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HARRIS COUNTY
REQUEST FOR PROPOSAL Job No. 08/0322
Cover Sheet Date Due: August 4, 2008
DUE NO LATER THAN 2:00 P.M.
LOCAL TIME IN HOUSTON, TEXAS
Proposals received later than the date
and time above will not be considered.
PROPOSAL FOR: Group Medical, Flexible Spending Accounts and Related Employee Benefits for
Harris County, Harris County Flood Control District and Harris County Community Supervision
and Corrections Department (For one year beginning approximately March 1, 2009)
OFFERORS NOTE!!
Carefully read all instructions, requirements and Please return proposal in an appropriately sized
specifications. Fill out all forms properly and envelope or box. PACKAGE MUST SHOW THE JOB
completely. Submit your proposal with all appropriate NUMBER, DESCRIPTION AND BE MARKED
supplements and/or samples. "SEALED PROPOSAL".
RETURN PROPOSAL TO:
HARRIS COUNTY PURCHASING AGENT
1001 PRESTON AVENUE, SUITE 670
HOUSTON, TEXAS 77002
For additional information, contact William Perry at (713) 755-4961
You must sign below in INK; failure to sign WILL disqualify the offer. All prices must be typewritten or written
in ink.
Total Amount of Proposal $
Company Name:
Company Address:
City, State, Zip Code:
Taxpayer Identification Number (T.I.N.):
Do you carry Health Insurance on your employees? ___Yes ___No
If yes, what is the percentage of employees insured? _____%
Telephone No. : FAX No.: e-mail:
Print Name:
Signature: _________________________________________________________________________
WCP/vcj
Revised 11/06
Page 1 of 92
TABLE OF CONTENTS
Items checked below represent components which comprise this bid/proposal package. If the item IS NOT checked, it is NOT
APPLICABLE to this bid/proposal. Offerors are asked to review the package to be sure that all applicable parts are included. If any
portion of the package is missing, notify the Purchasing Department immediately.
It is the Offeror's responsibility to be thoroughly familiar with all Requirements and Specifications. Be sure you understand the following
before you return your bid packet.
__X__ 1. Cover Sheet
Your company name, address, the total amount of the bid/proposal, and your signature (IN INK) should appear on this
page.
__X__ 2. Table of Contents
This page is the Table of Contents.
__X__ 3. General Requirements
You should be familiar with all of the General Requirements.
__X__ 4. Special Requirements/Instructions
This section provides information you must know in order to make an offer properly.
__X__ 5. Specifications
This section contains the detailed description of the product/service sought by the County.
__X__ 6. Pricing/Delivery Information
This form is used to solicit exact pricing of goods/services and delivery costs.
__X__ 7. Attachments
__X__ a. Residence Certification/Tax Form
Be sure to complete this form and return with packet.
_____ b. Bid Guaranty & Performance Bond Information & Requirements
This form applies only to certain bids/proposals. All public work contracts over $25,000 require a
Payment Bond and over $100,000 must also have a Performance Bond, in a form approved by the
County. Please read carefully and fill out completely.
_____ c. Bid Check Return Authorization Form
This form applies only to certain bids/proposals. Please read carefully and fill out completely.
_____ d. Vehicle Delivery Instructions
Included only when purchasing vehicles.
__X__ e. Minimum Insurance Requirements
(Included in specific requirements when applicable (does not supersede “Hold Harmless” section of
General Requirements).
_____ f. Worker’s Compensation Insurance Coverage Rule 110.110
This requirement is applicable for a building or construction contract.
_____ g. Financial Statement
When this information is required, you must use this form.
__X__ h. Reference Sheet
When this information is required, you must use this sheet.
__X__ i. HIPAA Requirements
__X__ j. Detailed Plan Design Options, Underwriting Information and Questionnaire Response
__X__ k. Questionnaire
__X__ l. Transmittal Statement
Revised 03/04
Page 2 of 92
GENERAL REQUIREMENTS FOR PROPOSALS
READ THIS ENTIRE DOCUMENT CAREFULLY. FOLLOW ALL INSTRUCTIONS. YOU ARE RESPONSIBLE
FOR FULFILLING ALL REQUIREMENTS AND SPECIFICATIONS. BE SURE YOU UNDERSTAND THEM.
General Requirements apply to all advertised requests for proposals; however, these may be superseded, whole or in part, by
the SPECIAL REQUIREMENTS/INSTRUCTIONS OTHER DATA CONTAINED HEREIN. Review the Table of Contents.
Be sure your proposal package is complete.
ACCESS TO RECORDS
In special circumstances, vendor may be required to allow duly authorized representatives of Harris County, the Harris
County Hospital District or the state and federal government access to contracts, books, documents, and records necessary
to verify the nature and extent of the cost of services provided by vendor.
ADDENDA
When specifications are revised, the Harris County Purchasing Agent will issue an addendum addressing the nature of the
change. Offerors must sign it and include it in the returned proposal package.
ASSIGNMENT
The successful offeror may not assign, sell, or otherwise transfer this contract without written permission of Harris County
Commissioners Court.
AWARD
Harris County reserves the right to award this contract on the basis of LOWEST AND BEST OFFER in accordance with the
laws of the State of Texas, to waive any formality or irregularity, to make awards to more than one offeror, to reject any or all
proposals. In the event the lowest dollar offeror meeting specifications is not awarded a contract, the offeror may appear
before the Commissioners Court, Hospital District Board of Managers, the Juvenile Board or other applicable governing body
and present evidence concerning his responsibility after officially notifying the Office of the Purchasing Agent of his intent to
appear.
BONDS
If this proposal requires submission of proposal guarantee and performance bond, there will be a separate page explaining
those requirements. Offers submitted without the required proposal bond or Cashier's Check are not acceptable.
CERTIFICATION REGARDING DEBARMENT, SUSPENSION INELIGIBILITY, AND VOLUNTARY
EXCLUSION
The Contractor certifies by execution of this Contract that it is not ineligible for participation in federal or state assistance
programs under Executive Order 12549, "Debarment and Suspension." The Contractor further agrees to include this
certification in all contracts between itself and any subcontractors in connection with the services performed under this
Contract. Contractor also certifies that contractor will notify Harris County in writing immediately if contractor is not in
compliance with Executive Order 12549 during the term of this contract. Contractor agrees to refund Harris County for
any payments made to the contractor while ineligible.
CONTRACT OBLIGATION
Harris County Commissioners Court must award the contract and the County Judge or other person authorized by the Harris
County Commissioners Court must sign the contract before it becomes binding on Harris County or the offeror. Department
heads are NOT authorized to sign agreements for Harris County. Binding agreements shall remain in effect until all products
and/or services covered by this purchase have been satisfactorily delivered and accepted.
CONTRACT RENEWALS
Renewals may be made ONLY by written agreement between Harris County and the offeror. Any price escalations are
limited to those stated by the offeror in the original proposal.
Revised 04/07
Page 3 of 92
DIGITAL FORMAT
If offeror obtained the proposal specifications in digital format in order to prepare a response, the proposal must be
submitted in hard copy according to the instructions contained in this proposal package. If, in its proposal response,
offeror makes any changes whatsoever to the County's published proposal specifications, the County's proposal
specifications as published shall control. Furthermore, if an alteration of any kind to the County's published proposal
specifications is only discovered after the contract is executed and is or is not being performed, the contract is subject to
immediate cancellation.
DISQUALIFICATION OF OFFEROR
Upon signing this proposal document, an offeror offering to sell supplies, materials, services, or equipment to Harris
County certifies that the offeror has not violated the antitrust laws of this state codified in §15.01, et seq., Business &
Commerce Code, or the federal antitrust laws, and has not communicated directly or indirectly the offer made to any
competitor or any other person engaged in such line of business. Any or all proposals may be rejected if the County
believes that collusion exists among the offerors. Proposals in which the prices are obviously unbalanced may be rejected.
If multiple proposals are submitted by an offeror and after the proposals are opened, one of the proposals is withdrawn, the
result will be that all of the proposals submitted by that offeror will be withdrawn; however, nothing herein prohibits a
vendor from submitting multiple offers for different products or services.
E-MAIL ADDRESSES CONSENT
Vendor affirmatively consents to the disclosure of its e-mail addresses that are provided to Harris County, the Harris
County Flood Control District, the Harris County Hospital District including its HMO, the Harris County Appraisal
District, or any agency of Harris County. This consent is intended to comply with the requirements of the Texas Public
Information Act, Tex. Gov’t Code Ann. §522.137, as amended, and shall survive termination of this agreement. This
consent shall apply to e-mail addresses provided by Vendor, its employees, officers, and agents acting on Vendor’s behalf
and shall apply to any e-mail address provided in any form for any reason whether related to this bid/proposal or otherwise.
EVALUATION
Evaluation shall be used as a determinant as to which proposed items or services are the most efficient and/or most economical
for the County. It shall be based on all factors which have a bearing on price and performance of the items in the user
environment. All proposals are subject to negotiations by the Purchasing Agent and other appropriate departments, with
recommendation to the appropriate governing body. Compliance with all requirements, delivery and needs of the using
department are considerations in evaluating proposals. Pricing is NOT the only criteria for making a recommendation. A
preliminary evaluation by Harris County will be held and appropriate proposals will be subjected to the negotiating process.
Upon completion of the negotiations, Harris County will make an award. All proposals that have been submitted shall be
available and open for public inspection after the contract is awarded except for trade secrets or confidential information
contained in the proposals and identified as such.
FISCAL FUNDING
A multi-year lease or lease/purchase arrangement (if requested by the specifications), or any contract continuing as a result of
an extension option, must include fiscal funding out. If, for any reason, funds are not appropriated to continue the lease or
contract, said lease or contract shall become null and void on the last day of the current appropriation of funds. After
expiration of the lease, leased equipment shall be removed by the contractor from the using department without penalty of any
kind or form to Harris County. All charges and physical activity related to delivery, installation, removal and redelivery shall
be the responsibility of the offeror.
GOVERNING FORMS
In the event of any conflict between the terms and provisions of these requirements and the specifications, the specifications
shall govern. In the event of any conflict of interpretation of any part of this overall document, Harris County's interpretation
shall govern.
Revised 09/05
Page 4 of 92
GOVERNING LAW
This request for proposals is governed by the competitive bidding requirements of the County Purchasing Act, Texas Local
Government Code, §262.021 et seq., as amended. Offerors shall comply with all applicable federal, state and local laws and
regulations. Offeror is further advised that these requirements shall be fully governed by the laws of the State of Texas and
that Harris County may request and rely on advice, decisions and opinions of the Attorney General of Texas and the County
Attorney concerning any portion of these requirements.
GRANT FUNDING
Any contract entered into by the County that is to be paid from grant funds shall be limited to payment from the grant
funding and the vendor/provider understands that the County has not set aside any County funds for the payment of
obligations under a grant contract. If grant funding should become unavailable at any time for the continuation of services
paid for by the grant, and further funding cannot be obtained for the contract, then the sole recourse of the provider shall
be to terminate any further services under the contract and the contract shall be null and void.
HIPAA COMPLIANCE
Offeror agrees to comply with the Standards for Privacy of Individually Identifiable Health Information of the Health
Insurance Portability and Accountability Act of 1996, PL 104-191, 45 CFR Parts 160-164, as amended, and the Texas
Medical Records Privacy Act, Texas Health and Safety Code Chapter 181, as amended, collectively referred to as
"HIPAA", to the extent that the Offeror uses, discloses or has access to protected health information as defined by HIPAA.
Offeror may be required to enter a Business Associate Agreement pursuant to HIPAA.
HOLD HARMLESS AGREEMENT
Contractor, the successful offeror, shall indemnify and hold Harris County harmless from all claims for personal injury, death
and/or property damage resulting directly or indirectly from contractor's performance. Contractor shall procure and maintain,
with respect to the subject matter of this proposal, appropriate insurance coverage including, as a minimum, public liability
and property damage with adequate limits to cover contractor's liability as may arise directly or indirectly from work
performed under terms of this proposal. Certification of such coverage must be provided to the County upon request.
INSPECTIONS & TESTING
Harris County reserves the right to inspect any item(s) or service location for compliance with specifications and
requirements and needs of the using department. If an offeror cannot furnish a sample of a bid item, where applicable, for
review, or fails to satisfactorily show an ability to perform, the County can reject the bid as inadequate.
INVOICES AND PAYMENTS
Offerors shall submit an original invoice on each purchase order or purchase release after each delivery, indicating the
purchase order number. Invoices must be itemized. Any invoice which cannot be verified by the contract price and/or is
otherwise incorrect will be returned to the offeror for correction. Under term contracts, when multiple deliveries and/or
services are required, the offeror may invoice following each delivery and the County will pay on invoice. Contracts
providing for a monthly charge will be billed and paid on a monthly basis only. Prior to any and all payments made for
goods and/or services provided under this contract, the offeror should provide his Taxpayer Identification Number or social
security number as applicable. This information must be on file with the Harris County Auditor’s office. Failure to
provide this information may result in a delay in payment and/or back-up withholding as required by the Internal Revenue
Service.
MAINTENANCE
Maintenance required for equipment proposed should be available in Harris County by a manufacturer-authorized
maintenance facility. Costs for this service shall be shown on the Pricing/Delivery Information. If Harris County opts to
include maintenance, it shall be so stated in the purchase order and said cost will be included. Service will commence only
upon expiration of applicable warranties and should be priced accordingly.
Revised 09/05
Page 5 of 92
MATERIAL SAFETY DATA SHEETS
Under the "Hazardous Communication Act", commonly known as the "Texas Right To Know Act", an offeror must provide to
the County with each delivery, material safety data sheets which are applicable to hazardous substances defined in the Act.
Failure of the offeror to furnish this documentation will be cause to reject any bid applying thereto.
NEW MILLENIUM COMPLIANCE
All products and/or services furnished as part of this contract must be compliant for the present year and forward. This
applies to all computers including hardware and software as well as all other commodities with date sensitive embedded
chips.
POTENTIAL CONFLICTS OF INTEREST
An outside consultant or contractor is prohibited from submitting a proposal for services on a Harris County project of
which the consultant or contractor was a designer or other previous contributor, or was an affiliate, subsidiary, joint
venturer or was in any other manner associated by ownership to any party that was a designer or other previous contributor.
If such a consultant or contractor submits a prohibited proposal, that proposal shall be disqualified on the basis of conflict
of interest, no matter when the conflict is discovered by Harris County. Potential proposers are advised that they may have
disclosure requirements pursuant to Texas Local Government Code, Chapter 176. This law requires persons desiring to do
business with the County to disclose any gifts valued in excess of $250 given to any County Official or the County
Official’s family member, or employment of any County Official or the County Official’s family member during the
preceding twelve (12) month period. The disclosure questionnaire must be filed with the Harris County Clerk. Refer to
Texas Local Government Code, Chapter 176 for the details of this law.
PRICING
Prices for all goods and/or services shall be negotiated to a firm amount for the duration of this contract or as agreed to in
terms of time frame. All prices must be written in ink or typewritten. Where unit pricing and extended pricing differ, unit
pricing prevails.
PROPOSAL COMPLETION
Fill out and return to Purchasing, ONE (1) complete proposal form in an appropriately sized envelope or box. PACKAGE
MUST SHOW THE JOB NUMBER, DESCRIPTION AND BE MARKED “SEALED PROPOSAL.” An authorized
company representative should sign the Proposal Cover Sheet. Completion of these forms is intended to verify that the offeror
has submitted the proposal, is familiar with its contents and has submitted the material in accordance with all requirements.
PROPOSAL RETURNS
Offerors must return all completed proposals to the office of the Harris County Purchasing Agent reception desk at 1001
Preston Avenue, Suite 670, Houston, Texas before 2:00 P.M. LOCAL TIME IN HOUSTON, TEXAS on the date
specified. Late proposals will not be accepted.
PURCHASE ORDER AND DELIVERY
The successful offeror shall not deliver products or provide services without a Harris County Purchase Order, signed by an
authorized agent of the Harris County Purchasing Agent. The fastest, most reasonable delivery time shall be indicated by the
offeror in the proper place on the proposal document. Any special information concerning delivery should also be included,
on a separate sheet, if necessary. All items shall be shipped F.O.B. INSIDE DELIVERY unless otherwise stated in the
specifications. This shall be understood to include bringing merchandise to the appropriate room or place designated by the
using department. Every tender or delivery of goods must fully comply with all provisions of these requirements and the
specifications including time, delivery and quality. Nonconformance shall constitute a breach which must be rectified prior to
expiration of the time for performance. Failure to rectify within the performance period will be considered cause to reject
future deliveries and cancellation of the contract by Harris County without prejudice to other remedies provided by law.
Where delivery times are critical, Harris County reserves the right to award accordingly.
Revised 09/05
Page 6 of 92
RECYCLED MATERIALS
Harris County encourages the use of products made of recycled materials and shall give preference in purchasing to products
made of recycled materials if the products meet applicable specifications as to quantity and quality. Harris County will be the
sole judge in determining product preference application.
SEVERABILITY
If any section, subsection, paragraph, sentence, clause, phrase or word of these requirements or the specifications shall be held
invalid, such holding shall not affect the remaining portions of these requirements and the specifications and it is hereby
declared that such remaining portions would have been included in these requirements and the specifications as though the
invalid portion had been omitted.
