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					RFP NO. 2011-001


Request for Proposals -
EAP and Self-Funded Mental Health/Substance Abuse
Benefits Administration

The Public Employee Benefits
Cooperative of North Texas

May 11, 2011

Proposals Due: 3:00 P.M. CT, Friday, June 10, 2011




RFP NO. 2011-001
                                                     RFP FOR MENTAL HEALTH BENEFITS


                                                                        TABLE OF CONTENTS

1. GENERAL INFORMATION AND REQUIREMENTS .................................................................................................. 2

2. CONTRACT PROVISIONS. ..................................................................................................................................... 3

3. OVERVIEW OF PEBC MEDICAL PLANS .................................................................................................................. 6

4. FINANCIAL REQUIREMENTS ............................................................................................................................... 10

5. OPERATIONAL REQUIREMENTS ......................................................................................................................... 11

6. ELIGIBILITY AND ENROLLMENT .......................................................................................................................... 14

7. COMMUNICATIONS REQUIREMENTS ................................................................................................................ 15

8. PERFORMANCE REQUIREMENTS AND PENALTIES ............................................................................................. 16

9. TIMETABLE ......................................................................................................................................................... 16

10. PROPOSAL EVALUATION CRITERIA.................................................................................................................... 17

11. PROPOSAL FORMAT.......................................................................................................................................... 20

12. QUESTIONNAIRE ............................................................................................................................................... 24

13. SIGNATURES ..................................................................................................................................................... 53

14. APPENDICES ...................................................................................................................................................... 58
       A.      CURRENT PLAN DESIGNS.......................................................................................................................... 58
       B.      PAID CLAIM AND ENROLLMENT EXPERIENCE .......................................................................................... 75
       C.      CENSUS .................................................................................................................................................... 76
       D.      LETTER OF UNDERSTANDING ................................................................................................................... 82
       E.      BUSINESS ASSOCIATE AGREEMENT ......................................................................................................... 84

ENCLOSURE – PROPOSAL RESPONSE SPREADSHEETS

This Table of Contents is intended as an aid to contractors and not as a comprehensive listing of the proposal package.
Contractors are responsible for reading the entire proposal package and complying with all specifications. The terms
“Vendor” and “Contractor” can be used interchangeably in this RFP.




                                                              Page 1 of RFP No. 2011-001
                                 RFP FOR MENTAL HEALTH BENEFITS



1.   GENERAL INFORMATION AND REQUIREMENTS

     1.1     PEBC ORGANIZATION
     The Public Employee Benefits Cooperative of North Texas (PEBC) is a coalition established through an
     interlocal agreement. The 2011 PEBC member groups are Dallas County, Tarrant County, Denton County,
     the North Texas Tollway Authority (NTTA) and Parker County. On behalf of its member governments, the
     PEBC keeps employee benefits affordable through common benefit plan designs and centralized
     administration of benefit programs. The PEBC serves as Plan Administrator for its benefit programs. The
     combined group’s self-funded medical plans currently consist of approximately 13,000 employees, COBRA
     members and under-age-65 retirees, along with an additional 11,500 covered dependents. While the
     groups move as a block, the PEBC is not a risk pool. Each group stands on its own, and its experience and
     risk is based on its own population’s costs. The benefit plan year is based on a calendar year.

     The groups share a common management philosophy, structure and regulatory environment. These plans
     are all self-funded, non-federal governmental plans not subject to the provisions of ERISA. Each group
     elects, under authority of section 2722(a)(2) of the Public Health Service (PHS) Act, and 45 CFR 146.180 of
     Federal regulations, to exempt the plan from the requirements of Title XXVII of the PHS Act including parity
     in the application of certain limits to mental health benefits.

     From time to time, the PEBC extends an invitation to a similar group to participate with the PEBC. A request
     to join does not automatically result in an invitation to participate. If a group is extended an invitation to
     participate, the PEBC benefit plans will extend to that group’s population as well.

     The PEBC is governed by a Board of Governors and is administered under the direction of the Executive
     Director. Through interlocal agreement, the PEBC is located at the North Central Texas Council of
     Government’s (NCTCOG) offices. This RFP is jointly administered through the NCTCOG and the PEBC.

     The purpose of this Request for Proposals (RFP) is to request proposals from qualified and appropriately
     licensed vendors to provide self-funded mental health/substance abuse benefits administration and a
     capitated EAP for the PEBC’s self-funded medical plans. Please see Section 3 of this RFP for detailed
     information on the services included in this RFP.

     1.2     CONTRACTOR RELATIONSHIPS
     The Executive Director of the PEBC (or Executive Director’s designee) serves as the primary contact for all
     external vendor/contractor contracts and relationships. As such, the Executive Director of the PEBC (or the
     Executive Director’s designee) must be the sole contact regarding any potential proposals or outstanding
     work. Contact with any PEBC Member Group directly is strictly prohibited.


     1.3     CONFIDENTIALITY
     All information presented in this RFP, including information which is subsequently disclosed by the PEBC
     during the RFP process, will be considered strictly confidential. All parties involved are expected to treat
     this information in a professional manner. Information should not be released to parties external to the

                                      Page 2 of RFP No. 2011-001
                                  RFP FOR MENTAL HEALTH BENEFITS


     proposing contractor without the express written consent of the PEBC. Vendors should refer to Item 11.8
     for information connected to the Texas Public Information Act and potential for post-award disclosure.


     1.4     CONFLICT OF INTEREST

     Contractors shall not, under penalty of law, offer or provide any gratuities, favors or anything of monetary
     value to any officer, member, employee or agent of the NCTCOG or the PEBC for the purpose of or having
     the effect of influencing favorable disposition toward their own proposal or any other proposal submitted
     hereunder.

     No employee, officer or agent of the NCTCOG or the PEBC shall participate in the selection, award or
     administration of a contract if a conflict of interest, real or apparent, exists.

     Contractors shall not engage in any activity that will restrict or eliminate competition. Violation of this
     provision may cause a contractor's bid to be rejected. This does not preclude joint ventures or
     subcontracts, subject to the provisions of this RFP.


     1.5     ADDITIONAL INFORMATION FROM RESPONDING VENDORS

     The PEBC reserves the right to request additional documentation regarding submitted proposals.
     Responding vendors must agree to provide any information requested.


2.   CONTRACT PROVISIONS
     2.1     THE CONTRACT
     The Contract (and any subsequent amendments if needed) shall be in the format specified by the PEBC. While
     there will be one set of contractual terms, each PEBC Employer Group, as a member of the PEBC, will sign an
     individual contract with the successful vendor. In other words, the final result will be five (5) executed identical
     contracts.
     The Contract will incorporate the RFP, the responding vendor’s proposal to the RFP, and any other clarifying
     information the responding vendor may be required to provide. Until a Contract has been executed and
     signed, the RFP and the selected vendor proposal will be binding. The selected vendor will be required to sign
     the Letter of Understanding (LOU) shown in Appendix D of this RFP as confirmation of the agreement, until the
     final Contract can be executed. Vendors unable to agree to each term as set forth in this RFP, including in
     Section 2.2, Required Contractual Provisions, and in the LOU should not submit a proposal in response to this
     RFP.
     No Contract will be executed until the PEBC has accepted the responding vendor’s proposal and the PEBC has
     notified the responding vendor of its approval. The Contract will be for a two-year term beginning on January
     1, 2012 and extend through December 31, 2013, to be renewed at the PEBC’S option for an additional three-
     year period unless terminated as provided herein or in the Contract. PEBC Employer Groups must be able to
     terminate the agreement at any time with 180 days notice. The Vendor cannot change contract terms or
     terminate the contract (without PEBC approval) during any period the contract is in force.


