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					                                                                      REQUEST FOR PROPOSAL: R-1168
                                                                                  CLASS/ITEM: 953-48
                                                                                DATE: JUNE 24, 2002

PROPOSAL DEADLINE: 3:00 P.M. ON JULY 19, 2002, TO THE OFFICE OF PURCHASING SERVICES

                              REQUEST FOR PROPOSALS
The City of Aurora, Colorado, will accept priced technical proposals from qualified, accredited firms for
Health Insurance Services for City of Aurora Participants at the Office of Purchasing Services, 1470 South
Havana Street, Suite 324, Aurora, Colorado 80012, until 3:00 P.M. on July 19, 2002. Late proposals will
not be accepted for review or consideration.

PROPOSALS MAY BE              SUBMITTED      ELECTRONICALLY          TO   PURCHASING         SERVICES    AT
bfilling@ci.aurora.co.us.

TEN (10) COPIES OF ANY SUPPLEMENTAL INFORMATION SHALL BE SUBMITTED AND RETAINED
BY THE CITY OF AURORA. SUPPLEMENTAL INFORMATION MUST BE SUBMITTED TO THE
OFFICE OF PURCHASING SERVICES

FOR THE PERIOD COVERED: DATE OF AWARD UP TO FORTY EIGHT (48) MONTHS.                                    THIS
AWARD BEGINS JANUARY 1, 2003.

QUESTIONS:
Questions regarding this Request for Proposals (RFP) may be submitted to Mr. Kin Shuman, Director of
Human Resources in writing by fax or via e-mail no later than 3:00 p.m. on Wednesday, July 2, 2002. Fax
number is 303-739-7243 and e-mail address is kshuman@ci.aurora.co.us. Questions may address any
aspect of the RFP, including Special Conditions, Statement of Work, and other technical and contractual
matters. Answers to all questions will be issued in a written addendum to this RFP no later than 3:00 p.m.
on Tuesday, July 9, 2002. No additional questions regarding the RFP will be accepted after the specified
date and time.

Specific requirements for this service are contained in the attached Statement of Work (Section I).

A TENTATIVE SCHEDULE of key dates for the this solicitation have been established as follows:

       June 24, 2002                              Request for Proposal issued
       July 2, 2002                               Written questions due by 3:00 p.m.
       July 9, 2002                               Addendum issued providing written answers to questions
       July 19, 2002                              Priced Technical Proposals due by 3:00 p.m.
       August 12 – 16, 2002                       Discussions with top-ranked firms, if needed
       August 30, 2002                            Best and Final Offers due by 3:00 p.m.
       September 23, 2002                         City Council Approval
       September 30, 2002                         Award Actions Complete




                                                      1
SOLICITATION PROCESS:
This RFP is being solicited under a multi-step procurement procedure consisting of three phases. The first
step requires all firms to submit PRICED technical proposals addressing only those items cited in Section II,
Proposal Submittal Requirements, of this RFP. Proposals will be evaluated and ranked based on the
evaluation criteria outlined in Section III, Proposal Evaluation. A short list of firms will be selected for further
evaluation. Only those firms who are placed on the short list on the basis of the evaluation criteria will be
considered during the second phase. During the second phase, discussions will be held with the short
listed firms, if necessary. During the third phase, Best and Final Offers will be requested from all short
listed firms.

PERIOD OF AWARD:
The term of the contract shall be from the date of award through a twelve-month period. The award
period will not exceed a total of four years, including extensions as appropriate.

EXTENSIONS:
The City shall have the option to extend the contract for three (3) one-year option periods (total of 4 years)
from the original date of award upon the same terms and conditions. If the City desires to extend the
contract, not later than one hundred and twenty (120) days prior to expiration, the City shall send a notice
in writing to the vendor requesting firm pricing for the next twelve-month period. After the City receives the
firm pricing proposal from the firm, it will determine whether to extend the contract. All awards and
extensions are subject to annual appropriation of funds. The provisions of the foregoing paragraphs with
respect to extension of the term of the contract shall be null and void if the contract has been terminated
or revoked during the initial term or any extension thereof.

All decisions to extend the contract are at the option of the City.

CONDITION OF AWARD:
It is the intent of the City to award to the most responsible offeror provided the Proposal has been
submitted in accordance with the requirements of the RFP. The City shall be the sole judge of the
offeror’s qualifications, and whether the Proposal is in the best interests of the City.

The City may conduct such investigations as the City considers necessary to assist in the evaluation of
any Proposal and to establish the responsibility, qualifications and financial ability of the offerors and
award in accordance with the RFP document to the City’s satisfaction within the prescribed time. The City
may consider, but not be limited to operating costs, maintenance requirements, performance data, and
guarantees of materials and equipment as part of its evaluation.

The City shall have the right in its sole discretion to terminate the award with or without cause.

Terms and conditions of the RFP shall be incorporated into the purchase order, which will include a
Professional Services Agreement (see attached sample). The agreement will be executed after final
review and appropriate authorization of the award. No other documents, agreements, contracts or
addendums will be a part of this proposal and/or award, unless authorized through the Office of
Purchasing Services.

AVAILABILITY OF FUNDS FOR NEXT CALENDAR YEAR
Funds are currently not available for the award beyond this current calendar year. Therefore, the City is
not obligated under this bid beyond this current calendar year. This provision is notwithstanding any other
provision of the RFP addressing or affecting the contract period.

Proposals will be considered only from firms or individuals that are firmly established in an appropriate
business, who are financially responsible, and who have the resources and ability to offer services in a
professional and expedient manner. The City may request additional information as deemed necessary.
Failure to provide such information may result in the proposal being considered non-responsive.

If the proposal is submitted electronically and all information cannot be attached, ten (10) copies of the
supplemental information will be required. If submitting hard copy proposals, ten (10) copies will be
required. These proposals shall be retained by the City of Aurora and cannot be returned.




                                                         2
Priced technical proposals will be accepted electronically at bfilling@ci.aurora.co.us or at the Office of
Purchasing Services Division, 1470 South Havana Street, Suite 324, Aurora, Colorado 80012, until 3:00
p.m., July 19, 2002. No late proposals or supplemental information shall be considered.

The City of Aurora reserves the right to reject any and all Proposals, to waive any informalities in the
Proposals received, and to accept the proposal deemed most advantageous to the best interest of the
City.


CITY OF AURORA, COLORADO




Bryn Fillinger
Procurement Agent, Purchasing Services




                                                    3
  Project Title: Health Insurance Services
                          ATTACHMENTS
Section I       Statement of Work for Health Insurance Services
Section II      Proposal Submittal Requirements
Section III     Proposal Evaluation Process
Section IV      Census Data
                Part A: Active City Employees
                Part B: Retirees
                Part C: COBRA Participants
Section V       Geo Access Analysis
Section VI      Plan Provisions
Section VII     Price Proposal Matrix
Section VIII    Special Conditions
Section IX      Sample Professional Services Agreement


Appendix:
   Appendix A - Medical Network Statistical Data Request
   Appendix B - Carrier Questionnaire
   Appendix C - Plan Design Alternatives
   Appendix D - Rate History (Total and City Contributions)
   Appendix E - 3-year premium and claims experience
   Appendix F - Large Claims experience




                                   4
                                                 SECTION I

                                          STATEMENT OF WORK

                                     HEALTH INSURANCE SERVICES

I.       Objective

The City of Aurora is soliciting technical proposals from qualified, accredited Health Insurance providers
who can supply insurance, health care, administration, and billing services for the City’s employees.
Award of the contract will depend upon accessibility to physician’s facilities, comprehensiveness of
physician/hospital/pharmacy networks, premium and member expenses, customer service, availability of
routine and special benefits, and the billing/eligibility process.