SILENCE OF SPECIFICATIONS
The apparent silence of specifications as to any detail, or the apparent omission from it of a detailed description concerning
any point, shall be regarded as meaning that only the best commercial practice is to prevail and that only material and
workmanship of the finest quality are to be used. All interpretations of specifications shall be made on the basis of this
statement. The items furnished under this contract shall be new, unused of the latest product in production to commercial
trade and shall be of the highest quality as to materials used and workmanship. Manufacturer furnishing these items shall be
experienced in design and construction of such items and shall be an established supplier of the item proposed.
SUPPLEMENTAL MATERIALS
Offerors are responsible for including all pertinent product data in the returned proposal package. Literature, brochures, data
sheets, specification information, completed forms requested as part of the proposal package and any other facts which may
affect the evaluation and subsequent contract award should be included. Materials such as legal documents and contractual
agreements, which the offeror wishes to include as a condition of the proposal, must also be in the returned proposal package.
Failure to include all necessary and proper supplemental materials may be cause to reject the entire proposal.
TAXES
Harris County is exempt from all federal excise, state and local taxes unless otherwise stated in this document. Harris County
claims exemption from all sales and/or use taxes under Texas Tax Code §151.309, as amended. Texas Limited Sales Tax
Exemption Certificates will be furnished upon written request to the Harris County Purchasing Agent.
TERM CONTRACTS
If the contract is intended to cover a specific time period, the term will be given in the specifications under SCOPE.
TERMINATION
Harris County reserves the right to terminate the contract for default if Seller breaches any of the terms therein, including
warranties of offeror or if the offeror becomes insolvent or commits acts of bankruptcy. Such right of termination is in
addition to and not in lieu of any other remedies which Harris County may have in law or equity. Default may be construed
as, but not limited to, failure to deliver the proper goods and/or services within the proper amount of time, and/or to properly
perform any and all services required to Harris County's satisfaction and/or to meet all other obligations and requirements.
Harris County may terminate the contract without cause upon thirty (30) days written notice.
Termination for Health and Safety Violations.
Harris County has the option to terminate this contract immediately without prior notice if offeror fails to perform any of
its obligations in this contract if the failure (a) created a potential threat to health or safety or (b) violated a law, ordinance,
or regulation designed to protect health or safety.
Revised 09/05
Page 7 of 92
TESTING
Harris County reserves the right to test equipment, supplies, material and goods proposed for quality, compliance with
specifications and ability to meet the needs of the user. Demonstration units must be available for review. Should the goods
or services fail to meet requirements and/or be unavailable for evaluation, the offer is subject to rejection.
TITLE TRANSFER
Title and Risk of Loss of goods shall not pass to Harris County until Harris County actually receives and takes possession of
the goods at the point or points of delivery. Receiving times may vary with the using department. Generally, deliveries may
be made between 8:30 a.m. and 4:00 p.m., Monday through Friday. Offerors are advised to consult the using department for
instructions. The place of delivery shall be shown under the "Special Requirements/Instructions" section of this proposal
and/or on the Purchase Order as a "Deliver To:" address.
WAIVER OF SUBROGATION
Offeror and offeror's insurance carrier waive any and all rights whatsoever with regard to subrogation against Harris County as
an indirect party to any suit arising out of personal or property damages resulting from offeror's performance under this
agreement.
WARRANTIES
Offerors shall furnish all data pertinent to warranties or guarantees which may apply to items in the proposal. Offerors may
not limit or exclude any implied warranties. Offeror warrants that product sold to the County shall conform to the standards
established by the U.S. Department of Labor under the Occupational Safety and Health Act of 1970. In the event product does
not conform to OSHA Standards, where applicable, Harris County may return the product for correction or replacement at the
offeror's expense. If offeror fails to make the appropriate correction within a reasonable time, Harris County may correct at
the offeror's expense.
VENDORS OWING TAXES
Pursuant to TX Local Government Code 262.0276, Harris County Commissioners Court has adopted a policy which
requires that vendors’ taxes be current as of the date bids/proposals are due. Bidders with delinquent county taxes on the
due date will not be eligible for award. Whether or not a vendor’s taxes are delinquent will be determined by an
independent review of the Tax Office records. Vendors who believe a delinquency is reflected in error must contact the
Tax Office to correct any errors or discrepancies prior to submitting their bid in order to ensure that their bid will be
considered. Tax records are available online at the Tax Office website—www.hctax.net. Prior to submitting a bid,
vendors are encouraged to visit the Tax Office website, set up a portfolio of their accounts and make their own initial
determination of the status of their tax accounts. Furthermore, if, during the performance of this contract, a vendor’s taxes
become delinquent, Harris County reserves the right to provide notice to the Auditor or Treasurer pursuant to Texas Local
Government Code §154.045. This policy is effective for all bids due on or after May 1, 2004.
Revised 05/07
Page 8 of 92
SPECIAL REQUIREMENTS/INSTRUCTIONS
The following requirements and instructions supersede General Requirements where applicable.
Should this contract apply to other governmental entities, references to “Harris County” and the “Harris County
Commissioners Court” may apply to one or both of the following:
“Harris County Flood Control District” governed by “Harris County Commissioners Court” herein, referred to
as the “County”
“Greater Harris County 9-1-1 Emergency Network” governed by its “Board of Managers” herein, referred to
as the “County”
“Harris County Community Supervision and Corrections Department” governed by its “Standing
Committee for Probation Matters”
A. INSTRUCTIONS
1. Nature of Request for Proposal (RFP)
This is an Alternative Competitive Proposal and as such is governed by the procedures as contained in the
Texas Local Government Code §262.030. Therefore, the award of contracts shall be made to the
responsible offerors whose proposals are determined to be the lowest evaluated offers resulting from
negotiation, taking into consideration the relative importance of the evaluation factors as set forth below.
Discussions may be conducted with responsible offerors who submit proposals reasonably susceptible of
being selected for award. Offerors will be accorded fair and equal treatment with respect to any
opportunity for discussion and revision of proposals, and revisions may be permitted after submission and
before award for the purpose of obtaining best and final offers. Harris County does not accept any
financial responsibility or any cost incurred by any proposer in responding to this RFP. After evaluation
of the proposals, Harris County reserves the right not to award a contract, to accept or reject any or all
proposals or waive any and all formalities not considered advantageous to Harris County.
Under the RFP process, sealed offers will be received and opened in the Office of the Purchasing Agent.
At and after opening, proposals will NOT be part of the public record and subject to disclosure, but will
be kept confidential until time of award. When such award is completed, proposals will be available
for public inspection including those portions marked confidential and/or proprietary.
2. Evaluation Process
All proposals will be screened and examined by the evaluation committee and negotiations will occur only
with those reasonably susceptible of being selected for award.
Harris County may initiate discussions with offerors. Offers resulting from discussions will be accepted
during the evaluation process but only from offerors who responded to the original request. Offerors may
not initiate discussions. Harris County expects to hear presentations and enter into discussions with
personnel authorized to contractually obligate the offerors.
Offerors may be required to make presentations to the evaluation committee. Presentations should
address the offeror’s capabilities and qualifications as well as other factors deemed necessary by Harris
County. Presenters and their staff should be prepared to answer questions regarding procedural,
administrative and technical issues. Presentations may develop into negotiating sessions.
Page 9 of 92
All correspondence related to this RFP, from advertisement to award, shall be sent to the Harris County
Office of the Purchasing Agent. The Office of the Harris County Purchasing Agent shall coordinate all
presentations and/or all meetings between Harris County and the offerors relating to this RFP. Deviations
from this requirement may cause the disqualification of the offeror’s proposal and/or cancellation of this
RFP process.
Submission of a proposal implies the offeror’s acceptance of the evaluation criteria and offeror’s
recognition that subjective judgments may be made by the evaluation committee.
This request for proposal in no manner obligates Harris County or any of its agencies to the eventual
purchase of any services described, implied or proposed, until confirmed by a written contract. Progress
toward this end is solely at the discretion of Harris County and may be terminated at any time prior to the
signing of a contract.
3. Evaluation Criteria
The award of a contract shall be made to the responsible offerors, whose proposal(s) are determined to be
the best evaluated offers resulting from negotiations, taking into consideration the following:
a.) Scope of Services 25%
b.) Information technology capabilities 15%
c.) Requested information included and thoroughness of response 15%
and other criteria presented in the proposal
d.) Price (initial and subsequent year guarantees) 25%
e.) Background of offeror, experience and references 10%
f.) Claims processing accuracy and efficiency 10%
In addition to any rights or remedies detailed in the General Requirements of this RFP,
authorized representatives of Harris County may contact any proposer, company, or individual at
any time during the proposal process in order to clarify, verify, or request information, or to
negotiate regarding the contents of any proposal. Harris County also reserves the right to visit any
offeror’s site at any time during the proposal process for the purposes of evaluating components of
the proposal.
4. Termination of Agreement
In addition to any rights and remedies detailed in the General Requirements of this RFP, Harris County
reserves the right to terminate any agreement based upon failure to comply with usual and customary
practices of the industry, breach of any laws, rules or regulations, or failure to significantly comply or
meet the performance expectations as established in a subsequent contract, if any, between Harris County
and an offeror.
5. Policy Period and Renewal Options
The required insurance coverage and services are scheduled to commence for an initial period beginning
March 1, 2009, and continue until February 28, 2010. In addition, Harris County may desire, at its option,
to continue the insurance coverage or service beyond the initial one (1) year period for up to six (6)
additional one (1) year periods, renewable one (1) year at a time.
6. Invoicing
Page 10 of 92
For verification of enrollment purposes, all Harris County invoices will be sent to: Harris County
Office of Human Resources & Risk Management, 1310 Prairie, Suite 400, Houston, TX 77002. All
costs of services will be itemized when invoiced. Billed rates/premiums and charges will be total and
final, including all losses, loss adjustments, reinsurance, and other company expenses.
Harris County prepares eligibility and billing from internally produced enrollment records and forwards
this information to the appropriate provider. It is the responsibility of the carrier to confirm eligibility
of any covered participant prior to any claim payment or service rendered.
7. Proposed RFP Schedule
Representatives from each proposer are invited together by the type of plans/services being requested.
Due to the limited space, a maximum of three representatives from each company may attend a
meeting. The purpose of the conference is to answer questions and provide clarification to the RFP. So
that answers can be prepared, the proposers should submit their questions and comments by 1:00 p.m. on
July 8, 2008 to: William Perry, Office of the Harris County Purchasing Agent, 1001 Preston Avenue,
Suite 670, Houston, Texas 77002 (phone 713-755-4961 and fax 713-755-6695).
Pre-Proposal Conferences……………………………..………………………………………….July 10,
2008
(Location: 1310 Prairie St, 2nd floor, Houston, TX 77002, 713-755-6495 for directions/information)
Group Medical (includes wellness programs, Employee Assistance Plan,
Flexible Spending Accounts) 9:00 a.m. to 10:30 a.m.
Prescription Drugs 10:45 a.m. to 11:30 a.m.
Medicare Supplemental Plans 1:00 p.m. to 2:00 p.m.
Proposal Due Date (not later than 2:00 p.m.)…………………….………MONDAY, AUGUST 4, 2008
Post-Proposal Presentations .......................................................................... To Be Announced
After the proposals are received, opened and reviewed, certain proposers may be asked to give an oral
presentation to outline and explain their proposal. The Office of the Harris County Purchasing Agent
will schedule these presentations. If the person who is to make the presentation is someone other than
the person listed on the Cover Sheet, provide the name and phone number of the individual in Section
VII. of the offer. Missed appointments may not be made up, so it is imperative to have someone
available during this time period if an oral presentation is desired.
Meeting with Selected Provider(s) to Discuss Implementation of Plans ............... Post Award
Printed Materials Ready for Distribution ..... …………………………….November 14, 2008
Employee Meetings and Open Enrollment Begins ........................ ………..December 1, 2008
Plan Year Begins .................................................................................................March 1, 2009
Page 11 of 92
8. Health Insurance Portability and Accountability Act (HIPAA)
To the extent that contractor uses, discloses, or has access to Protected Health Information as defined at 45
CFR § 164.501, contractor agrees to fully comply with the applicable rules and regulations of the Health
Insurance Portability and Accountability Act of 1996, PL 104-191, 45 CFR 160 and 164, as amended, and
the Texas Medical Records Privacy Act, Texas Health and Safety Code, Chapter 181, as amended.
Awarded contractor will be required to enter into a Business Associates Agreement for the duration of the
contract. Please see Attachment i., HIPPA Requirements.
B. PROPOSAL REQUIREMENTS
Carefully review the components of this RFP as listed in the Table of Contents. Include with your proposal all
required forms, completed and signed as necessary. Submit your proposal indicating the Job Number, Job
Description, and the wording “SEALED PROPOSAL”, on the outside of the envelope.
Each proposal will be submitted in triplicate (one original and two copies) and include the signed Cover Sheet
and the items and information required in Section I. through Section VII. as detailed below. Clearly identify and
address each requirement as specifically as possible, in ink or typewritten. Use additional pages, if necessary,
maintaining proper identification for items. Proposals shall be firm and effective for at least ninety (90) days after
date of submission. Withdrawal of offer after receipt by Harris County may be considered a breach of contract.
If the proposal involves subcontractors, Harris County reserves the right to review the terms of agreements/contracts
with the subcontractors and approve the subcontractors prior to the contract with Harris County. Thereafter, should
the subcontractor be replaced during the contract period, notification will be provided sixty (60) days in advance to
Harris County and approval obtained. The primary contractor shall at all times be fully responsible for all contract
provisions and services proposed.
Section I. Proposal Sheet and Executive Summary
The offeror will complete and include as the first page of Section I. of the submitted proposal the first page of
this RFP, the Cover Sheet. The authorizing signature indicates the proposer’s desire to provide the
products/services as submitted in the applicable proposal.
In addition, the proposer will include in Section I. with the Cover Sheet, an Executive Summary of the
proposal, asserting that, and briefly describing how, all requirements of the applicable items of this RFP will
be met. Not to exceed three (3) pages, the Executive Summary should briefly explain the proposer’s ability
to meet the needs and requirements of the applicable items of this RFP.
Section II. Questionnaire
Each offeror will complete Attachment k., Questionnaire, to this RFP and include it in Section II. of the
submitted proposal. The information will be used in the evaluation process; therefore, responses should be as
thorough and definitive as possible. Failure to complete applicable questions may result in rejection of the
proposal as non-responsive.
Page 12 of 92
Section III. References/Financial Statements
Each offeror will complete Attachment h., Reference Sheet, to this RFP and include it in Section III. of
the submitted proposal. References from large government entities are recommended. In addition, each
proposer will include the two most recent audited financial statements and include industry financial rating
information for any publicly held companies they represent.
Section IV. Residence Certification
Each proposer will complete Attachment a., Residence Certification, to this RFP and include it in
Section IV. of the submitted proposal.
Section V. Scope of Service and Pricing/Delivery Information
Each proposer should include in Section V. of their offer, a detailed explanation of their intention and ability
to satisfy the needs and requirements as described in this RFP. Fully explain your organization’s experience
and diversity of resources, which qualify it for consideration. In addition, complete and include in Section
V., the completed applicable Pricing Sheets from this RFP. The proposer may duplicate the Pricing Sheets
to indicate rate/pricing guarantees for multiple years and/or multiple products.
Premiums and pricing, as provided in the submitted proposal, shall be all-inclusive and firm for the duration
of the initial contract year. All costs will be total and final.
Each proposer should also include in Section V. of this proposal, the completed and signed Attachment k.,
Transmittal Statement, assuming coverage for all plan participants who are currently covered under the
expiring group insurance policies which the proposed benefits are to replace.
Section VI. Special Requirements
The proposer should include in Section VI. of the submitted proposal, any appropriate company brochures,
products guides, etc. Proposer should include a copy of the proposed policy and coverage, complete with all
forms, certificates, endorsements, instructions, and an outline detailing the method for processing any claims
that may be incurred under the policy. In addition, any proposing agent or broker acting on behalf of an
insurer shall provide a Certificate of Insurance showing errors and omissions liability and a letter of
authority from the prospective provider(s) confirming the ability of the broker to represent the insurer.
Section VII. Contact Information
Each proposer will include in Section VII. of the submitted proposal the identities, addresses and telephone
numbers of representatives that can be reached for the purpose of clarifying, verifying, and/or negotiating the
contents of the submitted proposal, as well as supplying additional information, as requested.
Page 13 of 92
SPECIFICATIONS
Request for Proposal for Group Medical, Flexible Spending Accounts and Related Employee Benefits
for Harris County, Harris County Flood Control District and Harris County Community Supervision
and Corrections Department
SCOPE
It is the intention of this Request for Proposal (RFP) for Harris County to purchase group medical and related
employee benefits programs for Harris County, the Harris County Flood Control District, and Community
Supervision and Corrections (CSC) (approximately 200 CSC retirees only) from a qualified and reputable provider
beginning March 1, 2009.