                                        Page 3 of RFP No. 2011-001
                             RFP FOR MENTAL HEALTH BENEFITS


The PEBC and the contracting vendor shall agree and acknowledge, as applicable, that the benefits and
coverage to be provided under the Contract will be provided from January 1, 2012 through December 31,
2013. However, the PEBC and the contracting vendor shall also agree and acknowledge that there are duties
and obligations specified by the RFP to be performed prior to January 1, 2012 and following December 31,
2013, and the Contract will specify that the parties agree to perform all such duties and obligations. Once
executed, the Contract shall comprise the complete and exclusive statement of each agreement between the
PEBC Employer Group and the contracting vendor and supersede all prior or contemporaneous agreements,
negotiations, course of prior dealings, and oral representations relating to the subject matter hereof.
All work performed, as herein shown under the specifications, shall be of the highest quality and shall in every
respect meet or exceed the industry standards for this type service.
In the event that a contracting vendor fails or refuses to perform any of its duties or obligations as provided by
the Contract, the PEBC Employer Group, without limiting any other rights or remedies it may have by law,
equity or under contract, will have the right to terminate the Contract immediately. Notwithstanding such
termination, certain obligations of the vendor shall survive the termination of the Contract.


2.2     REQUIRED CONTRACTUAL PROVISIONS
The PEBC has specific contracting requirements that cannot be waived or altered. All vendors should carefully
review the LOU in Appendix D as well as the required provisions below. Vendors should include in their written
proposals all additional requirements, terms or conditions they wish to have considered. Vendors should not
assume that an opportunity exists to add such matters through the contract negotiation process. Unacceptable
terms and conditions added by a vendor may cause the PEBC to reject a proposal, despite other factors of the
evaluation. In addition, vendors should not strike-through or otherwise alter anything in the LOU. Submission
of an altered LOU or Required Contractual Provisions under this Section 2.2 as part of a proposal may cause the
PEBC to reject a proposal, despite other factors of the evaluation.
In particular, the following provisions must be in the Contract:
        2.2.1    No Binding Arbitration - Each proposal must specify that the vendor will not impose a
                 binding arbitration requirement upon a plan participant or a PEBC Employer Group. A
                 proposal containing a requirement that plan participants and/or PEBC Employer Groups
                 must agree to engage in binding arbitration will not be accepted and disqualifies the
                 submitting vendor.
        2.2.2    Termination – Except for breach of Contract and similar situations, the PEBC Employer
                 Groups must be able to terminate the Contract at any time with 180 days notice. However,
                 the contracting vendor cannot change contract terms or terminate the Contract while it is in
                 force, except for material breach of agreement.
        2.2.3    PEBC Approval of Communications/Publicity - The contracting vendor must agree not to
                 publicize the Contract or disclose, confirm or deny any details thereof to third parties or use
                 any photographs or video recordings of the PEBC Employer Group’s employees or use the
                 PEBC name OR PEBC Employer Group names in connection with any sales promotion or
                 publicity event without the prior express written approval of the PEBC.
        2.2.4    No Assignment - This Contract is for the professional services provided by the vendor and the
                 vendor’s interest in such agreement. Duties assigned to the successful vendor under the
                 contract may not be assigned or delegated to a third party without the advance written

                                  Page 4 of RFP No. 2011-001
                     RFP FOR MENTAL HEALTH BENEFITS


        consent of the PEBC. Such consent shall not relieve the assignor of liability in the event of
        default by its assignee.
2.2.5   Indemnification – Each of the PEBC Employer Groups expressly does not waive any
        applicable local, State and federal rules and laws, including Sovereign Immunity. None of
        the PEBC Employer Groups will indemnify the vendor (or its officers, directors, employees,
        agents – whether employed directly or indirectly) for its negligent performance, omission or
        act, or non-performance of its obligations under the Contract.

2.2.6   Insurance Requirements - At all times during the term of this Contract, the vendor shall
        procure, pay for and maintain, with approved insurance carriers, the minimum insurance
        requirements set forth below, and shall require all subcontractors and sub-subcontractors
        performing work for which the same liabilities may apply under this contract to do likewise.
        The PEBC reserves the right to waive or modify insurance requirements at its sole discretion.

        2.2.6.1 Workers’ Compensation: Statutory limits and employer’s liability of not less than
                $100,000 for each accident.
        2.2.6.2 Commercial General Liability:
                a.   Minimum Required Limits:
                     $1,000,000 per occurrence
                     $1,000,000 General Aggregate
                b.   Commercial General Liability policy shall include:
                     (i)      Coverage A:       Bodily injury and property damage
                     (ii)     Coverage B:       Personal and Advertising Injury liability
                     (iii)    Coverage C:       Medical Payments
                     (iv)     Products:         Completed Operations
                     (v)      Fire / Legal Liability
                c.   Policy coverage must be on an “occurrence” basis using CGL forms as
                     approved by the Texas Department of Insurance
                d.   Attachment of Endorsement CG 20 10 - additional insured
                e.   All other endorsements shall require prior approval by the PEBC.
        2.2.6.3 Comprehensive Automobile/Truck Liability: Coverage shall be provided for all owned,
                hired and non-owned vehicles. Minimum Required Limit: $500,000 combined single
                limit.
        2.2.6.4 Professional Liability:
                a.       Minimum Required Limits:
                         $1,000,000 Each Claim
                         $1,000,000 Policy Aggregate

2.2.7   Payment Grace Period - All contracts must contain a payment grace period of 45 days from
        the later of the last day of the coverage month or receipt of an invoice (if applicable).

2.2.8   Minimum Enrollment – Minimum enrollment or minimum participation requirements by any
        PEBC Employer Group is not allowed.

                         Page 5 of RFP No. 2011-001
                                 RFP FOR MENTAL HEALTH BENEFITS



             2.2.9   Fiscal Funding - Notwithstanding anything to the contrary, the obligations of the PEBC
                     Employer Groups are contingent upon the availability of appropriated funds. In the event of
                     lack of sufficient funds or if no funds are appropriated to meet its obligations under the
                     Contract, a PEBC Employer Group may terminate the Contract. To the extent it is reasonably
                     possible, the PEBC Employer Group agrees to provide 30 days advanced written notice of
                     termination. Vendor shall be entitled to compensation for services performed prior to the date
                     of termination.

     2.3     RIGHT TO AUDIT
     At any time during the term of a Contract and for a period of four (4) years thereafter, the PEBC or a duly
     authorized audit representative of the PEBC, at its expense and at reasonable times, reserves the right to audit
     the contracting vendor’s records and books relevant to all services provided under the Contract. In the event
     such an audit reveals any errors/overpayments by the PEBC, the contracting vendor will be required to refund
     the full amount of such overpayments within thirty (30) days of such audit findings to the specific PEBC
     Employer Group, or the PEBC Employer Group may, at its option, reserve the right to deduct such amounts
     from any payments due the vendor.

     2.4     HIPAA COMPLIANCE
     The PEBC acts as a covered entity under the Health Insurance Portability and Accountability Act (HIPAA) with
     regard to its self-funded plans. The responding vendor will be required to comply with all applicable provisions
     of HIPAA and any regulations, rules, and mandates pertaining to the HIPAA privacy and security rules, as
     amended, in addition to all applicable state privacy requirements. The vendor will be considered to be the
     Business Associate of each participating PEBC Employer Group; however, all communication is with the PEBC.
     As Plan Administrator, the PEBC has access to PHI and all eligibility, payment, treatment and operation
     information. The successful vendor must execute a Business Associate Agreement as required by HIPAA on
     behalf of each PEBC Group as part of the Contract. The vendor Contract must include the PEBC Business
     Associate Agreement in Appendix E of this RFP.


3.   OVERVIEW OF PEBC MEDICAL PLANS

     3.1     CURRENT PLANS AND VENDORS

     The PEBC currently offers its active and under-age-65 retirees a choice of two self-funded medical plans: an
     EPO and a PPO. Active employees must enroll in either the EPO or PPO Plan, and are allowed to Opt-Out of
     medical plan coverage only with proof of comparable coverage from another source, such as other
     employer coverage. Although PEBC employees reside in North Texas, both the EPO and PPO plans are
     national plans, available to PEBC covered members throughout the country using nationwide networks.

     Mental health/substance abuse (MH/SA) benefits for the EPO and PPO (“Managed Care”) plans and an
     Employee Assistance Program (“EAP”) are currently provided by MHN. MHN has been the carve-out
     behavioral health and EAP provider for the PEBC for over 10 years.

