative - 95 percent in 30 seconds after original menu selection on-going and during Open Enrollment
☐
n) Case management responsiveness (when employees call the call center): 90 percent of issues resolved within 24 hours; 95 percent of issues resolved within 48 hours
☐
Additional Information
305 Please indicate any additional services you would suggest be considered by the City's Plan.
306 Please provide any other data that you consider essential to the evaluation of your proposal. If there is no additional data you wish to present, please indicate, "N/A."
C. CONVERSION QUESTIONS
Responses to the following are required of non-incumbent proposers in order for your proposal to be considered responsive but will not be rated.
CONVERSION
Please note that the following questions will not be rated, and are for the City's informational purposes only.
# Question Response
1 Explain your implementation/conversion process including timeframe, based upon a June 1, 2018 conversion.
2 By what date would you need authority to proceed to accommodate a June 1, 2018 recordkeeping and administrative transfer?
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3 What involvement will be required from the City during the implementation process?
4 Do you have any limitations as to the format/media of member data?
5 How are benefits eligibility, enrollments, life event changes, and payroll processing handled during the conversion process?
6
What is the length of the blackout period you would propose for the City? Assume complete data is received from the prior TPA in good order. Fully describe all the components and restrictions of the blackout period. Indicate a minimum and maximum number of days.
7
Identify comparable plan conversions in which you have been involved. How many conversions and plan implementations has your company conducted during the past two years involving 10,000 employees or more and how many involving 25,000 employees or more?
8 Describe the roles and responsibilities of your conversion team. Identify the expected members of the implementation team(s) by functionality.
9 If the team (or any team member) will not be working exclusively on this implementation, how many additional plans/programs will they be working on?
10 For the plans that your firm has converted in the last year, indicate what percentage of them, if any, had to convert their data to your specifications. Please describe.
11 How do you monitor the effectiveness and quality of your conversion process and team?
12 For conversions completed in the last two years, identify the average number of business days it took to complete them after receipt of data from the prior TPA and any necessary information from the City.
13 How will you guarantee your stated implementation time frame? How will you measure the success of the plan implementation?
14 Does your organization require a test conversion of current member benefits elections prior to the go-live date?
15 Have you completed conversions over a weekend? If yes, how many?
16
Indicate whether you have converted other clients from the incumbent within the last five years. Also, indicate what categories of data you were able to load onto your recordkeeping system and what categories of data you were not able to load.
17 Please provide the following statistics regarding conversion:
Minimum and maximum business days from receipt of data from prior TPA and any necessary information from the City until system “live date”
Minimum number of business days from system “live date” until:
Member internet inquiry access
Plan sponsor on-line/internet access
18 Indicate what transactions can be permitted during conversion blackout period:
Yes/No?
New hires benefits eligibility
Electing benefits online via the member self-service website and the call center
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Life event change processing online via the member self-service website and the call center
Transmission of payroll information to the City's payroll system on a biweekly basis
Transmission of benefits elections and cancellations to the City's benefits carriers on a biweekly basis
Open Enrollment benefits elections and new plan year payroll processing
Dual year processing from September through December of the plan year
19 What is the minimum amount of implementation lead-time you need to initiate services for the City? Please provide a high-level action/project plan for implementation.
20
Assuming a contract award date of 10/1/17 and beginning service date of 6/1/18, provide a proposed implementation plan and timetable, beginning with the award of business to effective date of coverage, including the following:
a) Steps required to implement the systems architecture you expect to use to provide the services proposed, including your primary benefits management system
b) Contacts and personnel assigned to each step of the implementation process
c) Tasks of person(s) from your organization and the City responsible for each step of the implementation process
d) General timeline of the major events and milestones that need to take place during implementation, scheduled meetings during the course of the project, and the delivery of status reports
21
List any transition issues the City should consider with respect to moving services from its current TPA to your services. (1) Identify your ability to accept/transfer current usernames and passwords of member accounts. (2) Identify your ability to accept/transfer the current toll free phone line.
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Describe your project management methodology for conversion. Include task, responsibilities, and interdependencies (such as conversions of current member benefits elections from incumbent TPA). Describe the responsibilities of City staff and your organization to plan and execute the conversion.
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SECTION 4
PROPOSAL FORMAT AND
SUBMISSION REQUIREMENTS Proposals must be based only on the material contained in the RFP, Pre-Proposal Conference responses, amendments, addenda and other material published by the City relating to the RFP. The proposer must disregard any previous RFP draft material. Proposals must be submitted in accordance with the requirements set forth in this RFP.