Information regarding technical aspects of the proposal should be directed to the following Human Resources &
Risk Management staff: Robin Vincent at (713) 755-6495; Krista Britt at (713) 755-5349; Shain Carrizal at (713)
755-8773 or Larry Durant at (713) 755-8260. Questions regarding proposal procedures should be addressed to
William Perry, Office of the Harris County Purchasing Agent, at (713) 755-4961.
Pre-proposal conferences are scheduled for July 10, 2008 from 9:00 a.m. until 2:00 p.m. Please see Section 7
under Special Requirements/Instructions for details. The conferences will be held in the 2nd floor conference
room at 1310 Prairie St, Houston, TX 77002. For detailed directions, please call (713) 755-6495. Attendance is
not mandatory but all proposers are encouraged to attend in order to have a better understanding of the
requirements of this RFP. Persons with disabilities requiring special accommodations should contact the Office of
the Purchasing Agent at (713) 755-5036 at least two (2) days prior to the conferences.
TASK DESCRIPTION
Harris County is committed to providing a broad spectrum benefits plan to its employees, retirees and their eligible
dependents while containing cost. This employee benefits plan is designed to attract and retain qualified personnel.
Considerations for the provision of these benefits include access and efficient delivery of care, case management,
disease management and cost containment while providing high quality care. Additional considerations include an
emphasis on preventive care, wellness programs and communication.
To provide a high quality group medical care benefits program at a competitive price that satisfies the needs of, and
gains acceptance by, Harris County participants, the plans proposed should include a comprehensive provider
network, which can provide appropriate treatment and cost effective care. Management of health care must not be
perceived by employees as withholding of health care.
Proposers are requested to submit offers on any or all of the following employee benefit programs:
1. Group Medical, includes wellness, Employee Assistance Plan (EAP) and Flexible Spending Accounts
(FSA)
2. Prescription Drugs
3. Voluntary Medicare Supplement Policies
For a complete description of current Harris County benefits and plan documents please visit our website at
http://www.co.harris.tx.us/hrrm/.
Page 14 of 92
PROPOSALS BY PLAN ITEM
The following specific information by plan item, including current coverage, required design options, and
applicable funding alternatives, should be considered in submitting proposals:
I. GROUP MEDICAL COVERAGE: Based on the following considerations and the summary of present
coverage, proposers should submit up to three (3) separate offers, one for each of the following plan design
options. Funding alternatives include administrative service only (ASO). In addition, proposers should submit
offers, on the applicable pricing sheets attached, for stop loss insurance for each plan design option proposed.
a. Plan Design Options:
Option I: Base Plan & Plus Plans (current plans)
Option II: Base Plan & Plus Plan with modified benefits
Option III: Base Plan & Plus Plan with modified benefits (Base Plan – in network, only)
Reference Attachment j., Detailed Plan Design Options, Underwriting Information and
Questionnaire Response.
Pre-existing Condition: Harris County is compliant with the Health Insurance Portability and
Accountability Act (HIPAA).
Hospital Confinement on Effective Date of Coverage: Under the current plan, if a member is a patient in
a hospital on the effective date of coverage, the member will be covered as of that date unless he/she
becomes ineligible under the plan or if the group contract is discontinued and not replaced by another.
Such services are not covered if the member is covered by another health plan on that date and the other
health plan is responsible for the costs of the services. Proposers would be required to provide coverage
from the effective date of insurance to eligible members who are hospitalized on the date of inception of
the contract.
No Loss/No Gain Provision: This applies to coverage with credit given for partially and fully satisfied
deductibles and out-of-pocket costs.
On-Site Customer Service Unit: Harris County currently has an on-site customer service unit. If the
proposer has any objections to establishing an on-site customer service unit, state this in the offer.
Service Requirements: In addition to the above, Harris County requests the following:
o Maintain comprehensive network of qualified cost-effective providers;
o Timely access to health care;
o Provide integrated claims systems;
o Ensure claims match with negotiated charges by network providers and review charges with related
injury, illness and/or disease;
o Audit for un-bundling and up-coding of services;
Page 15 of 92
o A dedicated service unit(s) to receive claims submitted by Harris County members;
o Provide customized reporting;
o Ensure compliance with applicable legislation;
o Twenty-four (24) hour customer service to be available and staffed by qualified personnel for all
participants to be able to obtain assistance relating to emergencies;
o Health hot-line staffed by qualified personnel for members to call to obtain assistance and
information in relation to health-related issues;
o If contracts are awarded to different providers such as a pharmacy benefit manager (PBM), then the
health care provider shall have the capability and ability to interface with these providers;
o Employee assistance (EAP) and wellness programs are to be integrated with the group medical
plan;
o Flexible Spending Accounts are to be integrated with the group medical plan; and
o User-friendly website and e-mail capabilities for Harris County and its members to obtain
information and communicate with contractors subject to applicable confidentiality laws and
regulations.
Page 16 of 92
II. PRESCRIPTION DRUG PROGRAM: Based on the following considerations and the summary of present
coverage, proposers should submit up two (2) separate offers, one for each of the following plan design options.
Plan Design Options: A managed care prescription drug plan through network community pharmacies and
mail order. Proposals may be submitted either by the group medical plan provider or by a pharmacy benefits
manager (PBM). Include a written plan indicating your managed care approach, disease management, plan
design, quality assurance, and list of network providers.
Option I. Current Plan
The County’s current plan documents are located on our website at http://www.co.harris.tx.us/hrrm/ .
Option II. Increase maximum copays - reference chart
Option I., Current Plan Option II., Increased Max Copay
Drug Type Community Mail-order Community Mail-order
(30 Day Supply) (31-90 Day Supply) (30 Day Supply) (31-90 Day Supply)
Generic 25% 25% 25% 25%
$5 min. $10 min. $5 min. $10 min.
$15 max. $30 max. $20 max. $40 max.
Brand 25% 25% 25% 25%
$20 min. $40 min. $20 min. $40 min.
$60 max. $120 max. $75 max. $150 max.
Self-Injectables 25% 25% 25%
$20 min. $40 min. $25 min.
$60 max. $120 max. $100 max.
30 day supply only
III. EMPLOYEE ASSISTANCE PLAN (EAP): Based on the following summary of present coverage,
proposers should submit an offer for administration of EAP and related services for Harris County’s group medical
plan. Independent EAP providers must submit in partnership with a group medical plan provider.
Summary of Present Coverage: The EAP is included under the Group Medical plan and provides for up to
three (3) free confidential visits or referral services for life cycle and mental issues for employees/retirees and
anyone living in their household. Mental health benefits are outlined in the summary of present coverage under
the Group Medical plan.
IV. VOLUNTARY MEDICARE SUPPLEMENT POLICIES: Harris County does not currently offer any
Medicare Supplement Policies to its retirees or their dependents. Plans described in Specifications for Group
Medical above will be considered along with any Medicare Supplement Policies, i.e., prescription drug plans, etc.
The only acceptable funding method is a fixed monthly premium.
Page 17 of 92
V. FLEXIBLE SPENDING ACCOUNTS (FSA): Based on the following summary of present coverage,
proposers should submit an offer for administration of FSA and related services in conjunction with Harris
County’s group medical plan. Independent FSA providers must submit in partnership with a group medical plan
provider.
Summary of Present Coverage: Three types of flexible spending accounts are presently being offered: 1)
health care reimbursement, 2) dependent care reimbursement, and 3) qualified transportation account. Currently,
these accounts are administered by Aetna.
Page 18 of 92
Harris County Enrollment
Use the enrollment estimates below for the plan design(s) you are proposing (Medical Options I., II. and/or III. and
Prescription Drug Options I. and II.).
Three Tier
Base Plan
Employee:
Employee Only 5,086
Employee + One Dependent 1,407
Employee + Two or More Dependents 1,731
Subtotal 8,224
Retiree:
Retiree Only 1,676
Retiree + One Dependent 646
Retiree + Two or More Dependents 71
Subtotal 2,393
Plus Plan
Employee:
Employee Only 3,517
Employee + One Dependent 1,336
Employee + Two or More Dependents 1,408
Subtotal 6,261
Retiree:
Retiree Only 466
Retiree + One Dependent 265
Retiree + Two or More Dependents 59
Subtotal 790
Total Subscribers 17,668
Note: For complete demographics for the above enrollment estimates, refer to Attachment j – Detailed Plan
Design Options, Underwriting Information and Questionnaire Response. The table above does not include
COBRA.
Page 19 of 92
GROUP MEDICAL
and
EMPLOYEE BENEFITS RFP
PRICING SHEETS
for:
HARRIS COUNTY, HARRIS
COUNTY FLOOD CONTROL
DISTRICT and HARRIS
COUNTY COMMUNITY
SUPERVISION AND
CORRECTIONS
Page 20 of 92
PRICING/DELIVERY INFORMATION
Company Name:
Offerors will use the following forms to submit pricing for the plan design options described in the Specifications
section of this RFP. Duplicate the Pricing Sheets as necessary to quote various options and to indicate rate/pricing
for renewal years. The startup date for this contract is March 1, 2009.
Participants listed are based on June 2008 enrollment. Pricing will be inclusive of all costs, and not subject to
change based upon enrollment during the contract period specified. Rates quoted should be incremental according
to given enrollment for a particular classification. If rates vary based on enrollment assumptions, make
appropriate notes on the Pricing Sheets. If not quoting on a particular element of the plans/services requested,
indicate on the appropriate Pricing Sheet.
Indicate plans and services quoted:
YES NO
1. Group Medical
2. Prescription Drug Program
3. Employee Assistance (EAP)
4. Medicare Supplement Policies
5. Flexible Spending Accounts (FSA)
Multi-Year Rate Guarantees
Harris County may wish to renew for up to six (6) additional contract years. Offerors may duplicate the Pricing
Sheets to indicate renewal rate/pricing for renewal years. If any change to initial year pricing is requested,
offeror must include the methodology that will be used to determine the actual adjustment. Once proposed and
accepted by Harris County, exercise of any renewal pricing option is solely at the discretion of the Harris
County.
Page 21 of 92
GROUP MEDICAL ADMINISTRATION
Pricing: Bidder must complete open boxes to right of double vertical lines. Participants are based on current
enrollment and Harris County may require more or less. In case of discrepancy between monthly rate and
extended pricing, monthly rate governs. If for any reason your administrative cost varies by plan option,
indicate on separate attachment.
Medical Options I., II., and III. - Excluding Prescription Drugs
2009-10
Participants UM Monthly Rate Monthly Cost Annual Cost
Base Plan
Administration 10,617 each
EAP 10,617 each
Other (Specify) 10,617 each
10,617 each
10,617 each
10,617 each
Plus Plan
Administration 7,051 each
EAP 7,051 each
Other (Specify) 7,051 each
7,051 each
7,051 each
7,051 each
Total Cost:
2010-11
Participants UM Monthly Rate Monthly Cost Annual Cost
Base Plan
Administration 10,617 each
EAP 10,617 each
Other (Specify) 10,617 each
10,617 each
10,617 each
10,617 each
Plus Plan
Administration 7,051 each
EAP 7,051 each
Other (Specify) 7,051 each
7,051 each
7,051 each
7,051 each
Total Cost:
2011-12
Participants UM Monthly Rate Monthly Cost Annual Cost
Base Plan
Administration 10,617 each
EAP 10,617 each
Other (Specify) 10,617 each
10,617 each
10,617 each
10,617 each
Page 22 of 92
Plus Plan
Administration 7,051 each
EAP 7,051 each
Other (Specify) 7,051 each
7,051 each
7,051 each
7,051 each
Total Cost:
2012-13
Participants UM Monthly Rate Monthly Cost Annual Cost
Base Plan
Administration 10,617 each
EAP 10,617 each
Other (Specify) 10,617 each
10,617 each
10,617 each
10,617 each
Plus Plan
Administration 7,051 each
EAP 7,051 each
Other (Specify) 7,051 each
7,051 each
7,051 each
7,051 each
Total Cost:
2013-14
Participants UM Monthly Rate Monthly Cost Annual Cost
Base Plan
Administration 10,617 each
EAP 10,617 each
Other (Specify) 10,617 each
10,617 each
10,617 each
10,617 each
Plus Plan
Administration 7,051 each
EAP 7,051 each
Other (Specify) 7,051 each
7,051 each
7,051 each
7,051 each
Total Cost:
2014-15
Participants UM Monthly Rate Monthly Cost Annual Cost
Base Plan
Administration 10,617 each
EAP 10,617 each
Other (Specify) 10,617 each
10,617 each
10,617 each
10,617 each
Page 23 of 92
Plus Plan
Administration 7,051 each
EAP 7,051 each
Other (Specify) 7,051 each
7,051 each
7,051 each
7,051 each
Total Cost:
2015-16
Participants UM Monthly Rate Monthly Cost Annual Cost
Base Plan
Administration 10,617 each
EAP 10,617 each
Other (Specify) 10,617 each
10,617 each
10,617 each
10,617 each
Plus Plan
Administration 7,051 each
EAP 7,051 each
Other (Specify) 7,051 each
7,051 each
7,051 each
7,051 each
Total Cost:
Recap Annual Total for Plan Year 1:
Annual Total for Plan Year 2:
Annual Total for Plan Year 3:
Annual Total for Plan Year 4:
Annual Total for Plan Year 5:
Annual Total for Plan Year 6:
Annual Total for Plan Year 7:
Total for all seven years:
Page 24 of 92
GROUP MEDICAL CLAIMS PROJECTIONS
OPTION I
To assist in the proposal comparison, we are requesting that all proposals provide the following information regarding the level of claim payments
beginning with the fiscal year March 1, 2009 through February 28, 2010. Complete without Prescription Drugs and do not include any pooled
claims based on stop loss limits requested in the proposal. If your PPO network does not include network fees, please mark “N/A”.
2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16
Option I
Base Plan:
(a) Paid Claims
(b) Network Fees
(c) IBNR Reserves Including Network Fees
(a+b+c) Total Incurred
Plus Plan:
(e) Paid Claims
(f) Network Fees
(g) IBNR Reserves Including Network Fees
(e+f+g) Total Incurred
Total Base and Plus Plans:
Paid Claims
Network Fees
IBNR Reserves Including Network Fees
Total Incurred
Notes: Assume constant enrollment as described on page 19 for all plan years.
Page 25 of 92
GROUP MEDICAL CLAIMS PROJECTIONS
OPTION II
To assist in the proposal comparison, we are requesting that all proposals provide the following information regarding the level of claim payments
beginning with the fiscal year March 1, 2009 through February 28, 2010. Complete without Prescription Drugs and do not include any pooled
claims based on stop loss limits requested in the proposal. If your PPO network does not include network fees, please mark “N/A”.
2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16
Option II
Base Plan:
(a) Paid Claims
(b) Network Fees
(c) IBNR Reserves Including Network Fees
(a+b+c) Total Incurred
Plus Plan:
(e) Paid Claims
(f) Network Fees
(g) IBNR Reserves Including Network Fees
(e+f+g) Total Incurred
Total Base and Plus Plans:
Paid Claims
Network Fees
IBNR Reserves Including Network Fees
Total Incurred
Notes: Assume constant enrollment as described on page 19 for all plan years.
Page 26 of 92
GROUP MEDICAL CLAIMS PROJECTIONS
OPTION III
To assist in the proposal comparison, we are requesting that all proposals provide the following information regarding the level of claim payments
beginning with the fiscal year March 1, 2009 through February 28, 2010. Complete without Prescription Drugs and do not include any pooled
claims based on stop loss limits requested in the proposal. If your PPO network does not include network fees, please mark “N/A”.
2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16
Option III
Base Plan:
(a) Paid Claims
(b) Network Fees
(c) IBNR Reserves Including Network Fees
(a+b+c) Total Incurred
Plus Plan:
(e) Paid Claims
(f) Network Fees
(g) IBNR Reserves Including Network Fees
(e+f+g) Total Incurred
Total Base and Plus Plans:
Paid Claims
Network Fees
IBNR Reserves Including Network Fees
Total Incurred
Notes: Assume constant enrollment as described on page 19 for all plan years.
Page 27 of 92
GROUP MEDICAL ADMINISTRATION
Pricing: Bidder must complete open boxes to right of double vertical lines. Participants are based on current
enrollment and Harris County may require more or less. In case of discrepancy between monthly rate and
extended pricing, monthly rate governs.