The City currently offers three health care programs to approximately 2,300 employees and 35 COBRA
participants:
     Aetna U.S. Healthcare -- HMO (community)
     PacifiCare of Colorado -- HMO (community)
     Kaiser Permanente -- HMO (staff)

The City of Aurora also offers the all three HMO’s to 240 retirees. Retirees must meet retirement plan
eligibility to qualify for the retiree medical plan. Employees over the age of 65 participate in Medicare
HMO plans offered by Kaiser and PacifiCare and must elect Medicare Parts A and B.

The HMO proposals must be offered on a fully insured basis. The City will also entertain a minimum
premium alternative to the current insured arrangement.

The City of Aurora is interested in maintaining similar plan offerings (i.e., up to three HMO’s) and may
choose up to three carriers in order to offer employees a variety of plan choices and types. Alternatively,
the City is interested in the possibility of offering multi-options (e.g., HMO/POS or HMO/PPO) with either
one carrier or a combination of two or three carriers.

The contracting health insurance carrier must offer the following services and coverage:
     ·   Hospitalization
     ·   Physician’s office visits & treatment
     ·   Mental health treatment
     ·   Alcohol/drug rehabilitation
     ·   Convalescence care
     ·   Vision exam
     ·   Eye Wear
     ·   Prescription drugs
     ·   Hospice care
     ·   Pre-admission testing
     ·   Outpatient surgery
     ·   Non-hospital emergency clinic
     ·   Home health care
     ·   Well baby checkups
     ·   Wellness care
     ·   Annual physical and immunizations
     ·   Common-law spouse eligibility

The City of Aurora is desirous of a preferential plan design/pricing model for the C.U. Health Sciences
Center. Please describe any existing or anticipated arrangements of this nature. If such an arrangement
is not currently in existence, please describe timeframe to implement.




                                                     5
You are asked to MATCH THE CURRENT HMO benefits as closely as possible. You are also
encouraged to offer recommended alternative plans that provide a comprehensive level of
benefits and competitive pricing. Please reference the Appendix for suggested alternative plan
design components.

The City of Aurora may select at least one plan offering some or all of the following additional coverage
and services:

      ·   Hearing care
      ·   Chiropractic care
      ·   Discounts for non-smokers
      ·   Open Access

THE CONTRACTING FIRM(S) NEED TO BE AVAILABLE AT ALL TIMES DURING NORMAL (8 A.M. TO 5
P.M. MST) BUSINESS HOURS TO CONSULT WITH THE HUMAN RESOURCES DEPARTMENT AND/OR
THE PAYROLL/BILLING DEPARTMENT ON EMPLOYEE BENEFITS AND ELIGIBILITY, CUSTOMER
SERVICE, AND ADMINISTRATIVE ISSUES.


II.       SCOPE OF WORK

Contracting firm(s) will be required to provide the City with professional health care insurance services on
a definite schedule for 52 weeks of the contract period of one year. The specific obligations of the
contracting firm(s) will include the following (not necessarily in order of importance):

1. Provide coverage for: eligible full-time and part-time employees; spouses and common-law spouses;
   biological, adopted, and stepchildren; and, retirees.

      ELIGIBILITY CRITERIA

      Full time employees must work a minimum of 32 hours to receive full time benefits. Part time
      employees must work a minimum of 20 hours to be eligible for part time benefits. Retiree medical
      coverage is available to employees at age 50 with 10 years of service OR those employees meeting
      the “rule of 80” (age and years of service). Spouses of deceased retirees are eligible to continue
      coverage following the retiree’s death. Fire and Police employees are eligible for the retiree medical
      plan following 20 years of service, regardless of age.

2. Provide a substantial physician/hospital/pharmacy network, emphasizing stability and long-term
   relationships. The turnover rate of primary care physicians and specialists cannot be more than 25%
   annually.

3. Provide an accessible customer service department to members by providing a designated account
   representative or team familiar with the City of Aurora account.

4. Provide an emphasis on preventative and wellness services.

5. Provide an accurate and timely billing/eligibility process with a designated representative or team.

6. Provide regular reports as determined. The selected medical carrier(s) should be able to provide the
   City with census and utilization data no less than annually in conjunction with the renewal.

7. Provide a comprehensive customer service plan.




                                                      6
8. Assist in Open Enrollment process annually in November including:
    Participation in three (3) employee benefit fairs.
    Provide ample quantities of forms and pre-made enrollment packets as requested.
    Provide timely processing of enrollment and change forms, printing of I.D. cards, mailing of
                                                            th
       appropriate documents – to be completed by January 5 annually.

9. Must provide HIPAA certificates for all members terminating coverage (dependents, mid-year and
   open enrollment member changes).




                                                  7
                                          SECTION II
                               PROPOSAL SUBMITTAL REQUIREMENTS

Each Proposal must include, as a minimum, the following information for your HMO or POS plan and, if
applicable, your PPO plan:

1. A statement indicating your ability/agreement to provide the 9 specific services required under “Scope
   of Work” in Section I of this Request for Proposal.

2. The Network Statistics as outlined in (Section V and Appendix A) of this Request for Proposal.

3. Your most current HMO/POS (and PPO, if applicable) physician and hospital provider directories for
   Colorado and the website where this information is available.

4. Your most current HMO/POS (and PPO, if applicable) pharmacy directories for Colorado and the
   website where this information is available.

5. Your most current HMO/POS (and PPO, if applicable) vision care network directories for Colorado
   and the website where this information is available.

6. Your most current HMO/POS (and PPO, if applicable) mental health and substance abuse
   provider/treatment facility directories for Colorado and the website where this information is available.

7. Your willingness to co-exist with another carrier’s HMO. Include any requirements you may have to
   co-exist with another carrier.

8. Contact names and phone numbers for three references of similar size/nature preferably one of which
   is a city or other public employer and one of which is a former client.

9. A statement indicating your ability/agreement to conform to the proposed “Professional Services
   Agreement”, including the Insurance Requirements and Independent Contractor Affidavit attachments,
   as provided in Section VI of this Request for Proposal. Indicate any deviations.

10. The following, completed in full:
     Plan Provisions – Request for Proposal Section VI
     Price/Proposal Matrix – Request for Proposal Section VII
    Regarding the plan provisions, please also provide a detailed plan description that identifies all
    covered and all excluded services.

11. You must be licensed to conduct business in the State of Colorado. Note any states in which you are
    unable to conduct business.

12. Plan designs for retirees residing outside of Colorado must be comparable to at least one option
    available to active employees. Please outline, in your proposal, any differences in plan design for
    retirees or dependents living outside of the service area and/or out of state.

13. Provide names and background information for the sales and account management teams who will be
    assigned to the City account.

14. Coverage must be provided on a no-loss, no-gain basis so that the current group does not suffer a
    loss of benefits solely due to the transfer of coverage. Confirm.

15. Carrier Questionnaire completed in full (Appendix B of this Request for Proposal.

16. Proposed design alternatives as described at Appendix C of this Request for Proposal, if applicable.




                                                     8
17. A Performance Guarantee Agreement by the selected medical carrier is preferred.
     Please outline your criteria for the agreement and include associated penalties.
     Outline whether the criteria and/or penalties of the agreement are negotiable.
     Verify whether this Agreement is ongoing in nature.
     Provide a sample agreement.

18. Indicate which types of medical/utilization management your plan employs:

           Pre-certification
           Concurrent Review
           Discharge Planning
           Second Surgical Opinion
           Utilization Review
           Case Management
           Disease Management


19. Please describe the disease management programs currently operational in your plan. Include an
    explanation of how participants are targeted, criteria used to identify the at-risk population, and how
    many members are currently participating. If available, provide documented savings attributable to
    these programs.




                                                    9
                                                SECTION III

                                  PROPOSAL EVALUATION PROCESS

The following criteria will be used to evaluate the proposals:


Criteria                                                   Objective

Scope of Proposal                                             Does the proposal show an understanding of
                                                               the objectives and scope of work for ongoing
                                                               support of all requested programs?

Carrier Capability                                            Is the carrier capable of doing the necessary
                                                               work?
                                                              Does the carrier have the resources necessary
                                                               to provide the services requested?
                                                              Does the carrier meet or exceed the minimum
                                                               qualifications?