             3.1.1   Managed Care - During 2010, the PEBC competitively bid the self-funded medical plans, and

                                       Page 6 of RFP No. 2011-001
                   RFP FOR MENTAL HEALTH BENEFITS


        United Healthcare (UHC) was selected to administer both medical plans effective January 1,
        2011. The arrangement with UnitedHealthcare does not allow access to behavioral health
        providers in connection with behavioral health/substance abuse services. Behavioral health
        and pharmacy benefit administration were not included in the medical RFP process and
        remained in place with the prior carve-out providers. Pharmacy benefit administration is
        provided by Express Scripts. Through its affiliation with Express Scripts, Curascript
        administers specialty drugs covered by the plans. Prescription drug administration is not a
        part of this RFP. Proposing vendors must confirm their ability to coordinate with UHC,
        Express Scripts and Curascript, to exchange patient health care information connected to
        payment, treatment and operations as needed.

        Age-65-and-older retirees are not eligible for the self-funded EPO and PPO plans. The PEBC
        also manages retiree-only plans reserved for age-65-and-older retirees, and those retiree
        plans are not a part of this RFP.

        COBRA Administration is currently outsourced to PayFlex Systems USA and is managed by
        the PEBC. That relationship will continue, and COBRA administration services are not
        included as part of this RFP.

3.1.2   EAP - All active employees and their family members are eligible to use the EAP, even if they
        opt out of the medical plans. The current EAP program provides clinical support, work & life
        services, smoking cessation coaching and other online member services.

                Clinical Support: Members can access clinical support 24 hours a day, seven days a
                week, for assistance with marriage, family and relationship issues, stress and
                anxiety, depression, grief and loss, anger management, domestic violence, alcohol
                and drug dependency and other emotional health issues.

                       Up to three (3) face-to-face counseling sessions (outpatient) per member,
                        per incident, each year at no cost to the member (MHN network providers);
                        active employees and their family members first access services via the
                        capitated EAP program
                       Telephonic consultations
                       Web-video consultations

                Work & Life Services: Members can access telephonic consultations in the
                following areas.

                       Childcare and eldercare assistance - needs assessment/referrals
                       Financial services - budgeting, credit and financial guidance (investment
                        advice, loans and bill payment not included), retirement planning, and
                        assistance with tax issues
                       Legal services - one free telephonic or face-to-face consultation per incident
                        related to civil, consumer, personal and family law, financial matters,
                        business law, real estate, and estate planning; excludes disputes or actions
                        between member and member’s employer or MHN as well as medical

                        Page 7 of RFP No. 2011-001
                            RFP FOR MENTAL HEALTH BENEFITS


                                 malpractice assistance. After the initial visit, legal counsel can be retained
                                 at a 25% discount for subsequent visits.
                                Identity theft recovery services - ID theft prevention, ID theft emergency
                                 response kit, assistance from fraud resolution specialist if victimized
                                Daily living services - referrals to consultants and businesses to assist with
                                 tasks of every living (does not cover the cost or guarantee of vendor
                                 services)

                        Online Member Services: Members can access a counselor and referral (if needed),
                        self-help programs for stress, weight management, nutrition, fitness and smoking
                        cessation, and find additional information, tips, tools and calculators.

3.2     PROPOSALS REQUESTED FOR MENTAL HEALTH BENEFITS

The PEBC is requesting proposals for self-funded mental health/substance abuse benefits administration
and an integrated/capitated EAP which will allow national coverage for both. The PEBC is seeking to secure
a minimum 2-year contract effective January 1, 2012. The objective of this process is to identify the most
favorable behavioral health benefits provider for the PEBC covered membership, which includes active
employees, COBRA membership and under-age-65 retirees, as well as eligible covered dependents, which
will combine favorable access to contracted providers plus competitive fees and aggressive network
discounts for the PEBC Employer Groups. Through this RFP process, the PEBC intends to select and contract
with one (1) organization to provide behavioral health services through an integrated provider network,
MH/SA medical management and self-funded claims administration for both the EPO and PPO plans, along
with an integrated EAP for active employees. In other words, through use of an integrated national
network, a member will not be requested to change a clinician when moving from EAP to managed care
services. The PEBC reserves the right to continue its existing relationships in total or in part if a favorable
vendor is not identified.

The current PEBC plan designs can be found in the Appendices to this RFP. All proposed plan design
features or administrative requirements are assumed to be the same as plans/contracts currently in place
with existing vendors (with the acknowledgement that certain plan provisions may need to change in the
future due to health care reform or PEBC cost containment strategies). To be considered, a responding
vendor must submit a proposal using the current PEBC plan design and administrative processes, including
applicable pricing. If the vendor cannot administer certain portions of the plan design, disclosure is
required listing the specific portion(s) that cannot be administered on the Deficiencies and Deviations
Form of the RFP (Section 13), along with detailed information surrounding the vendor’s substituted
portion and related cost impact.

A critical factor in the choice of a successful vendor is that all services to be provided in the North Texas
(Dallas/Fort Worth) area must be fully integrated and fully owned by one (1) proposing organization. This
means that one organization has full ownership of all of the following components:

            3.2.1       A fully owned national MH/SA provider network, including a Texas MH/SA provider
                        network of sufficient size with particular strength in the 40 county North Texas area;
            3.2.2       MH/SA case management capabilities fully owned by the proposing organization,
                        including licensed clinicians and a licensed medical director (physician) employed by

                                 Page 8 of RFP No. 2011-001
                            RFP FOR MENTAL HEALTH BENEFITS


                        the organization;
            3.2.3       Fully owned and integrated MH/SA claims payment systems and administration
                        capabilities; AND
            3.2.4       Fully owned EAP capabilities, with Critical Incident Stress Management (CISM) services
                        readily available in the North Texas area.

To illustrate, proposals from organizations which may fully own and provide items 3.2.1 and 3.2.2, but
subcontract for item 3.2.4 (listed above) will not be considered nor evaluated, as they do not meet the
requirement of a fully integrated organization for this RFP, even if those subcontracted arrangements have
been in place for many years.
Proposing organizations may, however, subcontract for other services needed to propose on this RFP, provided
those subcontracted contractual arrangements are existing and already in place, such as additional local
resources for Critical Incident debriefing in certain locations outside of North Texas. All subcontracted
arrangements must be clearly disclosed and must be transparent to the PEBC from a contractual perspective.


3.3     STOPLOSS INSURANCE
The PEBC has contracted with one stoploss insurer to provide reinsurance for PEBC Employer Groups. Each
PEBC Employer Group has its own level of Specific Deductible and each group has individualized premium
rates. While the PEBC Employer Groups are not required to carry aggregate coverage, one of the smaller
groups does carry reinsurance in the aggregate. The PEBC Employer Groups reinsure medical, prescription drug
and mental health claims and currently pay based on a composite rate based on the number of employees
with single coverage and those with dependent coverage. All groups benefit from the efficiency of the group
purchasing arrangement and centralized PEBC plan management.
Stoploss insurance is not included as part of this RFP. However, because mental health claims are included in
the current reinsurance arrangement, vendors proposing on this RFP must agree to provide the claim
information needed to allow the PEBC to monitor claims effectively and maximize reimbursement.
In addition to monthly reports identifying all members with cumulative claims paid to date (including the
claims paid amount) which exceed $25,000, the proposing vendor must agree to make all case management,
detailed claims information, diagnosis and prognosis information and related stoploss information (including
any reserves information) available to the PEBC Executive Director on a monthly basis or upon request. The
vendor will report trigger diagnoses as required. PEBC stoploss coverage is based on 12 months of claims
incurred during the plan year, which is also the calendar year.


3.4     LOCAL MEDICAL MANAGEMENT AND UTILIZATION REVIEW

The vendor will have an employed medical director, who is a physician licensed in the appropriate state and
in good standing, with final authority on MH/SA medical necessity decisions. The vendor proposal must
demonstrate interaction between the medical director and MH/SA network providers via such
arrangements as protocol committees and utilization review groups. From time to time, the vendor will
request review through an external review process and at vendor’s sole cost, using Board certified clinicians
in the area of expertise, to supplement medical director determinations in connection with an appeal.