4.0 Addendum(a) The City reserves the right to issue addendum(a) to this RFP, which may add additional requirements which must be met in order for a proposal to be considered responsive. All proposers must acknowledge any addendum(a) issued as a result of any change in this RFP on the Proposer Signature Declaration Page. Failure to indicate receipt of addendum(a) may result in a proposal being rejected as non-responsive. 4.1 In Writing All proposals must be submitted in writing and proposers shall complete and return any and all applicable documents including but not limited to written responses, questionnaires, forms, appendices, spreadsheets, and any electronic files. The City may deem a proposer non-responsive if the proposer fails to provide all required documentation, copies, or electronic files. 4.2 Cover Letter Each proposal must include a cover letter limited to two pages. The cover letter must include the title, address, email address, and telephone number of the person or persons who will be authorized to represent the proposer. 4.3 Best Offer The proposal shall include the proposer’s best terms and conditions. Submission of the proposal shall constitute a firm and fixed offer to the City that will remain open and valid for a minimum of 12 months from the submission deadline. 4.4 Authorized Signatures Proposals must be signed by a duly authorized officer eligible to sign contract documents and authorized to bind the company to all commitments made in the proposal. A non-officer individual, with the authority to bind the proposer to a contract, is sufficient to sign all applicable documents for the purpose of this RFP. Consortiums, joint ventures, or teams submitting proposals will not be considered responsive unless it is established that all contractual responsibility rests solely with one proposer or one legal entity. The proposal must identify the responsible entity.
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4.5 Number of Proposal Copies Required Proposers are required to submit:
One (1) original written proposal sent to the City of Los Angeles RFP Administrator proposal delivery address which includes all required responses to Part A (see specific instructions in Section 3) and Part B, with all documents signed in ink.
Two (2) copies of the written proposal sent to the City of Los Angeles RFP Administrator proposal delivery address which includes all required responses to Part A only.
One (1) copy of the written proposal sent to the City of Los Angeles consultant proposal delivery address (Section 1.8) which includes all required responses to Part A only.
Four (4) electronic (USB drive) copies of your Part A response in Word and PDF formats: three to the City of Los Angeles RFP Administrator, and one to the City of Los Angeles consultant for this RFP. Please see additional information in Section 4.6.
Original and copies should be identified as such. If any proposal contains any trade secrets or other proprietary information that the proposer claims is exempt from disclosure under the California Public Records Act (see Section 6.0 of this RFP), then one (1) redacted copy of the proposal must also be submitted in addition to the original version. Written proposals must be presented in a sealed envelope or box. Proposer must enter the title and proposer’s name on the outside of the envelope or box. Sealed proposals are to be delivered to the address listed in this RFP no later than the stated proposal submission deadline. Certain efficiencies in how proposals are prepared and submitted are requested in order to facilitate the review, storage, and recycling processes for proposal materials. Economy in presentation and packaging is preferred over materials which are not easily reproduced, create unnecessary waste, or are awkward to store. Please do not submit materials in plastic binders. Each response should have the bulk of its contents prepared on standard 8½ x 11 paper. Non-essential promotional materials and over-sized materials should be avoided wherever possible except as otherwise requested within the RFP. 4.6 Electronic (USB Drive) Submission In addition to the written copies of the proposal, proposers are required to provide a copy of the proposal in Adobe PDF, Microsoft Word, and (questionnaire only) Microsoft Excel format on a USB flash drive. Redacted versions should be sent separately and identified as such. The USB flash drive containing the proposal versions should be labeled with the firm name and title of this RFP and placed in a sealed envelope with the firm’s name written across the front of the envelope and attached or affixed to the original RFP response.
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4.7 Information Requested and Not Furnished The information requested and the manner of submission are essential to permit prompt evaluation of all proposals. Accordingly, the City reserves the right to declare as non-responsive and reject any proposals in which information is requested and is not furnished or when a direct or complete answer is not provided. 4.8 Alternatives The proposer shall not change any wording in the RFP or associated documents. Any explanation or alternatives offered shall be submitted in a letter attached to the front of the proposal documents. Alternatives that do not substantially meet the City’s requirements cannot be considered. Proposals offered subject to conditions and/or limitations may be rejected as non-responsive. 4.9 Proposal Errors Proposer is responsible for all errors or omissions incurred by proposer in preparing the proposal. Proposer will not be allowed to alter proposal documents after the Proposal Submission Deadline, except as allowed by the City. The City reserves the right to make corrections or amendments due to errors identified in the proposal by the City or the proposer. This type of correction or amendment will only be allowed for typographical errors, transposition, or other obvious error. Any changes will be dated and time stamped, and attached to the proposal. All changes must be coordinated in writing with, authorized by, and made by the Contract Administrator. 4.10 Proposal Clarification The City reserves the right to request proposers at any phase of the evaluation process to clarify information provided in RFP responses including clarification of assumptions used in the RFP response. All clarifications must be coordinated in writing with, authorized by, and made by the Contract Administrator. Clarifications must be submitted in writing by the requested deadline, otherwise the RFP response will be deemed non-responsive or evaluated without the benefit of the clarification requested.
