rfp_actuarial.doc

REQUEST FOR PROPOSAL

HEALTH INSURANCE RISK-SHARING PLAN AUTHORITYACTUARIAL SERVICES CONTRACT

LATE PROPOSALS WILL BE REJECTED

THE HIRSP AUTHORITY RESERVES THE RIGHT TO REJECT ANY OR ALL PROPOSALS

HIRSP Authority Actuarial Services Contract RFP

TABLE OF CONTENTS

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1.0 GENERAL INFORMATION...............................................................................11.1 Introduction and Background..................................................................................11.2 Overview of HIRSP Eligibility Requirements.........................................................21.3 Overview of HIRSP Benefit Plans...........................................................................41.4 Summary of HIRSP Cost-Sharing Requirements by Plan.......................................61.5 Premium, Deductible and Drug Coinsurance Subsidy Program..............................71.6 Covered Services.....................................................................................................91.7 Plan Administration...............................................................................................101.8 Overview of the HIRSP Funding Model...............................................................101.9 Scope of the Project...............................................................................................121.10 Definitions and Acronyms.....................................................................................121.11 Access to Program Information for Proposers.......................................................13

2.0 STATEMENT OF OBJECTIVES......................................................................14

3.0 PROCUREMENT AND CONTRACTING INFORMATION........................153.1 Procuring and Contracting Entity..........................................................................153.2 Clarification or Revisions to Specifications and Requirements............................153.3 Vendor Conference................................................................................................163.4 Calendar of Events.................................................................................................163.5 Contract Term........................................................................................................173.6 Letter of Intent to Submit Proposal........................................................................17

4.0 PREPARING AND SUBMITTING A PROPOSAL........................................184.1 General Instructions...............................................................................................184.2 Incurring Costs.......................................................................................................184.3 Submitting the Proposal.........................................................................................184.4 Use of Subcontractors............................................................................................194.5 Proposal Organization and Format........................................................................204.6 Multiple Proposals.................................................................................................204.7 Oral Presentations..................................................................................................214.8 Withdrawal of Proposals........................................................................................21

5.0 PROPOSAL SELECTION AND AWARD PROCESS....................................225.1 Preliminary Evaluation..........................................................................................225.2 Proposal Scoring....................................................................................................225.3 Right to Reject Proposals and Negotiate Contract Terms.....................................225.4 Evaluation Criteria.................................................................................................235.5 Award and Final Offers.........................................................................................235.6 Notification of Intent to Award..............................................................................235.7 Appeals Process.....................................................................................................23

6.0 GENERAL PROPOSAL REQUIREMENTS...................................................256.1 Designation of Primary Contact Person.................................................................25

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6.2 Organization Capabilities.......................................................................................256.3 Financial Statements..............................................................................................266.4 Desired Experience Qualification..........................................................................266.5 Staff Qualifications................................................................................................266.6 Proposer Client List and References......................................................................266.7 Contractor Location and Staffing...........................................................................276.8 Disaster Recovery Plan..........................................................................................276.9 HIPAA Compliance...............................................................................................276.10 Transmittal Letter...................................................................................................27

7.0 TECHNICAL REQUIREMENTS.....................................................................297.1 Actuarial Services..................................................................................................297.2 Performance Standards..........................................................................................317.3 Constraints Upon Contractor.................................................................................327.4 Detailed Transition Plan........................................................................................327.5 Data Collection and Reporting...............................................................................33

8.0 COST PROPOSAL..............................................................................................348.1 General Instructions and Information on Preparing Cost Proposals......................348.2 Method of Invoicing and Payment.........................................................................348.3 Allocation of Actuarial Fees..................................................................................348.4 Format for Submitting Cost Proposals...................................................................348.5 Fixed Price Period..................................................................................................348.6 Inflationary Adjustment.........................................................................................34

9.0 SPECIAL CONTRACT TERMS AND CONDITIONS...................................369.1 Executed Contract to Constitute Entire Agreement...............................................369.2 Applicable Law and Compliance...........................................................................369.3 Contractor Nondiscriminatory Employment Practice Requirement......................369.4 Data Management Requirements...........................................................................369.5 Public Record Access............................................................................................379.6 Hold Harmless.......................................................................................................379.7 Force Majeure........................................................................................................379.8 Certification of Independent Price Determination.................................................379.9 Independent Capacity of Contractor......................................................................389.10 Performance Review and Remedies......................................................................389.11 Contractor Compensation Remittance...................................................................399.12 News Releases.......................................................................................................399.13 Right to Publish......................................................................................................399.14 Contract Term and Termination.............................................................................39

10.0 REQUIRED FORMS...........................................................................................40

11.0 ATTACHMENTS................................................................................................41A. DESIGNATION OF CONFIDENTIAL AND PROPRIETARY INFORMATION...42B Cost Proposal Form.......................................................................................................43

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1.0 General Information

1.1 Introduction and Background

The purpose of this document is to provide interested parties with information to enable them to prepare and submit a proposal for an Actuarial Services contract, to provide actuarial services for the Health Insurance Risk-Sharing Plan Authority (HIRSP Authority). The HIRSP Authority intends to use the results of this solicitation to award a contract for the actuarial services.

The HIRSP Authority is a Wisconsin public body corporate and politic. The HIRSP Authority was established under Chapter 149, Wis. Stats., for the purpose of maintaining and administering the insurance risk-sharing pool known as the Health Insurance Risk-Sharing Plan (HIRSP), and assumed responsibility for administration of HIRSP effective July 1, 2006. HIRSP provides individual health care insurance policies to Wisconsin residents who cannot obtain health insurance in the commercial individual health insurance market or who lose their employer-sponsored coverage.

HIRSP functions as a health insurer, and issues policies to eligible individuals under four indemnity benefit plans and one Medicare supplemental plan. HIRSP also provides health care policies to persons who are entitled to continuation of coverages under federal law including the Health Insurance Portability and Accountability Act (HIPAA) under Title XXII, P.L.104-191. Individuals who lose their employer-sponsored group health insurance coverage and meet certain criteria may enroll in HIRSP without serving a pre-existing condition waiting period. As of August 31, 2008, total program enrollment in HIRSP was 16,344.

The HIRSP Authority qualifies as exempt from federal income taxation pursuant to Internal Revenue Code Section 501 (c) (26). An application for recognition of the HIRSP Authority’s tax-exemption under Section 501(c)(26) is currently pending before the Internal Revenue Service.

The HIRSP Authority administrative office exercises executive managerial oversight of the HIRSP plan. The HIRSP Authority is supervised by a board of directors comprised of thirteen voting members who are nominated by the governor and ratified by the senate. The board of directors also includes the commissioner of insurance or his designee as a non-voting board member. Four of the appointed directors represent insurers participating in the plan, four of the directors represent health care providers, and three of the directors represent consumer interests, including two directors who have coverages under HIRSP benefit plans. One director represents small business, and one director represents the public.

The HIRSP Authority derives all funding for its plan costs and policyholder subsidy costs through a funding formula prescribed by s. 149.143, Wis. Stats. Sixty percent of plan cost is funded by insurance policy premiums paid by policyholders, twenty percent of plan cost is funded through assessments levied on insurance companies that write health insurance coverages in Wisconsin, and

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twenty percent of plan cost is funded by health care providers through discounts on payments remitted by the HIRSP Authority as consideration for covered health care services rendered to HIRSP enrollees.

HIRSP enrollees who have annual income of less than $32,999 are eligible for subsidized assistance for premium payments, health care deductible payments, and drug co-payments. The costs for funding the low-income policyholder subsidies are paid on an equal-share basis by the assessed insurance companies and the participating health care providers.

The HIRSP Authority executive staff and board of directors are responsible for oversight of all financial matters related to the HIRSP plan including monitoring of HIRSP financial performance and establishing the annual HIRSP operating budget. The annual budgetary process includes utilization of actuarial projections and modeling to estimate annual program costs and revenue requirements, and entails the establishment of annual premium rates, policyholder subsidy levels, deductible and coinsurance amounts, the setting and collection of insurer assessments, and the adjustment of provider payment rates, as necessary, to meet program funding requirements.

HIRSP has no marketing staff and incurs no sales commissions. Policy acquisition costs are minimal and are expensed as incurred through the payment of one-time referral fees, in the amount of $40 for each policy issued, which are remitted to insurance agents who assist individuals with the HIRSP application process. All health insurers that do business in Wisconsin are required by law to notify individuals about HIRSP if an insurer declines to provide health care coverage. Individuals may also apply directly to HIRSP.

1.2 Overview of HIRSP Eligibility Requirements

Eligibility requirements for HIRSP are specified in state law. Wisconsin residents are eligible to enroll in HIRSP as a result of having health insurance coverage rejected or limited by an insurer, as a result of having tested positive for human immunodeficiency virus (HIV), or being eligible for Medicare due to disability or as a result of the loss of group sponsored health care coverage. An individual who is eligible for HIRSP based on the action of an insurer, an HIV diagnosis, or a Medicare qualified disability cannot receive coverage for services related to a pre-existing medical condition during the first six months of HIRSP benefit coverage. An individual who is eligible for HIRSP due to the loss of group sponsored health coverage is not required to serve a waiting period for coverage of pre-existing conditions.

A HIRSP policyholder enrolled in a HIRSP indemnity insurance plan who attains the age of 65 becomes eligible to continue as a HIRSP enrollee in the HIRSP Medicare Supplement Plan. Individuals who are eligible for Medicaid or the Wisconsin BadgerCare program are not eligible for enrollment in HIRSP. As of February 1, 2008, all children under 19 years of age in Wisconsin became eligible for BadgerCare.

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Eligibility as a Result of Action by an Insurer:Individuals under the age of 65 may apply for enrollment in HIRSP if, during the nine months prior to the application, they received and submitted with their application any of the following, based wholly or partially on medical underwriting considerations:

Notice of rejection or cancellation of coverage from two health insurers. Notice of reduction or limitation in coverage, including restrictive riders,

from an insurer if the effect of the reduction is to substantially reduce coverage compared to the coverage available to a person considered a standard risk for the type of coverage provided by the plan.