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                                RFP FOR MENTAL HEALTH BENEFITS


     The vendor is responsible for cost containment procedures, which will include, but not be limited to,
     preauthorization and utilization review activities. Under the current PEBC medical plan designs, all
     outpatient and inpatient MH/SA services (with the exception of the 3 visits provided through the EAP or
     emergencies) must be pre-certified in advance, before treatment is received. In the case of an emergency,
     MHN must be notified within 48 hours of the emergency or treatment.

     The vendor will have in place processes to monitor the provider network, the quality of patient care and
     participant satisfaction, reporting such results to the PEBC on a regular basis.


     3.5     COVERAGES, LIMITATIONS, AND EXCLUSIONS

     PEBC plan coverage, limitations, and exclusions must be administered in substantially the same manner as
     they are currently administered. Benefit Limitations and Exclusions are found in the Appendix section of the
     RFP.

4.   FINANCIAL REQUIREMENTS
     4.1     TERM

     Proposed services should be for a two-year term beginning on January 1, 2012 and extending through
     December 31, 2013, to be renewed at the PEBC’S option for an additional three-year period unless terminated
     as provided herein or in the Contract.

     4.2     ADMINISTRATIVE FEES
     Proposed administrative fees and capitated EAP rates must be firm for two years (2012 – 2013) and cannot
     be contingent upon minimum participation or any other factor. If a start-up administrative fee is quoted, it
     must be amortized over the three year period. The administrative fee proposed by the vendor should be
     adequate to cover the cost incurred for the performance of all services described in this RFP for the period
     prior to and during the period of the Contract, and for a 12-month runout self-funded claims payment
     period following termination of the Contract.

     The PEBC manages all eligibility for each of the PEBC Employer Groups. At approximately the 10th of each
     month and for the period ending the last week of the previous month, the PEBC will forward a snapshot
     summary census to each PEBC Employer Group in order to facilitate “self-bill” payment of the
     Administrative Fees/Rates from each Employer Group. The PEBC forwards the same document to the
     vendor, which lists the total number of employees, retirees and COBRA participants for the previous
     coverage month. This file is a summary only and does not include individual identifying information;
     however, the information can be tied to a specific date allowing the vendor to validate identifying
     information. A detailed eligibility list can be made available upon request and on a frequency not exceeding
     once each month.

     Each PEBC Employer Group must be allowed a period of at least 45 days from the end of the applicable
     coverage month in which to submit payment.




                                     Page 10 of RFP No. 2011-001
                                 RFP FOR MENTAL HEALTH BENEFITS


     4.3     BANKING ARRANGEMENTS
     Currently, the PEBC member groups fund MH/SA claims on a monthly basis. The successful vendor will
     process and pay all claims submitted under the plan in accordance with the provisions of the plan design.
     In all cases, the specific PEBC Employer Group must have the ability to view the check register (or access
     electronic payment information) in advance of release of payments to each vendor in order to perform a
     final eligibility check for the date of service indicated. The check register must include claimant identifying
     information (Excel preferred) in order to confirm eligibility. Each individual PEBC Employer Group will fund
     their respective claims.

     The vendor must perform monthly bank and claims reconciliation services and provide a copy of the
     reconciliation to the PEBC on a monthly basis. PEBC Employer Groups are not responsible for any bank
     service fees or banking costs connected with each account. Please refer to the Questionnaire for
     information regarding banking arrangements.

     4.4     TAX EXEMPTION
     The North Central Texas Council of Governments (NCTCOG) and the PEBC Employer Groups are local
     governmental entities and are exempt from all city, state, and federal sales and use taxes.


5.   OPERATIONAL REQUIREMENTS
     5.1     CENTRALIZED PRIMARY CONTACT
     The Executive Director of the PEBC (or Executive Director’s designee) serves as the primary contact for all
     external vendor/contractor contracts and relationships. Further, the Executive Director serves as the PEBC
     Privacy Officer and Security Officer. As such, the Executive Director of the PEBC (or the Executive Director’s
     designee) must be the sole contact regarding eligibility, benefits, communications, contracts, claims, billing
     and HIPAA related issues.

     5.2     USE OF PEBC DATA
     PEBC Employer Group data is the property of the applicable PEBC Employer Group. The selected vendor
     must specifically agree that the vendor shall never use any information about PEBC employees, retirees, or
     covered members, regardless of source, for any marketing purpose, advertisements or to solicit other
     business of any type. This agreement extends to information supplied to the vendor and applicable parent
     company, subsidiary, affiliate or related third-party, and includes but is not limited to, detailed membership
     census information, summary information, written and verbal communications. This prohibition also
     applies to electronic use of the information, and this prohibition applies even after termination of the
     Contract.


     5.3     MEMBER ID CARDS, EXPLANATION OF BENEFITS (EOB) FORMS, USE OF SOCIAL SECURITY NUMBERS
     Currently UHC issues medical ID cards which include the contact telephone number for MH/SA benefits. A
     separate MH/SA ID card is not allowed. The successful vendor must confirm its agreement to continue this
     process.

     The vendor must be able to use a subscriber’s Benefit-ID for both the subscriber and their covered
                                      Page 11 of RFP No. 2011-001
                           RFP FOR MENTAL HEALTH BENEFITS


dependents as well as be able to place both the subscribers’ and dependents’ Benefit-IDs on the claims
records and any electronic communication. The PEBC submits each member’s SSN to the vendor, including
those of covered dependents. The vendor must communicate both the Benefit-ID and complete SSN when
providing reports to PEBC. Vendors must be able to accept that the Benefit-ID will remain the identification
for a subscriber even though the subscriber may become a retiree or COBRA member, or move to an
alternate location. In all cases, PHI is communicated via encrypted or protected data mechanisms
consistent with the attached Business Associate Agreement.

The PEBC requires pre-approval of any EOB form and its listed data prior to its use. Unless a member agrees
to electronic access only, the EOB must be mailed at vendor’s sole expense to the participant at the address
provided by the PEBC. Members must have the ability to view and print an EOB via a secure website.

Vendors must be able to comply with all federal and Texas state legislation applicable to the protection and
use of Social Security Numbers, including the limitations placed on the use of Social Security Numbers on ID
cards, EOBs and plan documents by Section 35.58 of the Texas Business and Commerce Code,
CONFIDENTIALITY OF SOCIAL SECURITY NUMBER.


5.4     ADMINISTRATIVE REQUIREMENTS

The Vendor shall provide all services associated with the administration of the plans including, but not
limited to, the following:

        5.4.1   Customer Service

                    a. Toll-free telephone line available 24/7 and 365 days a year, with appropriate
                       staffing levels and procedures to handle emergency calls;

                    b. The Customer Service Call Center must be located within the United States. No out-
                       of-country call centers are allowed;

                    c. The vendor warrants and represents that it will provide a sufficient number of
                       Customer Service licensed triage clinicians to meet PEBC needs, and that it will
                       adequately train team members to support the PEBC’s requirements; AND

                    d. Only licensed clinicians should make referrals, basing their decision on the caller’s
                       identified needs and a brief assessment.