Assigned Personnel                                            Does the team assigned to The City have the
                                                               necessary skills and qualifications?
                                                              Does the carrier have the support capabilities
                                                               that the assigned persons will require?
                                                              Are sufficient references listed?
                                                              Have the assigned persons worked with
                                                               governmental entities and groups of The City of
                                                               Aurora’s size?

Cost of Proposed Coverage                                     Does the proposed cost fit into the budget?
                                                              How does the price and proposed coverage
                                                               compare to competing carriers?




Provider Network                                              Does the proposed network compare favorably
                                                               with current providers?



Plan Design                                                   Has the carrier been able to match current plan
                                                               design?
                                                              What alternatives have they offered?




                                                      10
                                    SECTION IV

                                   CENSUS DATA

CENSUS DATA MAY BE OBTAINED UPON REQUEST BY CONTACTING TERRI STAFFORD,
EMPLOYEE BENEFITS ADMINISTRATOR AT (303) 739-7242 OR tstaffor@ci.aurora.co.us.




                                          11
                                                       SECTION V

                                              GEO ACCESS ANALYSIS


                                                   GeoAccess Analysis


         Please provide a GeoAccess analysis for the employees of the City of Aurora. Assume the parameters
         are as follows:

                    PCPs:                 2 provider within 3 miles; 2 provider within 10 miles
                    Pediatricians:        2 provider within 3 miles; 2 provider within 10 miles
                    OB/GYNs:              2 provider within 3 miles; 2 provider within 10 miles
                    Mental Health:        2 provider within 3 miles; 2 provider within 10 miles
                    Specialists:          2 provider within 3 miles; 2 provider within 10 miles
                    Hospitals:            1 provider within 10 miles

         Please complete the following chart for both HMO and PPO plans, providing the percentage of employees
         with access to providers according to the access standards above and attach all GeoAccess analysis
         material to your proposal.

         HMO PLAN
  Parameter               PCPs         Pediatricians       OB/GYNs         Mental Health          Specialists      Hospitals
2 within 3 miles                                                                                                       NA
2 within 10 miles                                                                                                      NA
1 within 10 miles           NA              NA                 NA                NA                   NA



         PPO PLAN
  Parameter               PCPs         Pediatricians       OB/GYNs         Mental Health          Specialists      Hospitals
2 within 3 miles                                                                                                       NA
2 within 10 miles                                                                                                      NA
1 within 10 miles           NA              NA                 NA                NA                   NA

         Following is a list of the 100 most frequently visited providers for the Aetna and Pacificare HMO’s. Please
         indicate those included in your network. (This data will be provided in an addendum to follow release of
         the RFP)

                          PACIFICARE                                                AETNA
                          Name                Included                              Name                   Included
                                              (Place X)                                                    (Place X)




                                                              12
                                                      SECTION VI

                                                  PLAN PROVISIONS

          The following are the current and requested plan provisions for the existing HMO’s and the out of area
          PPO plan provided. Please indicate whether you can conform to the benefits requested, and identify any
          alternative plans in the proposed columns.

                                        HMO – AETNA U.S. HEALTHCARE
                                    Current                             Proposed
                                                                         Actives                  Retirees
Annual Deductible                   None
Annual Maximum Out-of-              $1,500 per person
Pocket                              $3,000 per family
Lifetime Maximum                    Unlimited
Office Visit                           $15 copay – PCP
                                       $20 copay - Specialist
Preventive Care                     $15 copay
Prenatal Care                       $20 copay – 1 X
Rx – Retail
 Generic                            $10
 Formulary brand                    $20
 Non-form. brand                    $35
Rx – Mail Order                     2 x retail
Mental Health
 Inpatient                            $240 copay/admit;
                                        45 days/year
   Outpatient                         $25 copay/visit;
                                        20 visits/year
Substance Abuse
 Inpatient                            $240 copay/admit;
                                        30 days/year
   Outpatient                         $25 copay/visit;
                                        60 visits/year
Inpatient Hospital                  $240 copay/admit
Outpatient Surgery                  $100 copay
D.M.E.                              No charge
Emergency Room                      $100 copay
Chiropractic                        No coverage
Other Alternative Care                 Vision discount
                                       Natural alternatives
Vision Care                            $20 co-pay
                                       $125 vision
                                        reimbursement every
                                        24 months




                                                               13
                                        SECTION VI (cont.)

                                        PLAN PROVISIONS

                         HMO – AETNA U.S. HEALTHCARE (Continued)

                           Current                       Proposed
                                                          Actives   Retirees
                           
Home Health                No charge
Hospice Care               IP: $240 copay/admit
                           OP: $100 copay
Skilled Nursing            $240 copay/admit
Transplants                Covered per provisions
Lab and x-ray              Specialist copay: $20
                           copay/visit

                                        HMO – PACIFICARE
                           Current                       Proposed
                                                          Actives   Retirees
Annual Deductible          None
Annual Maximum Out-of-     $3,500 per person
Pocket                     $8,000 per family
Lifetime Maximum           Unlimited
Office Visit               $15 copay
Preventive Care            $15 copay
Prenatal Care              $15 copay
Rx – Retail
 Formulary generic           $10
 Formulary brand             $20
 Non-formulary               $35
Rx – Mail Order            2 x retail
Mental Health
 Inpatient                   $50 copay/day;
                               45 days/year
   Outpatient                Visits 1-5: no charge;
                               then: $15 copay
Substance Abuse
 Inpatient                   $50 copay/day;
                               21 days/year
   Outpatient                 Visits 1-5: no charge;
                               then: $15 copay




                                                    14
                                       PLAN PROVISIONS

                              HMO – PACIFICARE (Continued)
                         Current                         Proposed
                                                          Actives   Retirees
Inpatient Hospital       $200 copay/admit
Outpatient Surgery       $100 copay
D.M.E.                   No charge; $1,500 per
                         year (with limitations on
                         certain items)
Emergency Room           $100 copay
Chiropractic             No coverage
Other Alternative Care   No coverage
Vision Care              $15 copay/visit; 1 visit
                         every 12 months
Home Health              No charge
Hospice Care             No charge
Skilled Nursing          No charge; 120 days/year
Transplants              Covered per provisions
Lab and x-ray            No charge (MRI, CT,
                         SPECT, PET = $75)




                                                    15
                                           SECTION VI (cont.)

                                          PLAN PROVISIONS

                                               HMO – KAISER
                                     Current                    Proposed
                                                                 Actives   Retirees

Annual Deductible        None
Annual Maximum Out-of-   $2,000 per person
Pocket                   $4,500 per family
Lifetime Maximum         Unlimited
Office Visit             $10 copay
Preventive Care          $5 copay
Prenatal Care            $5 copay
Rx – Retail              60-day supply
 Generic                 $15
 Brand                   $25
Rx – Mail Order          N/A
Mental Health
 Inpatient                   $100 copay/admit;
                               45 days/year
   Outpatient                $10 copay/visit;
                               20 visits/year
Substance Abuse
 Inpatient Detox             $100 copay/admit
 Inpatient Rehab             $100 copay/admit;
                               30 days/year
   Outpatient                $10 copay/visit;
                               20 visits/year
Inpatient Hospital       $100 copay/admit
Outpatient Surgery       $50 copay
D.M.E.                   20% copay; $2,000 per year
                         (arms/legs no annual max)
Emergency Room           $50 copay
Chiropractic             No coverage
Other Alternative Care   No coverage
Vision Care              $10 copay/visit; $150 credit
                         toward lenses, frames,
                         contacts
Home Health              No charge
Hospice Care             No charge
Skilled Nursing          No charge;100 days
Transplants              Covered per provisions
Lab and x-ray            Diagnostic: no charge
                         Therapeutic: $10 copay




                                                        16
                         PPO– PACIFICARE – OUT OF AREA RETIREES
                         Current                                   Proposed
                                                                     Actives                 Retirees
                                                Out of                      Out of                   Out of
                         In Network            Network        In Network   Network   In Network     Network