Notice of an increase in premium of 50% or more for a current policy, unless the increase is applicable to all of the insurer's health insurance policies then in effect.

Notice of a premium for a prospective policy from two or more insurers that is 50% or more in excess of the premium that would be paid by persons considered a standard risk for similar coverage.

Receipt of any of the above notices from a person who is an insurance intermediary (that is, an insurance broker or agent acting only on his or her authority) is not sufficient to qualify an individual for participation in the plan. An individual cannot be certified as eligible for participation in HIRSP without having actual receipt of one or more of the appropriate qualifying notices.

Eligibility as a Result of Certain Specified Diseases or Disabilities:Individuals under the age of 65 may also be eligible for coverage under HIRSP without having received any of the notices described above if they have certain specific diseases or disabilities. Persons may enroll in HIRSP if they submit evidence of:

A positive test for the human immunodeficiency virus or an antibody to HIV.

Coverage under Medicare because of a disability, defined as a condition which causes the individual to be unable to perform substantial, gainful activity because of a physical or mental impairment which will last at least 12 months.

Other Persons Eligible for HIRSP:Persons who meet the definition of an "eligible individual," under s. 149.10 (2t), Wisconsin Statutes, are also eligible to enroll in HIRSP. An eligible individual is an individual for whom all of the following apply:

The aggregate of the individual's period of creditable coverage is 18 months or more.

The individual's most recent period of creditable coverage was under a group health plan, governmental plan, federal governmental plan or church plan, or under any health insurance offered in connection with any of those plans.

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The individual does not have creditable coverage and is not eligible for coverage under a group health plan, Part A, Part B, or Part D of Medicare or Medical Assistance or any successor program.

The individual's most recent period of creditable coverage was not terminated for any reason related to fraud or intentional misrepresentation of material fact or a failure to pay premiums.

If the individual was offered the option of continuation coverage under a federal continuation provision or similar state continuation program, the individual elected the continuation coverage.

The individual has exhausted the continuation coverage.

1.3 Overview of HIRSP Benefit Plans

All HIRSP plans provide coverage for major medical and prescription drug expenses. Policyholders are responsible for paying premiums, annual deductibles, medical coinsurance, and prescription drug co-payment amounts.

HIRSP offers the same benefit plans and options to “eligible” individuals (HIPAA portability requirements) and to all other applicants. Four indemnity health insurance plans are offered to non-Medicare eligible individuals. The plans include: HIRSP 1,000, a $1,000 deductible plan; HIRSP 2,500, a $2,500 deductible plan; HIRSP 5,000, a $5,000 deductible plan; and HIRSP Health Savings Account, which has a $3,500 medical and drug deductible requirement and qualifies for the tax-deductible status of an individual HSA account. The HIRSP Medicare Supplement plan is available to persons who are eligible for Medicare health benefits. The available HIRSP plans and options are described in the following tables:

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Effective January 1, 2009HIRSP Non-HSA Benefit

PlansHIRSP 1,000 HIRSP 2,500 HIRSP 5,000 HIRSP Medicare

SupplementHIRSP Health Savings

AccountHIRSP Health

Savings AccountPremium reductions available if you qualify

Yes (Low-Income Subsidy summarized below)




Premium reductions available if you qualify


Medical deductible (you pay)

$1,000 per year $2,500 per year $5,000 per year $500 per year Medical/Drug deductible (you pay)

$3,500 per year

Medical deductible reductions available if you qualify




No Medical deductible reductions available if you qualify


Medical Coinsurance (you pay)

20% of allowed amount $1,000 per year



No Medical Coinsurance (you pay)

20% of allowed amount

Individual medical out-of-pocket maximum (your total expenditures for medical deductible and medical coinsurance, after which HIRSP will pay at 100%)

$2,000 per year $3,500 per year $6,000 per year $500 per year Drug Coinsurance (you pay)

20% of allowed amount

Family medical out-of-pocket maximum (all family members must be on the same plan)

$4,000 per year $7,000 per year $12,000 per year $1,000 per year Individual medical/drug coinsurance maximum

$2,100 per year

Drug Co-pay (you pay) $10 Tier 1 / $30 Tier 2Up to a maximum of $2,000 per year

$10 Tier 1 / $30 Tier 2Up to a maximum of $2,000 per year

$10 Tier 1 / $30 Tier 2Up to a maximum of $2,000 per year

$10 Generic / $30 BrandUp to a maximum of $1,500 per year

Individual medical/drug out-of-pocket maximum (your total expenditures for deductible and coinsurance, after which HIRSP will pay at 100%)

$5,600 per year

Drug out-of-pocket maximum reductions available if you qualify





Family out-of-pocket maximum (all family members must be on the same plan)

$11,200 per year

Pre-existing condition waiting period

Yes (refer to “Pre-existing” summarized below)




Out-of-pocket maximum reductions available if you qualify

Yes (refer to “Pre-existing” summarized below

Maximum lifetime benefit

$1,000,000 $1,000,000 $1,000,000 $1,000,000 Pre-existing condition waiting period


Maximum lifetime benefit $1,000,000

Low-Income Subsidy: Available for policyholders with household incomes of less than $32,999.HIRSP 1,000 / HIRSP 2,500 / HIRSP 5,000 – subsidized premium, medical deductible, and drug out-of-pocket maximumHIRSP HSA – subsidized premium and medical/drug deductible

Pre-existing: If an individual is eligible for HIRSP based on medical condition, HIRSP does not cover services or medications related to a pre-existing injury or illness, including maternity, during the first six months of HIRSP coverage. A pre-existing injury or illness is a condition, whether physical or mental, regardless of the cause of the condition, which was diagnosed or for which medical advice, care, or, treatment was recommended or received during the six months immediately preceding the HIRSP policy effective date.

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1.4 Summary of HIRSP Cost-Sharing Requirements by Plan

Policyholders enrolled in HIRSP indemnity benefit plans are required to satisfy medical deductible, medical coinsurance, drug co-payment, and maximum out-of-pocket expenditure requirements, which are calendar-year based and vary by plan option. Once the deductible, coinsurance, and co-payment out-of-pocket maximums have been met, HIRSP pays 100% of covered expenses for the remainder of the calendar year. HIRSP Medicare Supplement policyholders are required to satisfy calendar year medical deductible and drug co-payment out-of-pocket maximums. In the event that any part of a policyholder’s deductible amount is satisfied due to a claim incurred during the last three months of the year, the policyholder’s deductible amount for the following calendar year is reduced by an equal amount.

HIRSP 1,000 plan policyholders pay the first $1,000 of covered expenses as a medical deductible. Policyholders with qualifying income levels pay reduced deductibles. After the medical deductible has been met, policyholders pay 20% of the next $5,000 of covered expenses as medical coinsurance, up to a maximum of $1,000. All remaining covered medical services are paid by HIRSP.

HIRSP 2,500 plan policyholders pay the first $2,500 of covered expenses as a medical deductible. Policyholders with qualifying income levels pay reduced deductibles. After the medical deductible has been met, policyholders pay 20% of the next $5,000 of covered expenses as medical coinsurance, up to a maximum of $1,000. All remaining covered services are paid by HIRSP.

HIRSP 5,000 plan policyholders pay the first $5,000 of covered medical expenses as a medical deductible. Policyholders with qualifying income levels pay reduced deductibles. After the medical deductible has been met, policyholders pay 20% of the next $5,000 of covered expenses as medical coinsurance, up to a maximum of $1,000. All remaining covered medical services are paid by HIRSP.

HIRSP Health Savings Account (HSA) policyholders pay the first $3,500 of covered medical and drug expenses as a combined deductible. Policyholders with qualifying income levels pay reduced deductibles. After the combined deductible has been met, policyholders pay 20% of covered expenses up to a maximum of $5,600 annually. After the $5,600 policyholder liability is met, HIRSP pays 100% of the remaining covered medical and drug services.

HIRSP Medicare Supplement policyholders pay the first $500 of covered medical expenses as medical deductible and are not eligible for deductible reductions. The plan requires no medical coinsurance; therefore, HIRSP pays the full Medicare deductible and coinsurance for covered medical expenses once the $500 deductible has been met. HIRSP also wraps around the Medicare Part-D drug benefit with a maximum policyholder liability of $1,500 annually.

Annual family medical out-of-pocket maximums, not including drug coinsurance, apply to family members who are on the same plan; the maximums are $4,000 for HIRSP 1,000, $7,000 for HIRSP 2,500, $12,000 for HIRSP 5,000 and $1,000 for the HIRSP Medicare Supplement. The maximum out-of-pocket cost for a family that has more than one member enrolled in the HSA is $11,200, including drugs, and is set by federal law.

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Drug Co-payments and Annual Out-of-Pocket MaximumsPolicyholders in each indemnity plan must pay drug co-payments of $10 per prescription for Tier 1 drugs and $30 for Tier 2 drugs. Policyholders in the Medicare Supplement plan must pay drug co-payments of $10 for generic drugs and $30 for branded drugs. Maximum out-of-pocket co-payments are $2,000 for HIRSP 1,000, HIRSP 2,500 and HIRSP 5,000, and $1,500 for HIRSP Medicare Supplement. HIRSP Health Savings Account has an annual individual drug co-payment out-of-pocket maximum of $5,600 and a family out-of-pocket drug maximum of $11,200 (both are combined medical and drug maximum out-of-pocket costs). Once the drug co-payment out-of-pocket maximums have been met, HIRSP pays 100% of allowed prescription drug costs for the remainder of the calendar year.

Lifetime Benefit MaximumThe lifetime benefit maximum for all HIRSP plans is $1,000,000. The benefit maximum is the total amount that can be paid out to a HIRSP enrollee over the course of his or her lifetime, and includes both medical and drug benefits.