Medical Options I., II., and III. (circle one) - Including Prescription Drugs Option I. and II. (circle one)
2009-10
Participants UM Monthly Rate Monthly Cost Annual Cost
Base Plan
Administration 10,617 Each
EAP 10,617 Each
Other (Specify) 10,617 Each
10,617 Each
10,617 each
10,617 each
Plus Plan
Administration 7,051 each
EAP 7,051 each
Other (Specify) 7,051 each
7,051 each
7,051 each
7,051 each
Total Cost:
2010-11
Participants UM Monthly Rate Monthly Cost Annual Cost
Base Plan
Administration 10,617 each
EAP 10,617 each
Other (Specify) 10,617 each
10,617 each
10,617 each
10,617 each
Plus Plan
Administration 7,051 each
EAP 7,051 each
Other (Specify) 7,051 each
7,051 each
7,051 each
7,051 each
Total Cost:
2011-12
Participants UM Monthly Rate Monthly Cost Annual Cost
Base Plan
Administration 10,617 each
EAP 10,617 each
Other (Specify) 10,617 each
10,617 each
10,617 each
10,617 each
Page 28 of 92
Plus Plan
Administration 7,051 each
EAP 7,051 each
Other (Specify) 7,051 each
7,051 each
7,051 each
7,051 each
Total Cost:
2012-13
Participants UM Monthly Rate Monthly Cost Annual Cost
Base Plan
Administration 10,617 each
EAP 10,617 each
Other (Specify) 10,617 each
10,617 each
10,617 each
10,617 each
Plus Plan
Administration 7,051 each
EAP 7,051 each
Other (Specify) 7,051 each
7,051 each
7,051 each
7,051 each
Total Cost:
2013-14
Participants UM Monthly Rate Monthly Cost Annual Cost
Base Plan
Administration 10,617 each
EAP 10,617 each
Other (Specify) 10,617 each
10,617 each
10,617 each
10,617 each
Plus Plan
Administration 7,051 each
EAP 7,051 each
Other (Specify) 7,051 each
7,051 each
7,051 each
7,051 each
Total Cost:
2014-15
Participants UM Monthly Rate Monthly Cost Annual Cost
Base Plan
Administration 10,617 each
EAP 10,617 each
Other (Specify) 10,617 each
10,617 each
10,617 each
10,617 each
Plus Plan
Administration 7,051 each
Page 29 of 92
EAP 7,051 each
Other (Specify) 7,051 each
7,051 each
7,051 each
7,051 each
Total Cost:
2015-16
Participants UM Monthly Rate Monthly Cost Annual Cost
Base Plan
Administration 10,617 each
EAP 10,617 each
Other (Specify) 10,617 each
10,617 each
10,617 each
10,617 each
Plus Plan
Administration 7,051 each
EAP 7,051 each
Other (Specify) 7,051 each
7,051 each
7,051 each
7,051 each
Total Cost:
Recap Annual Total for Plan Year 1:
Annual Total for Plan Year 2:
Annual Total for Plan Year 3:
Annual Total for Plan Year 4:
Annual Total for Plan Year 5:
Annual Total for Plan Year 6:
Annual Total for Plan Year 7:
Total for all seven years:
Page 30 of 92
PRESCRIPTION DRUG ADMINISTRATION
Pricing: Use this pricing sheet only if you are proposing a “stand alone” prescription drug plan. Bidder must
complete open boxes to right of double vertical lines. Participants are based on current enrollment and Harris
County may require more or less. In case of discrepancy between monthly rate and extended pricing, monthly
rate governs.
Prescription Drug Option I. (Drug Rebates to Harris County)
2009-10
Participants UM Monthly Rate Monthly Cost Annual Cost
Administration 17,668 each
Other (Specify) 17,668 each
17,668 each
17,668 each
17,668 each
Total Cost:
2010-11
Participants UM Monthly Rate Monthly Cost Annual Cost
Administration 17,668 each
Other (Specify) 17,668 each
17,668 each
17,668 each
17,668 each
Total Cost:
2011-12
Participants UM Monthly Rate Monthly Cost Annual Cost
Administration 17,668 each
Other (Specify) 17,668 each
17,668 each
17,668 each
17,668 each
Total Cost:
2012-13
Participants UM Monthly Rate Monthly Cost Annual Cost
Administration 17,668 each
Other (Specify) 17,668 each
17,668 each
17,668 each
17,668 each
Total Cost:
2013-14
Participants UM Monthly Rate Monthly Cost Annual Cost
Administration 17,668 each
Other (Specify) 17,668 each
17,668 each
17,668 each
17,668 each
Total Cost:
2014-15
Participants UM Monthly Rate Monthly Cost Annual Cost
Administration 17,668 each
Page 31 of 92
Other (Specify) 17,668 each
17,668 each
17,668 each
17,668 each
Total Cost:
2015-16
Participants UM Monthly Rate Monthly Cost Annual Cost
Administration 17,668 each
Other (Specify) 17,668 each
17,668 each
17,668 each
17,668 each
Total Cost:
Recap Annual Total for Plan Year 1:
Annual Total for Plan Year 2:
Annual Total for Plan Year 3:
Annual Total for Plan Year 4:
Annual Total for Plan Year 5:
Annual Total for Plan Year 6:
Annual Total for Plan Year 7:
Total for all seven years:
Page 32 of 92
PRESCRIPTION DRUG ADMINISTRATION
Pricing: Use this pricing sheet only if you are proposing a “stand alone” prescription drug plan. Bidder must
complete open boxes to right of double vertical lines. Participants are based on current enrollment and Harris
County may require more or less. In case of discrepancy between monthly rate and extended pricing, monthly
rate governs.
Prescription Drug Option II. (Drug Rebates to Harris County)
2009-10
Participants UM Monthly Rate Monthly Cost Annual Cost
Administration 17,668 each
Other (Specify) 17,668 each
17,668 each
17,668 each
17,668 each
Total Cost:
2010-11
Participants UM Monthly Rate Monthly Cost Annual Cost
Administration 17,668 each
Other (Specify) 17,668 each
17,668 each
17,668 each
17,668 each
Total Cost:
2011-12
Participants UM Monthly Rate Monthly Cost Annual Cost
Administration 17,668 each
Other (Specify) 17,668 each
17,668 each
17,668 each
17,668 each
Total Cost:
2012-13
Participants UM Monthly Rate Monthly Cost Annual Cost
Administration 17,668 each
Other (Specify) 17,668 each
17,668 each
17,668 each
17,668 each
Total Cost:
2013-14
Participants UM Monthly Rate Monthly Cost Annual Cost
Administration 17,668 each
Other (Specify) 17,668 each
17,668 each
17,668 each
17,668 each
Total Cost:
2014-15
Participants UM Monthly Rate Monthly Cost Annual Cost
Administration 17,668 each
Page 33 of 92
Other (Specify) 17,668 each
17,668 each
17,668 each
17,668 each
Total Cost:
2015-16
Participants UM Monthly Rate Monthly Cost Annual Cost
Administration 17,668 each
Other (Specify) 17,668 each
17,668 each
17,668 each
17,668 each
Total Cost:
Recap Annual Total for Plan Year 1:
Annual Total for Plan Year 2:
Annual Total for Plan Year 3:
Annual Total for Plan Year 4:
Annual Total for Plan Year 5:
Annual Total for Plan Year 6:
Annual Total for Plan Year 7:
Total for all seven years:
Page 34 of 92
PRESCRIPTION DRUG ADMINISTRATION
Pricing: Use this pricing sheet only if you are proposing a “stand alone” prescription drug plan. Bidder must
complete open boxes to right of double vertical lines. Participants are based on current enrollment and
Harris County may require more or less. In case of discrepancy between monthly rate and extended pricing,
monthly rate governs.
Prescription Drug Option I. (Drug Rebates to Proposer)
2009-10
Participants UM Monthly Rate Monthly Cost Annual Cost
Administration 17,668 each
Other (Specify) 17,668 each
17,668 each
17,668 each
17,668 each
Total Cost:
2010-11
Participants UM Monthly Rate Monthly Cost Annual Cost
Administration 17,668 each
Other (Specify) 17,668 each
17,668 each
17,668 each
17,668 each
Total Cost:
2011-12
Participants UM Monthly Rate Monthly Cost Annual Cost
Administration 17,668 each
Other (Specify) 17,668 each
17,668 each
17,668 each
17,668 each
Total Cost:
2012-13
Participants UM Monthly Rate Monthly Cost Annual Cost
Administration 17,668 each
Other (Specify) 17,668 each
17,668 each
17,668 each
17,668 each
Total Cost:
2013-14
Participants UM Monthly Rate Monthly Cost Annual Cost
Administration 17,668 each
Other (Specify) 17,668 each
17,668 each
17,668 each
17,668 each
Total Cost:
2014-15
Page 35 of 92
Participants UM Monthly Rate Monthly Cost Annual Cost
Administration 17,668 each
Other (Specify) 17,668 each
17,668 each
17,668 each
17,668 each
Total Cost:
2015-16
Participants UM Monthly Rate Monthly Cost Annual Cost
Administration 17,668 each
Other (Specify) 17,668 each
17,668 each
17,668 each
17,668 each
Total Cost:
Recap Annual Total for Plan Year 1:
Annual Total for Plan Year 2:
Annual Total for Plan Year 3:
Annual Total for Plan Year 4:
Annual Total for Plan Year 5:
Annual Total for Plan Year 6:
Annual Total for Plan Year 7:
Total for all seven years:
Page 36 of 92
PRESCRIPTION DRUG ADMINISTRATION
Pricing: Use this pricing sheet only if you are proposing a “stand alone” prescription drug plan. Bidder must
complete open boxes to right of double vertical lines. Participants are based on current enrollment and
Harris County may require more or less. In case of discrepancy between monthly rate and extended pricing,
monthly rate governs.
Prescription Drug Option II. (Drug Rebates to Proposer)
2009-10
Participants UM Monthly Rate Monthly Cost Annual Cost
Administration 17,668 each
Other (Specify) 17,668 each
17,668 each
17,668 each
17,668 each
Total Cost:
2010-11
Participants UM Monthly Rate Monthly Cost Annual Cost
Administration 17,668 each
Other (Specify) 17,668 each
17,668 each
17,668 each
17,668 each
Total Cost:
2011-12
Participants UM Monthly Rate Monthly Cost Annual Cost
Administration 17,668 each
Other (Specify) 17,668 each
17,668 each
17,668 each
17,668 each
Total Cost:
2012-13
Participants UM Monthly Rate Monthly Cost Annual Cost
Administration 17,668 each
Other (Specify) 17,668 each
17,668 each
17,668 each
17,668 each
Total Cost:
2013-14
Participants UM Monthly Rate Monthly Cost Annual Cost
Administration 17,668 each
Other (Specify) 17,668 each
17,668 each
17,668 each
17,668 each
Total Cost:
Page 37 of 92
2014-15
Participants UM Monthly Rate Monthly Cost Annual Cost
Administration 17,668 each
Other (Specify) 17,668 each
17,668 each
17,668 each
17,668 each
Total Cost:
2015-16
Participants UM Monthly Rate Monthly Cost Annual Cost
Administration 17,668 each
Other (Specify) 17,668 each
17,668 each
17,668 each
17,668 each
Total Cost:
Recap Annual Total for Plan Year 1:
Annual Total for Plan Year 2:
Annual Total for Plan Year 3:
Annual Total for Plan Year 4:
Annual Total for Plan Year 5:
Annual Total for Plan Year 6:
Annual Total for Plan Year 7:
Total for all seven years:
Page 38 of 92
PRESCRIPTION DRUG PROJECTIONS
OPTION I
To assist in the proposal comparison, we are requesting that all proposals provide the following information regarding the level of claim payments
beginning with the fiscal year March 1, 2009 through February 28, 2010. Complete without Medical Claims.
2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16
Option I
Base Plan:
(a) Paid Claims
(b) IBNR Reserves
(a+b) Total Incurred
Plus Plan:
(c) Paid Claims
(d) IBNR Reserves
(c+d) Total Incurred
Total Base and Plus Plans:
Paid Claims
IBNR Reserves
Total Incurred
Notes: Assume constant enrollment as described on page 19 for all plan years.
Page 39 of 92
PRESCRIPTION DRUG PROJECTIONS
OPTION II
To assist in the proposal comparison, we are requesting that all proposals provide the following information regarding the level of claim payments
beginning with the fiscal year March 1, 2009 through February 28, 2010. Complete without Medical Claims.
2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16
Option II
Base Plan:
(a) Paid Claims
(b) IBNR Reserves
(a+b) Total Incurred
Plus Plan:
(c) Paid Claims
(d) IBNR Reserves
(c+d) Total Incurred
Total Base and Plus Plans:
Paid Claims
IBNR Reserves
Total Incurred
Notes: Assume constant enrollment as described on page 19 for all plan years.
Page 40 of 92
MEDICARE SUPPLEMENT POLICY1
Pricing: Bidder must complete open boxes to right of double vertical lines. Participants are estimated and
Harris County may require more or less. In case of discrepancy between monthly rate and extended pricing,
monthly rate governs.
Medical Only - Excluding Prescription Drugs Fully Insured
Plan Description:
2009-10
Participants2 UM Monthly Premium Monthly Cost Annual Cost
Retirees 180 each
Dependents 56 each
Total Cost:
2010-11
Participants2 UM Monthly Premium Monthly Cost Annual Cost
Retirees 180 each
Dependents 56 each
Total Cost:
2011-12
Participants2 UM Monthly Premium Monthly Cost Annual Cost
Retirees 180 each
Dependents 56 each
Total Cost:
2012-13
Participants2 UM Monthly Premium Monthly Cost Annual Cost
Retirees 180 each
Dependents 56 each
Total Cost:
2013-14
Participants2 UM Monthly Premium Monthly Cost Annual Cost
Retirees 180 each
Dependents 56 each
Total Cost:
2014-15
Participants2 UM Monthly Premium Monthly Cost Annual Cost
Retirees 180 each
Dependents 56 each
Total Cost:
2015-16
Participants2 UM Monthly Premium Monthly Cost Annual Cost
Retirees 180 each
Dependents 56 each
Total Cost:
Recap Annual Total for Plan Year 1:
Annual Total for Plan Year 2:
Annual Total for Plan Year 3:
Page 41 of 92
Annual Total for Plan Year 4:
Annual Total for Plan Year 5:
Annual Total for Plan Year 6:
Annual Total for Plan Year 7:
Total for all seven years:
1
Describe in detail your renewal calculation/formula for plan years 2 through 7. Attach additional pages, if necessary.
2Participant enrollment is incremental and monthly premiums quoted for dependents should not include the retiree monthly premium.
Participants are based on 10% voluntary enrollment.
Page 42 of 92
MEDICARE SUPPLEMENT POLICY1
Pricing: Bidder must complete open boxes to right of double vertical lines. Participants are estimated and
Harris County may require more or less. In case of discrepancy between monthly rate and extended pricing,
monthly rate governs.
Medical and Prescription Drugs Fully Insured
Plan Description:
2009-10
Participants2 UM Monthly Premium Monthly Cost Annual Cost
Retirees 180 each
Dependents 56 each
Total Cost:
2010-11
Participants2 UM Monthly Premium Monthly Cost Annual Cost
Retirees 180 each
Dependents 56 each
Total Cost:
2011-12
Participants2 UM Monthly Premium Monthly Cost Annual Cost
Retirees 180 each
Dependents 56 each
Total Cost:
2012-13
Participants2 UM Monthly Premium Monthly Cost Annual Cost
Retirees 180 each
Dependents 56 each
Total Cost:
2013-14
Participants2 UM Monthly Premium Monthly Cost Annual Cost
Retirees 180 each
Dependents 56 each
Total Cost:
2014-15
Participants2 UM Monthly Premium Monthly Cost Annual Cost
Retirees 180 each
Dependents 56 each
Total Cost:
2015-16
Participants2 UM Monthly Premium Monthly Cost Annual Cost
Retirees 180 each
Dependents 56 each
Total Cost:
Recap Annual Total for Plan Year 1:
Annual Total for Plan Year 2:
Annual Total for Plan Year 3:
Page 43 of 92
Annual Total for Plan Year 4:
Annual Total for Plan Year 5:
Annual Total for Plan Year 6:
Annual Total for Plan Year 7:
Total for all seven years:
1
Describe in detail your renewal calculation/formula for plan years 2 through 7. Attach additional pages, if necessary.
2Participant enrollment is incremental and monthly premiums quoted for dependents should not include the retiree monthly premium.
Participants are based on 10% voluntary enrollment.
Page 44 of 92
GROUP MEDICAL STOP LOSS INSURANCE1
OPTION A
Contract Type 12/12
ISL Level $500,000
Specific Covered Benefit Medical/Rx
Coinsurance % 100%
Max. Annual ISL Payment Amount Unlimited
Attachment Point 115%
Aggregate Covered Benefit Medical/Rx
Max. Annual ASL Payment Amount Unlimited
Terminal Liability Option2 Contract Type 3 Months
1
Describe in detail your renewal calculation/formula for plan years 2 through 7. Attach additional pages, if necessary.
2
Describe your terminal liability premium calculation.
Pricing: Participants are based on current enrollment and Harris County may require more or less. Premiums should be on a “per employee/retiree
per month (PEPM)” basis. In case of discrepancy between monthly rate and extended pricing, monthly rate governs. Please complete the table
below using your group medical and prescription claims projections.