Annual Deductible        $200/person        (combined
                         $600/family        w/in network)
Annual Maximum Out-of-   $700/person        (combined
Pocket                   $1,600/family      w/in network)
Lifetime Maximum                  $2,000,000
Office Visit             $10 copay      70%; after
                                        deductible
Prenatal Care                       As any other
Rx – Retail
 Generic                $10 copay          70% after
 Brand                  $10 copay          deductible
                         (mandatory
                         generic)
Rx – Mail Order          2 X retail         N/A


Mental Health
 Inpatient              90% to 45          70% facility
                         days/year;         charges; 50%
                         $1,000 max. -      physician
                         physician.         charges; after
                         charges/year       deductible


   Outpatient           $10 copay;         50% after
                         limited to 20      deductible
                         visits/year or
                         $1,000

                         (in and out
                         patient benefits
                         comb.
                         w/substance
                         abuse)




                                                         17
                         PPO– PACIFICARE – OUT OF AREA RETIREES
                         Current                                    Proposed
                                                                         Actives                Retirees
                                                Out of                         Out of                   Out of
                         In Network            Network         In             Network   In Network     Network
                                                               Network

Substance Abuse
 Inpatient              $90% to 45         70% facility
                         days/year;         charges; 50%
                         $1,000 max. -      physician
                         physician.         charges; after
                         charges/year       deductible


   Outpatient           $10 copay;         50% after
                         limited to 20      deductible
                         visits/year or
                         $1,000

                         (in and out
                         patient benefits
                         comb. w/mental
                         health)


Inpatient Hospital       90%                70%
Outpatient Surgery
   In doctor’s office   $10 copay          70%
   Other Facility       90%                70%


Emergency Room           $50 copay          70%
Vision Care              $60 copay – Exam/12 mos.
                         $125/24 mos. For materials
Home Health              90% to 60          70% to 60
                         visits/year        visits/year
                         (combined)         (combined)
Hospice Care             90%                70%
Lab and x-ray            90%                70%




                                                          18
                                                        SECTION VII

                                                PRICE PROPOSAL MATRIX

                                 INSURED HMO                                       INSURED PPO/POS
                                                                              Assumes you also   Assumes you do not
                        Rates if Sole Carrier   Rates if Co-Carrier            underwrite HMO      underwrite HMO
Actives & Early
Retirees - Blended
 Single
 Single +1
 Family
Actives & Early
Retirees - Segregated
ACTIVES
 Single
 Single +1
 Family
EARLY RETIREES
(<65)
 Retiree Only
 Spouse Only
 Couple
 Family
Medicare Eligible
Retirees
 Retiree Only
 Spouse Only
 Couple
 Family
   NOTE: Use the following tier structure and ratios:                 Single       -   1.0
                                                                      Single + 1   -   1.9
                                                                      Family       -   3.0




                                                             19
                                                                                                         k:Prospect\City of Aurora
                                                                                                        Medical RFP-June 2002.doc
                         SECTION VII

     PRICE PROPOSAL MATRIX – ALTERNATIVE OPTION

                            INSURED BASIC PPO
                        Assumes you also    Assumes you do not
                         underwrite HMO       underwrite HMO
Actives & Early
Retirees - Blended
 Single
 Single +1
 Family
Actives & Early
Retirees - Segregated
ACTIVES
 Single
 Single +1
 Family
EARLY RETIREES
(<65)
 Retiree Only
 Spouse Only
 Couple
 Family
Medicare Eligible
Retirees
 Retiree Only
 Spouse Only
 Couple
 Family
NOTE: Use the following tier structure and ratios:   Single -       1.0
                                                     Single + 1 -   1.9
                                                     Family -       3.0




                              20
                                                                           k:Prospect\City of Aurora
                                                                          Medical RFP-June 2002.doc
                                           SECTION VII

                                  PRICE PROPOSAL MATRIX

                                       Additional Questions


1. What will you do if you do not achieve your minimum enrollment/participation requirements?

2. Confirm that your rates contain no commissions.

       HMO _______
       POS _______
       PPO _______


3. Provide a retention illustration in the following format for the 1st year:


Claims Expenses                                Year 1                           Year 2
Paid Claims                            $                              $
Pooled Claims at $________             $                              $
Pooling Charge                         $                              $
Reserves Required                      $                              $

Retention                                                      % of Premium
Claims Administration
Network Access Fees
Pre-Certification/UR
Premium Administration
Premium Taxes – Exempt                              0%                           0%
Contracts/SPDs
Risk Charge/Profit
General Overhead
Commissions                                        0%*                           0%*
Total Expenses

Verify who will be holding the reserves__________________________

       *IF NOT 0% describe the amount and why it is included




                                                  21
4. What is the percentage load to your rates if the City chooses to offer chiropractic or
   alternative care benefits?
                                    HMO             POS            PPO
       Chiropractic                 _____           _____          _____
       Alternative Care             _____           _____          _____




                                                22
                                             SECTION VIII

                                  SPECIAL CONDITIONS

GENERAL INFORMATION
Proposals will be considered only from those firms who are financially responsible and have the capability to
provide those services as noted herein.

SAMPLE PROFESSIONAL SERVICES CONTRACT
Included in this package is a sample of the standard "Professional Services Contract", used by the City.
Prospective firms are requested to review this document and comment on any areas of objections in their
technical proposals.

INSURANCE REQUIREMENTS
Attached to the sample "Professional Services Contract" is a copy of the City's current insurance
requirements (Form 410-33).

If prospective firms do not have insurance coverage in any of the identified areas, the reason for lack of
coverage should be clearly stated in the technical proposal. The City may consider granting a waiver if the
amount of coverage in any of the identified areas does not meet the City's required minimums.

INDEPENDENT CONTRACTOR AFFIDAVIT
The successful firm is required to sign and notarize an affidavit stating that they are an independent
contractor. A sample affidavit is attached for your review. THE INDEPENDENT CONTRACTOR IS NOT
ENTITLED TO WORKERS' COMPENSATION BENEFITS. AN INDEPENDENT CONTRACTOR IS
OBLIGATED TO PAY FEDERAL AND STATE INCOME TAX ON ANY MONIES EARNED PURSUANT TO
THE CONTRACT RELATIONSHIP. ADDITIONALLY, IT IS UNDERSTOOD THAT THE INDEPENDENT
CONTRACTOR IS NOT ENTITLED TO UNEMPLOYMENT INSURANCE BENEFITS UNLESS
UNEMPLOYMENT COMPENSATION COVERAGE IS PROVIDED BY THE INDEPENDENT
CONTRACTOR OR SOME ENTITY OTHER THAN THE CITY OF AURORA, COLORADO.

SUBLETTING OF CONTRACT
The firm will agree not to assign or sublet the whole or any part of the contract without the prior written
consent of the City.

CHANGES IN SCOPE OF SERVICES
The Project Manager will agree that any change of scope in the work to be performed after the original
contract has been signed shall be documented as a written change order, be accepted by all parties, and
made a part of the original contract by addendum.

SPECIAL INSTRUCTIONS
As referenced in Section II, Proposal Submittal Requirements, contractor’s proposals must include the
necessary submittals in order for that firm to be properly evaluated. Any omissions of submittals may be
determined as non-responsive and the proposal will not considered.

AMENDMENTS TO THE REQUEST FOR PROPOSAL
The City of Aurora reserves the right to amend this Request for Proposal by an addendum at any time
prior to the date set for receipt of proposals. Addenda or amendments will be posted to the City of Aurora
web site as soon as available and shall be the responsibility of the vendor to obtain all addenda. Vendors
registered for the paid service shall be notified either by fax or email depending on the service that they
have subscribed to. If revisions are of such a magnitude to warrant, in the City of Aurora’s opinion, the
postponement of the date for receipt of bids, an addendum will be issued announcing the new date.