1.5 Premium, Deductible and Drug Coinsurance Subsidy Program

Low-income policyholders who qualify may apply for reduced premiums, medical deductible and drug coinsurance. The qualification criteria and amount of these reductions are specific to the respective HIRSP plan and the annual household income level of the policyholder. Approximately 25 percent of HIRSP policyholders receive subsidies.

Beginning January 1, 2009, the HIRSP low-income subsidy program offers premium discounts for all policyholders with household income below $32,999, regardless of benefit plan. A deductible discount is available to HIRSP 1,000, HIRSP 2,500, HIRSP Health Savings Account (HSA) and HIRSP 5,000 policyholders. The deductible discount for HIRSP HSA policyholders is a combined medical and drug deductible discount. HIRSP also offers a drug maximum out-of-pocket subsidy for all plans, including the HIRSP Medicare Supplement plan, except the HSA due to the combined medical/drug deductible.

The following tables summarize the subsidy discounts available to low-income HIRSP policyholders as of January 1, 2009.

HIRSP 1,000, 2,500 and 5,000 Plans

Household Income

Medical Deductible Discount

Premium DiscountDrug Out-of-Pocket

Maximum

$33,000 and Above

No Discount No Discount $2,000

$32,999-29,999 $100 15% $1,250

$25,000 - 29,999.99

$100 20% $1,000

$20,000 - 24,999.99

$100 25% $750

$17,000 – 19,999.99

$200 29% $600

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Household Income



Maximum

$14,000 – 16,999.99

$300 34% $525

$10,000 – 13,999.99

$400 39% $450

Less than $10,000

$500 43% $375

HIRSP Health Savings Account (HSA)*

Household Income



Maximum

$33,001 and Above

No Discount No Discount Not Applicable

$33,000-30,000 $100 15% Not Applicable

$25,000 - 29,999.99

$100 20% Not Applicable

$20,000 - 24,999.99

$100 25% No Applicable

$17,000 – 19,999.99


$14,000 – 16,999.99


$10,000 – 13,999.99


Less than $10,000


* The medical and drug benefit in the HSA plan is a combined benefit; therefore, a cap on out-of-pocket drug costs is not available. The maximum out-of-pocket cost of the HSA plan is set by federal law and is currently $5,600, unless you qualify for a reduced deductible.

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HIRSP Medicare Supplement

Household Income



Maximum

$33,001 and Above

No Discount No Discount $1,500

$33,000-30,000 No Discount 10% $500

$25,000 - 29,999.99

No Discount 10% $250

$20,000 - 24,999.99


$17,000 – 19,999.99


$14,000 – 16,999.99


$10,000 – 13,999.99


Less than $10,000


1.6 Covered Services

HIRSP indemnity plan benefits are consistent with Alternative Two in Section 8 of the NAIC Model Health Plan for Uninsurable Individuals Act. HIRSP benefit plans provide coverage of usual, customary and reasonable charges for medically necessary and appropriate services rendered by Wisconsin Medicaid-certified physicians. A partial list of covered services includes the following:

Physician and Hospital services Medical-surgical services Anesthesia services Consultations Prescription drugs Home care Radiology services Laboratory services Skilled nursing care Hospice care Transplant services Durable medical equipment PET scans and MRA studies Dental repair related to an injury

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1.7 Plan Administration

HIRSP day-to-day insurance operations are performed by a third-party plan administrator under an administrative services agreement with Wisconsin Physicians Service Insurance Corporation (WPS). The WPS plan administration of HIRSP operations commenced April 1, 2005. The administrative services agreement provided for an initial termination date of April 1, 2008, with three one-year renewals possible. The agreement was extended through March 31, 2010, at the July 2008 Board of Directors Meeting.

Business-operation services currently provided under the administrative services agreement include eligibility determination, policyholder and provider services, claims and systems administration, medical management, data collection and reporting, subrogation, coordination of benefits, disaster recovery, pharmacy benefit management, and actuarial services. The third-party plan administrator maintains the HIRSP general ledger and other financial accounts and records necessary to effectively administer HIRSP, and prepares monthly financial statements and HIRSP Monthly Reports and Annual Reports. HIRSP pharmacy benefit management services are currently performed by the third party contractor Navitus Health Solutions, and actuarial services are currently performed by the third-party contractor Milliman, Inc. HIRSP has established a direct contract for pharmacy benefit management services with MedTrak Pharmacy Services, LLC, effective January 1, 2009. The objective of this RFP is to establish a direct contract between HIRSP and an actuarial service provider, to commence effective February 1, 2009.

1.8 Overview of the HIRSP Funding Model

The HIRSP Authority derives funding for its plan costs and policyholder subsidy costs through a statutory funding formula prescribed by s. 149.143, Wis. Stats. Plan costs include claim costs and administrative expenses necessary to provide HIRSP contractual plan benefits, and exclude the costs of providing policyholder subsidies. As provided by the statute, sixty percent of HIRSP plan cost is funded by insurance policy premiums paid by policyholders, twenty percent of plan cost is funded through assessments levied on insurance companies that write health insurance coverages in Wisconsin, and twenty percent of plan cost is funded by health care providers through discounts on payments remitted by the HIRSP Authority as consideration for health care services rendered to HIRSP enrollees. The cost of policyholder subsidies is shared equally by insurers and participating providers and is in addition to those parties’ requirements for plan cost funding. The HIRSP plan does not receive any funding from state government appropriation of general purpose revenues.

1.8.1 Policyholder PremiumsHIRSP policyholders have a statutory requirement to fund 60% of HIRSP program costs through payment of insurance premiums. The full premium rates for HIRSP policyholders who are not eligible for a premium subsidy are determined during the annual budget planning process, and are established through actuarial modeling of projected annual revenues and plan costs. Chapter 149, Wis. Stats., provides that HIRSP subsidized premium rates are established as discounted from the HIRSP full premium rates, with discounts of 10% to 43% depending on annual household income. Averaged premium rates for unsubsidized HIRSP Policyholders equal 119.5% of the standard-risk rate for the second quarter of 2008 through the fourth quarter of 2008.

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1.8.2 Assessment of InsurersAn assessment to provide funding contribution for HIRSP program costs is levied on commercial insurance companies that issue health insurance coverages in Wisconsin. The commercial insurers have a statutory requirement to fund 20% of HIRSP plan costs plus one-half of the premium, deductible, and prescription drug subsidies that are granted to qualified low-income policyholders.

An insurer having written health insurance premiums in one calendar year is legally obligated to participate in the HIRSP assessment which will be issued in the subsequent calendar year. Section 149.13, Wis. Stats., provides that each insurer participating in the assessment pays a proportionate share of the total assessment that corresponds to that insurer’s proportionate share of the aggregate premiums charged for health insurance coverages issued in Wisconsin in the prior calendar year. Assessment receipts are recognized as earned revenue during the budget period for which the assessments are levied as a funding contribution.

Assessments for current year funding are billed to insurers semi-annually in January and July. The January billing is a provisional estimate that is calculated based on annual health insurance premiums written during the second-prior year. Assessment billings in July are calculated using premium written data from the immediate prior year, and are calculated to true-up the January assessment billing so that all of the assessment billed and paid in the current year is calculated based on the immediate prior year health insurance premiums written in Wisconsin.

1.8.3 Health Care Provider ContributionsA payment discounting methodology to provide funding contribution for HIRSP program costs is applied to health care providers who bill for health care services rendered to HIRSP enrollees as HIRSP plan benefits. Participating providers have a statutory requirement to fund 20% of HIRSP plan costs plus one-half of the premium, deductible, and prescription drug subsidies that are granted to qualified low-income policyholders.

Provider contributions are obtained by reducing the amount remitted by the HIRSP Authority to participating providers as consideration for billed services. The discount between HIRSP-defined usual and customary charges and the amount allowed as payment equals the provider contribution. Provider contributions represent expense payments forgone and are not a source of revenue.

The basis for calculating HIRSP program costs is usual and customary charges derived using a HIRSP Fee Schedule, which is based on actuarial analysis of HIRSP claim experience and analysis of generalized medical payment billing and payment practices in the health care industry. The HIRSP Fee Schedule payment rates serve as the usual and customary rates, to which a discount is taken to derive the HIRSP allowed payment amount. For most health care services, the current discount factor applied to HIRSP Fee Schedule rates to derive the HIRSP allowed amount is approximately 29%. The provider contribution discount exceeds 20% because providers contribute 20% of plan costs plus 50% of policyholder subsidy costs.

HIRSP has historically performed periodic actuarial analysis and review of the provider payment methodology to ensure that providers are adequately and fairly compensated and

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that the appropriate discount is applied to derive the health provider funding contribution that is required by statutes. The discount of usual and customary costs has been 28.5% for the past several years.

1.9 Scope of the Project

The Contractor will perform actuarial services for HIRSP as described in this RFP including, but not limited to, performing an annual survey of standard rate development, performing an annual Interim Accrual Reconciliation and determination of Reconciliation balances of HIRSP's three funding constituencies, preparation on a prospective basis of an annual operating budget, preparation of monthly reports of estimated unpaid medical and pharmacy claims based on actuarial analysis of historic paid claim files, calculation of premium rates for benefit plans, determination of the usual and customary provider contribution discount rates, and various ad-hoc analysis such as benefit design changes or responses to Board or Legislative inquiries.

The Contractor must have the flexibility to meet and respond to the changing requirements of HIRSP, including: increasing enrollment, new initiatives, or policy changes requiring additions or changes to benefit designs or discounting arrangements, or other related responsibilities for HIRSP.

If significant changes in the Contractor’s responsibilities are required, the HIRSP Authority will attempt to provide the Contractor with as much lead time as possible.

1.10 Definitions and Acronyms

The following definitions and acronyms are used throughout the RFP:

Board of Directors means HIRSP Authority Board of Directors.

Contract means the agreement to be executed between the selected proposer and the HIRSP Authority to accomplish the purposes specified in this RFP.