If the City determines that all proposers failed to submit requested information or adequately responded to the same RFP question or request for data, the City may, at its discretion, issue an RFP Addendum and provide all proposers with an opportunity to provide a response to the RFP question. Responses to RFP Addendum questions must be submitted in writing by the stated deadline otherwise the RFP response will be deemed non-responsive or evaluated without the benefit of the clarification requested. 4.11 Waiver of Minor Administrative Irregularities The City reserves the right, at its sole discretion, to waive minor administrative irregularities contained in any proposal. 4.12 Interpretation and Clarifications of RFP Requirements The City will consider prospective recommendations or suggestions regarding any requirements before the Pre-Proposal Conference. All recommendations or suggestions must be in writing and submitted to the Contract Administrator (see page 1 of the RFP). The City reserves the right to modify or amend any and all requirements of the RFP.
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4.13 Proposal Submission Deadline Timely submission of proposals is the sole responsibility of the proposer. The City reserves the right to determine the timeliness of all submissions. The proposals, including all hard copies, redacted copies and electronic copies of the final proposals and proposal questionnaire must be received by the RFP Administrator at the published location and by the published due date included with this RFP. It should be noted that all persons and materials entering the Employee Benefits Division’s City Hall location must go through a security check. Proposers should allow ample time to clear security in order to meet the deadline listed above. All proposals will be date and time stamped upon receipt. 4.14 Late Proposals Proposals submitted after the Proposal Submission Deadline shall be considered late. Late proposals will not be considered. 4.15 Cost of RFP The City is not responsible for any costs incurred by proposer while submitting proposals. All proposers who respond to the RFP do so solely at their own expense. 4.16 Withdrawal of Proposals Proposer may withdraw a submitted proposal in writing at any time prior to the Proposal Submission Deadline. A written request, signed by an authorized representative of the proposer, must be submitted to the RFP Administrator. After withdrawing a previously submitted proposal, the proposer may submit another proposal at any time up to the Proposal Submission Deadline. 4.17 Selection of Vendor The proposer with the highest score based on the RFP criteria and that also satisfies all City contracting requirements will be recommended for selection. Selection is not restricted to the lowest offer or bid. Should contract negotiations not be successful with the selected proposer, the City may, based on its exclusive discretion, negotiate with the next most qualified proposer or cancel the RFP selection process. 4.18 Rejection of Proposals The City reserves the right to reject any proposal due to non-compliance with the RFP requirements and/or non-compliance with City policies or reject all proposals; to waive any minor informality in proposals received; to reject any unapproved alternate proposal(s); and reserves the right to reject the proposal of any proposer who has previously failed to perform competently in any prior business relationship with the City and/or is determined to be non-responsive to the requirements of this RFP. The rejection of any or all proposals will not render the City liable for costs or damages.
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4.19 RFP Withdrawal, Cancellation, Other Options The City reserves the right to withdraw or cancel the RFP at any time, if it deems such action necessary. If such action is taken, the City may re-issue the RFP. The City also reserves the right to contract with more than one respondent to this RFP. Furthermore, the City may exercise its right to not select any proposer from this RFP, if it determines that there was no responsive proposer. If an inadequate number of proposals is received or the proposals received are deemed non-responsive, not qualified, or not cost effective, the City may, at its sole discretion, reissue the RFP or award a sole-source contract with a vendor. The award of the contract is subject to the successful negotiation of the terms and conditions of an agreement.
The City reserves the right to verify all information in the proposal. If the information cannot be verified, the City reserves the right to reduce the rating points awarded. The City reserves the right to require a pre-award interview and/or site inspection. 4.20 Contract Evaluation Program When the term of the contract pursuant to this RFP has concluded, the City will conduct an evaluation of the Contractor’s performance. The City may also conduct evaluations of the Contractor’s performance during the term of the contract. As required by Section 10.39.2 of the Los Angeles Administrative Code, evaluations will be based on specified criteria, including the quality of the work product or service performed, the timeliness of performance, financial issues, and the expertise of personnel that the Contractor assigns to the Contract. A Contractor who receives a “Marginal” or “Unsatisfactory” rating will be provided with a copy of the final City evaluation and allowed fourteen (14) calendar days to respond. The City will use the final City evaluation and any response from the Contractor to evaluate Proposals and to conduct reference checks when awarding future service contracts. 4.21 Campaign Contributions
a) Proposers are subject to Charter Section 470(c)(12) and related ordinances. As a result, proposers may not make campaign contributions to and or engage in fundraising for certain elected City officials or candidates for elected City office from the time they submit the Proposal until either the contract is approved or, for successful proposers, twelve months after the contract is signed. The proposer’s principals and subcontractors performing $100,000 or more in work on the contract, as well as the principals of those subcontractors, are also subject to the same limitations on campaign contributions and fundraising.
b) Proposers must submit CEC Form 55, provided as Attachment 11 in Part B,
to the awarding authority at the same time the Proposal is submitted. The Form requires proposers to identify their principals, their subcontractors performing $100,000 or more in work on the contract, and the principals of those subcontractors. Proposers must also notify their principals and subcontractors in writing of the restrictions and include such notice in
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contracts with subcontractors. Proposals submitted without a completed CEC Form 55 shall be deemed non-responsive. Proposers who fail to comply with City law may be subject to penalties, termination of Contract, and debarment. Additional information regarding these restrictions and requirements may be obtained from the City Ethics Commission at (213) 978-1960 or http://ethics.lacity.org/.