                                                     23
                                               SECTION IX

                     SAMPLE PROFESSIONAL SERVICE AGREEMENT




                            PROFESSIONAL SERVICE AGREEMENT
                                            CITY OF AURORA
                                          AURORA, COLORADO




                TITLE:

                FILE NO.:

                P.O. NO.:




Professional Services Agreement (REV. 12/01)




                                                   24
                TABLE OF CONTENTS




Section I        CONSULTANT Responsibilities and Basic Services

Section II       The City's Responsibilities

Section III      Mutual Obligations of the City and Consultant

Section IV       Payment and Fee Schedule

Section V        Charter, Laws and Ordinances

Section VI       Termination of Contract

Section VII      Change Orders or Extensions

Section VIII     Equal Employment Opportunity

Section IX       Special Conditions

Section X        Insurance Requirements

Section XI       Examination of Records

Section XII      Indemnification


Attachment 1:    City of Aurora Insurance Requirements

Attachment 2:    Independent Contractor Affidavit




                            25
                                          AGREEMENT

         THIS AGREEMENT, made as of the                   day of                            in the year Two
Thousand and Two by and between the CITY OF AURORA, COLORADO, hereinafter called the CITY,
and                             ,a                                  corporation with its principal place of
business at                                       , hereinafter called the CONSULTANT, WITNESSETH,
that whereas the CITY intends that the CONSULTANT, upon written authorization as hereinafter specified,
shall perform services as hereinafter provided; which are in accordance with the project scope and any
addenda thereto, which scope of services by this CONSULTANT together with addenda, if any, shall become
a part of this Agreement.

   NOW, THEREFORE, the CITY and the CONSULTANT for the consideration hereinafter set forth agree
as follows:


               SECTION I – CONSULTANT RESPONSIBILITIES AND BASIC SERVICES


        A.      The CONSULTANT agrees to perform services in connection with projects as hereinafter
                stated. Refer to Special Conditions where applicable.

        B.      All work to be performed by the CONSULTANT shall be authorized in writing through the
                office of Purchasing and Contract Services subject to award as provided by Ordinance.
                Said award shall set forth all special conditions and requirements not otherwise provided for
                in this Agreement, but included in the Purchase Order.

        C.      Time of performance. The services to be performed under this Agreement shall be
                commenced immediately upon issuance of a Professional Service Agreement and a
                Purchase Order from the CITY and shall be completed no later than      unless
                extended by the CITY in writing.

        D.      The CONSULTANT shall inform the CITY in writing of any additional firms it intends to hire
                to perform work in connection with this Agreement and shall keep the CITY informed on any
                changes or additions to this information. The CITY will approve any additional firms prior to
                commencement of work per this Agreement. The CONSULTANT shall be responsible for
                the performance of the additional firm(s). Nothing contained herein shall create any
                contractual relationship between any additional firm(s) and the CITY.

        E.      Scope of Work:

        F.      The CONSULTANT shall be responsible for any injury to persons or damage to property to
                the extent arising from negligent or otherwise wrongful acts or errors and omissions of the
                CONSULTANT, its agents and employees. If the CONSULTANT knows of the damage the
                CONSULTANT shall notify the City immediately. If the City discovers the damage, City will
                notify CONSULTANT immediately. Repair shall be accomplished under City direction and
                to City specifications so property is in as good or better condition then before damage. The
                CONSULTANT shall provide the CITY with a certificate of liability coverage in accordance
                per the attached form 410-33.




                                                    26
        SECTION II - THE CITY'S RESPONSIBILITIES


The CITY shall:

A.      Provide full information including detailed scope as to its requirements for the services.

B.      Give prompt notice to the CONSULTANT whenever the CITY observes or otherwise
        becomes aware of any discrepancies in the services provided.

C.      Furnish, or direct the CONSULTANT to provide at the CITY'S expense, any necessary
        additional services.

D.      The CONSULTANT is not liable for delays in performance which are caused by the CITY,
        the CITY’S Consultants, or events which are outside the control of the parties and could not
        be avoided by the exercise of due care.



      SECTION III - MUTUAL OBLIGATIONS OF THE CITY AND CONSULTANT


A.      This Agreement does not guarantee to the CONSULTANT any work except as authorized in
        accordance with Section I above, or create an exclusive contract.

B.      The services and any and all interests contemplated under this Agreement shall not be
        assigned, sublet or transferred without the written consent of the CITY.

C.      The CONSULTANT and any and all of its personnel utilized by the CONTRACTOR under
        the terms of this Agreement shall remain the agents and employees of the CONSULTANT
        and are not, nor shall be construed to be, agents or employees of the CITY.

D.      All data collected by the CONSULTANT and all originals, or reproductions at the option of
        the CITY provided that in no event shall the CITY be responsible for the costs of such
        reproduction, of documents, notes, drawings, tracings, databases, and files collected or
        prepared in connection with these services, except the CONSULTANT’S personnel and
        administrative files, shall become and be the property of the City. However, the
        CONSULTANT shall retain the right to freely use, publish and apply to other projects the
        information, data, results, and materials developed by the CONSULTANT in the course of
        performing under this Agreement.

        The CITY recognizes that all-technical data, evaluations, reports and other work products
        are instruments of the CONSULTANT’S services and not designed for use other than what
        is intended by or reasonably foreseeable to the parties to this Agreement. The CITY shall
        make no other use of the CONSULTANT’S work product without the prior approval of the
        CONSULTANT.




                                              27
SECTION IV - PAYMENT AND FEE SCHEDULE

It is understood and agreed by and between the parties hereto, that the CITY shall pay the CONSULTANT
for services furnished, and the CONSULTANT shall accept as full payment for such services, amounts of
money computed as follows:

        A.      Total Compensation: The CITY agrees to pay and the CONSULTANT agrees to accept for
                the services contained in Section I contracted herein a sum not to exceed
                dollars. This amount shall include all services rendered by the CONSULTANT under this
                Agreement including all travel, living and overhead expenses incurred in connection with
                performing the services herein except for special services authorized in writing by the CITY.
                The sum above stipulated shall be considered a "Not to Exceed" cost to the CITY.
                CONSULTANT shall submit an invoicing schedule to be approved by the Project Manager.

                Upon submission of CONSULTANT invoicing to the CITY, payment shall be issued. It is to
                be understood and agreed that the CITY may require up to 21 days to process payment
                after date of receipt of invoicing.


                SECTION V - CHARTER, LAWS AND ORDINANCES


The CONSULTANT, at all times, agrees to observe all applicable Federal and State Laws, Ordinances and
Charter Provisions of the City of Aurora, and all rules and regulations issued pursuant thereto, which in any
manner affect or govern the services contemplated under this Agreement.


                SECTION VI - TERMINATION OF CONTRACT


A.      TERMINATION FOR CAUSE

In the event a material breach of this Agreement remains uncured following reasonable notice of said breach,
the non-breaching Party may terminate this Agreement upon written notice specifying the effective date
thereof, provided the CITY shall have at least thirty (30) days to cure any such alleged breach. In the event
CONSULTANT illegally discriminates among or against any person or persons, no opportunity to cure such
breach need be provided by the CITY.


B.      TERMINATION FOR GOVERNMENTAL CONVENIENCE

        1. Change in CITY Policy. The CITY may terminate this Agreement at any time upon
           reasonable notice specifying the date thereof, provided the CONSULTANT shall be
           compensated in accordance with this Agreement for all work performed up to the effective
           date of termination.

        2. Non-Appropriation of Funds. The expenditure by the CITY of any funds or other resources in
           any future fiscal year, regardless of the stated term of this Agreement, is subject to the lawful
           appropriation of sufficient funds therefor in the sole and unfettered discretion of the CITY’S
           governing body. In the event sufficient funds are not appropriated, the CITY may terminate this
           Agreement upon thirty (30) days prior notice.