Contractor(s) means proposer(s) awarded the contract resulting from this RFP to provide HIRSP actuarial consultant services.

HIPAA means Health Insurance Portability and Accountability Act.

HIRSP means the Health Insurance Risk-Sharing Plan.

Health Insurance Risk-Sharing Plan Authority (HIRSP Authority) means the public body corporate and politic established under Ch. 149, Wis. Stats., responsible for the executive administration of HIRSP.

OCI means Office of the Commissioner of Insurance.

Proposer or Vendor means a firm submitting a Proposal in response to the RFP.

Provider means Wisconsin Medicaid Certified Health Care Provider.

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Policyholder means an individual who is enrolled as a member of a HIRSP health benefit plan, has paid premiums, and is eligible to receive benefits under a HIRSP policy.

RFP means Request for Proposal.

State means State of Wisconsin.

Wisconsin Medicaid Program (MA) means the program operated by the Wisconsin Department of Health and Family Services under Title XIX of the Federal Social Security Act, Ch. 49, Wis. Stats., and related State and Federal rules and regulations.

1.11 Access to Program Information for Proposers

Proposers are encouraged to view information regarding HIRSP on the HIRSP Authority website at www.hirsp.org. Information available at the website will assist proposers in the preparation of proposals. Available information includes the most recent HIRSP Annual Report, the HIRSP Outline of Coverage, the HIRSP Policy, Premium Tables, application materials, HIRSP newsletter, etc. While a reasonable attempt is made to maintain accurate and up-to-date information on the website, the HIRSP Authority makes no assurances or guarantees that all information and data displayed are accurate or complete. The HIRSP Authority disclaims responsibility for the accuracy or completeness of the information displayed on the HIRSP Authority website. If any materials, documentation, information, or data displayed on the website are discovered to be inaccurate and/or incomplete, such inaccuracy or incompleteness shall not constitute a basis for challenging the contract award or contract rejection, nor shall it provide a basis to renegotiate a payment amount or rate after contract award.

Requirements specified in the RFP shall take precedence over any documentation on the website if a conflict exists.

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2.0 STATEMENT OF OBJECTIVES

The purpose of the contract for Actuarial Services is to provide the HIRSP Authority with comprehensive professional actuarial services that are required in operating a solvent, cost-effective, efficient and customer-friendly risk-sharing health benefits program in conformance with all applicable state and federal regulations. Objectives include contracting with an organization that will:

Ensure a smooth transition with minimal disruption to financial oversight of HIRSP performed by the HIRSP Board of Directors and executive management, and minimal disruption to HIRSP operations administered by WPS, from contract implementation and throughout the contract term, including the transition to the succeeding Actuarial Services contractor.

Demonstrate a proven ability to provide comprehensive actuarial services in actuarial work on private sector individual health insurance, private sector small employer health insurance, private sector managed care environments, and risk-sharing insurance plans similar to HIRSP. Must demonstrate ability to perform the required actuarial services in a cost-effective manner and assure compliance with all state and federal regulations throughout the contract period.

Demonstrate proven excellence in Client Relations and the ability to service organizations similar to HIRSP.

Incorporate continuous quality improvement principles and practices in all aspects of operation.

Demonstrate data management capabilities to include the production of timely and accurate cost, statistical and utilization reports for program analysis and use as management tools.

Incorporate quality assurance best practices such as periodic peer reviews and independent evaluation processes to assure that the contractor’s work product is based on appropriate actuarial methodologies, is free of material error, and meets the highest professional standards of the actuarial industry.

Maintain the physical capacity and the overall motivation to maintain the highest level of responsiveness to the Board of Directors and HIRSP administrative management, to serve the actuarial service needs of HIRSP in a timely and effective manner.

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3.0 PROCUREMENT AND CONTRACTING INFORMATION

3.1 Procuring and Contracting Entity

The HIRSP Authority is the issuer of this RFP and is the sole point of contact during the vendor selection process. The HIRSP Authority administrative staff will administer the contract resulting from this RFP. The Contract Administrator and RFP Manager will be Amie Goldman, HIRSP Authority Chief Executive Officer.

3.2 Clarification or Revisions to Specifications and Requirements

Any questions concerning this RFP must be submitted in writing on or before October 31, 2008, to:

Amie Goldman, CEOHIRSP Authority33 East Main StreetSuite 230Madison, WI 53703Fax: (608) 441-5776E-mail: [email protected]

Vendors are expected to raise any questions, exceptions, or additions they have concerning the RFP document at this point in the RFP process. If a vendor discovers any significant ambiguity, error, conflict, discrepancy, omission, or other deficiency in this RFP, the vendor should immediately notify the above named individual in writing by the date above, of such error and request modification or clarification of the RFP document.

In the event that it becomes necessary to provide additional clarifying data or information, or to revise any part of this RFP, such revisions, amendments, and/or supplements will be provided to vendors who have submitted a letter of intent to submit a proposal in accordance with section 3.6 of this RFP.

Each proposal shall stipulate that it is predicated upon the terms and conditions of this RFP and any supplements or revisions thereof.

All contact with HIRSP Authority employees concerning the RFP is prohibited, except as authorized by Amie Goldman, CEO, the RFP Manager, during the period from date of release of the RFP until the notice of intent to contract is released.

Violations of these conditions may, at the sole discretion of the HIRSP Authority, be considered sufficient cause for the HIRSP Authority to reject a bid, irrespective of any other consideration.

All written questions submitted on or before October 31, 2008, or at the Vendor Conference will be answered in writing by the HIRSP Authority. Questions received after the due dates specified will not be answered. To the extent practicable, a proposer’s questions will remain as written. However, the HIRSP Authority may consolidate and paraphrase questions received.

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mailto:[email protected]


Any oral responses, information, dates, or advice (including telephonic responses, information and/or advise, and any oral responses given during the Vendor Conference) received by a prospective proposer from the HIRSP Authority or HIRSP Authority staff shall not, in any manner whatsoever and whether before or after the release of this RFP, be binding on the HIRSP Authority, unless followed-up and explicitly confirmed and stated in writing by the Contract Administrator.

3.3 Vendor Conference

A vendor conference will be held on November 6, 2008, at 10:00 A.M. Central Standard Time to respond to questions and to provide any needed additional instruction to vendors on the submission of proposals. The vendor conference will be held via teleconference at the administrative office of the HIRSP Authority, located at 33 East Main Street, Suite 230, Madison, Wisconsin. If no questions are received, the HIRSP Authority reserves the right to cancel the vendor conference. All vendors who intend to respond to the RFP are strongly encouraged to participate in the vendor conference. Prospective proposers will have an opportunity to request clarification of any uncertainties that may exist in the RFP.

The HIRSP Authority reserves the right to hold the conference in an alternative location, and if so will post the location of the alternative room/location unless there is sufficient time to notify proposers by mail.

3.4 Calendar of Events

Listed below are specific and estimated dates and times of actions related to this RFP. The actions with specific dates must be completed as indicated, unless otherwise changed by the HIRSP Authority. In the event that the HIRSP Authority finds it necessary to change any of the specific dates and times in the calendar of events listed below, it will do so by issuing a supplement to this RFP. There may or may not be a formal notification issued for changes in the estimated dates and times.

Date Event

October 22, 2008 Date of issue of the RFP

October 27, 2008 Letter of Intent to Submit Proposal due

October 31, 2008 Last day for submitting written questions

November 6, 2008 Vendor teleconference

November 14, 2008Mail responses to questions and notification to vendors of supplements or revisions to the RFP

November 21, 2008 Proposals due from vendors by 4:00 p.m. CST

As Deemed Necessary Oral presentations

December 23, 2008 Notification of intent to award sent to vendors

February 1, 2009 (est.) Contract start

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3.5 Contract Term

The contract shall be effective on the date specified in the contract through December 31, 2009, with four possible one-year renewal options from January 1st of each of the successive four calendar years. The earliest effective date will be February 1, 2009

3.6 Letter of Intent to Submit Proposal

Prospective proposers are requested to submit a Letter of Intent to Submit Proposal by October 27, 2008. The Letter of Intent shall clearly and completely identify the prospective proposer and the full name, title, complete street address, office telephone number, e-mail address, and fax number of the prospective proposer’s contact person. It shall also be clearly marked as Letter of Intent to Propose to Provide Actuarial Consultant Services to HIRSP.

The Letter of Intent should be sent by October 27, 2008 to:

Amie Goldman, CEOHIRSP Authority33 East Main StreetSuite 230Madison, WI 53703Fax Number: 608.441.5776E-mail: [email protected]

Failure to submit a timely and complete Letter of Intent will not preclude the submission of a proposal, nor does submission of a timely and complete Letter of Intent require that the prospective proposer submit a proposal.

However, only those prospective bidders submitting a timely and complete Letter of Intent will remain on the mailing list for:

A. RFP addenda or clarifications (if any);

B. Answers to oral and written questions;

C. Notices of changes to the procurement schedule specified below (if any); and

D. Other important information from the HIRSP Authority regarding this RFP. Such mailings will be sent to the contact persons identified in the respective Letters of Intent.

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4.0 PREPARING AND SUBMITTING A PROPOSAL

4.1 General Instructions

The evaluation of the proposal and selection of a contractor will be based on the information submitted in the vendor’s proposal and references (and oral presentations if required by the HIRSP Authority). Failure to respond to each of the requirements in the RFP may be the basis for rejecting a proposal.

Elaborate proposals (e.g., expensive artwork) beyond that sufficient to present a complete and effective proposal are not necessary or desired.

The HIRSP Authority reserves the right to reject any or all proposals deemed by the HIRSP Authority as not meeting the provisions contained herein. The HIRSP Authority will not accept late or incomplete proposals. All proposals are to be complete when they are submitted. Failure to submit a complete proposal may be the basis for rejecting a proposal.

4.2 Incurring Costs

The HIRSP Authority is not liable for any costs incurred by proposers in replying to this RFP.