        5.4.2   Self-Funded MH/SA Claims Processing and Handling of Appeals/Grievances

                    a. Vendor will process all required PEBC MH/SA claims incurred in connection with
                       services rendered on or after January 1, 2012 and throughout the term of the
                       Contract.

                    b. Vendor will review claims for eligibility based on covered dates of services and in
                       accordance with the eligibility information provided by the PEBC. Any ineligible
                                Page 12 of RFP No. 2011-001
        RFP FOR MENTAL HEALTH BENEFITS


     claims inadvertently paid by the vendor shall be recaptured and returned to the
     PEBC Employer Group in the form of a check made payable to the Group,
     accompanied by a report (Excel preferred) showing the original claim number,
     amount, date of service, and applicable member, and amount recovered, with a
     copy to the PEBC. Return of funds to the PEBC Employer Group via a credit against
     administrative fees (present or future) is not allowed.

c. In the event the vendor issues excess payments or payments for ineligible claims or
   participants, the vendor will take all steps necessary to recover the overpayment,
   including recoupment (offset) from the participants’ or providers’ subsequent claim
   payments. The vendor is required to assume 100% liability for incorrect payments
   which result from errors attributable to the vendor in whole or in part. The vendor
   is required to provide the PEBC with detailed reports on a monthly basis that
   itemize the amounts of each overpayment, the reason for the overpayment, a
   listing of payees with outstanding overpayment recoveries due, an account of prior
   balances of recoveries due, the current month overpayments, recoveries, new
   balances and percentage of overpayment dollars recovered, and an aging of
   receivables report for 30, 60, 90 and 91+ days provided in Excel format or another
   mutually agreeable format.

d. Vendor shall use automated systems to detect fraud and misuse of the plan,
   overpayments, wrongful or incorrect payments, unusual or extraordinary charges,
   and unnecessary treatment. The vendor will also conduct thorough, diligent and
   timely investigations with regard to fraudulent and suspicious claims and report
   monthly all such suspicious claims to the PEBC. Vendor will provide a toll free
   number and, if possible, an internet link for participant reporting of fraud and
   abuse.

e. The vendor will maintain a complete and accurate claims reporting system and
   provide for the retention, maintenance and storage of all payment records with
   provisions for appropriate reporting to the PEBC. The vendor will maintain all such
   records throughout the term of the Contract and for at least three (3) years
   following the end of the Contract, and shall make such records accessible and
   available to the PEBC for inspection and audit upon PEBC request. The vendor will
   provide claims payment electronic records in Excel format (or other mutually
   agreeable format) to the PEBC upon request. In the event the vendor is scheduled
   to destroy payment records, the vendor must contact the PEBC for approval prior to
   the destruction of the payment records.

f.   The vendor agrees to provide the PEBC claims information for Early Retirees and
     enrolled family members consistent with the requirements of the Early Retiree
     Reinsurance Program (ERRP) upon request and at no additional charge. Because
     MH/SA is a carve-out service, the claims for the entire Early Retiree population
     must be provided, regardless of any threshold requirement. Claims data will be
     provided in the HHS ERRP layout.

     On a monthly basis, the vendor must provide the PEBC with a financial accounting
            Page 13 of RFP No. 2011-001
                                 RFP FOR MENTAL HEALTH BENEFITS


                              of the PEBC claims paid (Excel), by each PEBC Employer Group, by Plan, and in total.
                               The vendor will also provide the PEBC with other experience data, utilization data,
                              and accounting information as the PEBC shall reasonably request and as listed in
                              the Contract.

             5.4.3   Subrogation

             The PEBC manages subrogated claims in accordance with the plan’s Third Party
             Payments/Subrogation Language and Right of Recovery, which is included in the Appendix of this
             RFP. The vendor must assume a role in this process; however, the vendor is expressly prohibited
             from settling any claim or reducing/waiving any Notice of Lien. Vendor will dedicate a position to
             coordinate PEBC subrogation activities and communicate with the PEBC Executive Director on a
             regular basis. The Vendor will perform services including, but not limited to, those services listed
             below, on a regular and continued basis, regularly advising the PEBC of the status of each case.
             Vendor is responsible for costs associated with subrogation activities listed below, and such costs
             should be included in the proposed administrative fees. Contingency arrangements are not
             allowed.

                 a. Identify claims that could result in a recovery as a result of a participant’s injury for which
                    benefits under the plan shall be or have been provided.
                 b. Using PEBC approved correspondence and forms, request accident reports and subrogation
                    information from the insured/patient.
                 c. Obtain police reports and insurance benefits from third parties.
                 d. Using PEBC approved notification documents, notify all involved parties of the PEBC
                    Employer Group’s Notice of Lien, updating the information on a regular basis.
                 e. Track specific claims information connected with each specific case.
                 f. Perform regular updates and follow-up as to the status of any recovery.
                 g. Communicate information to and from third party legal counsel as appropriate.
                 h. Provide documented call notes and file copies of each opened subrogation case to the
                    PEBC.
                 i. Provide additional information upon request of the PEBC Executive Director.

             5.4.4   Other Services

             The vendor must provide the PEBC Executive Director with a senior level management contact who
             can intervene with eligibility and/or claims issues upon request and in an expedient manner,
             supplying her with specific information as requested, and a high-level management contact who can
             receive verbal or individual electronic updates (adds or terms) from the PEBC pending receipt of the
             weekly data file.

6.   ELIGIBILITY, ENROLLMENT AND DATA
     The PEBC eligibility process identifies those eligible for benefits, and transmitted data records reflect correct
     eligibility information. The responding vendor’s ability to accommodate PEBC data and eligibility
     transmission is an important consideration in this selection process. The PEBC manages all data
     transmission on behalf of each of its Employer Groups. The data transmission method in place today is to
     push data to the vendor via the use of FTP over the Internet in a fixed-length, ASCII text file. The PEBC is

                                      Page 14 of RFP No. 2011-001
                                 RFP FOR MENTAL HEALTH BENEFITS


     encrypted using Pretty Good Privacy (PGP) public key encryption. The PEBC is in the process of updating its
     systems so that eligibility data can be transmitted using Secure FTP (SFTP). The PEBC sends all group data
     via one data file with appropriate indicators to identify each group and data element.

      Annual enrollment occurs in November each year, and a “baseline” full file is forwarded by mid-December
     each year for coverage beginning January 1. Thereafter, changes only to the baseline file are forwarded on
     a weekly basis for the remainder of the year with the expectation that vendor data files are updated within
     24 business hours of receipt. The selected vendor must accommodate PEBC initiated emergency updates as
     needed. The PEBC conducts a full-file audit compare process approximately three times each year to ensure
     vendor and PEBC records are in synch.

     Because the PEBC performs multiple tests on data prior to forwarding to each vendor, the PEBC is the only
     source of data update. Vendors are not to accept updates directly from a PEBC Employer Group or
     members. Employees must be referred to their respective Human Resources Department to update
     addresses and other information. By doing so, source data always initiates via the PEBC data file.

     Each PEBC Employer Group owns its data. Vendors are not entitled to disclose or otherwise use any PEBC
     Employer Group data for any purpose whatsoever except for responding to an RFP in which case all data will
     be de-identified, or otherwise administering a plan benefit on behalf of a PEBC Employer Group.

     The vendor will provide the PEBC with priority positioning for delivery of ad hoc system service requests
     and/or issue resolutions. The vendor shall designate a Technical Consultant to lead the management of all
     technical issues including, but not limited to PEBC service requests and items requested by the PEBC
     Executive Director. The vendor shall use its best effort to implement all PEBC information requests and
     correct all information issues as required by the PEBC. The vendor will further provide and distribute, at
     vendor’s expense, certain reports that are required to administer a self-funded plan including, but not
     limited to, IRS Form 1099.

     The PEBC does utilize retroactive eligibility as it pertains to ineligible member claims. The PEBC does not
     adjust administrative fees for the period of ineligibility, recognizing the monthly census snapshot is a picture
     reflecting eligibility at the time fees are owed.

7.   COMMUNICATIONS REQUIREMENTS
     The PEBC Executive Director centrally controls and reviews all communication materials distributed to plan
     participants. The selected vendor is expressly prohibited from distributing any collateral or communication
     item (including correspondence) unless the item has been pre-approved by the PEBC.

     Communication materials include, but are not limited to, hard-copy and electronic versions of:

            Participant brochures, booklets and newsletters
            Scripted responses to participants and PEBC Employer Groups
            Claim forms
            Explanation of benefits (EOB) forms
            Provider directory
            Participant welcome packets or materials
            Any form or collateral item used in conjunction with a PEBC Employer Group
                                      Page 15 of RFP No. 2011-001
                                 RFP FOR MENTAL HEALTH BENEFITS



     In preparation for annual enrollment each year, the vendor must supply the PEBC with electronic versions of
     PEBC approved plan information, including a link to provider search, no later than September 30th prior to the
     start of any plan year. The PEBC will order communication materials on behalf of each PEBC employer group.
     Additional collateral items (flyers, etc.) approved by the PEBC may be provided at vendor’s expense.

     The PEBC does not currently hold employee meetings during annual enrollment. However, a representative
     from the selected vendor may participate in 3-4 retiree meetings each year, as a resource only, not as a speaker.