                                                     28
C.     EFFECT OF TERMINATION

       1. Ownership of Work Product. In the event of termination, all finished and unfinished work
          product(s) prepared by the CONSULTANT pursuant to this Agreement shall become the sole
          property of the CITY, provided the CONSULTANT is compensated in accordance with this
          Agreement for all work performed in accordance with this Agreement up to the effective date
          of termination. CONSULTANT shall not be liable with respect to the CITY’S subsequent use
          of any incomplete work product, provided CONSULTANT has notified the CITY in writing of
          the incomplete status of such work product.

       2. CITY’S Right to Set-Off and other Remedies. Termination shall not relieve CONSULTANT
          from liability to the CITY for damages sustained as the result of CONSULTANT’S breach of
          this Agreement; and the CITY may withhold funds otherwise due under this Agreement in lieu
          of such damages, until such time as the exact amount of damages, if any, has been
          determined.



               SECTION VII - CHANGE ORDERS OR EXTENSIONS

The CITY, may from time to time, require changes in the scope of the services of the CONSULTANT to be
performed herein. Such changes, including any increase or decrease in the amount of the CONSULTANT'S
compensation, which are mutually agreed upon by and between the CITY and the CONSULTANT, shall be
incorporated in written Change Orders or Extensions to this Contract.


               SECTION VIII - EQUAL EMPLOYMENT OPPORTUNITY


       A.      The CONSULTANT will not discriminate against any employee or applicant for employment
               on the basis of race, color, national origin, ancestry, age, sex (gender), religion, creed, or
               physical or mental disability. The CONSULTANT may adhere to lawful equal opportunity
               guidelines in selecting employees, provided that no person is illegally discriminated against
               on any of the preceding bases. This provision shall govern, but shall not be limited to,
               recruitment, employment, promotion, demotion, and transfer, and advertising therefor; layoff
               or termination; rates of pay or other compensation; and selection for training, including
               apprenticeship. The CONSULTANT shall post, in all places conspicuous to employees and
               applicants for employment, notices provided by the State of Colorado setting forth the
               provisions of this nondiscrimination clause.

       B.      All solicitations and advertisements for employees placed by or on behalf of the
               CONSULTANT, shall state that CONSULTANT is an equal opportunity employer.

       C.      The CONSULTANT shall cause the foregoing provisions to be inserted in all subcontracts
               for any work contemplated by this Agreement or deemed necessary by CONSULTANT, so
               that such provisions are binding upon each sub-Consultant.

       D.      The CONSULTANT shall keep such records and submit such reports concerning the racial
               and ethnic origin of employees and of applicants for employment as the U.S., the State of
               Colorado, the City of Aurora, or their respective agencies may require.

       E.      The CONSULTANT shall comply with such rules, regulations and guidelines as the United
               States, the State of Colorado, the City of Aurora, or their respective agencies may issue to
               implement these requirements.




                                                    29
                 SECTION IX - SPECIAL CONDITIONS



                 SECTION X - INSURANCE REQUIREMENTS

The CONSULTANT shall provide the appropriate certificates of insurance and Worker Compensation
documents, at no cost to the City, as described on Attachment #1. The CONSULTANT further agrees and
understands that they are to maintain and keep in force the appropriate insurance certificates throughout the
term of this Agreement.

                 SECTION XI - EXAMINATION OF RECORDS

This clause applies if this contract agreement exceeds $10,000.00.

The Internal Auditor of the City of Aurora, or a duly authorized representative from the City of Aurora shall
until three (3) years after final payment under this contract agreement have access to and the right to
examine any of the Consultant/Consultant's directly pertinent books, documents, papers, or other records
involving transactions related to this contract agreement.

The CONSULTANT agrees to include in first-tier subcontracts under this contract agreement a clause to the
effect that the City's Internal Auditor, or a duly authorized representative from the City of Aurora shall, until 3
years after final payment under the subcontract have access to and the right to examine any of the
Consultant's directly pertinent books, documents, papers, or other records involving transactions related to
the subcontract. "Subcontract," as used in this clause, excludes (1) purchase orders not exceeding
$10,000.00 and (2) subcontracts or purchase orders from public utility services at rates established to apply
uniformly to the public, plus any applicable reasonable connection charge.

The periods of access and examination as noted above for records relating to (1) litigation or settlement of
claims arising from the performance of this contract agreement, or (2) costs and expenses of this contract
agreement to which the City's Internal Auditor, or duly authorized representative from the City of Aurora has
taken exception, shall continue until such appeals, litigation, claims, or exceptions are disposed of.

                 SECTION XII – INDEMNIFICATION

The CONSULTANT shall indemnify, defend, and hold harmless the City, its officers, agents, and
employees, from and against all claims, damages, liabilities, and court awards, including costs, expenses,
and reasonable attorney fees, to the extent caused by any negligent or otherwise wrongful act, error, or
omission of the CONSULTANT, its officers, agents, and employees. The CONSULTANT shall provide the
City with prompt notice of any claim for which CONSULTANT may be liable. Likewise, the City agrees to
provide the CONSULTANT with prompt notice of any claim for which indemnification may be sought
hereunder and, further, to cooperate with the CONSULTANT in the resolution of such claim. Nothing
herein is intended to be or shall be construed to be a waiver of the City’s governmental immunity under
C.R.S. Section 24-10-101, et. Seq., as amended. In WITNESS WHEREOF, the parties hereto have
executed this Agreement as of the day and year first above written.




                                                        30
ATTEST:                   CITY OF AURORA, COLORADO




                          By:
City Clerk                      Robert E. Cook, Manager
                                Purchasing Services


                          Date:

APPROVED AS TO FORM:



Assistant City Attorney



Risk Manager


                          Consultant


                          By:
                             Signature



                          Name (Type or Print)



                          Title



                          Date




                             31
                                                         ATTACHMENT 1
INSURANCE REQUIREMENTS
The vendor or contractor providing services under this agreement will be required to procure and maintain,
at their own expense and without cost to the City of Aurora, until final acceptance by the City of all work
covered by the Purchase Order or contract the following types of insurance. The policy limits required are
to be considered minimum amounts:

 Commercial General Liability Insurance policy with minimum limits of $600,000 combined single limit
     for each occurrence. This policy should have a Broad Form Endorsement and include the
     following coverages: Blanket Contractual Liability, Broad Form Property Damage, Completed
     Operations and Personal Injury.

 Comprehensive Automobile Liability Insurance which includes coverage for all owned, non-owned
      and rented vehicles with a minimum limit of $600,000 combined single limit for each occurrence.

 Worker Compensation and Employers Liability Insurance shall cover the obligations of the
      vendor/contractor accordance with the provisions of the Workers Compensation Act, as
      amended, by the State of Colorado.

 Subcontractor's Insurance shall be the responsibility of the vendor/contractor to ensure that
      subcontractors are properly insured to meet the above requirements before they are permitted to
      commence work on the project.

In the event that the contract involves professional or consulting services, in addition to the
aforementioned insurance requirements, the contract shall also be protected by a Professional Liability
Insurance policy. The following policy limit is to be considered a minimum amount.

Professional Liability Insurance policy with a minimum limit of $1,000,000 per claim. The policy shall
provide coverage to protect the contractor against liability incurred as a result of the professional services
performed under this contract.

The contractor shall provide Certificates of Insurance to the City of Aurora demonstrating that the
aforementioned insurance requirements have been met prior to the commencement of work under this
contract. The Comprehensive General Liability and Automobile Liability Certificates of Insurance shall
have the City of Aurora, its elected and appointed officials, officers, employees, agents, representatives
and the title of the contract as additional insured. These Certificates of Insurance shall also contain a
valid provision or endorsement that these policies may not be canceled, terminated, changed or
modified to the extent such change or modification would cause the City's mandatory coverage
requirements as stated herein to be violated without a forty-five (45) day written notice prior to
expiration of same to the City of Aurora. Such notice to be forwarded to the Purchasing and Contract
Services Division of the City of Aurora, 1470 South Havana, Aurora, Colorado. The insurance
coverages enumerated above constitute the minimum requirements and said enumerations shall in no
way lessen or limit the liability of the contractor under the terms of the Contract. The contractor may
procure and maintain at their own expense, any additional kinds and amounts of insurance, that in their
own judgment, may be necessary for their proper protection in the performance of the work. Any of the
minimum limits of insurance set out herein may be raised or lowered at the sole discretion of the Risk
Manager for the City of Aurora in response to the particular circumstances giving rise to the contract.