4.3 Submitting the Proposal

Proposers must submit an original and four copies of their proposal and all materials required for acceptance of their proposal by 4:00 p.m. November 21, 2008, to:

Amie Goldman, CEOHIRSP Authority33 East Main StreetSuite 230Madison, WI 53703

All proposals must be time-stamped in the HIRSP Authority by the above stated time. Proposals not so stamped will not be accepted. Proposers mailing their proposals or using a commercial delivery service must allow sufficient time for delivery of their proposals by the specified time.

Proposals submitted by fax or e-mail, in whole or in part, shall be rejected. Late proposals shall be rejected and will be returned unopened. There are no exceptions.

All proposals must be packaged, sealed and show the following information on the outside of the package:

Proposer’s name and address Proposal to Provide Actuarial Services for HIRSP Proposal due date – November 21, 2008, at 4:00 p.m. CDT

An original plus three (3) copies of the Cost Proposal Form (Attachment B) must be sealed and submitted as a separate part of the proposal. (Refer to sections 4.5 and 8.0 for additional instructions regarding the Cost Proposal.) The outside of the envelope must be clearly labeled

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with the words “Cost Proposal, HIRSP Actuarial Services” and the name of the vendor and due date. The Cost Proposal is due to the addressee on the due date and time noted above. Faxed, E-mailed and late Proposals will not be accepted.

4.4 Use of Subcontractors

In the event of a proposal submitted jointly by two or more organization, one (1) organization must be designated as the prime contractor, and the prime contractor will be solely responsible for assuring the performance of all aspects of the contract. All other participants shall be designated as subcontractors. Any use of subcontractors for this contract shall meet the requirements of this RFP.

Once the Letter of Intent to Award a Contract is issued and a contract is awarded, the use of subcontractors by the prime contractor (for any portion of the scope of work) is subject to the prior written consent of the HIRSP Authority (whether or not such subcontractor(s) were identified in the prime contractor’s proposal). The HIRSP Authority may request such additional information and/or written assurances as deemed necessary to ensure that only qualified, competent vendors perform services under the RFP and contract, and to ensure that the scope of work is performed in a professional manner.

No services performed under this contract may be subcontracted without the prior written consent of the HIRSP Authority, and the HIRSP Authority must approve any vendors that will serve as subcontractors for HIRSP.

At any time during the contract period, the contractor shall not subcontract out, in whole or in part, any portion of the scope of work to an individual(s), corporation(s), partnership(s), agent(s), subsidiary(ies), or public agency(ies) without the express prior written consent of the HIRSP Authority.

If subcontractors are to be used, the proposer must clearly explain the subcontractor participation. Subcontractors are required to abide by all terms and conditions of the contract. The prime contractor will be responsible for contract performance, including the oversight of and responsibility for all delegated/subcontracted functions, when subcontractors are used.

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4.5 Proposal Organization and Format

Proposals should be typed and submitted on 8.5 by 11-inch paper bound securely. Proposals should be organized and presented in the order and by the number assigned in the RFP. Proposals must be organized with the headings and subheadings listed below. Each heading and subheading should be separated by tabs or otherwise clearly marked.

Technical ProposalCover PageExecutive Summary of ProposalResponse to General Proposal Requirements (Section 6.0)

Organization CapabilitiesFinancial StatementsStaff QualificationsProposer Client List and ReferencesOral Presentation and MaterialsTransmittal LetterDesignation of Primary Contact PersonLocation and StaffDisaster Recovery PlanHIPAA Compliance

Response to Technical Requirements (Section 7.0)Actuarial ServicesPerformance StandardsConstraints Upon ContractorDetailed Transition PlanData Collection and Reporting

Required forms (Section 10.0)Designation of Confidential and Proprietary Information

No mention of the cost proposal may be made in the Technical Proposal of this RFP.

Cost Proposal (see Attachment B)Cost Proposal Form

The vendor must submit its Cost Proposal on the form provided in Attachment B according to the instructions provided. Failure to provide any requested information in the prescribed format may result in disqualification of the proposal.

4.6 Multiple Proposals

Multiple proposals from a vendor will be permissible; however, each proposal must conform fully to the requirements for proposal submission. Each such proposal must be submitted separately and labeled as Proposal #1, Proposal #2, etc., on each page included in the response.

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4.7 Oral Presentations

Vendors may be required to make oral presentations, which will be scored by the evaluation committee, regarding their written proposals. Key personnel of the vendor, to include any subcontractor personnel designated with the direct responsibility for the areas they are presenting, shall conduct the oral presentation. No outside consultants shall be used in the presentation.

The purpose of the oral presentation would be for the vendor to demonstrate understanding of the requirements of the prospective contract and demonstrate its capability, including staffing, to meet those requirements. The presentation shall not be a marketing or sales presentation. The presentation shall address the vendor’s technical solution to the RFP technical requirements.

4.8 Withdrawal of Proposals

Proposals shall be irrevocable until contract award unless the proposal is withdrawn. Proposers may withdraw a proposal in writing at any time up to the proposal closing date and time or upon expiration of three (3) business days after the due date. To accomplish this, the written request must be signed by an authorized representative of the proposer and submitted to:

Amie Goldman, CEOHIRSP Authority 33 East Main StreetSuite 230Madison, WI 53703

If a previously submitted proposal is withdrawn before the proposal due date and time, the proposer may submit another proposal at any time up to the proposal closing date and time.

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5.0 PROPOSAL SELECTION AND AWARD PROCESS

5.1 Preliminary Evaluation

Proposals will be reviewed initially to determine if mandatory proposal requirements, as listed in Section 7.0 of this RFP, are met. Failure to meet mandatory requirements may result in rejection of the proposal. In the event that all vendors do not meet one or more of the mandatory requirements, the HIRSP Authority reserves the right to continue the evaluation of the proposals and to select the proposal which most closely meet the requirements specified in this RFP. Any proposal failing to provide all response requirements as specified in this RFP, and in the prescribed format, may be removed from further consideration and the vendor notified accordingly.

5.2 Proposal Scoring

Accepted proposals will be reviewed by an evaluation committee and scored against the stated criteria. A proposer may not have contact with any member of an evaluation committee except at the HIRSP Authority’s direction. The committee may review references and/or request interviews, and use the results in scoring the proposals. The evaluation committee’s scoring will be tabulated and proposals ranked based on the numerical scores received.

Various costing methodologies and models are available to analyze the cost information to determine the lowest cost to the agency. The HIRSP Authority will select one method for scoring costs and will use it consistently throughout its analysis of all the cost proposals. The selected methodology will be available after the HIRSP Authority issues a notification of intent to award the contract.

5.3 Right to Reject Proposals and Negotiate Contract Terms

The HIRSP Authority reserves the right to reject any and all proposals and to negotiate the terms of the contract, including the award amount, with the top scoring proposers, prior to entering into a Contract.

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5.4 Evaluation Criteria

The proposals will be scored using the following criteria:

Description Points

1. General Proposal Requirements (see Section 6.0) 200a. Organization Capabilitiesb. Financial Statementsc. Staff Qualificationsd. Proposer Client List and

Referencese. Oral Presentation and Materials

2. Technical Proposal Requirements (see Section 8.0) 400a. Actuarial Servicesb. Performance Standardsc. Constraints upon Contractord. Detailed Transition Plane. Data Collection and Reporting

3. Cost Proposal (see Section 9.0) 400Total 1,000 total

5.5 Award and Final Offers

The HIRSP Authority will compile the final scores (technical proposal and cost proposal) for each proposal. The award will be granted in one of two ways. The award may be granted to the highest scoring responsive and responsible proposer. Alternatively, the HIRSP Authority may negotiate with the highest scoring proposer or proposers or may request they submit final and best offers.

5.6 Notification of Intent to Award

All vendors who respond to this RFP will be notified in writing of the HIRSP Authority’s intent to award the contract(s) as a result of this RFP.

5.7 Appeals Process

Notices of intent to protest and protests must be made in writing. Protesters should make their protests as specific as possible and should identify statutes and provisions that are alleged to have been violated.

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Any written notice of intent to protest the intent to award a contract must be filed with:

Amie Goldman, CEOHIRSP Authority33 East Main StreetSuite 230Madison, WI 53703Fax: (608) 441-5776E-mail: [email protected]

The notice must be received in the HIRSP Authority office no later than five (5) working days after the notice of intent to award is issued.

Any written protest must be received within ten (10) working days after the notice of intent to award is issued.

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6.0 GENERAL PROPOSAL REQUIREMENTS

Provide the following comprehensive information required under subsections 6.1 through 6.6 for the proposer and, in separate and independent sets of documents, for each respective proposed subcontractor to the proposer.

6.1 Designation of Primary Contact Person

In conducting any services under an agreement resulting from this proposal, the Contractor shall designate in writing a primary contact person to open and maintain lines of communication with the HIRSP Authority. The primary contact person may not be changed without written notification to the HIRSP Authority. All initial contacts and meetings with the Contractor shall be arranged through the HIRSP administrative staff.

6.2 Organization Capabilities

6.2.1 Provide a statement identifying the formal name, title, type of business, business address, location of the proposer or subcontractor business entity’s principal offices, and an identification of any other location or site which is proposed to provide any services or resources in the execution of duties of this RFP.

6.2.2 Provide a brief history of the proposer or subcontractor business entity and the firm’s experience over the past five (5) years, especially in providing comprehensive actuarial services similar to those required in this RFP for private sector individual health care and/or governmental high-risk pool health insurance programs similar to HIRSP. Your response should include, but not be limited to, the following:

Names and types of programs Specific dates and length of contracts or renewals Scope of your involvement Number of clients/customers served Specific outcomes

6.2.3 Advise of any outstanding significant legal actions pending against the proposer or proposed subcontractors. Please provide a detailed summary of the cause of action and the current status of each action, including an evaluation of expected outcome and an estimate of any potential financial liability that would result if the outcome of the action is adverse to the proposer or proposed subcontractor.