Medical Option I with Rx Option I 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16
(a) Specific Stop Loss Premium (PEPM)
(b) Aggregate Stop Loss Premium (PEPM)
(a+b) Total Stop Loss Premium (PEPM)
(c) Participants 17,668 17,668 17,668 17,668 17,668 17,668 17,668
Monthly Cost (a+b) x (c)
Annual Cost (Monthly Cost x 12)
Terminal Liability Premium (PEPM)
Aggregate Attachment Point (PEPM)
Medical Option II with Rx Option I 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16
(a) Specific Stop Loss Premium (PEPM)
(b) Aggregate Stop Loss Premium (PEPM)
(a+b) Total Stop Loss Premium (PEPM)
(c) Participants 17,668 17,668 17,668 17,668 17,668 17,668 17,668
Monthly Cost (a+b) x (c)
Annual Cost (Monthly Cost x 12)
Page 45 of 92
Terminal Liability Premium (PEPM)
Aggregate Attachment Point (PEPM)
Medical Option III with Rx Option I 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16
(a) Specific Stop Loss Premium (PEPM)
(b) Aggregate Stop Loss Premium (PEPM)
(a+b) Total Stop Loss Premium (PEPM)
(c) Participants 17,668 17,668 17,668 17,668 17,668 17,668 17,668
Monthly Cost (a+b) x (c)
Annual Cost (Monthly Cost x 12)
Terminal Liability Premium (PEPM)
Aggregate Attachment Point (PEPM)
Medical Option I with Rx Option II 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16
(a) Specific Stop Loss Premium (PEPM)
(b) Aggregate Stop Loss Premium (PEPM)
(a+b) Total Stop Loss Premium (PEPM)
(c) Participants 17,668 17,668 17,668 17,668 17,668 17,668 17,668
Monthly Cost (a+b) x (c)
Annual Cost (Monthly Cost x 12)
Terminal Liability Premium (PEPM)
Aggregate Attachment Point (PEPM)
Medical Option II with Rx Option II 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16
(a) Specific Stop Loss Premium (PEPM)
(b) Aggregate Stop Loss Premium (PEPM)
(a+b) Total Stop Loss Premium (PEPM)
(c) Participants 17,668 17,668 17,668 17,668 17,668 17,668 17,668
Monthly Cost (a+b) x (c)
Annual Cost (Monthly Cost x 12)
Terminal Liability Premium (PEPM)
Aggregate Attachment Point (PEPM)
Page 46 of 92
Medical Option III with Rx Option II 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16
(a) Specific Stop Loss Premium (PEPM)
(b) Aggregate Stop Loss Premium (PEPM)
(a+b) Total Stop Loss Premium (PEPM)
(c) Participants 17,668 17,668 17,668 17,668 17,668 17,668 17,668
Monthly Cost (a+b) x (c)
Annual Cost (Monthly Cost x 12)
Terminal Liability Premium (PEPM)
Aggregate Attachment Point (PEPM)
Page 47 of 92
GROUP MEDICAL STOP LOSS INSURANCE1
OPTION B
Contract Type 12/12
ISL Level $750,000
Specific Covered Benefit Medical/Rx
Coinsurance % 100%
Max. Annual ISL Payment Amount Unlimited
Attachment Point 115%
Aggregate Covered Benefit Medical/Rx
Max. Annual ASL Payment Amount Unlimited
Terminal Liability Option2 Contract Type 3 Months
1
Describe in detail your renewal calculation/formula for plan years 2 through 7. Attach additional pages, if necessary.
2
Describe your terminal liability premium calculation.
Pricing: Participants are based on current enrollment and Harris County may require more or less. Premiums should be on a “per employee/retiree
per month (PEPM)” basis. In case of discrepancy between monthly rate and extended pricing, monthly rate governs. Please complete the table
below using your group medical and prescription claims projections.
Medical Option I with Rx Option I 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16
(a) Specific Stop Loss Premium (PEPM)
(b) Aggregate Stop Loss Premium (PEPM)
(a+b) Total Stop Loss Premium (PEPM)
(c) Participants 17,668 17,668 17,668 17,668 17,668 17,668 17,668
Monthly Cost (a+b) x (c)
Annual Cost (Monthly Cost x 12)
Terminal Liability Premium (PEPM)
Aggregate Attachment Point (PEPM)
Medical Option II with Rx Option I 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16
(a) Specific Stop Loss Premium (PEPM)
(b) Aggregate Stop Loss Premium (PEPM)
(a+b) Total Stop Loss Premium (PEPM)
(c) Participants 17,668 17,668 17,668 17,668 17,668 17,668 17,668
Monthly Cost (a+b) x (c)
Annual Cost (Monthly Cost x 12)
Page 48 of 92
Terminal Liability Premium (PEPM)
Aggregate Attachment Point (PEPM)
Medical Option III with Rx Option I 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16
(a) Specific Stop Loss Premium (PEPM)
(b) Aggregate Stop Loss Premium (PEPM)
(a+b) Total Stop Loss Premium (PEPM)
(c) Participants 17,668 17,668 17,668 17,668 17,668 17,668 17,668
Monthly Cost (a+b) x (c)
Annual Cost (Monthly Cost x 12)
Terminal Liability Premium (PEPM)
Aggregate Attachment Point (PEPM)
Medical Option I with Rx Option II 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16
(a) Specific Stop Loss Premium (PEPM)
(b) Aggregate Stop Loss Premium (PEPM)
(a+b) Total Stop Loss Premium (PEPM)
(c) Participants 17,668 17,668 17,668 17,668 17,668 17,668 17,668
Monthly Cost (a+b) x (c)
Annual Cost (Monthly Cost x 12)
Terminal Liability Premium (PEPM)
Aggregate Attachment Point (PEPM)
Medical Option II with Rx Option II 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16
(a) Specific Stop Loss Premium (PEPM)
(b) Aggregate Stop Loss Premium (PEPM)
(a+b) Total Stop Loss Premium (PEPM)
(c) Participants 17,668 17,668 17,668 17,668 17,668 17,668 17,668
Monthly Cost (a+b) x (c)
Annual Cost (Monthly Cost x 12)
Terminal Liability Premium (PEPM)
Aggregate Attachment Point (PEPM)
Page 49 of 92
Medical Option III with Rx Option II 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16
(a) Specific Stop Loss Premium (PEPM)
(b) Aggregate Stop Loss Premium (PEPM)
(a+b) Total Stop Loss Premium (PEPM)
(c) Participants 17,668 17,668 17,668 17,668 17,668 17,668 17,668
Monthly Cost (a+b) x (c)
Annual Cost (Monthly Cost x 12)
Terminal Liability Premium (PEPM)
Aggregate Attachment Point (PEPM)
Page 50 of 92
GROUP MEDICAL STOP LOSS INSURANCE1
OPTION C
Contract Type 12/12
ISL Level $500,000
Specific Covered Benefit Medical/Rx
Coinsurance % 90%
Max. Annual ISL Payment Amount Unlimited
Attachment Point 115%
Aggregate Covered Benefit Medical/Rx
Max. Annual ASL Payment Amount Unlimited
Terminal Liability Option2 Contract Type 3 Months
1
Describe in detail your renewal calculation/formula for plan years 2 through 7. Attach additional pages, if necessary.
2
Describe your terminal liability premium calculation.
Pricing: Participants are based on current enrollment and Harris County may require more or less. Premiums should be on a “per employee/retiree
per month (PEPM)” basis. In case of discrepancy between monthly rate and extended pricing, monthly rate governs. Please complete the table
below using your group medical and prescription claims projections.
Medical Option I with Rx Option I 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16
(a) Specific Stop Loss Premium (PEPM)
(b) Aggregate Stop Loss Premium (PEPM)
(a+b) Total Stop Loss Premium (PEPM)
(c) Participants 17,668 17,668 17,668 17,668 17,668 17,668 17,668
Monthly Cost (a+b) x (c)
Annual Cost (Monthly Cost x 12)
Terminal Liability Premium (PEPM)
Aggregate Attachment Point (PEPM)
Medical Option II with Rx Option I 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16
(a) Specific Stop Loss Premium (PEPM)
(b) Aggregate Stop Loss Premium (PEPM)
(a+b) Total Stop Loss Premium (PEPM)
(c) Participants 17,668 17,668 17,668 17,668 17,668 17,668 17,668
Monthly Cost (a+b) x (c)
Annual Cost (Monthly Cost x 12)
Page 51 of 92
Terminal Liability Premium (PEPM)
Aggregate Attachment Point (PEPM)
Medical Option III with Rx Option I 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16
(a) Specific Stop Loss Premium (PEPM)
(b) Aggregate Stop Loss Premium (PEPM)
(a+b) Total Stop Loss Premium (PEPM)
(c) Participants 17,668 17,668 17,668 17,668 17,668 17,668 17,668
Monthly Cost (a+b) x (c)
Annual Cost (Monthly Cost x 12)
Terminal Liability Premium (PEPM)
Aggregate Attachment Point (PEPM)
Medical Option I with Rx Option II 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16
(a) Specific Stop Loss Premium (PEPM)
(b) Aggregate Stop Loss Premium (PEPM)
(a+b) Total Stop Loss Premium (PEPM)
(c) Participants 17,668 17,668 17,668 17,668 17,668 17,668 17,668
Monthly Cost (a+b) x (c)
Annual Cost (Monthly Cost x 12)
Terminal Liability Premium (PEPM)
Aggregate Attachment Point (PEPM)
Medical Option II with Rx Option II 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16
(a) Specific Stop Loss Premium (PEPM)
(b) Aggregate Stop Loss Premium (PEPM)
(a+b) Total Stop Loss Premium (PEPM)
(c) Participants 17,668 17,668 17,668 17,668 17,668 17,668 17,668
Monthly Cost (a+b) x (c)
Annual Cost (Monthly Cost x 12)
Terminal Liability Premium (PEPM)
Aggregate Attachment Point (PEPM)
Page 52 of 92
Medical Option III with Rx Option II 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16
(a) Specific Stop Loss Premium (PEPM)
(b) Aggregate Stop Loss Premium (PEPM)
(a+b) Total Stop Loss Premium (PEPM)
(c) Participants 17,668 17,668 17,668 17,668 17,668 17,668 17,668
Monthly Cost (a+b) x (c)
Annual Cost (Monthly Cost x 12)
Terminal Liability Premium (PEPM)
Aggregate Attachment Point (PEPM)
Page 53 of 92
GROUP MEDICAL STOP LOSS INSURANCE1
OPTION D
Contract Type 12/12
ISL Level $750,000
Specific Covered Benefit Medical/Rx
Coinsurance % 90%
Max. Annual ISL Payment Amount Unlimited
Attachment Point 115%
Aggregate Covered Benefit Medical/Rx
Max. Annual ASL Payment Amount Unlimited
Terminal Liability Option2 Contract Type 3 Months
1
Describe in detail your renewal calculation/formula for plan years 2 through 7. Attach additional pages, if necessary.
2
Describe your terminal liability premium calculation.
Pricing: Participants are based on current enrollment and Harris County may require more or less. Premiums should be on a “per employee/retiree
per month (PEPM)” basis. In case of discrepancy between monthly rate and extended pricing, monthly rate governs. Please complete the table
below using your group medical and prescription claims projections.
Medical Option I with Rx Option I 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16
(a) Specific Stop Loss Premium (PEPM)
(b) Aggregate Stop Loss Premium (PEPM)
(a+b) Total Stop Loss Premium (PEPM)
(c) Participants 17,668 17,668 17,668 17,668 17,668 17,668 17,668
Monthly Cost (a+b) x (c)
Annual Cost (Monthly Cost x 12)
Terminal Liability Premium (PEPM)
Aggregate Attachment Point (PEPM)
Medical Option II with Rx Option I 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16
(a) Specific Stop Loss Premium (PEPM)
(b) Aggregate Stop Loss Premium (PEPM)
(a+b) Total Stop Loss Premium (PEPM)
(c) Participants 17,668 17,668 17,668 17,668 17,668 17,668 17,668
Monthly Cost (a+b) x (c)
Annual Cost (Monthly Cost x 12)
Page 54 of 92
Terminal Liability Premium (PEPM)
Aggregate Attachment Point (PEPM)
Medical Option III with Rx Option I 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16
(a) Specific Stop Loss Premium (PEPM)
(b) Aggregate Stop Loss Premium (PEPM)
(a+b) Total Stop Loss Premium (PEPM)
(c) Participants 17,668 17,668 17,668 17,668 17,668 17,668 17,668
Monthly Cost (a+b) x (c)
Annual Cost (Monthly Cost x 12)
Terminal Liability Premium (PEPM)
Aggregate Attachment Point (PEPM)
Medical Option I with Rx Option II 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16
(a) Specific Stop Loss Premium (PEPM)
(b) Aggregate Stop Loss Premium (PEPM)
(a+b) Total Stop Loss Premium (PEPM)
(c) Participants 17,668 17,668 17,668 17,668 17,668 17,668 17,668
Monthly Cost (a+b) x (c)
Annual Cost (Monthly Cost x 12)
Terminal Liability Premium (PEPM)
Aggregate Attachment Point (PEPM)
Medical Option II with Rx Option II 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16
(a) Specific Stop Loss Premium (PEPM)
(b) Aggregate Stop Loss Premium (PEPM)
(a+b) Total Stop Loss Premium (PEPM)
(c) Participants 17,668 17,668 17,668 17,668 17,668 17,668 17,668
Monthly Cost (a+b) x (c)
Annual Cost (Monthly Cost x 12)
Terminal Liability Premium (PEPM)
Aggregate Attachment Point (PEPM)
Page 55 of 92
Medical Option III with Rx Option II 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16
(a) Specific Stop Loss Premium (PEPM)
(b) Aggregate Stop Loss Premium (PEPM)
(a+b) Total Stop Loss Premium (PEPM)
(c) Participants 17,668 17,668 17,668 17,668 17,668 17,668 17,668
Monthly Cost (a+b) x (c)
Annual Cost (Monthly Cost x 12)
Terminal Liability Premium (PEPM)
Aggregate Attachment Point (PEPM)
Page 56 of 92
GROUP MEDICAL STOP LOSS INSURANCE1
OPTION E
Contract Type 12/12
ISL Level $500,000
Specific Covered Benefit Medical/Rx
Coinsurance % 100%
Max. Annual ISL Payment Amount $500,000
Attachment Point 115%
Aggregate Covered Benefit Medical/Rx
Max. Annual ASL Payment Amount Unlimited
Terminal Liability Option2 Contract Type 3 Months
1
Describe in detail your renewal calculation/formula for plan years 2 through 7. Attach additional pages, if necessary.
2
Describe your terminal liability premium calculation.
Pricing: Participants are based on current enrollment and Harris County may require more or less. Premiums should be on a “per employee/retiree
per month (PEPM)” basis. In case of discrepancy between monthly rate and extended pricing, monthly rate governs. Please complete the table
below using your group medical and prescription claims projections.
Medical Option I with Rx Option I 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16
(a) Specific Stop Loss Premium (PEPM)
(b) Aggregate Stop Loss Premium (PEPM)
(a+b) Total Stop Loss Premium (PEPM)
(c) Participants 17,668 17,668 17,668 17,668 17,668 17,668 17,668
Monthly Cost (a+b) x (c)
Annual Cost (Monthly Cost x 12)
Terminal Liability Premium (PEPM)
Aggregate Attachment Point (PEPM)
Medical Option II with Rx Option I 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16
(a) Specific Stop Loss Premium (PEPM)
(b) Aggregate Stop Loss Premium (PEPM)
(a+b) Total Stop Loss Premium (PEPM)
(c) Participants 17,668 17,668 17,668 17,668 17,668 17,668 17,668
Monthly Cost (a+b) x (c)
Annual Cost (Monthly Cost x 12)
Page 57 of 92
Terminal Liability Premium (PEPM)
Aggregate Attachment Point (PEPM)
Medical Option III with Rx Option I 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16
(a) Specific Stop Loss Premium (PEPM)
(b) Aggregate Stop Loss Premium (PEPM)
(a+b) Total Stop Loss Premium (PEPM)
(c) Participants 17,668 17,668 17,668 17,668 17,668 17,668 17,668
Monthly Cost (a+b) x (c)
Annual Cost (Monthly Cost x 12)
Terminal Liability Premium (PEPM)
Aggregate Attachment Point (PEPM)
Medical Option I with Rx Option II 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16
(a) Specific Stop Loss Premium (PEPM)
(b) Aggregate Stop Loss Premium (PEPM)
(a+b) Total Stop Loss Premium (PEPM)
(c) Participants 17,668 17,668 17,668 17,668 17,668 17,668 17,668
Monthly Cost (a+b) x (c)
Annual Cost (Monthly Cost x 12)
Terminal Liability Premium (PEPM)
Aggregate Attachment Point (PEPM)
Medical Option II with Rx Option II 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16
(a) Specific Stop Loss Premium (PEPM)
(b) Aggregate Stop Loss Premium (PEPM)
(a+b) Total Stop Loss Premium (PEPM)
(c) Participants 17,668 17,668 17,668 17,668 17,668 17,668 17,668
Monthly Cost (a+b) x (c)
Annual Cost (Monthly Cost x 12)
Terminal Liability Premium (PEPM)
Aggregate Attachment Point (PEPM)
Page 58 of 92
Medical Option III with Rx Option II 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16
(a) Specific Stop Loss Premium (PEPM)
(b) Aggregate Stop Loss Premium (PEPM)
(a+b) Total Stop Loss Premium (PEPM)
(c) Participants 17,668 17,668 17,668 17,668 17,668 17,668 17,668
Monthly Cost (a+b) x (c)
Annual Cost (Monthly Cost x 12)
Terminal Liability Premium (PEPM)
Aggregate Attachment Point (PEPM)
Page 59 of 92
GROUP MEDICAL STOP LOSS INSURANCE1
OPTION F
Contract Type 12/12
ISL Level $750,000
Specific Covered Benefit Medical/Rx
Coinsurance % 100%
Max. Annual ISL Payment Amount $500,000
Attachment Point 115%
Aggregate Covered Benefit Medical/Rx
Max. Annual ASL Payment Amount Unlimited
Terminal Liability Option2 Contract Type 3 Months
1
Describe in detail your renewal calculation/formula for plan years 2 through 7. Attach additional pages, if necessary.