4.22 Business Inclusion Program Requirements (BIP) It is the policy of the City to provide Minority Business Enterprise (MBE), Women Business Enterprise (WBE), Small Business Enterprise (SBE), Emerging Business Enterprise (EBE), Disabled Veteran Business Enterprise (DVBE), and all Other Business Enterprise (OBE) concerns an equal opportunity to participate in the performance of all City contracts. Proposers will assist the City in implementing this policy by taking all reasonable steps to ensure that all available business enterprises, including MBEs, WBEs, SBEs, EBEs, DVBEs, and OBEs, have an equal opportunity to compete for, and participate in, City contracts. Equal opportunity will be determined by the proposer’s BIP outreach documentation, as described in Part B, Attachment 13, and the Business Inclusion Program for this RFP. Participation by MBEs, WBEs, SBEs, EBEs, DVBEs, and OBEs may be in the form of subcontracting. Proposers must refer to Attachment 13 Business Inclusion Program to this RFP for additional information and instructions. BIP outreach must be performed using the Business Assistance Virtual Network (www.labavn.org). A proposer’s failure to utilize and complete their BIP Outreach as described in Attachment 13 may result in their proposal being deemed non-responsive. Please note this RFP’s published deadline for submitting the BIP Summary Sheet on www.labavn.org. 4.23 Local Business Preference Program Ordinance Proposers are advised that any proposal submitted and or contract awarded pursuant to this procurement process shall be subject to the applicable provisions of Los Angeles Administrative Code Section 10.47, Local Business Preference Program (LBPP) Ordinance. The City is committed to maximizing opportunities for local businesses, as well as encouraging local businesses to locate and operate in Los Angeles County. The LBPP Ordinance allows the Department to apply additional points to the Proposal’s final score under certain conditions.
Proposers shall refer to Part B, Attachment 12, “Local Business Preference Program” for further information regarding the requirements and application of the Ordinance. If applicable, proposers may choose to complete and upload the Local Business Certification Affidavit of Eligibility available on the City of Los Angeles’ Business Assistance Virtual Network (BAVN) residing at www.labavn.org prior to the Proposal Submission Deadline. The City may request supporting documentation to verify qualification for designation as a Local Business. Only those proposers who apply and qualify for a Local Business designation (or otherwise qualify by using a qualified Local Subcontractor) by the Proposal Submission Deadline will be made eligible for additional points that can be awarded under the ordinance.
Proposers seeking additional information regarding the requirements of the Local Business Preference Program Ordinance may visit the Bureau of Contract Administration’s web site at http://bca.lacity.org. 4.24 Confidentiality All documents, records, and information provided by the City to the Contractor, or accessed or reviewed by the Contractor, during performance of the services will remain the property of the City. All documents, records, and information provided by the City to the Contractor, or accessed or reviewed by the Contractor and any if its employees during performance of services, are confidential (hereinafter collectively referred to as “Confidential Information”). The Contractor agrees not to provide Confidential Information, nor disclose its content or any information contained in it, either orally or in writing, to any other person or entity. The Contractor agrees that all Confidential Information used or reviewed in connection with the Contractor's work for the City will be used only for the purpose of carrying out City business and cannot be used for any other purpose. The Contractor will be responsible for protecting the confidentiality and maintaining the security of City documents and records in its possession.
Any Confidential Information provided by the City to the Contractor, or accessed or reviewed by Contractor, during performance of services, will be made available to its employees, agents, and subcontractors only on a need to know basis. Further, the Contractor will provide written instructions to all of its employees, agents, and subcontractors, with access to the Confidential Information about the penalties for its unauthorized use or disclosure. The Contractor must not remove Confidential Information or any other documents or information used or reviewed in connection with the Contractor's work for the City from City facilities without prior approval from the City. At no cost to the City, the Contractor will, at the conclusion of services, or at the request of the City, promptly return in an organized manner that preserves and protects the documentation, any and all Confidential Information and all other written materials, notes, documents, or other information obtained by the Contractor during the course of work under the contract. The Contractor will not make or retain copies of any such information, materials, or documents. The Contractor and its employees, agents, and subcontractors may have access to confidential employee personnel information. Misuse of such information may adversely affect the subject individual’s civil rights and violates the law. The Contractor will implement reasonable and prudent measures to keep secure employee personnel information accessed by its employees, agents, and subcontractors during the performance of services. The Contractor will advise its employees, agents, and subcontractors of this confidentiality requirement. The Contractor shall disclose the intent to use any service provider outside the continental United States of America to handle any aspect of the work within the scope of services, and shall describe to the City’s satisfaction the methods, which will be utilized to protect the City’s interests and confidentiality of City records and information in doing so. The City reserves the right to approve any such service provider throughout the term of the contract at its sole and absolute discretion.