Form No. 410-33




                                                        32
                                             ATTACHMENT 2




It is hereby understood by the City of Aurora, Colorado and the Contractor                    that all work
performed on Request for Proposal Number                            is that of an independent contractor. An
independent contractor is NOT a City of Aurora Employee and as such IS NOT ENTITLED TO WORKERS'
COMPENSATION BENEFITS. THE INDEPENDENT CONSULTANTIS OBLIGATED TO PAY FEDERAL
AND STATE INCOME TAX ON ANY MONIES EARNED PURSUANT TO THE CONTRACT
RELATIONSHIP. ADDITIONAL, IT IS UNDERSTOOD THAT INDEPENDENT CONTRACTOR IS NOT
ENTITLED        TO    UNEMPLOYMENT            INSURANCE       BENEFITS        UNLESS      UNEMPLOYMENT
COMPENSATION COVERAGE IS PROVIDED BY THE INDEPENDENT CONSULTANTOR SOME
OTHER ENTITY THAN THE CITY OF AURORA, COLORADO.

The parties hereto are in agreement.




Consultant                                       Title




Signature                                        Date




Name (type or print)




Notary



My Commission Expires




                                                    33
                                    APPENDIX A

                                  CITY OF AURORA

                                  MEDICAL
                             NETWORK STATISTICS

  Complete the following chart for the five County (Denver, Jefferson, Adams, Arapahoe &
                                Douglas) Metro Denver area.

                       Carrier _____________________________

                                       Accepting New                                Accepting New
                         PPO             Patients?              HMO/POS               Patients?

# of Primary Care
    Physicians



 # of Specialists



  # of Hospitals



List participating
    hospitals



From the census
list zip codes not
 covered by your
      network.

   How will you
address coverage
  for individuals
 residing in these
    locations?




                                            34
    APPENDIX B




CARRIER QUESTIONNAIRE

  MEDICAL: HMO/POS




         35
                                  CITY OF AURORA

               QUESTIONS FOR MEDICAL CARE – HMO / POS
SPECIFICATIONS – Please respond in the corresponding right hand column


1.   Provide a directory of providers and list website where
     current information is available.


2.   Claims experience must be provided no less than ____ Agree              ____ Disagree
     quarterly. Additional, detailed reporting must be provided
     with the renewal notification (at least 90 days prior to
     renewal date).




QUESTIONS – Please respond in the corresponding right hand column


1.   Has your HMO / POS received NCQA accreditation?             _____ Yes       _____ No

     If yes, when? And for how long?



2.   Does your HMO / POS plan require a referral from the _____ Yes        _____ No
     PCP to a specialist or is it considered “open access”? Open Access? _______________


3.   Can a female member visit her OB/GYN without a _____ Yes                  _____ No
     referral?


4.   Can a female member use an OB/GYN as a PCP?               Limits:




                                             36
5.    Does your HMO / POS include the following:
          Chiropractors                                          _____ Yes        _____ No
          Ambulance                                              _____ Yes        _____ No
          Home Health Care                                       _____ Yes        _____ No
          Hospice Care                                           _____ Yes        _____ No
          Alcohol Rehabilitation                                 _____ Yes        _____ No
          Physician Assistants/Surgical Assistants               _____ Yes        _____ No
          Acupuncturists                                         _____ Yes        _____ No
          Vision Care                                            _____ Yes        _____ No
          Other alternative medicine provider (list)             _____ Yes        _____ No


6.    Does your plan have a prescription drug formulary?        _____ Yes       _____ No

            If so, please provide details (i.e., modified open,
           open, closed, etc.)
            Explain the copay tiers of your formulary
            Please describe your mail order benefit
            Is prior authorization required for non-formulary _____ Yes         _____ No
           medications?
            Outline the member’s responsibility for non-
           formulary medications.


7.    Is your HMO /POS network arranged in a “POD” system?      _____ Yes       _____ No

      If yes, describe referral requirements.



8.    For active and retired employees and dependents:
           Describe out of state coverage
           Describe out of service area coverage
           Describe out of the country coverage


9.    How are PCP’s and Specialists reimbursed?

             Salary
             Capitation
             Discounted fee for service
             Other


10.   Provide examples of available financial reports and the     Provided in Section ______.
      frequency of each.




                                                37
11.   Provide the following HEDIS data:

             Data as of (year)                                                  __________
             Admits per 1,000 Members                                           __________
             Days per 1,000 Members                                             __________
             Average Length of Stay                                             __________
             C-Section Rate                                                     __________
             Mammogram Rate                                                     __________
             % of Utilization of PCP’s versus Specialists                       __________



12.   Will you implement new ERISA claim procedures for all
      employer groups, or will non-ERISA employers have
      separate procedures? Explain.


13.   Are you prepared to comply with upcoming regulations
      concerning HIPAA privacy regulations. Explain your
      timeline and procedures.


14.   Explain your procedures for members in “transition of
      care” situations. This would include termination of a
      physician from the network, members in 3rd trimester of
      pregnancy, cancer treatment, etc.


15.   Will you co-exist with another carrier’s HMO?              _____ Yes   _____ No
            If so, please outline your conditions to co-exist.




                                                  38
CARRIER QUESTIONNAIRE

    MEDICAL: PPO




         39
                                   CITY OF AURORA

                       SPECIFICATIONS AND QUESTIONS
                          FOR MEDICAL CARE – PPO
SPECIFICATIONS – Please respond in the corresponding right hand column


1.   Provide a directory of providers and list website where
     current information is available.


2.   Claims experience must be provided no less than ____ Agree                ____ Disagree
     quarterly. Additional, detailed reporting must be provided
     with the renewal notification (at least 120 days prior to
     renewal date).


QUESTIONS – Please respond in the corresponding right hand column


1.   Do you have a national network?                           _____ Yes         _____ No

     If yes, can an active employee/dependent or Active _____ Yes                       _____ No
     retiree/dependent access the national network when out Retiree _____ Yes           _____ No
     of the local service area?


2.   Describe your out-of-country benefits for:
         Active employees and dependents
         Retired employees and dependents


3.   Does your directory of providers include the following?

         Chiropractors                                        _______   Yes       _______ No
         Ambulance                                            _______   Yes       _______ No
         Home Health Care                                     _______   Yes       _______ No
         Hospice Care                                         _______   Yes       _______ No
         Alcohol Rehabilitation                               _______   Yes       _______ No
         Surgical/Physician Assistants                        _______   Yes       _______ No
         Acupuncturists                                       _______   Yes       _______ No
         Vision Care                                          _______   Yes       _______ No
         Other alternative medicine provider (list)           _______   Yes       _______ No




                                                  40
4.    Does your plan have a prescription drug formulary?         _______ Yes     _______ No

            If so, please provide details (i.e., modified open,
           open, closed, etc.)
            Explain the copay tiers of your formulary
            Please describe your mail order benefit
            Is prior authorization required for non-formulary _______ Yes        _______ No
           medications?
            Outline the member’s responsibility for non-
           formulary medications.


5.    Does your system pay PPO benefits if the service/supply _______ Yes        _______ No
      is not available in network?


6.    How are non-network providers reimbursed when the
      patient is referred outside the network?


7.    Will you co-exist with another carrier’s HMO?              _______ Yes     _______ No
            If so, please outline your conditions to co-exist.




8.    Provide examples of the various financial reports Provided in Section ________.
      available without cost, i.e., enrollment, premium, hospital
      days per 1,000, outpatient hospital visits, utilization by
      diagnosis, etc.


9.    Provide examples and note the frequency of additional Provided in Section ________.
      reports and the cost for each.