8.   PERFORMANCE REQUIREMENTS AND PENALTIES
     Performance guarantees are required of the successful vendor. The PEBC will conduct quarterly and annual
     performance reviews of the vendor for medical benefits administration services provided with any performance
     penalties paid annually. The performance review will consist of a review and reconciliation of the performance
     standards achieved based on various tracking reports and surveys. Such guarantees apply to each PEBC
     Employer Group separately.

     Any penalties due for missed performance guarantees will be calculated and billed to the vendor and paid by
     the vendor annually.


9.   TIMETABLE
     The following table summarizes the timeframe required by the PEBC in responding to this RFP:


     Task                                                       Timing                      Responsibility
                                                       All times shown are CT
     RFP released to qualified contractors (Via       May 11, 2011 (Wed)                   PEBC
     Electronic Email Release only)
     Pre-Proposal Contractor’s Conference             May 26, 2011 (Thu)                   PEBC
                                                      2:00 P.M. – 3:30 P.M.
                                                      Attendance Optional
     Proposing contractor questions related           June 1, 2011 (Wed)                   Contractors
     to RFP due to the PEBC
                                                      By 5:00 P.M.
     Responses to questions released to               June 3, 2011 (Fri)                   PEBC
     proposing contractors
     Proposals due                                    June 10, 2011 (Fri)                  Contractors
                                                      By 3:00 P.M.
     Proposal opening                                 June 10, 2011 (Fri)                  PEBC
                                                      By 3:15 P.M.


                                      Page 16 of RFP No. 2011-001
                                  RFP FOR MENTAL HEALTH BENEFITS



      Task                                                       Timing                      Responsibility
                                                         All times shown are CT
      On-site visits and/or finalist                   June 29, 2011 – July 15, 2011         Contractors/PEBC
      presentations (at discretion of PEBC)

      Award notification date                         Target date July 29, 2011              PEBC
      Implementation Start Date                       Target date July 29, 2011              Contractor/PEBC
      Effective Date                                  January 1, 2012                        Contractor/PEBC


10.   PROPOSAL EVALUATION CRITERIA

      10.1    OPENING OF PROPOSALS
      A public opening of the proposals will be held on Friday, June 10, 2011, at 3:15 P.M. CT at the North Central
      Texas Council of Governments, Centerpoint Two, 616 Six Flags Drive, Arlington, TX 76011. Only the names of
      the respondents will be read aloud. No other information concerning the proposal will be provided.
      Proposals shall be opened so as to avoid disclosure of contents to competing vendors and kept confidential
      during the process of negotiation. However, all proposals that have been submitted shall be open for public
      inspection after the contract is awarded. After proposals are opened, the proposals will be evaluated using
      the process and scoring criteria shown in this RFP.


      10.2    EVALUATION PROCESS
      Proposals will be evaluated by the PEBC with the assistance of its consultants, Towers Watson, and the PEBC will
      retain responsibility for the final selection of the contractor. Vendors should not contact Towers Watson in
      connection with this RFP, but should follow the instructions included in the RFP. Each contractor will be
      reviewed in the context of the PEBC’s philosophy and objectives. The PEBC reserves the right to reject any and
      all proposals for any reason at its sole discretion.

      An on-site visit and/or finalist presentation may be requested by the PEBC as part of its evaluation. The purpose
      of these meetings, if requested, is to substantiate proposal representations, increase the PEBC’s understanding
      of the services and operations of the proposing organization, and meet the individuals who will have a
      significant role in servicing the PEBC. However, the PEBC reserves the right to make a selection decision based
      on proposal responses alone, without on-site visits or additional presentations.

      Consulting firm Towers Watson currently provides actuarial assistance to the PEBC and may assist with the
      financial analysis of proposals received.

      The PEBC Board of Governors must approve selection of a vendor. Once the PEBC has identified the successful
      contractor, all responders will be notified in writing via email.

      10.3    SCORING CRITERIA
      The criteria used in selecting a contractor will be as outlined in the chart below. Note that the scoring criteria
                                       Page 17 of RFP No. 2011-001
                            RFP FOR MENTAL HEALTH BENEFITS


below correspond to the questions in the Questionnaire section of this RFP.

                                     Criteria                                         Maximum Points

  A.      MH/SA provider network composition and access; MH/SA medical
                                                                                          30 points
          and case management capabilities and experience; EAP benefits

  B.      References                                                                      10 points


  C.      Cost, including administrative fees, EAP rates, provider network
                                                                                          30 points
          discounts, and performance guarantees

  D.      Ability to administer benefits in accordance with PEBC contractual
          requirements, data requirements and administrative requirements;
          experience with administration of self-funded group medical
          benefits to employers with more than 10,000 employees; EAP
                                                                                          30 points
          resources; MH/SA and EAP experience with a large public employer
          plan; organization financial stability, and ability to provide solid,
          responsive customer service to the PEBC and to member groups’
          covered employees, retirees and their dependents.

  TOTAL POINTS                                                                           100 points


Please note: There is an additional Section in the Questionnaire, Section E, which contains questions
regarding current practices for benefit plan coverage and management of autism cases and related services,
including applied behavioral therapy (ABA). The questions in Section E do not count towards the scoring of
the RFP. These questions are designed to gather current information on what major MH/SA managed care
organizations and their self-funded, non-federal governmental employer clients (who are not subject to
ERISA) are doing with regard to managing these cases, and to examine the specific plan design in connection
with that coverage. Please disclose if the client elects to exempt its plan from the requirements of Title
XXVII of the PHS Act including parity in the application of certain limits to mental health benefits. If you do
not have any self-funded, non-federal governmental clients, please disclose and do not respond to Section
E. If you do have clients in this category, we appreciate your response. You should not assume or conclude
that the PEBC groups will cover additional services in connection with questions asked in Section E. This is
an information gathering section only and will not be scored. Responses received in Section E are subject to
the same open records requirements shown in Section 11.8 of this RFP.


10.4    ALTERNATIVE BENEFIT DESIGNS/FINANCIAL ARRANGEMENTS
Alternative benefit design or financial arrangements, other than as requested herein, will not be
considered unless fully disclosed on the Deficiencies and Deviations Form (Section 13) as described in this
RFP. However, the PEBC reserves the right to revise the benefits and/or financial arrangements should that
become necessary due to legislative, budgetary, or other factors. The purpose of this RFP and the
subsequent review process is to select the vendor that the PEBC considers to be most qualified to provide

                                Page 18 of RFP No. 2011-001
                            RFP FOR MENTAL HEALTH BENEFITS


the most effective, efficient and high-quality services, supplies and products to the PEBC Employer Groups
and covered plan participants. The PEBC views the relationship with the vendor as a cooperative one, and
nothing contained in this RFP, nor any action taken in the review and approval process, shall prevent the
PEBC from continuing negotiations with the selected vendor after the selection is made or to consider
quantified innovative design factors. The vendor must agree to act in good faith in connection with all such
negotiations and in performing all of its services, duties, and provisions of coverage related to this RFP.


10.5    RESERVED RIGHTS
The PEBC retains the right to reject any and/or all proposals submitted and/or call for new proposals. The
PEBC is not required to select the proposal with the lowest administrative fee, but shall take into
consideration other factors as described herein. The PEBC reserves the right to enter into discussions and
negotiations with one or more vendors selected at its discretion to determine the best and final terms. The
PEBC is not under obligation to hold these discussions or negotiations with each responding vendor that
submits a proposal. The PEBC is under no legal obligation to execute a Contract on the basis of this RFP or
upon receipt of a proposal. The PEBC reserves the right to reject any and all proposals received. The PEBC
specifically reserves the right to revise any or all RFP or Contract provisions set forth at any time prior to the
execution of a Contract where the PEBC deems it to be in the best interests of the PEBC Plans and its
participants. The PEBC reserves the right to audit/validate all materials and responses submitted with the
vendor’s proposal.