Any breach of security that occurs through Contractor’s website, offices, or network shall require Contractor to be responsible for notifying City and all affected by such breach. Contractor shall also be responsible for all costs associated with such notification. The Contractor shall indemnify the City for any breaches of its security and the improper disclosure of confidential information. 4.25 Government Taxation Forms Proposers must submit the following three forms found in Part B, Attachment 3 to the awarding authority at the same time the Proposal is submitted:
IRS Request for Taxpayer Identification and Certificate (Form W-9)
Evidence of having obtained or applied for a tax registration account number (City of L.A. Tax Registration Certificate number and/or Vender Registration number)
State of California Withholding Exemption Certificate (Form 590) or Non-resident Withholding Certification (Form 587), if the proposer is located outside of California.
4.26 On-Line Submission of Required Documents
a) Nondiscrimination, Equal Employment Practices and Affirmative Action Program (Non-Construction) Proposers are advised that any contract awarded pursuant to this procurement process shall be subject to the applicable provisions of Los Angeles Administrative Code Section 10.8.2., Non-discrimination Clause. Contractors that provide non-construction services to or for the City for which the consideration is $1,000 or more shall comply with the provisions of Los Angeles Administrative Code Sections 10.8.3., Equal Employment Practices Provisions. All proposers shall complete and upload the Non-Discrimination/Equal Employment Practices Affidavit (two (2) pages) available on the City of Los Angeles’ Business Assistance Virtual Network (BAVN) residing at www.labavn.org prior to award of a City contract valued at $1,000 or more. Contractors that provide non-construction services to or for the City for which the consideration is $100,000 or more shall comply with the provisions of Los Angeles Administrative Code Section 10.8.4., Affirmative Action Program Provisions. All proposers shall complete and upload the City of Los Angeles Affirmative Action Plan (four (4) pages) available on the City of Los Angeles’ Business Assistance Virtual Network (BAVN) residing at www.labavn.org prior to award of a City contract valued at $100,000 or more. Proposers opting to submit their own Affirmative Action Plan may do so by uploading their Affirmative Action Plan onto the City’s BAVN. Both the Non-Discrimination/Equal Employment Practices Affidavit and the City of Los Angeles Affirmative Action Plan Affidavit shall be effective for a period of twelve months from the date they are first uploaded onto the City’s BAVN.
Proposers seeking additional information regarding the requirements of the City’s Non-Discrimination Clause, Equal Employment Practices and Affirmative Action Program may visit the Bureau of Contract Administration’s web site at http://bca.lacity.org.
b) Equal Benefits Ordinance
Proposers are advised that any contract awarded pursuant to this procurement process shall be subject to the applicable provisions of Los Angeles Administrative Code Section 10.8.2.1, Equal Benefits Ordinance (EBO). All proposers shall complete and upload the Equal Benefits Ordinance Affidavit (two (2) pages) available on the City of Los Angeles’ Business Assistance Virtual Network (BAVN) residing at www.labavn.org prior to award of a City contract, the value of which exceeds $5,000. The Equal Benefits Ordinance Affidavit shall be effective for a period of twelve months from the date it is first uploaded onto the City’s BAVN. Proposers do not need to submit supporting documentation with their bids or proposals. However, the City may request supporting documentation to verify that the benefits are provided equally as specified on the Equal Benefits Ordinance Affidavit. Proposers seeking additional information regarding the requirements of the Equal Benefits Ordinance may visit the Bureau of Contract Administration’s web site at http://bca.lacity.org.
c) Slavery Disclosure Ordinance
Unless otherwise exempt, in accordance with the provisions of the Slavery Disclosure Ordinance, any contract awarded pursuant to this RFP will be subject to the Slavery Disclosure Ordinance, Section 10.41 of the Los Angeles Administrative Code. All proposers shall complete and upload the Slavery Disclosure Ordinance Affidavit (one (1) page) available on the City of Los Angeles’ Business Assistance Virtual Network (BAVN) residing at www.labavn.org prior to award of a City contract. Proposers seeking additional information regarding the requirements of the Slavery Disclosure Ordinance may visit the Bureau of Contract Administration’s web site at http://bca.lacity.org.
d) First Source Hiring Ordinance Unless approved for an exemption, contractors under contracts used primarily for the furnishing of services to or for the City and that involve an expenditure in excess of $25,000 and a contract term of at least three (3) months, and certain recipients of City Loans or Grants, shall comply with the provisions of Los Angeles Administrative Sections 10.44, et seq., First Source Hiring
Ordinance (FSHO). Proposers shall refer to Standard Provisions for City Contracts (Revised 1/17), Attachment 7, “First Source Hiring Ordinance”, for further information regarding the requirements of the Ordinance. The First Source Hiring Ordinance Compliance Affidavit shall only be required of the proposer that is selected for award of a contract.