10.   Do you have a pre-certification requirement?

          Hospitalizations                                      _______   Yes   _______ No
          Outpatient Surgery                                    _______   Yes   _______ No
          Specified Diagnostic Procedures                       _______   Yes   _______ No
          Outpatient Mental/Substance Abuse                     _______   Yes   _______ No
          Other ____________________________                    _______   Yes   _______ No


11.   Will you commit to having a preferential plan design _______ Yes           _______ No
      and/or pricing in place with The C.U. Health Sciences
      Center by January 1, 2003?

                                                  41
                                    APPENDIX C



                    PROPOSED PLAN DESIGN ALTERNATIVES


      Quote either a single plan offering or a dual option medical plan design
                            incorporating the following:

PROPOSED MEDICAL PLAN – HMO PLANS

Duplicate the current HMO plan design (or your closest equivalent plan option) as
previously outlined. You may also present alternative plan designs you deem as
attractive as options for consideration. Your quote should include coverage for eligible
retirees. If you are unable to provide coverage for retirees, please stipulate.


PROPOSED MEDICAL PLAN – POS PLAN

Provide a POS alternative that would either stand alone or as part of a dual option
HMO/POS offering.

PROPOSED MEDICAL PLAN – PPO PLAN

Provide a PPO plan (or plans) that would stand alone or as part of a dual option
HMO/PPO or high and low PPO offering. A PPO option should provide coverage to
retirees and out of area employees/dependents. Suggested PPO plans are:
        $250/$500 deductible, 90/70 coinsurance, $5,000 OOP maximum.               An
           alternative RX plan should be included. RX could include a deductible and/or
           be coinsurance based, but still be an on-line pharmacy card plan.
        $1,000/$1,500 deductible (basic PPO plan), 80/60 coinsurance, $10,000 OOP
           maximum. Premium savings on this plan would be applied to the employee’s
           FSA.


The City is open to alternative plan designs that would provide a good plan of benefits to
participants. However, they are seeking choice for active employees and retirees and
request a dual choice (HMO/POS, HMO/PPO, High/Low HMO, POS or PPO) offering.
Please note that your plan will co-exist with another carrier’s plan.




                                            42
                              PROPOSED PLAN DESIGNS


Please quote a triple option medical plan design incorporating the following

PROPOSED MEDICAL PLAN – HMO PLANS

Please duplicate the current HMO plan design as outlined above as closely as possible.
You may also present alternative plan designs you deem as attractive as options for
consideration.


PROPOSED MEDICAL PLAN – POS PLAN

Please duplicate the current POS – High plan design as outlined above as closely as
possible. It is not necessary to quote on the POS – Low design as the POS plans will be
consolidated. You may also present alternative plan designs you deem as attractive as
options for consideration.

PROPOSED MEDICAL PLAN – PPO PLAN

Please duplicate the current PPO plan designs (for active and retired employees) as
outlined above as closely as possible. If you are unable to offer a PPO option, please
quote an alternative plan design.




                                            43
                                       APPENDIX D

RATE HISTORY
MEDICAL PLAN - Regular Full-Time,            1/1/2002–           1/1/2001 –         11/2000 –
Part-Time Employees & Early Retirees         12/31/2002          12/31/2001         12/31/2000
PacifiCare – HMO
 Employee                                          $233.00          $192.00           $174.00
 Employee + 1                                      $484.00          $400.00           $355.24
 Employee + Family                                 $582.00          $480.00           $435.31
PacifiCare – PPO (Out of Area)
 Employee                                          $233.00          $192.00           $174.00
 Employee + 1                                      $484.00          $400.00           $355.24
 Employee + Family                                 $582.00          $480.00           $435.31
Aetna – HMO
 Employee                                          $236.00          $192.00           $174.00
 Employee + 1                                      $491.60          $400.00           $323.70
 Employee + Family                                 $588.00          $478.40           $424.20
Kaiser – HMO
 Employee                                          $220.00          $177.36           $174.00
 Employee + 1                                      $452.00          $381.32           $374.11
 Employee + Family                                 $525.00          $450.13           $441.62


MEDICAL PLAN - Medicare Eligible Retirees (age 65+)              1/1/2002–
                                                                 12/31/2002
PacifiCare – HMO & PPO*
 Single                                                              $ 59.00
 One Medicare/One Non-Medicare                                       $292.00
 Two on Medicare                                                     $118.00
Kaiser (Colorado Only)
 Single                                                              $ 66.00
 One Medicare/One Non-Medicare                                       $286.00
 Two on Medicare                                                     $132.00

       Rates are currently blended for all participants, active and early retirees.
       Retirees receiving a pension from the City have medical premium deducted
       from their pension payment. Retirees on a Money Purchase Plan pay the
       City for their medical premium.

Quotations should provide rates based on:
 Current blended structure
 Rates with actives only; retirees over age 65, retirees under age 65

* PacifiCare has PPO benefits available only for individuals living outside the HMO service area.




                                               44
SCHEDULE OF CONTRIBUTIONS – January 1 2002 – December 31,
2002
MEDICAL PLAN - Regular Full       Pacificare HMO
Time                              & PPO            Aetna HMO        Kaiser HMO
Employee
 Total Cost                          $233.00          $236.00         $220.00
 City Contribution                   $220.00          $220.00         $220.00
 Employee Cost                       $13.00           $16.00           $0.00
Employee + 1
 Total Cost                          $484.00          $491.60         $452.00
 City Contribution                   $462.00          $462.00         $452.00
 Employee Cost                       $22.00           $29.60           $0.00
Family
 Total Cost                          $582.00          $588.00         $525.00
 City Contribution                   $462.00          $462.00         $462.00
 Employee Cost                       $120.00          $126.00          $63.00

MEDICAL PLAN - Regular Part       Pacificare HMO
Time                              & PPO            Aetna HMO        Kaiser HMO
Employee
 Total Cost                          $233.00          $236.00         $220.00
 City Contribution                   $110.00          $110.00         $110.00
 Employee Cost                       $123.00          $126.00         $110.00
Employee + 1
 Total Cost                          $484.00          $491.60         $452.00
 City Contribution                   $231.00          $231.00         $231.00
 Employee Cost                       $253.00          $260.60         $221.00
Family
 Total Cost                          $582.00          $588.00         $525.00
 City Contribution                   $231.00          $231.00         $231.00
 Employee Cost                       $351.00          $357.00         $294.00

      Contributions by the City of Aurora for 2003:

The City will increase its contribution to premium by an amount equal to the first 7% of
the increase over current premium as applied to the lowest cost plan.               The
employee/retiree contribution will be increased by an amount equivalent to the next 7%
of the increase in premium to the lowest cost plan. Any increase in excess of 14% will
be shared 50/50 by the City and the employees/retirees.




                                           45
                                           APPENDIX E


PREMIUM / CLAIMS


                                        Premium               Claims
Pacificare

Kaiser

Aetna 1/1/2000 – 4/1/2001*                  $3,924,970          $3,730,285



*Excludes pooled claims over $75,000


(Missing data will be provided in an addendum to follow release of the RFP)




                                                   46
                                            APPENDIX F

                                     LARGE MEDICAL CLAIMS

                                                  2001


         Pacificare HMO (> $25,000)                                     Aetna
      Diagnosis          Dollar Amount


Lung Cancer                     $63,765.41
                            (now deceased – 5/2001)

Post Operative                  $28,252.59
Staph Infection

Lung Cancer                     $31,005.57
                                 (on going)




                                                  2000

         Pacificare HMO (> $25,000)                                     Aetna
      Diagnosis          Dollar Amount


Bacteria – Staph                $76,346.71
Infection - Stroke

Colon Cancer                    $70,263.40
                            (now deceased – 7/2001)


Lung Cancer                     $31,968.85
                            (now deceased – 5/2001)


Tibia Reinforcement             $24,079.67
w/implants



(Missing data will be provided in an addendum to follow release of the RFP)




                                                      47

				
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