10.6    REJECTION/DISQUALIFICATION OF PROPOSALS
Proposals will be considered irregular if they show any omissions, alterations of form, additions or
conditions not called for, unauthorized alternate proposals, or irregularities of any kind. The PEBC reserves
the right to waive any irregularities and to make the award in the best interest of the PEBC.
Proposals may be rejected, among other reasons, for any of the following reasons:
   a.   proposals received after the time set for receiving proposals as reflected on the cover page
   b.   proposal containing any irregularities
   c.   unbalanced value of any items
   d.   improper or insufficient guaranty
   e.   where the contractor, any subcontractor or supplier, or the surety on any bond given, or to be
        given, is in litigation with the PEBC or with Dallas County, Tarrant County, Denton County, the North
        Texas Tollway Authority (NTTA) or Parker County, or where such litigation is contemplated or
        imminent.

Contractors may be disqualified and their proposals not considered, among other reasons, for any of the
following specific reasons:
   a.   belief that collusion exists among the contractors;
   b.   where the contractor, any subcontractor or supplier, or the surety on any bond given, or to be
        given, is in litigation with the PEBC or with Dallas County, Tarrant County, Denton County, the NTTA,
        or Parker County, or where such litigation is contemplated or imminent, in the sole opinion of the
        PEBC;
   c.   the contractor being in arrears on any existing contract or having defaulted on a previous contract;
   d.   lack of competency as revealed by pertinent factors, including, but not limited to, experience, a
                                  Page 19 of RFP No. 2011-001
                                  RFP FOR MENTAL HEALTH BENEFITS


              financial statement and questionnaires;
         e.   insufficient resources, which in the judgment of the PEBC will prevent or hinder the prompt
              providing of additional services if awarded.

      10.7    NEWS RELEASES
      Advance written approval by the PEBC Executive Director is required prior to any issuance of any news
      releases or other public communication regarding a contract awarded to a responding vendor.


      10.8    PROCUREMENT DISPUTE RESOLUTION PROCESS
      The NCTCOG is the responsible authority for handling complaints or protests regarding the proposal
      selection process. This includes, but is not limited to, disputes, claims, protests of award, source evaluation
      or other matters of a contractual nature. Matters concerning violation of law shall be referred to such
      authority as may have proper jurisdiction.
      Once the PEBC has agreed upon selection(s), all contractors will be notified in writing of the results. Any protest
      regarding this process must be filed in accordance with the following procedure:

              The NCTCOG would like to have the opportunity to resolve any dispute prior to the filing of an
              official complaint by the protester. The protester should contact the NCTCOG’s Deputy Executive
              Director of Administration at (817) 695-9121, P.O. Box 5888, Arlington, Texas 76005-5888, so that
              arrangements can be made for a conference between the NCTCOG and the protester. Copies of the
              appeal process will be made available to the protester.

11.   PROPOSAL FORMAT

      11.1    QUESTIONS REGARDING THIS RFP
      Interested contractors will have the opportunity to ask questions to clarify information found in this RFP
      through attendance at the Pre-Proposal Contractor’s Conference:

              Date:            Thursday, May 26, 2011
              Time:            2:00 P.M. – 3:30 P.M. CT
              Location:        Metroplex Conference Room
                               North Central Texas Council of Governments
                               CENTERPOINT TWO
                               616 Six Flags Drive
                               Arlington, TX 76006-5888

      Attendance at the Pre-Proposal Contractor’s Conference is optional.

      Following the Contractor’s Conference, questions must be submitted in written form via e-mail, fax, or hard
      copy and received by the PEBC no later than 5:00 P.M. CT, Wednesday, June 1, 2011 to:

              Diana Kongevick, Executive Director
              PEBC

                                        Page 20 of RFP No. 2011-001
                           RFP FOR MENTAL HEALTH BENEFITS


        P.O. Box 5888
        Arlington, TX 76006-5888
        E-mail: dkongevick@pebcinfo.com
        Fax: (817) 695-9104

Questions received by the due date and time shown above will be answered and responses will be sent to
all interested contractors.

Interested contractors should NOT contact any of the Employer Groups of the PEBC directly regarding this
RFP. Direct contact with PEBC Employer Groups may cause disqualification from this process.

Except for the Pre-Proposal Contractor’s Conference, no oral explanation in regard to the meaning of the
proposal specifications will be made, and no oral instructions will be given before the award of the contract.

11.2    PROPOSAL CONTENT
Your proposal should consist of only the answers to the questions in Section 12, Questionnaire, and
Section 13, Signatures, including completion of the required forms and exhibits exactly as shown on the
enclosed Proposal Response Spreadsheet. Please do not include extraneous marketing or other materials.
Proposals must be valid for a minimum period of 180 days.


11.3    PROPOSAL FORMAT
Proposals must be submitted with clear indications as to the name of the submitting company and contact
person. All proposals must be received in a sealed envelope, clearly marked “PEBC Mental Health Benefits -
to be opened 3:15 P.M. CT, June 10, 2011.”

All proposal response forms and questionnaires must be fully completed and included in your response.
Detailed pricing exhibits and administration specifications have been provided in the enclosed Proposal
Response Spreadsheet, and any deviations or exceptions must be referenced in the designated response
sheets.

Vendors should submit three (3) signed hard copy originals of the proposal and an electronic version on CD
(with your responses to the Questionnaire in the acceptable electronic formats described below, including
the Proposal Response Spreadsheet, GeoAccess reports, provider network information, and other exhibits
as requested in this RFP). Acceptable electronic formats are Office 2007 Word and Excel (or lower versions)
and GeoAccess.
Proposals should be delivered to:
        PEBC
        c/o Diana Kongevick, Executive Director
        Centerpoint Two Building
        616 Six Flags Drive
        Arlington, TX 76011


                                Page 21 of RFP No. 2011-001
                            RFP FOR MENTAL HEALTH BENEFITS


Faxed or e-mailed responses are not acceptable and will not constitute delivery of your proposal.

It is the responsibility of the contractor to ensure all proposals are received no later than 3:00 P.M. CT on
June 10, 2011. All proposals become the property of the PEBC and will not be returned to the
contractor, except that any proposal received after the date and/or hour set for proposal submission will
be returned to the vendor, unopened. Respondents using U.S. mail or delivery services should take
precautions to ensure that their proposal is received by the due date and time.
The PEBC and its member groups assume no responsibility for delays caused by any mail or delivery service
or any other factor contributing to a contractor’s delay in delivery of these proposals. The PEBC is located in
close proximity to the Texas Rangers Ballpark and Cowboys Stadium in Arlington. Deadline dates may be on
scheduled game/event days. Respondents are encouraged to take precautions to avoid delays in delivery of
these proposals.
Alterations may be made before the official opening time provided such alterations are provided in writing
and signed by the proposing company certifying authenticity. Proposals may be withdrawn at any time
prior to the official opening with written notice.
Proposals may not be withdrawn after proposals have been opened, and the contractor, in submitting the
same, warrants and guarantees that its proposal has been carefully reviewed and checked and that it is in
all things true and accurate and free of mistakes, and that such proposal will not and cannot be withdrawn
because of any mistake committed by the contractor.


11.4    ORDERING OF PROPOSAL RESPONSES
The content of all responses submitted must be ordered to correspond with the specifications as they
appear in the RFP. Unless a deviation is specifically noted in the response, it will be assumed that the
responding vendor agrees to meet all specifications exactly as set forth in this RFP.
This proposal may not be divided into sections or bid by multiple contractors. This does not prohibit sub-
contracting as described herein. One proposal, inclusive of all provider network, MH/SA case management,
EAP, and claims administration services, and subject to the requirements of this RFP, must be submitted.
Financial proposals must be itemized by service as requested in the Questionnaire. Failure to itemize the
proposal using the provided exhibits may result in disqualification of the proposal.


11.5    NON-RESPONSIVE CRITERIA
The PEBC will not accept for consideration any proposals that do not comply with the criteria set forth
herein. Failure to address any of the RFP requirements may result in rejection of a proposal.


11.6    VENDOR REQUIREMENTS
To be considered for selection, responding vendors must be licensed in good standing from the Texas
Department of Insurance as an insurance company or third party administrator to provide MH/SA benefits
services in the State of Texas at all times throughout the RFP process. The PEBC will consider all applicable
factors in determining which proposal best serves its interests.