6.2.4 Advise of any potential conflict of interest that exists for the proposer or subcontractor. Rationale of mitigating circumstances regarding this contract may be explained. If no conflict of interest exists, provide an express statement in you response of the absence of conflict of interest.

6.2.5 Describe your organization’s capability to provide the actuarial services required in this RFP. Provide specimen copies of representative analytical documents and reports prepared for existing or former client entities which illustrate and demonstrate the contractor’s ability to provide documentary information and analytical reports sufficient

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to satisfy the actuarial services objectives of the HIRSP authority as expressed in the RFP technical requirements in Section 7.0.

6.3 Financial Statements

The proposer and each proposed subcontractor (if any) shall submit independently audited financial statements for the financially responsible business entity for the last two (2) completed fiscal years. If the proposer or subcontractor is a subsidiary, provide an organization chart of the parent holding company structure, and provide audited financial statements for the ultimate parent company and for any significant intermediate holding companies. Audited financial statements must include:

Balance sheet Statement of revenues, expenses & changes in net assets (profit & loss statement) Statement of cash flows Notes to financial statements Management discussion and analysis Auditors’ reports and statements

6.4 Desired Experience Qualification

The HIRSP Authority desires that the actuarial services contractor have experience and expertise that specifically pertains to high-risk pool and indemnity insurance operations and actuarial services. Provide description of the proposer’s experience and qualifications with regard to the following desired criteria of experience qualification:

1. Have recent, demonstrated experience in policy and benefit language interpretation and composition.

2. Have recent, demonstrated experience with high-risk pool operation or similar commercial insurance experience,

3. Have recent, demonstrated experience with public policy and legislative processes.4. Have recent, demonstrated experience with establishing the actuarial value of benefit

variations and provider payment rates.

6.5 Staff Qualifications

Describe the proposed staffing for this proposal. Provide resumés describing the educational and work experiences for each of the key staff who would be assigned to the project. Identify the percentage of time that key assigned staff will have available to devote to the HIRSP actuarial services contract.

6.6 Proposer Client List and References

Proposers must include in their RFPs a list of all significant client organizations, including points of contact (name, address, telephone number, and e-mail address). Identify the general provisions of client contracts, including the effective date and termination date and a high-level summary of the contractual relationship and the contracted services offered. The HIRSP Authority reserves the right to contact any clients listed, however the proposer may be required to recommend a maximum of five organizations that can be used as references. Selected organizations may be contacted to determine the quality of work performed and personnel

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assigned to the project. The results of the reference checks will be provided to the evaluation team and used in scoring the written proposals.

6.7 Contractor Location and Staffing

The actuarial contractor’s key staff must be readily accessible to interact with HIRSP Authority executive management, and from time-to-time must be available to participate in scheduled and add-hoc face-to-face meetings and telephone conference meetings. Mandatory participation is required for certain meetings of the Board of Directors, certain meetings of Committees of the Board, and various meetings with executive management. Describe your plans for meeting this requirement, and provide a work plan that details the following:

The location (by city) of each proposed physical site(s) of contractor operations for services provided under this contract;

The anticipated date(s) for locating staff at each site(s);

The timing of hiring and training of all project staff; and

The anticipated number of staff for each location if more than one location is proposed.

Describe program coverage in the event of employee absences, including long-term illness or interim hiring periods, and how continuity and project leadership will be maintained in the absence of the Project Manager or other key managerial positions.

6.8 Disaster Recovery Plan

Proposers will be required to have a disaster recovery plan, satisfactory to the HIRSP Authority, that will assure that key program operations of the proposer will remain operational in the event of unintended business interruption caused by major systems failure or other emergency circumstances. Please provide documentation of your organization’s comprehensive disaster recovery plan. Include information regarding any disaster recovery successes experienced.

6.9 HIPAA Compliance

The actuarial contractor must be able to perform all HIRSP business services, activities, or functions, such that the HIRSP Authority remains in compliance with all final regulations implementing the Health Insurance Portability and Accountability Act (HIPAA) including, but not limited to, the following; Transactions and Code Sets, Employer Identifier, Privacy, Security and National Provider Identifiers (NPI).

6.10 Transmittal Letter

The Transmittal Letter must be on the official business letterhead of the prime Contractor submitting the proposal, and must be signed by an individual authorized to legally bind the proposer. It must be part of the Technical Proposal. The Transmittal Letter must include the following statements:

An individual authorized to legally bind the proposer is signing the Transmittal Letter;

The proposer is the prime contractor and is a corporation or other legal entity;

A statement identifying any and all subcontractors that will be responsible for fulfilling the requirements of this RFP;

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No attempt has been made or will be made by the proposer to induce any other person or firm to submit or not to submit a proposal;

No cost or pricing information has been included in the Transmittal Letter or the Technical Proposal;

The Technical and Cost Proposal are valid for a minimum of six (6) months from the proposal due date;

The person signing this proposal is authorized to make decisions on behalf of the proposer’s organization as to the prices quoted and that the person has not participated, and will not participate, in any action contrary to the above statement; and

Assure that the proposer will agree to execute and fulfill a contract according to the conditions and terms specified in this RFP.

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7.0 TECHNICAL REQUIREMENTS

The proposer’s response to the following requirements will serve to evaluate the contractor’s capabilities for performing HIRSP actuarial services. The HIRSP Authority is seeking a Contractor with experience in and capacity for providing comprehensive actuarial services for a health insurance program, subject to the HIRSP program’s specific requirements.

The Technical Requirements are identified under the general headings 7.1.through 7.5. For each of the technical requirements under the general heading 7.1, Actuarial Services, including 7.1.1 through 7.1.6, your proposal must be organized to address, in order, each of the following:

1. Your proposed technical solution.2. Your strategies to monitor and assure quality.3. Your recommended performance standards.

1) Your proposed technical solution: Provide a comprehensive narrative assessment of the work to be performed, the proposer’s ability and approach, and the resources necessary to fulfill the requirement. Describe how your organization will support that technical requirement. Include in your description, your organization’s proposed staffing and technological solution to meet the technical requirement in the most cost-effective manner possible. Please note that some of the technical requirements in this section list specific required tasks. These are intended to provide proposers with additional information about program requirements. Your response need not address each specific task but rather describe how your staffing and technological solution will address the technical requirement.

2) Your strategies to monitor and assure quality: Describe how your organization will assure and monitor the quality and confidentiality of the associated services, data and information provided to the HIRSP Authority.

3) Your recommended performance standards: The Actuarial Services Contractor will be required to meet specific performance standards throughout the contract period. Describe the specific performance standards your organization recommends in order to assure quality for each particular technical requirement. The actual performance standards that the Actuarial Services Contractor will be required to meet will be specified in the contract and will be based, in part, on the staffing and technical solutions of the selected proposer. Therefore, your proposal must detail performance standards appropriate to services you propose and should also include proposed appropriate financial penalties for performance standards that are not met.

7.1 Actuarial Services

The Actuarial Services Contractor must provide actuarial services necessary for HIRSP Authority management and the HIRSP Authority Board of Directors to make appropriate decisions, consistent with statutory requirements and sound financial practices. Actuarial services are vital to matters such as establishing the annual HIRSP operating budget, preparation of the annual financial reconciliation, annual projections of medical and pharmacy claims and program costs, and the establishing of premiums rates, insurer assessments, and provider payment rates that are needed to provide for annual program funding.

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Actuarial Services must be performed by actuaries with the professional designation of Associate of the Society of Actuaries (ASA) or Fellow of the Society of Actuaries (FSA). In addition, actuarial services must be performed by individuals with the professional designation of Member of the American Academy of Actuaries (MAAA).

Duties of the Actuary include but are not limited to:

7.1.1 Establishing the annual operating budget and financial reconciliation of the prior calendar year in sufficient time for the HIRSP Authority management and Board to approve prior to September 30th of each year. This will require attendance at Board and Committee meetings and detailed presentations regarding budget development and recommendations.

7.1.2 Monitor operating budget as approved by the Board:

On a monthly basis, project the cash reserves adequate to pay all claims.

On an annual basis, prepare an actuarial opinion of loss liability estimates.

Use prior years plan enrollment, claims data, health care costs, and utilization trends to project HIRSP claim and administrative expenses.

On a quarterly basis, prepare loss ratio analysis and reports for analytical and financial reporting purposes.

7.1.3 Annually, conduct an industry survey of Wisconsin commercial health insurers to determine industry standard premium rates for a benefit package equivalent to the plans offered by HIRSP:

Select the top carriers that make up approximately 90 percent of the total volume as determined by policy and premium volume.

Choose the plan offered by these companies that provides the most comparable premium, coverage, deductible and coinsurance to the HIRSP plan and actuarially adjust, as necessary, for differences in coverage, benefits, effective date, and duration.

Calculate the HIRSP premium rate as a percentage of the standard rate to meet state laws and for federal grant reporting purposes.

Set HIRSP premium rates in conformance with state law. Premiums for the indemnity benefit plans can be no higher than 200 percent of the standard rate. Medicare Supplement Plan premiums are set based on the criteria set in the law, and can be no higher than 200 percent of the standard rate. Total premiums must be set at a level necessary to fund 60 percent of the costs of the program.

Calculate the discounts appropriate for low-income subsidy premium rates according to state law, and estimate the annual cost of the low-income subsidy program.

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Perform an annual survey of health provider payment rates for the Wisconsin commercial insurance industry to determine fee schedule trends for classes of health provider services. Present the survey data to inform decisions.

Determine total insurance industry assessment amount required to fund 20 percent of total program costs excluding premium and deductible subsidies plus 50 percent of the subsidy costs.

Calculate required adjustments to provider payment rates so that HIRSP health care providers fund 20 percent of total program costs excluding premium and deductible subsidies plus 50 percent of the subsidy costs.

7.1.4 Perform accrual reconciliation on a monthly and annual basis according to timelines established by HIRSP Authority management. The key purpose for this reconciliation is to determine any under or over payments made by policyholders, the insurance industry, and health care providers. Overpayments or underpayments at the end of a calendar year are applied to the funding requirements for the following calendar year, and are used to make any necessary adjustments in the following-year operating budget.