4.27 Americans with Disabilities Act As covered under Title II of the Americans with Disabilities Act, the City of Los Angeles does not discriminate on the basis of disability and, upon request, will provide reasonable accommodation to ensure equal access to its proposals, programs, services, and activities. If an individual with a disability requires accommodations to attend the Pre-Proposal Conference, please contact the Contract Administrator at least five working days prior to the scheduled event. 4.28 Fair Chance Initiative for Hiring Ordinance City contractors and subcontractors with 10 or more employees are prohibited under Los Angeles Administrative Code Section 10.48 from seeking a job applicant’s criminal history information until a job offer is made and from withdrawing a job offer unless the employer performs an assessment of the applicant’s criminal history and the duties of the position. Contractors and subcontractors are required to include information regarding the ordinance in all job solicitations and advertisements and to post notices informing job applicants of their rights. Additional information and forms may be found Department of Public Works, Bureau of Contract Administration at http://bca.lacity.org/. 4.29 Iran Contracting Act of 2010 In accordance with California Public Contract Code Sections 2200-2208, all bidders submitting proposals for, entering into, or renewing contracts with the City of Los Angeles for goods and services estimated at $1,000,000 or more are required to complete, sign, and submit the “Iran Contracting Act of 2010 Compliance Affidavit.”
EVALUATION OF PROPOSALS 5.0 Review Process Proposals received by the Proposal Submission Deadline as specified in this RFP will be evaluated as outlined below.
Preliminary Review - Level One Proposals will be reviewed to determine completeness of required documentation and compliance with the City’s administrative and general contracting requirements. Proposers that fail to submit or complete required documentation and/or satisfactorily comply with the City’s requirements will be deemed as non-responsive, eliminated from further consideration, and will not proceed to the Level Two review process. Proposers will be notified in writing or email regarding the results of the Level One review. Proposal Evaluation - Level Two A Review Committee will be designated to evaluate/score the proposals and generate recommendations for selection to the City. Following the City’s selection, the award of the contract is subject to successful negotiation of the terms and conditions of an agreement.
1) Written Responses - All written responses to the RFP questionnaire will be
considered and evaluated.
2) Performance Examinations - Proposers will be required to participate in a series of performance examinations as identified by topic in Section 5.1 (“Review Criteria”). The performance examinations will be narrowly focused on specific topics and will each vary in length (approximately one to two hours for most examinations). The examinations will occur on a date to be determined by the City. The performance examinations will address in more substantive detail certain topics included within the Scope of Services of this RFP. Proposers will receive more detailed information with respect to the background, details, and questions for each topic immediately preceding each examination. Proposers will not be permitted at the performance examinations to discuss the qualifications of their firm; clarify or enhance written responses to the written portion of the RFP; or otherwise discuss any other component of their RFP response or interest in securing business with the City. The performance examinations are a uniquely scored component of the RFP consistent with all other topics and sub-topics comprising the scored written responses to the RFP.
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The City may require that some or all performance exams be performed on-site at the proposer’s headquarters and/or proposed contract servicing locations. Proposers will receive advance notice of a request to arrange for on-site performance exams. Tentatively, the City expects to conclude all performance exams by September 2017. The length, structure, and format for all performance exams will be identical among all proposers.
The City’s Joint Labor-Benefits Management Committee reserves the right to request oral presentations of all of or the highest-ranked vendors prior to generating its recommendation for selection to the General Manager Personnel Department. However, the evaluation and scoring of vendor proposals will be based strictly on the vendor responses to the RFP, and the scoring of performance exams. Proposers will not be permitted to submit new materials or otherwise enhance their proposals as part to the oral presentation. 5.1 Review Criteria Evaluation of submitted proposals will be based on the following factors and the weights associated with each factor.
ORGANIZATIONAL STRENGTH, PLAN SPONSOR & RECORDKEEPING SERVICES
Media Technology: Video, Mobile Apps & Other Media
Performance Exam: Member Website
10%
PARTICIPANT CALL CENTER & REPRESENTATIVES
Call Center Location, Hours & Languages
Staffing & Training
Metrics & Standards
Case Management, Call Monitoring & Reporting Capabilities
Call Center Customization Capabilities & Resources
Performance Exam: Participant Call Center
7%
PARTICIPANT CALL CENTER (AUTOMATED)
Structure, Script, Time & Languages
Email, Fax & Mail Capabilities
3%
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MEMBER SATISFACTION
Complaint Resolution
Website, Participant & Automated Call Center Member Satisfaction
2%
MEMBER COMMUNICATIONS & COUNSELING SERVICES
Communications Philosophy & Resources
Enrollment Guide
Enrollment Worksheets & Confirmation Statements
Onsite Member Advocate & Local Counseling Services
3%
25%
FEES & GUARANTEES
Fees & Charges
Processing Standards and Performance Guarantees
15%
TOTAL
100%
5.2 Proposal Protest
Level One - Preliminary Review Proposer may file a protest regarding disqualification at the Level One review (see Section 5.0, “Preliminary Review - Level One”). A Notice of Protest must be filed in writing and submitted to the RFP Administrator within five (5) calendar days of the notification of disqualification date. The Notice of Protest must clearly state the grounds for the protest and the facts on which they are based. The Personnel Department will respond to a protest within 15 calendar days of receiving it, and the Department, at its election, may set up a conference call with the proposer to discuss the protest concerns. The decision of the General Manager Personnel Department will be final. Level Two - Award of Contract Recommendation Proposers may file a protest regarding the contract recommendation submitted to the General Manager Personnel Department. A Notice of Protest must be filed in writing and submitted to the RFP Administrator within seven (7) calendar days of the date the City makes its final vendor selections pursuant to this RFP. The Notice of Protest must clearly state the grounds for the protest and the facts on which they are based. A protest based on non-selection alone or disagreement with award of the contract recommendation is not sufficient grounds for a protest. Personnel Department staff will respond to a protest, in writing, within 20 calendar days of receiving it, and the Personnel Department, at its election, may set up a conference call or meeting with the proposer to discuss the protest concerns. Findings and/or recommendations will be submitted to the General Manager Personnel Department and the decision of the General Manager will be final.