2
Describe your terminal liability premium calculation.
Pricing: Participants are based on current enrollment and Harris County may require more or less. Premiums should be on a “per employee/retiree
per month (PEPM)” basis. In case of discrepancy between monthly rate and extended pricing, monthly rate governs. Please complete the table
below using your group medical and prescription claims projections.
Medical Option I with Rx Option I 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16
(a) Specific Stop Loss Premium (PEPM)
(b) Aggregate Stop Loss Premium (PEPM)
(a+b) Total Stop Loss Premium (PEPM)
(c) Participants 17,668 17,668 17,668 17,668 17,668 17,668 17,668
Monthly Cost (a+b) x (c)
Annual Cost (Monthly Cost x 12)
Terminal Liability Premium (PEPM)
Aggregate Attachment Point (PEPM)
Medical Option II with Rx Option I 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16
(a) Specific Stop Loss Premium (PEPM)
(b) Aggregate Stop Loss Premium (PEPM)
(a+b) Total Stop Loss Premium (PEPM)
(c) Participants 17,668 17,668 17,668 17,668 17,668 17,668 17,668
Monthly Cost (a+b) x (c)
Annual Cost (Monthly Cost x 12)
Page 60 of 92
Terminal Liability Premium (PEPM)
Aggregate Attachment Point (PEPM)
Medical Option III with Rx Option I 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16
(a) Specific Stop Loss Premium (PEPM)
(b) Aggregate Stop Loss Premium (PEPM)
(a+b) Total Stop Loss Premium (PEPM)
(c) Participants 17,668 17,668 17,668 17,668 17,668 17,668 17,668
Monthly Cost (a+b) x (c)
Annual Cost (Monthly Cost x 12)
Terminal Liability Premium (PEPM)
Aggregate Attachment Point (PEPM)
Medical Option I with Rx Option II 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16
(a) Specific Stop Loss Premium (PEPM)
(b) Aggregate Stop Loss Premium (PEPM)
(a+b) Total Stop Loss Premium (PEPM)
(c) Participants 17,668 17,668 17,668 17,668 17,668 17,668 17,668
Monthly Cost (a+b) x (c)
Annual Cost (Monthly Cost x 12)
Terminal Liability Premium (PEPM)
Aggregate Attachment Point (PEPM)
Medical Option II with Rx Option II 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16
(a) Specific Stop Loss Premium (PEPM)
(b) Aggregate Stop Loss Premium (PEPM)
(a+b) Total Stop Loss Premium (PEPM)
(c) Participants 17,668 17,668 17,668 17,668 17,668 17,668 17,668
Monthly Cost (a+b) x (c)
Annual Cost (Monthly Cost x 12)
Terminal Liability Premium (PEPM)
Aggregate Attachment Point (PEPM)
Page 61 of 92
Medical Option III with Rx Option II 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16
(a) Specific Stop Loss Premium (PEPM)
(b) Aggregate Stop Loss Premium (PEPM)
(a+b) Total Stop Loss Premium (PEPM)
(c) Participants 17,668 17,668 17,668 17,668 17,668 17,668 17,668
Monthly Cost (a+b) x (c)
Annual Cost (Monthly Cost x 12)
Terminal Liability Premium (PEPM)
Aggregate Attachment Point (PEPM)
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FLEXIBLE SPENDING ACCOUNTS (FSA)
Pricing: Bidder must complete open boxes to right of double vertical lines. Quantities are estimated, Harris
County may require more or less. In case of discrepancy between monthly rate and extended pricing,
monthly rate governs.
2009-10
Type of Spending Account Participants UM Monthly Rate Monthly Cost Annual Cost
Healthcare Spending Account 1,246 each
Dependent Care Spending Account 47 each
Both Health and Dependent Care 87 each
Parking Account 147 each
Transportation Account 80 each
Both QTA 10 each
Total Cost:
2010-11
Type of Spending Account Participants UM Monthly Rate Monthly Cost Annual Cost
Healthcare Spending Account 1,246 each
Dependent Care Spending Account 47 each
Both Health and Dependent Care 87 each
Parking Account 147 each
Transportation Account 80 each
Both QTA 10 each
Total Cost:
2011-12
Type of Spending Account Participants UM Monthly Rate Monthly Cost Annual Cost
Healthcare Spending Account 1,246 each
Dependent Care Spending Account 47 each
Both Health and Dependent Care 87 each
Parking Account 147 each
Transportation Account 80 each
Both QTA 10 each
Total Cost:
2012-13
Type of Spending Account Participants UM Monthly Rate Monthly Cost Annual Cost
Healthcare Spending Account 1,246 each
Dependent Care Spending Account 47 each
Both Health and Dependent Care 87 each
Parking Account 147 each
Transportation Account 80 each
Both QTA 10 each
Total Cost:
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2013-14
Type of Spending Account Participants UM Monthly Rate Monthly Cost Annual Cost
Healthcare Spending Account 1,246 each
Dependent Care Spending Account 47 each
Both Health and Dependent Care 87 each
Parking Account 147 each
Transportation Account 80 each
Both QTA 10 each
Total Cost:
2014-15
Type of Spending Account Participants UM Monthly Rate Monthly Cost Annual Cost
Healthcare Spending Account 1,246 each
Dependent Care Spending Account 47 each
Both Health and Dependent Care 87 each
Parking Account 147 each
Transportation Account 80 each
Both QTA 10 each
Total Cost:
2015-16
Type of Spending Account Participants UM Monthly Rate Monthly Cost Annual Cost
Healthcare Spending Account 1,246 each
Dependent Care Spending Account 47 each
Both Health and Dependent Care 87 each
Parking Account 147 each
Transportation Account 80 each
Both QTA 10 each
Total Cost:
Recap Annual Total for Plan Year 1:
Annual Total for Plan Year 2:
Annual Total for Plan Year 3:
Annual Total for Plan Year 4:
Annual Total for Plan Year 5:
Annual Total for Plan Year 6:
Annual Total for Plan Year 7:
Total for all seven years:
Page 64 of 92
Attachment a.
Job No. 08/0322
RESIDENCE CERTIFICATION/TAX FORM
Pursuant to Texas Government Code §2252.001 et seq., as amended, Harris County requests Residence
Certification. §2252.001 et seq. of the Government Code provides some restrictions on the awarding of
governmental contracts; pertinent provisions of §2252.001 are stated below:
(3) "Nonresident bidder" refers to a person who is not a resident.
(4) "Resident bidder" refers to a person whose principal place of business is in this state, including a
contractor whose ultimate parent company or majority owner has its principal place of business in
this state.
I certify that is a Resident Bidder of Texas as defined in
[Company Name]
Government Code §2252.001.
I certify that is a Nonresident Bidder as defined in
[Company Name]
Government Code §2252.001 and our principal place of business is .
[City and State]
Taxpayer Identification Number (T. I. N.):
Company Name submitting Bid/Proposal:
Mailing Address:
If you are an individual, list the names and addresses of any partnership of which you are a general partner:
PROPERTY: List all taxable property owned by you or above partnerships in Harris County.
Harris County Tax Acct. No.* Property address or location**
* This is the property account identification number assigned by the Harris County Appraisal District.
** For real property, specify the property address or legal description. For business personal property, specify the
address where the property is located. For example, office equipment will normally be at your office, but inventory
may be stored at a warehouse or other location.
Revised 11/06
Attachment e.
Minimum Insurance Requirements
Page 1 of 1
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Minimum Insurance Requirements
• The contractor shall, at all times during the term of this contract, maintain insurance coverage with not less
than the type and requirements shown below. Such insurance is to be provided at the sole cost of the
contractor. These requirements do not establish limits of the contractor's liability.
• All policies of insurance shall waive all rights of subrogation against the County, its officers, employees
and agents.
• Upon request, certified copies of original insurance policies shall be furnished to Harris County.
• The County reserves the right to require additional insurance should it be deemed necessary.
A. Workers' Compensation (with Waiver of subrogation to Harris County) Employer's Liability, including all
states, U.S. Longshoremen, Harbor Workers and other endorsements, if applicable to the Project.
Statutory, and Bodily Injury by Accident: $100,000 each employee. Bodily Injury by Disease: $500,000
policy limit $100,000 each employee.
B. Commercial General Liability Occurrence Form including, but not limited to, Premises and Operations,
Products Liability Broad Form Property Damage, Contractual Liability, Personal and Advertising Injury
Liability and where the exposure exists, coverage for watercraft, blasting collapse, and explosions,
blowout, cratering and underground damage.
$300,000 each occurrence Limit Bodily Injury and Property Damage Combined $300,000 Products-
Completed Operations Aggregate Limit $500,000 Per Job Aggregate $300,000 Personal and Advertising
Injury Limit. Harris County shall be named as "additional insured" on commercial general liability policy.
C. Automobile Liability Coverage:
$300,000 Combined Liability Limits. Bodily Injury and Property Damage Combined. Harris County shall
be named as "additional insured" on automobile policy.
Revised 12/00
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Attachment h.
REFERENCE SHEET
Complete the following regarding business references and include in Section III. the proposal.
A. Public Entities in Texas > 5,000 members
Firm Phone Contact
B. Other Industries:
Firm Phone Contact
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Attachment i.
HIPAA REQUIREMENTS
1. Contractor’s Responsibilities Regarding Use and Disclosure of Protected Health Information (“PHI”)
a. General: Contractor agrees to
(1) hold all Protected Health Information (“PHI”) confidential except to the extent that
disclosure is required by Federal or State law, including the Texas Public Information
Act, Chapter 552, Texas Government Code. TEX. GOV’T CODE ANN. §§ 552.001 et seq.,
as amended. PHI is defined in 45 CFR § 164.501 and is limited to information created or
received by Contractor from or on behalf of County.
(2) be bound by all applicable Federal and State of Texas licensing authorities’ laws, rules,
and regulations regarding records and governmental records, including the Health
Insurance Portability and Accountability Act of 1996 (“HIPAA”), PL 104-191, the
HIPAA regulations (codified at 45 CFR Parts 160 and 164), and Chapter 181, Texas
Health and Safety Code, as amended, collectively referred to herein as “Privacy
Requirements.”
(3) cooperate with the Texas Medicaid Fraud Control Unit and to make appropriate personnel
available for interviews, consultation, grand jury proceedings, pre-trial conference,
hearings, trial, and in any other process, including investigations that are required as a
result of Contractor’s Services to County. Compliance with this paragraph is at
Contractor’s own expense.
b. Representations: Contractor represents that Contractor is familiar with the Privacy Requirements, and with
State and Federal requirements relating to HIV/AIDS information, mental health information, and
drug/alcohol-related health information.
c. Business Associate: Contractor is a “Business Associate” of County as that term is defined under
the Privacy Requirements. Contractor agrees:
(1) Nondisclosure of PHI: Not to use or disclose the PHI received from County or created,
compiled, or used by Contractor pursuant to this Agreement other than as permitted or
required by this Agreement, or as otherwise required by law.
(2) Limitation on Further Use or Disclosure: Not to further use or disclose the PHI received
from County or created, compiled, or used by Contractor pursuant to this Agreement in a
manner that would be prohibited by the Privacy Requirements of HIPAA if disclosure
was made by County, or if either Contractor or County is otherwise prohibited from
making such disclosure by any present or future State or federal law, regulation, or rule.
(3) Safeguards: To use appropriate safeguards to prevent use or disclosure of the PHI other
than as provided for by this Agreement or as required by State or federal law, regulation,
or rule.
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(4) Reporting Unauthorized Disclosures: To report to County any use or disclosure of PHI
that is not authorized by this Agreement immediately upon becoming aware of such
unauthorized use or disclosure.
(5) Subcontractors and Agents: To make all reasonable efforts to ensure that any
subcontractor or agent to whom Contractor provides PHI received from County or
created, compiled, or used by Contractor pursuant to this Agreement agrees to the same
restrictions and conditions that apply to Contractor with respect to such PHI.
(6) Mitigation: To mitigate, to the extent practicable, any harmful effect that is known to
Contractor of a use or disclosure of PHI by Contractor or by a subcontractor or agent of
Contractor resulting from a violation of this Agreement.
(7) Notice – Access by Individual: To notify County in writing within three business days of
any request by an individual for access to the individual’s PHI and to, upon receipt of
such request from an individual, provide access to the degree required or permitted by
law or, if County maintains the requested records, direct the individual to County for
access to the individual’s PHI.
(8) Notice – Request for Amendment: To notify County in writing within three business days
of any request by an individual for amendment to the individual’s PHI and to, upon
receipt of such request from an individual, make such amendments as required or
permitted by law, or if County maintains the records, direct the individual to County to
request amendment of the individual’s PHI.
(9) Notice – Request for Accounting: Upon receipt of any request from an individual for an
accounting of disclosures made of the individual’s PHI, to provide such an accounting as
required or permitted by law, and to notify County in writing within three business day of
any such request; or if County maintains the records, direct the individual to County for
an accounting of the disclosures of the individual’s PHI. Pursuant to 45 CFR 164.528(a)
an individual has a right to receive an accounting of certain disclosures of PHI in the six
years prior to the date on which the accounting is requested.
(10) HHS Inspection: Upon written request, to make available to the Secretary of Health and
Human Services ("HHS") or his designee, Contractor’s internal practices, books, and
records relating to the use and disclosure of PHI received from or held for County in a
time or manner designated by the Secretary for purposes of the Secretary determining
Contractor’s compliance with the Privacy Requirements.
(11) County Inspection: Upon written request, to make available to County during normal
business hours Contractor’s internal practices, books, and records relating to the use and
disclosure of PHI received from or held for County in a time and manner designated by
County.
(12) PHI Amendment: To incorporate any amendments, corrections, or additions to the PHI
received from or created, compiled, or used by Contractor pursuant to this Agreement
when notified by County that the PHI is inaccurate or incomplete or that other documents
are to be added as required by or allowed by the Privacy Requirements.
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(13) Documentation of Disclosures: Contractor agrees to document disclosure of PHI and
information related to such disclosures as is necessary for County to respond to a request
by an individual for an accounting of disclosures of PHI in accordance with 45 CFR §
164.528 as amended.
(14) Termination Procedures: Upon termination of this Agreement for any reason, to transfer
to County all PHI received from County or created, compiled, or used by Contractor
pursuant to this Agreement or, if specially requested to do so by County in writing, to
destroy all such PHI. This provision applies when Contractor maintains PHI from County
in any form. If Contractor determines that transferring or destroying the PHI is infeasible,
Contractor shall (i) provide to County notification of the conditions that make transfer or
destruction infeasible; (ii) extend the protections of this Agreement to such PHI; and (iii)
limit any further uses and disclosures of such PHI to those purposes that make the return
or transfer to County or destruction infeasible.
(15) Notice-Termination: Upon written notice to Contractor, County may terminate any
portion of the Agreement under which Contractor maintains, compiles, or has access to
PHI. Additionally, upon written notice to Contractor, County may terminate the entire
Agreement if County determines, at its sole discretion, that Contractor has repeatedly
violated a Privacy Requirement.
(16) Security Incidents: Contractor shall report any security incident to County.
d. Survival of Privacy Provisions: Contractor’s obligations with regard to PHI shall survive the
termination of this Agreement.
e. Amendment Related to Privacy Requirements: The Parties agree to take such action as is
necessary to amend this Agreement if County, in its reasonable discretion, determines that
amendment is necessary for County to comply with the Privacy Requirements of HIPAA and
TEX. HEALTH & SAFETY CODE ANN. §§181.001 et seq., as amended, and any other law or
regulation affecting the use or disclosure of PHI. Any ambiguity in this Agreement shall be
resolved to permit County to comply with the Privacy Requirements of HIPAA and TEX. HEALTH
& SAFETY CODE ANN. §§ 181.001 et seq., as amended.
f. Indemnification. Contractor agrees to indemnify and hold harmless to the extent allowed by law
County and its directors, officers, employees, and agents (individually and collectively “County
Indemnitees”) against any and all losses, liabilities, judgments, penalties, awards and costs
(including costs of investigation and legal fees and expenses) arising out of or related to (1) a
breach of this Agreement relating to the Privacy Requirements by Contractor, or (2) any
negligent or wrongful acts or omissions of Contractor or its employees, directors, officers,
subcontractors, or agents, relating to the Privacy Requirements including failure to perform their
obligation under the Privacy Requirements.
