Renewals: Renewals must be submitted to the CITY 180 days prior to the contract renewal date. Agree Disagree Contract Termination: Respondent’s contract termination provision may not require more than a 180-day notice and can occur only at renewal. CITY can terminate coverage with a 30-day notice. Agree Disagree Designated Service Unit: Respondents must agree to provide a designated claim and customer service unit for CITY as a whole. While designated to the CITY, the unit does not need to be a “dedicated” service unit; the unit employees may work on other clients. The service unit must have bilingual (Spanish-speaking) capabilities. Agree Disagree Designated Eligibility Specialist: Respondents must agree to provide a designated eligibility specialist for the CITY as a whole. While designated as a CITY unit, the employee(s) may work on other clients. Agree Disagree Toll-Free 800 Number: Respondents must agree to provide a separate toll-free 800 number for each CITY agency. Agree Disagree Offshore Operations: Respondents must that all customer service operations requiring verbal communication will be performed in the (i.e., will not be provided offshore). Agree Disagree HIPAA and PPACA Compliance: Respondents must be in compliance with all HIPAA and PPACA requirements and be able to conduct all applicable employer/plan sponsor and provider transactions consistent with those requirements. Agree Disagree Administration: Respondents must agree to accommodate existing administration provisions of each CITY agency. Any modifications needed to accommodate CITY data will be done at the vendor’s own expense. Agree Disagree Participating Entities: The Participating Entities currently administers eligibility, premium/contribution collection and payment. Data is transmitted via fax using HIPAA standards. Agree Disagree Net of Commissions: All fees and premiums should be net of commissions. Commissions or service fees are not to be paid to any organization. Disagree Performance Guarantees: Respondents must agree to offer a Performance Guarantee on all lines of coverage. Desired performance criteria can be found in Appendix K. Detailed measurement criteria will be negotiated upon award of contract. Disagree Communications Requirements: Respondents must comply with funding the communications requirements outlined below in bullets 20 – 26. Agree Disagree Summary Plan Descriptions (SPDs): Each vendor is responsible for writing SPDs. Hard copy SPDs are to be Agree Disagree
Client Account Manager: Respondents agree to provide a dedicated Account Manager, who must be based in Albuquerque. Agree Disagree New Mexico Patient Protection Act: Respondents agree to comply with the New Mexico Patient Protection Act. Agree Disagree Years in Business: Respondents' organization(s) have been in business, under their current corporate name, performing the services being proposed herein, for a minimum of five (5) years. Disagree Covered Members: Respondents must currently administer a minimum of 100,000 covered members for medical plan(s). Agree Disagree Explanation of Benefits (EOBs): Respondents agree that EOBs will be provided online. Paper EOBs will NOT be provided unless requested. If requested, respondents must provide a paper EOB at no charge. Agree Disagree Plan Design Information: Respondents must confirm their proposal(s) include detailed plan summaries for all plans quoted. Agree Disagree Adherence to Requested Plan Design: Respondents must confirm they have reviewed, and agree to administer, the requested plan designs. Respondents must include a separate document that briefly describes any deviations to the requested plan design. Agree Disagree Proposal Response Format: Respondents must agree to complete all Questionnaires, and Response / Cost Exhibits included in the RFP, in the format indicated. Respondents may not leave any sections blank, with a reference to find answer(s) elsewhere in their proposal. ALL cost items must be included and reflected only on the appropriate Cost Appendices. Agree Disagree ****END OF MINIMUM REQUIREMENTS**** GENERAL INFORMATION 35 Do you carry an Errors & Omissions policy? A copy will be required from the selected vendor. Yes No 36 Will you hold the client harmless for suits resulting from your actions or omissions? Yes No 37 Do you a comprehensive general liability policy? Yes No
103 Does your DM program reporting include the following outcomes from all diabetes education programs: personal goal attainment, weight loss, improved physical activity, improved nutrition, tobacco cessation, or reduced medication? Yes No Briefly list what is included in your subrogation services. 104 Do you perform subrogation internally? Or, do you use an outside vendor? Internal External 105 Under what circumstances, or at what dollar threshold do you send a subrogation claim to an outside vendor? 106 Will you offer both health care systems (i.e., Lovelace and Presbyterian) in Albuquerque? Yes No 107 Does your network include the University of NM Hospital and UNM physicians?. Yes No Has your HMO / POS / PPO received NCQA / URAC accreditation? If yes NCQA Yes No URAC Yes No When? NCQA __________ URAC ___________ Accreditation expiration date? NCQA ___________ URAC ___________ 108 Do your network hospitals participate in the “Leapfrog” Project? Yes No 109 Do you have established procedures for when a physician terminates, and a member is in with that physician? Yes No 110 Identify your HMO by type (e.g., IPA, Group, etc.). Do you offer E-Visit or Telehealth services? Yes No If yes, please briefly answer the following: Usage in 2011, on a PMPY basis?
Onsite screening events Includes clinical and educational Includes all travel considerations Educational material and resources Includes all reports and data Integrates with health coaching and HRA Measures taken include: Fasting Blood Lipid Panel Blood Glucose Hemoglobin A1C Blood Pressure Body Fat Waist Circumference Body Mass Index Biometric screenings align with recommendations of the US Preventive Services Task Force (USPSTF) and other health organizations. Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No 133 Please indicate if the wellness services you are quoting include the following (check all that apply). Any additional costs must be reflected on the Wellness Cost Exhibit. Credible health risk appraisal (HRA) with cultural and ethnic sensitivity, individualized and clear feedback report, and links the person to local and national resources to address identified risk factors Yes No Telephonic Health Coaching integrated with HRA Yes No Online health coaching integrated with HRA Yes No
Premium web content and behavior change tools Yes No Advanced communications materials Yes No Discounted gym memberships Yes No Outbound calling to high risk population Yes No Tobacco Quit Line Yes No Tobacco Quit Line reports that include the number enrolled, number receiving nicotine replacement therapy or other pharmacotherapy, and quit rate Yes No Ability to provide onsite flu shots Yes No Ability to provide onsite mobile mammography Yes No Ability to provide onsite mobile health clinic (not related to Workers Compensation) Yes No Onsite evidence based behavior change programs to improve nutrition Yes No Onsite evidence based behavior change programs to improve physical activity Yes No Onsite evidence behavior change programs to improve weight. Yes No Comprehensive promotion and communication materials and campaign support including electronic newsletters, emails announcements, and printed brochures, posters, and flyers. Yes No Comprehensive reporting including incentive reporting Yes No Initiatives to create a health worksite culture Yes No Participation in monthly wellness committee meetings Yes No Collaboration with health and wellness vendors Yes No