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SECTION 6
GENERAL TERMS & CONDITIONS
6.0 Property of City/Proprietary Material All proposals submitted in response to this RFP will become the property of the City of Los Angeles and subject to the California Public Records Act (California Government Code Section 6250 et seq). Proposers must identify all trade secrets or other proprietary information that the proposers claim are exempt from the Public Records Act. The City Attorney will make an independent determination regarding whether the identified information is disclosable. In the event a proposer claims such an exemption, the proposer is required to state in the proposal the following: “The Proposer will indemnify the City and its officers, employees and agents, and hold them harmless from any claim or liability and defend any action brought against them for their refusal to disclose trade secrets or other proprietary information to any person making a request therefore.” Failure to include such a statement will constitute a waiver of a proposer’s right to exemption from this disclosure. 6.1 Pre-Award Negotiations Prior to award of the contract, the successful proposer(s) may be required to attend negotiation meetings that will be scheduled at a later date. The intent of the meeting(s) will be to discuss and negotiate contract requirements, prices/premiums, service level agreements, detailed scope of work specifications, ordering, invoicing, delivery, receiving and payment procedures, etc. in order to insure successful administration of the contract. 6.2 Execution of Contract Unless otherwise stated, proposals submitted will be irrevocable for a period of one-year following the Proposal Submission Deadline. A contract will be developed following action by the City.
Any contract made pursuant to this RFP must be accepted in writing by the Proposer. If for any reason, Proposer should fail to accept the contract in writing, then the Proposer may be deemed non-responsive and the City may commence contract negotiations with another proposer.
Please note that the City takes a legal approach whereby all contracts contain an order of precedence. In the event of a discrepancy between the provisions of the Contractor’s documents and the City’s documents, the City’s documents take precedence with respect to resolution of the discrepancy.
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6.3 Amendments/Modifications/Change Orders Any amendments, adjustments, alterations, additions, deletions, or modifications in the terms and/or conditions of the resultant agreement must be made by written amendment/change order approved by the Contracting Authority, the Contractor, and signed by the City Attorney. If Contractor performs any modification without a written amendment/change order, the City will neither pay for nor be obligated to accept said modification. 6.4 Prime Contractor & Subcontractors The Proposer awarded the contract must be the prime Contractor performing the primary functions of the contract. If any portion of the contract is to be subcontracted, it must be clearly set forth in the proposal document as to what part(s) are to be subcontracted, the reasons for the subcontracting, and a listing of subcontractors. Acceptance or rejection of a Proposer’s request to use subcontractors is at the sole discretion of the City. With approval of the City, the Contractor may enter into subcontracts and joint participation agreements with others for the performance of portions of the resultant agreement. The provisions of the resultant agreement will apply to all subcontractors in the same manner as to the Contractor. In particular, the City will not pay, even indirectly, the fees and expenses of subcontractors that do not conform to the limitations and documentation requirements of the resultant agreement. The City reserves the right to reject any proposal wherein use of subcontractors significantly affects the ability of the Proposer to function as the prime Contractor on the awarded contract. The prime Contractor will at all times be responsible for the acts and errors or omissions of its subcontractors or joint participants and persons directly or indirectly employed by them. Upon request from the City, the Contractor will supply the City with all subcontractor agreements at no cost. 6.5 Supplier Performance Feedback Meetings The Proposer awarded the resulting agreement is required to attend periodic performance feedback meetings facilitated by the City. The meetings will focus on the Contractor’s and the City’s performance in fulfilling the service level requirements contained in the contract. The meetings will provide a forum to informally discuss opportunities for improving contract terms and conditions, service level requirements, and cost reductions for both parties. 6.6 Replacement of Contractor’s Staff The City reserves the right to have the Contractor replace any contract personnel with equally or better qualified staff upon providing written notice to Contractor. In addition, the City reserves the right to approve in advance any changes in project personnel or levels of commitment by the Contractor to the project.