Account for any expense or revenue in the year it was incurred.

Reduce the HIRSP operating and administrative costs by the amount of prescription drug rebates.

Allocate the net HIRSP costs (after interest and miscellaneous revenues) to the three funding sources: Sixty percent to policyholder premiums, 20 percent to the insurance industry, and 20 percent to health care providers. The subsidy costs are evenly split between the insurers and health care providers.

Propose resolution to any overpayment or underpayment by the insurance industry, health care provider, or policyholder funding constituencies. Underpayments or overpayments by any one of the three funding groups may be offset when apportioning that respective group’s share of the HIRSP plan cost in the following plan year.

7.1.5 Establish adequate cash reserves to pay all claims, including a semi-annual actuarial opinion of loss liability estimates.

7.1.6 Periodically review premium rating curves, rating factors, and overall premium rates for appropriateness.

7.1.7 Prepare ad-hoc analyses and reports as directed by the HIRSP Authority.

7.2 Performance Standards

Perform actuarial services in accordance with the Standards of Practice as promulgated by the Actuarial Standards Board of the American Academy of Actuaries.

Actuarial services, including the annual budgetary analysis and the various monthly reserve liability estimation reports and other periodic analysis and add hoc reports, need to be completed

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on a timely basis to expedite, inform, and facilitate timely Board of Director and executive management financial oversight of the HIRSP enterprise.

Contractor actuary shall attend and present its reports and analysis as necessary at meetings of the Board of Directors, the Finance and Audit Committee, and at ad-hoc meetings required by executive management.

7.3 Constraints Upon Contractor

The administration of the HIRSP Authority is subject to the statutory provisions of Chapter 149, Wis. Stats., and other statutes and regulations that are applicable to the HIRSP Authority and the HIRSP program.

In conducting services under a contract resulting from this proposal, the contractor shall designate a primary contact person to maintain lines of communication with HIRSP Authority executive management. All initial contacts and meetings with the contractor shall be through the designated executive management contact. All contractor operations, data files, and records that pertain to the provision of contractual services shall be open for review or audit by the HIRSP Authority or its designee, including its external auditor, at any time.

The Actuarial Services Contractor shall implement and maintain a separate accounting function for services performed pursuant to the contract. The Actuarial Services Contractor shall maintain comprehensive auditing and internal control procedures. The results of all internal audits will be reported to the HIRSP Authority.

The Actuarial Services Contractor and all of its key subcontractors shall obtain, at least once a year, an independent external review of their respective internal control systems. One independent review mechanism, commonly referred to as a Statement of Auditing Standards (SAS) 70, is an in-depth audit of a service organization’s control activities and their operating effectiveness presented in a uniform reporting format. Please indicate whether or not your organization currently undergoes SAS 70 audits that would include HIRSP and, if SAS 70 reports are not prepared, please explain what in-depth audit procedures will be utilized and how the results will be reported.

7.4 Detailed Transition Plan

Proposers must describe in detail their proposed transition method(s) and timetable for transferring each of the required tasks from the current actuarial subcontractor. Proposers must demonstrate they will be able to adequately perform all of the tasks related to the actuarial administration of the Plan no later than February 1. 2009. The proposal should include a complete description of the transition work plan. Proposers must agree to cooperate in any transfer of function from the existing actuarial subcontractor to the replacement Actuarial Services Contractor. Proposers must also agree to finalize contract language by no later than January 31, 2009, and agree to begin operations on February 1, 2009.

Proposers should present a comprehensive description of and timeline for start-up activities and for the acquisition of historical data required for analysis of HIRSP actuarial trends. The description shall specifically address how the proposer will minimize disruption to HIRSP Authority management and policyholders. Continuity of services for policyholders during a contract transition should be made as seamless as possible.

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The plan must describe the process for start-up training, documentation and user support products proposed for accessing the data as well as the process for start-up and transition of data systems into and out of the prospective contract.

The proposer shall demonstrate a commitment to engage in a collaborative and partnering manner with other HIRSP contractors and subcontractors to successfully carry out the objectives and requirements of the HIRSP program.

7.5 Data Collection and Reporting

The contractor shall produce reports regarding the operation of HIRSP. The form of the reports shall be subject to approval of the HIRSP Authority. The content shall include information such as operational and financial information, data on claims and losses, and policyholder demographic information. The actuarial services contract will detail the reports required.

Please describe the types of reports your organization would provide as well as how your organization would review the information provided in the reports and advise the HIRSP Authority on emerging trends and make recommendations.

Specific reporting requirements include but are not limited to the following:

Monthly reports – projection of estimated loss reserve liability:

Monthly reports – Calculation of provider contribution reconciliation, and preparation of the monthly Interim Reconciliation of program costs, cost obligations of the three funding constituencies, and change in net retained earnings.

Annual Budget Analysis Reports – detailed development of financial operating budget used for calendar year financial planning.

Monthly Budget Analysis Reports – detailed development of financial operating budget used for monthly reconciliation, monthly budgetary performance evaluating, and monthly financial reporting purposes.

Quarterly Analysis of Loss Ratios by Health Benefit Plan

Ad-Hoc Reports – The Contractor must be prepared to produce ad-hoc reports at the request of the Board of Directors or executive management.

All reports and documentation shall be easily accessible and shall remain the property of the HIRSP Authority. Distribution of all reports and documentation shall be subject to Board of Director instructions and shall be consistent with any applicable state or federal laws regulating confidentiality.

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8.0 COST PROPOSAL

8.1 General Instructions and Information on Preparing Cost Proposals

The Cost Proposal Form (Attachment B) should be submitted in an envelope separate from the written proposal. The proposal will be scored using a standard quantitative calculation where the most points will be awarded to the proposal with the lowest cost.

8.2 Method of Invoicing and Payment

The contractor must submit invoices for Actuarial Services fees within 30 days following the end of the month for which the billed fees apply. Invoices must provide detailed information on the date, specific actuarial service, units of activity, unit price, and billed price of each individual category of billed service included in the invoice. For any particular billed actuarial service, the contractor shall employ the lowest cost qualified personnel needed to accomplish the scope of work, and will bill for its services accordingly. Remittance of invoice amounts will be paid monthly within thirty (30) days of the receipt of a detailed invoice.

8.3 Allocation of Actuarial Fees

Proposals for the cost(s) of actuarial services should be clearly defined and must adequately explain the basis for calculation of cost(s). At a minimum, a brief outline of services included in these costs should be given. Proposers are expected to quote firm hourly rate fee schedule prices for the delivery of specified actuarial services, employing the lowest cost qualified personnel required for each respective service for the contract period as it is described herein. Proposed hourly fees shall be all-inclusive of all charges to be paid by HIRSP for actuarial services rendered. In calendar year 2007, the incumbent actuarial subcontractor billed for approximately 776 hours of services, including 54 hours of principal actuary services, 488 hours of staff actuary services, 222 hours of actuarial assistant services, and 3 hours of administrative services.

8.4 Format for Submitting Cost Proposals

A cost proposal form and worksheet are included in Attachment B of this RFP. Complete it with your actuarial fee proposal for the initial contract period. Provide your proposed hourly rates for actuarial services by category of services and by skill levels of participating contractor personnel.Following the cost proposal worksheet, include a narrative that explains and justifies each line item shown in the cost proposal worksheet.

8.5 Fixed Price Period

All prices, costs, and conditions outlined in the proposal shall remain fixed and valid for acceptance for 180 calendar days starting on the due date for proposals.

8.6 Inflationary Adjustment

The Contractor may receive an inflationary adjustment to the actuarial services fee structure at the start of each annual contract extension/renewal period. This increase will be based on either seventy-five percent (75%) of the increase in the prevailing Consumer Price Index for Urban Wage Earners (CPI-U) for Milwaukee, Wisconsin, in effect for the quarter ending January of the

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then current year or five percent (5%) of the then current Contractor’s base fee, whichever is lower.

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9.0 SPECIAL CONTRACT TERMS AND CONDITIONS

9.1 Executed Contract to Constitute Entire Agreement

In the event of contract award, the contents of this RFP (including all attachments), RFP addenda and revisions, and the proposal of the successful proposer, and additional terms agreed to, in writing, by the HIRSP Authority and the contractor shall become part of the contract. Failure of the successful proposer to accept these as a contractual agreement may result in a cancellation of award. The awarded and executed written contract and/or order with referenced parts and attachments shall constitute the entire agreement and no other terms and conditions in any document, acceptance, or acknowledgement shall be effective or binding unless expressly agreed to in writing by the HIRSP Authority

9.2 Applicable Law and Compliance

The contract to be awarded from this RFP shall be governed by the laws of the State of Wisconsin. The contractor shall at all times observe and comply with all federal and state laws, local laws, ordinances, and regulations which are in effect during the period of the contract and which in any manner affect the work or the conduct of the work. HIRSP reserves the right to cancel the contract with any federally debarred contractor or a contractor that is presently identified on the list of parties excluded from federal procurement and non-procurement contracts.

9.3 Contractor Nondiscriminatory Employment Practice Requirement

The contractor shall agree that, in connection with the performance of work under a contract resulting from this RFP, the contractor will not discriminate against any employee or applicant for employment because of age, race, religion, color, handicap, gender, physical condition, developmental disability as defined in s. 51.01 (5), Wis. Stats., sexual orientation, or national origin. This provision shall include, but not be limited to the following: employment, upgrading, demotion or transfer, recruitment or recruitment advertising, layoff or termination, rates of pay or other forms of compensation, and selection for training, including apprenticeship. Expect with respect to sexual orientation, the contractor further agrees to take affirmative action to ensure equal employment opportunities. The contractor agrees to post in conspicuous places, available for employees and applicants for employment, notices to be provided by the contracting officer setting forth the provisions of the nondiscrimination clause. The affirmative action plan is waived if the contractor’s annual work force amounts to less than 25 employees.