2. Access to Books and Records of Contractor
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Contractor agrees to keep a separate record of all funds received and disbursed under this Agreement and
provide the County or its designee all information, records, papers, reports, and other documents regarding any
aspect of the services furnished as requested by County or its designee, and shall make records, books,
documents, and papers of Contractor that relate in anyway to the services provided available for inspection,
audit, examination, and copying by the County or the County’s representative. Contractor agrees to allow the
Comptroller General of the United States, the Department of Health and Human Services (“HHS”), the County
Auditor, and their duly authorized representatives, access to contracts, books, documents, and records necessary
to verify the nature and extent of the costs of the services provided by Contractor. Contractor agrees to allow
such access until the expiration of four (4) years after the services are furnished under the contract or
subcontract or until the completion of any audit or audit period, whichever is later. Such access will be
provided in accordance with the regulations of the Centers for Medicare and Medicaid Services (“CMS”) and 42
CFR 420.302, as amended. Contractor agrees to allow similar access to books, records, and documents related
to contracts between Contractor and organizations related to or subcontracted by Contractor, as defined by the
regulations of CMS. No records shall be destroyed that are required to be kept by federal, state, or county
statute, law, rule, ordinance, or order, or by application of conditions of Medicaid or Medicare provider
agreements or by other applicable agreements, including grant applications and requirements entered into
between the County or state and a third-party payer. Contractor shall keep all protected health information, as
defined herein, and records relating to disclosure of PHI for six years after the last date of service or, at County’s
option, shall transfer such records to County upon termination of this Agreement.
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Attachment j.
Detailed Plan Design Options,
Underwriting Information and
Questionnaire Response
Attachment j.
Detailed Plan Design Options, Underwriting
Information and Questionnaire Response
(For prospective bidders downloading this RFP from the Internet, the Underwriting
Information is available online.
Page 72 of 92
Attachment k.
Questionnaire
QUESTIONNAIRE
Introduction
Responses are to be provided in hard copy and electronic format utilizing the Excel spreadsheet provided. Answer
the questions on separate sheets of paper and include them in Section II. of the submitted proposal. Label at the
top of each sheet, “Attachment k, Questionnaire,” and clearly identify your answers by question number. Do not
re-type the questions.
Each provider shall respond to all questions applicable to their proposals being submitted. Failure to complete the
questions may result in rejection of the proposal as non-responsive. Answers are to be brief but have details
sufficient enough for Harris County to evaluate your answers. If one of the questions is not applicable to your
proposal, state "Not Applicable." Some questions may need to be answered more than once if proposing for more
than one product and/or option.
If you have any additional information pertaining to these questions which you would like Harris County to
consider, feel free to use attachments. Any attachments or pages used to answer the questions should be identified
by the question number referenced.
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INDEX
Question
General Information ......................................................................................................................... 1-12
Account Management .................................................................................................................... 13-17
Customer & Member Services ...................................................................................................... 18-27
Eligibility........................................................................................................................................ 28-35
Financial and Rate Information ..................................................................................................... 36-42
Group Medical
General ............................................................................................................................... 43-48
Wellness Programs ............................................................................................................ 49-58
Network ............................................................................................................................. 59-83
Credentialing .......................................................................................................................... 84
Access & Delivery of Health Services .............................................................................. 85-88
Utilization Review, Disease, Case & Quality Management............................................. 89-94
Claims .............................................................................................................................. 95-114
Performance Guarantees....................................................................................................... 115
Employee Assistance Plan (EAP) ................................................................................. 116-158
Prescription Drug Program
General ........................................................................................................................... 159-164
Claims Processing, Administration and Client Services .............................................. 165-174
Community Pharmacy Network and Mail-Order Pharmacy ........................................ 175-181
Drug Utilization Review and Drug Utilization Management ...................................... 182-190
Data Management and Reporting ................................................................................. 191-192
Medicare Supplemental Policies ............................................................................................... 193-194
Flexible Spending Accounts (FSA) ........................................................................................... 195-201
FSA Claims Processing ............................................................................................................. 202-216
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NOTE:
Responses, submissions, including best and final offers will be part of the master contract with Harris
County.
General
1. Provide the address of each of the following:
a. Home office
b. Regional home office
c. Service locations responsible for primary account support
2. Is the company licensed in the State of Texas? If not, what state is the company licensed in?
3. For insurance carriers only, are you a Texas-licensed (“admitted”) carrier?
4. Identify all organizations and individuals that have a substantial financial interest in your company.
Describe your relationship with these organizations and individuals.
5. Please provide your most recent financial history including ratings, if applicable and the date of the rating:
_______ Standard & Poor’s
_______ Moody’s
_______ A.M. Best
_______ Weiss
6. Provide information on your organization and any subcontractors providing services requested in this RFP:
a. Ownership/sponsorship
b. Date operational
7. List all accreditations you have obtained.
8. As part of the review process, we may request that you provide us with a certificate of insurance for your
errors and omissions, malpractice insurance (if applicable), general liability and workers’ compensation
coverage. Can you comply with this request?
9. The Harris County Attorney’s Office will draft a contract outlining the terms and conditions of doing
business with Harris County. Are you willing to enter into an agreement (contract) with Harris County?
Who will be the contact and liaison to draft and approve such a contract?
10. List your clients in the Houston metropolitan area and sort by client size.
11. List any Houston area clients over 500 or more members that have left your organization during the last
two years.
12. In the Houston area, if there was an increase/decrease in excess of 10% in your covered members from
2006 to 2007, what do you attribute this to?
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Account Management
13. Provide a biography of the account executives and service team to be assigned to Harris County.
14. Provide a detailed proposed timeline for each step of the installation and enrollment process beginning with
contract award October - 2008. Your matrix should include party responsible, task and the proposed date
of completion.
15. Describe how you will handle the transition from the current carrier to your company and how you will
assure that no member will lose coverage or benefits due to a change in carriers. Specifically identify your
company’s position on handling transition of members to your plan and from your plan. Include details
regarding claims administration, case management, disease management, physician changes, ongoing
admissions, treatment in progress, maternity, etc.
16. During open enrollment we will seek your assistance in communications for open enrollment meetings and
any further assistance that may be required to meet Harris County deadlines for administrative and payroll
purposes. Describe your capabilities in providing assistance during this process.
17. Provide samples of materials and specimen policies with riders, etc.
Customer & Member Services
18. Do you have a 24-hour toll-free number available for customer service? How is it staffed?
19. If you do not have a 24-hour toll free number, how do you plan to handle after hours member inquiries?
20. In reference to customer service, state your standards for:
a. Length of time in queue
b. Telephone call abandonment rate
c. Length of time a caller is placed on hold
d. Maximum length of time to return a telephone call
e. Training
21. Define a complaint and specify the number of complaints received per 1,000 participants in 2006 and 2007.
22. What percentage of member issues is resolved on a “first call” basis?
23. What standards do you use to monitor member satisfaction? How do you monitor and improve the
quality of service?
24. Is the cost of providing HIPAA certificates of coverage included in your proposed administrative fee?
25. For medical claims administration, Harris County desires to have claims administration and member
services to be performed at the Harris County site located in the Office of Human Resources & Risk
Management. Can you accommodate this request? If yes, how would you staff, supply, and support the
on-site unit?
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26. Will you provide an experienced claims/customer service unit to be dedicated to Harris County for claims
assistance? Identify the office location and staffing levels.
27. Will you maintain at least two (2) full-time customer/member services staff at Harris County?
Eligibility/Technology
28. Describe the role technology plays in your overall business strategy today and in the future. Describe in
detail your proposed Internet/web-based capabilities specifically for the Harris County plan.
29. Harris County will provide a general layout for data transfer utilizing an 834 format as required by HIPAA.
Are you willing to accept this format and make it conform to your system?
30. Are you able to perform periodic manual updates to eligibility? If so, at what cost?
31. How do you, and how often do you update members’ names, addresses, etc. to an eligibility file from the
data provided by Harris County?
32. Describe your procedures for safe guarding employee, dependent and retiree personal information.
33. Will you support the File Transfer Protocol via an FTP server? Will Harris County be able to login to the
FTP server?
34. Provide samples of routinely produced reports. Identify which reports are produced monthly or on an ad
hoc basis. Describe your capabilities in customizing additional reports as required by Harris County.
35. Please provide your online report capabilities.
Financial & Rate Information
36. Please list what is and is not included in your proposed administration fees.
37. As part of the proposal process, it is anticipated that we will ask you to provide your negotiated fee
payments to network providers for specified specialties and/or services. Will you be able to comply with
this request?
38. How do you establish and maintain usual, customary, and reasonable (UCR) professional fee profiles for
out of network claims? How often are these profiles updated? What is the UCR percentage in the plans
you propose? What options are available for the County to consider for the allowable payment of non-
network claims?
39. Harris County requires renewal information and notice by October 1st prior to the contract renewal period
on March 1st. Will you comply with this requirement?
40. Provide copies of a proposed administrative service agreement.
41. Explain any conditions or caveats in your proposal that could cause your quoted rates to change.
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42. How is terminal liability handled in the event of policy termination?
Medical - General
43. The County as a self-funded employer may desire to periodically modify its plan design and benefit
options. Describe the process to implement these changes and under what conditions would the
administrative fee change? The County’s current plan documents are located on our website
http://www.co.harris.tx.us/hrrm/ . Please describe in detail any and all enhancements, differences,
limitations and/or exclusions in the plans you propose in accordance with your claim practices and
company policies.
44. Describe your overall strategies in the management of medical care in terms of providing a broad range of
benefits coverage while providing quality care and containing cost.
45. What is your procedure for providing coverage for new treatment protocols? Clinical trials and
experimental medicine?
46. What is the grievance procedure for:
a. Claims and benefit determination disputes
b. Questionable physician practices
47. Explain your capability and procedure to interface with a separate pharmacy benefits manager if chosen by
the County.
48. Do you have a health advisory "hot line" staffed by qualified personnel for participants to call and obtain
assistance and information regarding health-related non-emergency issues? What are the hours of this
number?
Wellness Programs
The selected medical vendor is expected to coordinate activities and wellness screenings on a regular basis with
Harris County’s Health & Wellness Coordinator.
49. List and describe the preventive/wellness programs and health fairs you will provide at no additional cost to
Harris County.
50. What types of communication material will you be willing to provide and how will you promote the
programs that you propose?
51. How would you work with Harris County administrators to determine the need for special pilot programs,
educational programs and events to encourage employee wellness?
52. Would you be willing to designate a special fund to allow for implementation of new wellness projects? If
yes, what would be the annual allocation towards this effort? What recommendations do you have for the
County in utilizing this fund?
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53. Describe your smoking cessation program in detail and identify any additional cost for the program.
Include applicable brochures and documents.
54. Does your wellness program include healthy lifestyle coaching? If so, please identify the length of
intervention per year (i.e.; 8 week or 12 week program).
55. Identify the education level of your coaching staff, and whether you provide a single coach model vs. any
available coach? How many total coaching sessions within a year are available to a moderate or high risk
member?
56. Does your program offer built-in incentives?
57. Describe any health or fitness discounts available.
58. Describe staff available to Harris County for development of wellness programs and initiatives.
Network
59. Provide the total number of primary care physicians, specialists and hospitals in Harris County in the
network you are proposing.
60. Provide information as to how many of your network providers above are:
a. Primary care (Board Certified/Board Eligible)
b. Specialists (Board Certified/Board Eligible)
c. Hospitals with JCAHO accreditation
61. List the current number of covered lives in Harris County for the network proposed. Also provide this
information for the years ending 2005, 2006, and 2007.
62. List the number of primary care and specialty physicians (by specialty) separately in your preferred
network. Include totals and provide the detail attachment.
63. List facilities/physicians, which are not currently accepting new patients and provide the reason why they
are not.
64. How is it determined when it is in the “best interest” of the plan for providers not to accept new patients?
Do you set limits on the number of patients, which may be serviced by an individual PCP or do the PCPs
set their own limits?
65. What is the annual turnover rate of providers within the network? (Indicate separately for PCP's, Specialists
and Hospitals).
66. Do you notify clients and participants of changes in provider networks? What is the length of time of
notice provided?
67. What accommodations do you make to employees who have been displaced by provider changes to assure
continuity of care?
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68. Identify hospitals in the networks you propose and describe any special services offered by them such as
“centers of excellence”.
69. Identify any specialty centers where members receive comprehensive treatment for a chronic condition.
70. Do you have a specific provider network for kidney dialysis? What strategies do you have for managing
the cost of kidney dialysis treatment?
71. Describe your methodology of payment for participating hospital charges? Primary care? Specialists?
72. What are your previous two-year (2005 to 2006 and 2006 to 2007) increases in network hospital rate
increases? What do you anticipate for 2008 and 2009?
73. Are employees required to select PCPs? If yes, what is the selection process?
74. Do you provide financial incentives to any physician or provider for any reason? If so, describe.
75. Does the plan have any control over what a network provider charges to complete forms and certifications
required by a member's employer or requested by the member (i.e., FMLA illness certificate, sick notes or
disability certification, etc.)?
76. What services are available to assist employees on disputes with providers?
77. What are your standards on educating physicians and their office staff regarding procedures and operations
of the plan?
78. Include current copies of your directories with physicians and hospitals.
79. Can you provide a geographical mapping analysis (GeoAccess Survey) of primary care physicians and
hospitals using the Harris County employee and retiree lists (Attachment j., Detailed Plan Design
Options, Underwriting Information and Questionnaire Response) as provided in this RFP?
80. How often are provider directories updated including hard copies and online?
81. How frequently will you provide hardcopy directories at no cost to Harris County? Specify the quantity in
your response.
82. What are your current average network discounts for hospital, primary care, specialty and ancillary
services? Are you willing to guarantee your network discounts?
83. Is there a plan/network available to eligible employees, dependents and retirees living outside the network
service area?
Credentialing
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84. Describe your selection, credentialing and re-credentialing process for physicians, hospitals, ambulatory
surgery facilities and any other providers. What quality of care measures are used, and how often is the re-
credentialing process carried out and reviewed?
Access and Delivery of Health Services
85. Identify your standards for waiting times of appointments for:
a) Primary care - routine
b) Primary care - illness
c) Specialist
86. Regarding emergencies, what is your definition of:
a. Life threatening situation
b. Urgent care
87. What is the process of obtaining coverage for out-of-area emergencies (include out of the U.S.
emergencies)?
88. Provide a list of network urgent care centers in the Houston area. The list should include (at minimum)
Harris, Montgomery, Fort Bend, Brazoria and Galveston counties
Utilization Review, Disease, Case and Quality Management
89. Describe your utilization review process, disease and case management philosophy and how it directly
impacts the cost and quality of services of plan members.
90. Provide a list of conditions included in your disease management programs? How do you identify
candidates for disease management? How are these programs communicated?
91. How is your predictive modeling superior to others?
92. How are utilization review decisions coordinated with claims processing?
93. Describe your procedures for managing catastrophic and potentially high cost medical claims.
94. Describe your disease management/case management programs you currently offer to increase awareness
and decrease utilization.
Claims
95. In the administration of the proposed contract with Harris County provide your company’s general
guidelines to claims administration including, but not limited to, the following:
Recording complaints by participants, providers, etc.
Disposition of a claim
Appeals process
Subrogation
Coordination of benefits
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96. Explain your claim audit procedures & standards.
97. If a claim is processed incorrectly causing a negative financial impact to the County, who will be
responsible for the cost (if any) associated with this?
98. If a claim is not processed in accordance with Texas law and the contractor is required to pay billed charges
rather than negotiated rates, will you accept financial responsibility for the additional cost?
99. Do you have hold harmless agreements for our members if a network provider does not file claims within
the claim filing limit?
100. Do your provider contracts indicate that the patient will not be financially liable in the event your plan
denies, delays or fails to pay covered expenses? What steps are taken to avoid “balance billing” of
members?
101. What is your standard turnaround time for making payments to (a) hospitals, (b) physicians, and (c)
members?
102. How does the proposed policy coordinate with Medicare? Show illustrations including calculations of
coordination of benefits.
103. What safeguards and provisions do you have to prevent and monitor creative billing, up-coding,
unbundling, providers billing in excess of contracted rates, etc.?
104. If a member is referred to a network facility and is provided services by a non-participating provider will
you hold the member harmless?
105. Provide the following:
Group claims office location(s) corporate & local
Identify where claims are paid
Claims office hours of operation
Number of claims staff dedicated to the County
Toll-free number availability and to whom available
Toll-free number hours of operation
106. Describe how your claims systems help control claims costs, such as coordination of benefits, workers'
compensation, fraudulent claims, and duplicate claims.
107. Describe your proposed claims filing procedures and include a claim form, if applicable.
108. Does your organization have the capability to perform a computerized claims audit? Are audit reports
available on request?
109. The selected vendor will be required to provide a daily paid claims file. Can you achieve this requirement?
110. Define “medical necessity.”
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111. Are claims recorded on a check-issued or check-cleared basis?
112. What is your definition of a "paid" claim, a "clean" claim, and a "suspense" claim? State the time frames
required to process the claims under each of the categories mentioned. If you should have additional
categories, list them and state the time frames for processing those categories of claims.
113. In order to efficiently review the claims administration process, Harris County may wish to contract with an
independent consultant to periodically perform objective audits and evaluate performance. Explain if you
are unwilling to allow this to occur.