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6.7 Contractor’s Address The address given in the proposal response will be considered the legal address of the Contractor and will be changed only by written notice to the City. The Contractor will supply an address to which certified mail can be delivered. The delivery of any communication to the Contractor personally, or to such address, or the depositing in the United States Mail, registered or certified with postage prepaid, addressed to the Contractor at such address, will constitute a legal service thereof. Also, telephone numbers, fax numbers, and e-mail addresses (if applicable) must be provided.
6.8 Term & Option to Renew The term of any contract(s) established pursuant to this RFP shall be for the period identified in the RFP Introduction. The City reserves the right in its sole discretion to seek an extension of the term of the contract.
6.9 Standard Contract Provision Requirements Please carefully review the information contained in the City of Los Angeles Requirements and Checklist (Part B), including the Standard Provisions for City Contracts. Compliance with these requirements and submission of necessary forms is mandatory at the time of submission of a proposal, prior to award of contract, or both. These requirements will be discussed in detail at the Pre-Proposal Conference. Failure to comply with the requirements and accept the contract provisions will render proposals non-responsive and eliminate them from consideration. 6.10 Governing Law All matters relating to the formation, validity, construction, interpretation, performance, and enforcement of the RFP and the resultant agreement/contract, must comply with all applicable laws of the United States of America, the State of California, and the City. 6.11 California State Sales Tax Do not include California State sales tax in prices quoted unless otherwise requested. If requested, sales tax must be identified as being included in the pricing. 6.12 California State Board of Equalization Permit Proposer must enter the company’s State of California Board of Equalization permit number on the proposal form. If the company does not have this permit, the proposer must sign the proposal form declaring that the company has no California sales tax permit. 6.13 Federal Excise Taxes The City of Los Angeles is exempt from the payment of excise taxes imposed by the Federal Government. Such taxes must not be included in the proposed prices. The Department of General Services, upon request, will furnish Federal excise exemption certificates. 6.14 Periodic Independent Audit The City reserves the right to assign an independent auditor to assess the quality of services being provided and the extent to which the vendor and its subcontractors are
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conducting City business within generally accepted industry standard practices. Each Contractor will be required to cooperate fully with any external audit. 6.15 Financial Audit Firms providing services to the City will be responsible for the verification of the legitimacy of payments made to service providers and their subcontractors. The City therefore reserves the right for staff of its Office of the Controller or their designee to conduct audits of financial accountability procedures. 6.16 Proposer Background Information Proposers must submit contact information as requested in the Proposal Questionnaire. 6.17 Verification of Prior City Contracts Vendors are required to provide a list of all City contracts held within the past 10 years to be included in the response package for all bids and proposals. Performance on past contracts with the City of Los Angeles will be part of the evaluation criteria. Failure to disclose this information will deem the proposal non-responsive. 6.18 History of Terminated Contracts You must describe any incident within the past 10 years in which your business has had a contract terminated for default as requested in the Proposal Questionnaire. 6.19 Business Organization Proposer shall provide an overview of the entity submitting this RFP as requested in the Proposal Questionnaire. 6.20 Proposed Subcontractor Information If applicable to proposal, information must be provided for each proposed subcontractor as requested in the Proposal Questionnaire. 6.21 Proposer Signature Declaration Proposer shall provide a Signature Declaration as requested in the Proposal Questionnaire (Attachment J).
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Attachments A to I Supplemental information contained in Attachments A to I will be provided upon receipt of a signed mutual confidentiality agreement. Please contact Segal Consultants to receive a copy of the confidentiality agreement: Segal Consultants Attention: Stephen E. Murphy Vice President, Benefits Consultant 330 N. Brand Blvd., Suite 1100 Glendale, CA 91203-2337 Fax: 818-484-2697 [email protected]
PROPOSER SIGNATURE DECLARATION PAGE The undersigned hereby offers and agrees to furnish the goods and/or routine services in compliance with all the service level requirements, instructions, specifications, and any amendments contained in this RFP document and any written exceptions in the offer accepted by the City. This proposal is genuine, and not sham or collusive, nor made in the interest or in behalf of any person not herein named; the proposer has not directly or indirectly induced or solicited any other proposer to put in a sham proposal, or any other person, firm or corporation to refrain from submitting a proposal; and the proposer has not in any manner sought by collusion to secure for itself an advantage over any other proposer. Each proposal must be signed on behalf of the proposer by an officer authorized to bind the proposer to the proposal. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct and I agree to the terms and conditions in this proposal.
The proposer hereby acknowledges receipt of and agrees this Proposal is based on the RFP and the following addenda. Failure to indicate receipt of addenda may result in the proposal being rejected as non-responsive. To constitute a responsive proposal, you must return all pages of the proposal forms.
Company Name Date
Signature of Authorized Person
Printed Name Title
Address
City, State, Zip
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NO PROPOSAL
If not submitting a proposal, please state reason and return this sheet to:
City of Los Angeles Personnel Department Employee Benefits Division City Hall, Room 867 200 North Spring Street Los Angeles, CA 90012 Attention: Jenny M. Yau
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