9.4 Data Management Requirements

In connection with the performance of work under the actuarial services contract, the contractor shall agree that (i) all data provided to the contractor by HIRSP shall be kept confidential; (ii) all data provided to the contractor by HIRSP shall be used solely for the purposes expressed by HIRSP pursuant to the provisions of the actuarial services agreement, and (iii) all data provided to the contractor by HIRSP shall be destroyed by the contractor after the work performed by the contractor pursuant to the actuarial services agreement has been completed by the contractor.

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9.5 Public Record Access

It is the intention of the HIRSP Authority to maintain an open and public process for the solicitation, submission, review, and approval of procurement activities. Records may not be available for public inspection prior to issuance of the notice of intent to award or the award of the contract.

Any restrictions on the use of data contained within a response to a request must be clearly and expressly stated by the proposer in the bid/proposal itself. Proprietary information submitted in response to a request will be handled in accordance with Wisconsin public records law. Proprietary restrictions normally are not accepted. However, when accepted, it is the vendor’s responsibility to defend the determination in the event of an appeal or litigation.

Data contained in a bid/proposal, all documentation provided therein, and innovations developed as a result of the contracted commodities or services cannot be copyrighted or patented. All data, documentation, and innovations become the property of the HIRSP Authority.

Any material submitted by the proposer in response to this request that the proposer considers confidential and proprietary information and which qualifies as a trade secret pursuant to s. 19.36(5), Wis. Stats., or material which can be kept confidential under the Wisconsin public records law, must be identified on the Designation of Confidential and Proprietary Information form included in this RFP as Attachment A. Bid/proposer prices cannot be held confidential.

9.6 Hold Harmless

The contractor shall indemnify and save harmless the HIRSP Authority and all of its officers, agents, and employees from al suits, actions, or claims of any character brought for or on account of any injuries or damages received by any person or property resulting from the operations of the contractor, or of any of its contractors, in prosecuting the work under the actuarial services contract.

9.7 Force Majeure

Neither the HIRSP Authority nor the contractor shall be in default by reason of any failure in performance of the actuarial services contract in accordance with reasonable control and without fault or negligence on their part. Such causes may include, but are not restricted to, acts of nature or the public enemy, acts of the government in either its sovereign or contractual capacity, fire, floods, epidemics, quarantine restrictions, strikes, freight embargos and unusually severe weather, but in every case the failure to perform must be beyond the reasonable control and without the fault or negligence of the party.

9.8 Certification of Independent Price Determination

By signing the RFP bid/proposal, the proposer certifies and in the case of a joint bid/proposal each party thereto certifies as to its organization, that in connection with this procurement:

The prices in the proposal have been arrives at independently, without consultation, communication, or agreement for the purpose of restricting competition with regard to any matter relating to such prices with any other proposer or with any competitor;

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Unless otherwise required by law, the prices which have been quoted in the proposal have not been knowingly disclosed by the proposer and will not knowingly be disclosed by the proposer, prior to opening in the case of an advertised procurement or prior to award in the case of a negotiated procurement, directly or indirectly to any other proposer or to any competitor, and;

No attempt has been made or will be made by the proposer to induce any other person or firm to submit or not to submit a proposal for the purpose of restricting competition.

Each person signing the proposal certifies that: He/she is the person in the proposer’s organization responsible within the organization for the decision as to the prices being offered herein and that he/she has not participated and will not participate in any action that is contrary to the items listed above, (or) that he/she is not the person in the proposer’s organization responsible within the organization for the decision as to the prices being offered herein, but that he/she has been authorized in writing to act as an agent for the persons responsible for such decisions in certifying that such persons have not participated, and will not participate in any action contrary to the conditions listed above, and as their agent does hereby so certify, and he/she has not participated and will not participate in any action contrary to the items listed above.

9.9 Independent Capacity of Contractor

The contractor and its officers, agents, and employees, in the performance of their duties in accordance with the actuarial services contract, shall act in the capacity of an independent contractor and not as an officer, employee, or agent of the HIRSP Authority. The contractor shall agree to take such steps as may be necessary to ensure that each subcontractor of the contractor will be deemed to be an independent contractor and will not be considered or permitted to be an agent, servant, joint venture, or partner of the HIRSP Authority.

9.10 Performance Review and Remedies

All requirements described in this RFP and the final contract will be subject to monitoring by the HIRSP Authority. The HIRSP Authority reserves the right to monitor performance of the contractor (including any or all personnel and sub-contractors thereof) and may exercise such option at its discretion without notice. The results of the monitoring will be used to provide the basis for improved project implementation and operations and to determine whether the contractor has breached the contract.

The contractor agrees that the HIRSP Authority, in its sole discretion, in the event of contract non-compliance by the contractor, may terminate part of contractor’s obligations under this agreement and replace those services by either contracting with another entity to perform those obligations or performing those obligations itself. In the event the HIRSP Authority elects the remedy under this paragraph, the contractor may bill the HIRSP Authority only for those costs associated with performance of contract obligations that have not been terminated. The contractor will reimburse the HIRSP Authority for any replacement cost in excess of what the contractor would have been paid to continue performing those services.

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9.11 Contractor Compensation Remittance

Contractor compensation will be remitted according to monthly invoices submitted by the contractor along with detail and supporting information, as determined by the HIRSP Authority. Invoices will be submitted to:

Amie Goldman, CEOHIRSP Authority33 East Main StreetSuite 230Madison, WI 53703

9.12 News Releases

News releases pertaining to this procurement or any part of the proposal shall not be made without the prior approval of the HIRSP Authority.

9.13 Right to Publish

If an awarded contract results in a book or other material, the HIRSP Authority reserves a royalty-free, nonexclusive irrevocable license to reproduce, publish or otherwise use, and to authorize others to use, all material from the approved program. Any discovery or invention arising out of, or developed in the course of work aided by any awarded contract agreement, shall be promptly and fully reported to the HIRSP Authority.

9.14 Contract Term and Termination

9.14.1 The actuarial services agreement will be effective on the date it is signed. The contractor shall begin providing actuarial services as of February 1, 2009, and shall continue for eleven months through December 31, 2009. The agreement will be deemed to be renewed thereafter for successive periods of one (1) year each for (4) four subsequent calendar years, unless either party shall give to the other party not less than ninety (90) days’ written notice, prior to the expiration of the then-current term, of its intention to either terminate the agreement or to renegotiate the provisions thereof.

9.14.2 The contractor shall provide all required actuarial services prior to the effective date of the termination of the services agreement. Upon termination of the agreement the contractor will cooperate fully with the transition to a new successor contractor.

9.14.3 The HIRSP Authority reserves the right to terminate the actuarial services agreement for any reason or without cause and without penalty provided that notification is given in writing at least 120 days in advance. The HIRSP Authority reserves the right to cancel any contract in whole or in part without penalty in the event that the fails to comply with the terms, conditions, and specifications of the actuarial services contract.

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10.0 REQUIRED FORMS

The following forms must be completed and submitted with the proposal in accordance with the instructions given in Section 4.5. Blank forms are attached.

Designation of Confidential and Proprietary Information (Attachment A)Cost Proposal Form (Attachment B)

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11.0 ATTACHMENTS

Designation of Confidential and Proprietary Information Form ...........................................ACost Proposal Form.................................................................................................................B

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Attachment AA. DESIGNATION OF CONFIDENTIAL AND PROPRIETARY INFORMATION

The attached material submitted in response to HIRSP Authority Actuarial Services Contract RFP includes proprietary and confidential information which qualifies as a trade secret, as provided in s. 19.36(5), Wis. Stats., or is otherwise material that can be kept confidential under the Wisconsin Open Records Law. As such, we ask that certain pages, as indicated below, of this bid/proposal response be treated as confidential material and not be released without our written approval.

Prices always become public information when bids/proposals are opened, and therefore cannot be kept confidential.

The contract resulting from this procurement will be a public record and therefore cannot be kept confidential. Other information cannot be kept confidential unless it is a trade secret. Trade secret is defined in s. 134.90(1)(c), Wis. Stats. as follows: "Trade secret" means information, including a formula, pattern, compilation, program, device, method, technique or process to which all of the following apply:

1. The information derives independent economic value, actual or potential, from not being generally known to, and not being readily ascertainable by proper means by, other persons who can obtain economic value from its disclosure or use.

2. The information is the subject of efforts to maintain its secrecy that are reasonable under the circumstances.

We request that the following pages not be released

Section Page # Topic________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

IN THE EVENT THE DESIGNATION OF CONFIDENTIALITY OF THIS INFORMATION IS CHALLENGED, THE UNDERSIGNED HEREBY AGREES TO PROVIDE LEGAL COUNSEL OR OTHER NECESSARY ASSISTANCE TO DEFEND THE DESIGNATION OF CONFIDENTIALITY AND AGREES TO HOLD HIRSP HARMLESS FOR ANY COSTS OR DAMAGES ARISING OUT OF HIRSP’S AGREEING TO WITHHOLD THE MATERIALS.

Failure to include this form in the bid/proposal response may mean that all information provided as part of the bid/proposal response will be open to examination and copying. HIRSP considers other markings of confidential in the bid/proposal document to be insufficient. The undersigned agrees to hold HIRSP harmless for any damages arising out of the release of any materials unless they are specifically identified above.

Company Name ___________________________________________

Authorized Representative ___________________________________________Signature

Authorized Representative ___________________________________________Type or Print

Date ___________________________________________

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This document can be made available in accessible formats to qualified individuals with disabilities.

Attachment B

B Cost Proposal Form

Above (or Attached) is our hourly fee structure for the various skill levels of personnel who will perform work for the services to be billed in performing the services described in this RFP and in the subsequent contract. This amount is all-inclusive of costs in performing the contract and there are no other direct, indirect or incidental expenses to be charged in performance of contract.

Signature of Authorized Representative Date

Title

Company Name

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