114. What percentage of claims are electronically filed? Auto-adjudicated?
Performance Guarantees
115. Harris County currently has the following claims service guarantees:
a. 90% of clean claims will be paid within 10 working days of receipt
b. 93% of all claims will be correctly coded
c. 93% of all claims will be correctly and accurately processed
d. 95% of all claims will be paid accurately
e. 95% of all claims will be accurately coordinated with other plans
f. 99% of all claims will be financially drafted correctly
g. Process 90% of all oral or written complaints received within thirty (30) calendar days
Can you guarantee you can achieve or exceed these standards? What would you put at risk if these
standards were not met?
Employee Assistance Plan (EAP)/Managed Mental Health
116. Describe your capabilities in providing managed mental health coverage/support and detail the services
provided under your proposed EAP.
117. Provide a directory of providers and locations for both the EAP and mental health network providers
118. Provide a breakdown by type of professional for your organization. Count each provider only once -- based
on their highest degree level. Use 2007 staff information.
STAFF
Number
Psychiatrist ________
Psychologist ________
MSW ________
LCSW ________
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Other: (Specify) ________
119. What facilities are used for inpatient psychiatric care or substance abuse?
120. What are the qualifications of the staff members who answer the initial phone call during normal business
hours?
121. Are telephonic intake assessments performed by employees of your organization or by independent contract
practitioners? Explain.
122. In what circumstances does a physician from your organization become involved in the initial assessment
process?
123. Describe any differences in your approach for adults versus adolescents/children.
124. Indicate the hours, time zone, and days of the week of telephone access for case managers. What
specifically happens when a participant calls after hours?
125. Will a dedicated toll free phone number (for Harris County) be available?
126. Specifically identify your emergency criteria and how emergencies are handled.
127. What criteria would be used to determine when a patient would stay in an EAP environment for short-term
treatment or referred for extended treatment under the group medical plan?
128. Describe any patient education programs.
129. Describe your policies for psychological/behavioral testing and medically related mental illness screening.
130. What is the average wait time for non-emergency appointments?
131. Describe the process, including the personnel used, from the initial phone call through after-care
monitoring for the following circumstances:
a. Alcohol dependency
b. Adult substance abuse
c. Adolescent substance abuse
d. Major depression
132. Attach a sample copy of available communication materials.
133. Describe your formal member grievance process, including time frames for the various stages from the
initial receipt of a grievance.
134. Do members receive written notification when their counselor leaves the network? Will assistance be
provided to assist the member in locating a similar provider?
135. Does your provider list include religious counselors?
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136. How are your providers reimbursed?
137. How do you suggest that cases in progress on the program effective date be handled? Include different
approaches for inpatient versus outpatient.
138. What is your ratio of counselors to eligible members?
139. Do you have plans to increase or decrease the number of counselors or affiliates? If so, when?
140. How does your organization monitor staffing needs? What is the process for determining if your current
staffing is adequate? Who makes that decision?
141. Can you provide a geographical mapping analysis (GeoAccess Survey) of your providers and facilities
using the Harris County employee and retiree lists (Attachment j., Detailed Plan Design Options,
Underwriting Information and Questionnaire Response) as provided in this RFP?
142. Describe your 24-hour crisis intervention service.
143. How are appointments scheduled?
144. During 2007 what was the average waiting time for appointments?
145. When a referral has been made, does the assessment counselor call the individual to ensure a follow-up
appointment with the referral provider was made?
146. How are counselors trained to make assessments and referrals and what tools are available to them?
147. What percentage of calls results in referrals to:
Inpatient programs
Outpatient programs
Support groups
Other resources
148. What percentage of counselors are Certified Addictions Counselors?
149. Describe what continuing education is required of your providers.
150. Describe any in-house training programs. Include frequency, example of topics, and any attendance
requirements.
151. Detail your procedures for handling administrative/supervisor referrals (i.e., length of time to schedule
initial visit, how long before evaluation report, reporting method, follow-up, etc.).
152. Would the designated account manager be available for emergency (24 hr.) critical incident situations?
153. Are you willing to designate specific, qualified providers for all law enforcement administrative/supervisor
referrals? Would those providers be available for 24 hour on-site emergency contact for situations such as
suicide attempt, officer involved in a shooting or other trauma event, etc.?
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154. Do you have or are you willing to add providers who are Texas Commission on Law Enforcement Officer
Standards and Education (TCLOSE) certified to render law enforcement fitness for duty evaluations?
155. Do you consider a request for fitness for duty evaluation for law enforcement personnel the same as any
other administrative/supervisor referral under the EAP?
156. Do you include any presentations at Harris County facilities as part of your program? How many are
allowed during a benefit year?
157. Do you have networks outside the service area that an out-of-area member can access? If so, list the areas.
Do you give referrals to out-of-area members who are not in the network area?
158. Are the EAP services available to anyone residing with the employee?
PRESCRIPTION DRUG PROGRAM
These are the definitions for selected terms in this RFP and for the business relationship that would exist
between the contractor and Harris County:
Allowed Amount (Charge): the sum of total ingredient cost (actual amount paid to pharmacy providers, not
Average Wholesale Price [AWP]) and all dispensing fees, including the effects of lowest-of pricing (e.g., U & C
less than the contract price).
Average Allowed (Charge) per Day: (the sum of total drug ingredient costs [actual amount paid to pharmacy
providers, not AWP] and dispensing fees) divided by the total days supply of drug therapy.
Average Drug Cost per Day: total drug ingredient costs (actual amount paid to pharmacy providers, not AWP)
divided by the total days supply of drug therapy.
Generic Dispensing Ratio (GDR): Total generic prescriptions divided by total prescriptions
Multiple-Source Brand (MSB) drug: Drugs identified in Medi-Span as “O” (innovator brand) drugs; e.g.
Prilosec, Zantac, Zestril, Xanax, Prozac.
Drug manufacturer rebates as a % of total drug costs: (Total rebates – total rebate administrative costs)
divided by total drug ingredient costs (actual, not AWP).
Drug manufacturer rebates as a dollar ($) amount per day of drug therapy: (Total rebates – total rebate
administrative costs) divided by the total days supply of drug therapy.
Drug Utilization “Formulary” Rebates paid as a % of Total Rebate Revenues: Drug Utilization
“Formulary” rebates are those rebates paid by drug manufacturers specific to market penetration and
prescription claim and dollar volume. (These rebates are a subset of Total Rebate Revenues). Total Rebate
Revenues include all financial remuneration received from drug manufacturers, including but not limited to: (a)
rebates collected on drug utilization, (b) rebate and/or formulary access fees, (c) administrative fees, d) grants
including special purpose, as well as disease state management program development and sponsorship funds, (e)
any other funding for targeted purposes and (f) royalties and bonuses.
General
159. The prescription drug plan is described in the Plan Document. Identify any variances between the current
plan and your proposed plan provisions.
160. Describe your coverage for smoking cessation including drugs, nicotine patches and gum, the number of
days/weeks of therapy allowed, cost to the beneficiary and any provisions for recidivism.
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161. Provide a list of dispensing locations in the greater Houston/Harris County area. The list should include
actual location and hours and days of operations with 24-hour locations highlighted.
162. Identify your current nationwide participating pharmacy chains.
163. Describe your suggestions for interacting with Harris County’s Workers’ Compensation division to
prevent prescription drug misuse and over-utilization.
164. Describe in detail how rebates, grants and other payments from pharmacy manufacturers and other
sources are administered and shared with Harris County.
Prescription Drug Claims Processing, Administration and Client Services
165. Please identify what is and is not included in the pharmacy benefit administrative fee and whether the
administrative fee is assessed per transaction, paid claim or some other basis.
166. Identify your proposed dispensing fees for community, mail-order and specialty pharmacy and explain
the circumstances when the actual paid amount for the dispensing fee is less than these file dispensing
fees?
167. Specify the additional administrative fees, if any, for (a) prior authorization, (b) step-therapy edits and
(c) direct-member reimbursement (DMR) claims.
168. Specify the hours of operation and toll-free telephone numbers for your (a) pharmacy help desk, (b)
member-beneficiary help desk and (c) your client (Harris County) service representative.
169. Describe your service standards for mail-order (help desk) calls.
170. Affirm your ability to administer the following on-line transaction processing (OLTP) features:
a) Non-network pharmacy claims - identify any pharmacy provider reimbursement premiums or
additional administrative costs and the claims administration method for non-network pharmacy
claims
b) Edits for drug interactions, refill-too-soon and drug therapy duplication
c) Restrict a beneficiary to either a single pharmacy or a single prescriber, if required
d) Application of all system edits to mail-order and specialty pharmacy as well as community
pharmacy
e) Percentage coinsurance cost-share including the greater of the dollar copayment amount or
applicable percentage, for all pharmacies including mail-order
171. Will you provide all reports for the CMS/RDS Medicare Part D Subsidy Program? This includes:
Initial Enrollment File – For Inclusion with Subsidy Application to CMS/RDS.
Enrollment Eligibility File(s) Update – Upon receipt of Data Matching results from CMS/RDS – provide
and update the files.
Ongoing Enrollment Files – Provide to CMS/RDS.
Cost summary reports in the format required by CMS/RDS.
Complete claims detail reports including drug rebate information to the County to support the data used
to calculate and receive the annual subsidy.
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172. Will you file the above files and reports on behalf of the County?
173. In support of the interim payment process will you provide CMS/RDS at a frequency determined by the
Plan Sponsor (monthly, quarterly, or annually) Plan Aggregate Claim Reports, including drug rebate
information?
174. What audit support (staff) will you have available for the County and how many years will you assist the
County in an audit of the subsidy?
Community Pharmacy Network, Mail-Order and Specialty Pharmacy
175. Identify the list of drugs that you define as specialty pharmaceuticals and define your pricing proposal
for specialty pharmaceuticals including injectable and biotech drugs.
176. Describe your pricing for Harris County for generic, single-source brand and multiple-source brand
prescriptions at community, mail-order and specialty pharmacy including ingredient cost (e.g., AWP
discount) and average dispensing fee for each. Please make clear the difference between your price
schedule and the net effective rate after application of lowest-of pricing including pharmacy submitted
cost and usual and customary (U & C).
177. Explain your pricing of generic, single-source brand and multiple-source brand (MSB) prescriptions at
community, mail-order and specialty pharmacy for (a) lowest-of method when the U & C price is lower
than the allowed (calculated) charge, (b) MSB drugs under DAW “1” (physician request for brand) and
DAW “2” (member request for brand), and (c) the member (file) copayment is greater than the allowed
charge.
178. Explain how your pharmacy provider agreement addresses the discount generic drug offerings (e.g.,
$4.00) of community pharmacies and how this price is captured and used in lower-of U & C pricing for
adjudication of affected claims.
179. Harris County prefers one MAC price list that is applied in the same manner to mail-order and
community pharmacies. Include an electronic copy (preferably Excel format) of your current MAC price
list including generic drug name, GPI or GCN, and MAC price for each. Identify clearly and completely
(a) the effective date of the MAC price list, and (b) any margin that you intend to retain between the
amount paid to the pharmacy versus the amount charged to Harris County.
180. Please list in descending order by total expenditure the generic drugs that were NOT subject to MAC
pricing at any time in the first half of 2008.
181. Identify your postage or freight charges to Harris County, if any, for mail-order pharmacy and specialty
pharmacy prescriptions.
Drug Utilization Review and Drug Utilization Management
182. Describe (a) your philosophy and approach to drug utilization review (DUR) and drug utilization
management, and (b) the specific interventions that you propose for Harris County.
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183. Describe your methods, measures and reports for detecting and deterring pharmacy provider fraud.
Specify the number and type of pharmacy provider sanctions, if any, which you imposed on pharmacy
providers in the 12-month period ended December 31, 2007.
184. Please list the drugs that you propose for prior authorization (PA) for Harris County including the PA
criteria for each.
185. Please (a) list the non-preferred and preferred drugs that you propose for therapeutic interchange for Harris
County, (b) describe the methods of the therapeutic interchange interventions, and (c) identify the
administrative fees if any.
186. Describe any methods that you would recommend to manage costs and utilization of (a) Celebrex, (b)
proton-pump inhibitors, (c) dyslipidemic agents, (d) antidepressants, and (e) migraine medications.
187. How does your company prevent, track and report drug therapy conflicts which may have imminent
patient risk? Provide a representative sample of a client report of these events.
188. How does your program track, report and discourage misuse and overuse of Controlled Substances and
drugs for pain and migraine headaches? Provide examples of reports that you have produced for your
customers to support your answer.
189. Describe your step-therapy edits and how your system will support allowing a claim for a specific drug
to adjudicate without intervention if claims history includes prior treatment with a specified drug (i.e.,
smart edit). Second, please list the 6 highest priority specific step-therapy edits that you recommend for
Harris County. Third, identify your pricing for specific step-therapy edits if not included in your
proposed administrative fee.
190. Describe your experience with disease management programs and your recommendations for disease
management programs for Harris County drug benefit plans, if any.
Data Management and Reporting
191. Please provide sample copies of the 6 standard reports that you believe to be the most useful in effective
pharmacy benefit management.
192. The following data elements are used by Harris County’s pharmacy benefits consultant: (a) NDC
number, (b) drug (label) name, (c) drug strength, (d) quantity, (e) days supply, (e) pharmacy ID number,
(f) pharmacy name, (g) pharmacy address including zip code, (h) Rx number, (i) identifier for paid or
reversed claim, (j) DAW code, (k) drug ingredient cost allowed, (l) dispensing fee allowed, (m) total
allowed charge, (n) copayment amount, (o) deductible amount, (p) net paid to pharmacy provider, (q)
usual and customary amount submitted by the pharmacy, (r) prescriber ID number, (s) prescriber name,
(t) prescriber specialty, (u) Medi-Span GPI or drug class and drug-type identifier (i.e., standard
therapeutic class and GCN), (v) indicator for generic drug vs. brand only drug vs. multiple-source brand
drug with generic equivalent(s) vs. multiple-source brand drug without generic equivalent(s), (w)
member ID number (scrambled if necessary, but unique), (x) person code (employee, spouse or
dependent), (y) member birth date, (z) date of service, (aa) generic drug name and (ab) Harris County
group (i.e., active, retiree and COBRA) and subgroup numbers (i.e., 8 subgroups for base vs. plus for 4
groups: active, retiree under 65, retiree over 65, and COBRA).
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Please confirm that you will provide quarterly electronic files of pharmacy claim records with all of
these data elements and specify the number of calendar days after the close of the claims cycle that
Harris County can expect to receive the file of pharmacy claim records. Also, please identify the
preferred media for the transfer of the pharmacy claims file and if you can produce these data for fiscal
quarters (e.g., March 1 through May 31) rather than calendar quarters.
MEDICARE SUPPLEMENT POLICIES
193. Describe special programs and tools for retiree medical management.
194. Will you offer a separate customer service line for these enrollees? Is the staff trained to handle the
needs of this population?
FLEXIBLE SPENDING ACCOUNTS (FSA)
195. Provide detailed information regarding services available to participants and the plan sponsor online.
196. How would you account for and bill your administrative expense?
197. Will you require an initial funds deposit prior to receiving the participants’ initial account deposits which
occur the first pay period in March? If so, identify the amount.
198. Explain the banking and wire transfer procedure your company utilizes.
199. How soon will forfeitures of any accounts be paid to Harris County after a grace period?
200. Will you accept transfers of participant accounts from our current vendor for qualified transportation
accounts? Explain your requirements.
201. Will you transfer participant account balances to a vendor as directed by Harris County?
FSA Claims Processing
202. How are contributions posted to individual accounts?
203. How do you handle contribution adjustments?
204. What is the minimum reimbursement amount?
205. What documentation is required for processing each type of claim?
206. What is your turnaround time on claims submitted for payment?
207. Describe your claims accuracy standards.
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208. Does the system automatically “pend” Dependent Care claims which cannot be paid due to insufficient
funds? Is the member notified of the status?
209. What methods are available for participants to submit a claim for reimbursement?
210. Do you provide a toll free fax number for claims submission?
211. How are payment checks issued and from where are they mailed?
212. Do participants have the option of direct deposit reimbursement?
213. How frequently are statements provided to participants?
214. What is the grace period for claim submission after each plan year’s end?
215. Identify situations where claims are automatically processed without participant involvement.
216. May participants “opt out” of automatic claims processing?
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Attachment l.
TRANSMITTAL STATEMENT
INSURANCE COMPANY: _____________________________________________________
PROPOSED BENEFITS FOR: ___________________________________________________
PROPOSAL EFFECTIVE DATE: ________________________________________________
The Insurance Company agrees to assume coverage for all plan participants of Harris County who are currently
covered under the expiring group insurance policies or contracts, which these proposed benefits are to replace.
Further, it is agreed that any pre-existing condition clause (if any) and/or the actively at work requirements will be
waived for plan participants who are presently covered by the expiring policy and that full credit will be given to
any expenses, which have been incurred toward the satisfaction of any deductible and out-of-pocket expenses
during the current policy or contract year. This will apply to plan participants who are still considered as full-time
employees, eligible retirees, and their dependents and other participants who are eligible by reason of law even
though they might be currently disabled. Additionally, if you are proposing a benefit which is not currently
provided by Harris County, you must disclose any pre-existing condition limitations, exclusions, or actively at
work requirements.
Signed:__________________________________________________________________
Title: __________________________________________________________________
Phone: __________________________________________________________________
Date: _____
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