                                 Page 22 of RFP No. 2011-001
                            RFP FOR MENTAL HEALTH BENEFITS




11.7    AGENT OF RECORD / COMMISSIONS
The PEBC and its Groups shall not designate an Agent of Record or any other such company, employee or
commissioned representative to act on behalf of the PEBC, the Vendor or the PEBC Employer Groups. All
requests to provide such designation will be rejected. Vendors are specifically instructed to submit proposals
directly to the PEBC. Proposals submitted through a third party agent will not be accepted.
All proposals must be submitted without any commissions payable to any agent or agency, broker or brokerage.
Further, each proposing contractor must fully disclose payments to any individual(s) or company (ies) other than
compensation paid to active regular direct employees of the contractor earned in the course of carrying out
their regular duties in providing contracted services to the PEBC.


11.8    CONFIDENTIAL STATUS – DISCLOSURE OF PROPOSAL CONTENTS
Unless required to release such information by applicable law or court order, proposals submitted by
organizations will be deemed confidential until any announcement regarding the selection or rejection of a
proposal has been made. However, once a proposal has been received, it becomes subject to release in
accordance with the provisions of Chapter 552 of the Texas Government Code (The Public Information Act, “the
Act”). In order to permit the responding vendor to protect confidential information submitted by the vendor in
support of a proposal, the responding vendor must conspicuously label any information it believes to be
exempt from disclosure under the Act as “Confidential Proprietary Information.” The responding vendor
acknowledges and agrees that the PEBC and its Employer Groups shall have no liability to the responding vendor
or any other person or entity for disclosure of information in accordance with the Act. It is the responding
vendor’s sole obligation to advocate the confidential or proprietary nature of any information it provides in its
proposal. Responding vendors should understand and be aware that the Texas Attorney General may determine
that all or part of the claimed confidential or proprietary information should be disclosed. The PEBC shall not
advocate the confidentiality of the responding vendor’s material to the Texas Attorney General or to any other
person or entity. For the purpose of asking the Attorney General to determine whether an exception to
disclosure exists for information a vendor deems to be proprietary, PEBC will submit to the Attorney General
only that information the vendor has specifically labeled "Confidential Proprietary Information."

11.9    VENDOR EXPENSES

The PEBC and the NCTCOG will not be liable under any circumstances for any expenses incurred by any
service provider in connection with preparation of a proposal or for any part of the RFP process. All
proposals become the property of the PEBC and will not be returned to the service provider.

The only purpose of this RFP is to ensure uniform information in the selection of proposals and
procurement of services. This RFP is not to be construed as a purchase agreement or contract, or as a
commitment of any kind, nor does it commit the NCTCOG or the PEBC to pay for costs incurred prior to the
execution of a formal contract unless such costs are specifically authorized in writing by the PEBC.

                                              * * * * *



                                 Page 23 of RFP No. 2011-001
                                  RFP FOR MENTAL HEALTH BENEFITS


12.   QUESTIONNAIRE

      Be certain that all questions are answered completely and accurately. Include the question in your response.
      If the service you can provide involves subcontracting to or working through any other organizations, you
      must disclose all contractual relationships. If you are uncertain about this requirement, please err on the
      side of disclosing all information.
      In responding to the following questions, please provide only information relative to this project. If your
      information reflects information other than what is requested, your proposal may be removed from
      consideration, since the PEBC will not be able to make a fair comparison of potential service contractors.


      A.      MH/SA PROVIDER NETWORK AND MH/SA MEDICAL MANAGEMENT (30 points)
      Proposals must indicate that the responding vendor can provide all required services in the proposed provider
      network areas for PEBC employer group employees, retirees, and their covered dependents.

      1. Provide the following information to demonstrate your experience with MH/SA provider networks in North
         Texas:

            a. Year the MH/SA network was established in North Texas and length of time network has been in
               place.

            b. Name(s) and brief description of the network(s) you are proposing for the PEBC (MH/SA and EAP).

            c. Confirmation that your organization fully owns and controls these provider network(s).

            d. Total MH/SA covered members (insured or self-funded) for the North Texas network(s) proposed on
               January 1, 2011.

            Response:



       2.   For North Texas, are your contracts primarily with large groups and/or facilities or with individual
            providers? Please disclose the percentage of North Texas contracts with individual providers and with
            groups/facilities.

            Response:



       3.   Although all PEBC employees are located in the North Texas area, the covered population includes
            retirees and dependents that may reside throughout the country. Please:

            a. Confirm you can provide all required services in the proposed provider network areas for PEBC
               employer group employees, retired employees, and their covered dependents listed on the census
               provided.


                                      Page 24 of RFP No. 2011-001
                           RFP FOR MENTAL HEALTH BENEFITS


     b. Describe your network arrangements for national coverage (e.g., if you lease networks in other areas
        of the country, for how long has the arrangement been in place, etc.)

     Response:



4.   What do you require for a provider to become "credentialed" in your network? When is the process first
     completed and when is it re-verified? Be sure to include any professional liability requirements.

     Response:



5.   How do your contracts and provider search processes address providers who are not accepting new
     patients?

     Response:



6.   Provide the turnover rate for your MH/SA network providers in the North Texas area over the last two
     years (2009 and 2010).

     Response:



7.   What contractual provisions apply to a provider who decides to leave your network or change groups?
     Please address lead times, patient notification, and continuation of care for patients.

     Response:



8.   Do you have any reason to believe there will be upcoming changes to your MH/SA provider network in
     North Texas due to terminations by high volume providers or groups, or providers, including hospitals,
     challenging your pricing in certain locations or specialties? If not, please disclose if you have had material
     terminations as described in the past three years, providing the specific provider type and year of
     termination.

     Response:



9.   Is any MH/SA provider compensation related to utilization levels? If so, explain the methodology.

     Response:

                                 Page 25 of RFP No. 2011-001
                          RFP FOR MENTAL HEALTH BENEFITS




10. Is your organization NCQA accredited or certified? If so, provide proof of such certification.

     Response:



11. Using the Excel spreadsheet included with this RFP, complete the two tabs marked 11A and 11B (Facility
    and Provider Match), indicating whether each physician or MH/SA provider shown is currently under
    contract in your network for the given specialty. These lists contain information pertaining to providers
    currently utilized by PEBC membership based on PEBC claims data. Note that these lists include both in-
    network and out-of-network providers utilized; they are not intended to replicate the current provider
    networks. The file returned with your proposal must be in Excel format and follow the included format to
    allow for comparison of proposals. No other format will be accepted. All required data fields must be
    filled in or your proposal will be considered incomplete.

     (Respond on Excel spreadsheet)



12. Based on the census information contained in Appendix C, please provide a MH/SA network provider
    GEOAccess report for the North Texas area based on the specifications below, addressing both
    professional providers and behavioral health facilities. In the table below, provide a summary of the
    match for the PEBC, giving the percentage of employees whose access meets the specifications provided.

     When running GEOAccess reports, distance to providers should be measured by driving distance. Rivers,
     lakes, etc. should be taken into consideration when determining distance. Also, the GEOAccess
     methodology should exclude closed practices (those not accepting new patients or no longer in business.)

     (Respond with hard copy GEOAccess reports plus an electronic version on CD, plus completion of the
     exhibit below)



             Specification – Professional Providers            MD        Ph.D.    Masters       RN

      Urban: 2 professional providers within 10 miles

      Suburban: 2 professional providers within 20 miles

      Rural: 1 professional provider within 30 miles


                         Specification – Facilities                       Behavioral Health Facility

      Urban: 1 behavioral health facility within 20 miles


                               Page 26 of RFP No. 2011-001
                            RFP FOR MENTAL HEALTH BENEFITS



     Suburban: 1 behavioral health facility within 30 miles

     Rural: 1 behavioral health facility within 40 miles


    Your proposal response should include hard-copy reports as part of your hard-copy proposals as well as
    an electronic version of the GEOAccess reports on CD.


13. Provider Count – North Texas

    To demonstrate that your network contains a sufficient number of providers to service participants,
    please complete the chart shown below and on the enclosed spreadsheet, Question 13 (Provider Count),
    providing counts for each of the following specialties in the North Texas area. Include only those
    providers with signed contracts in place at the time of proposal submission. Please also provide three (3)
    hard-copies of your most recent regional provider directory which includes the North Texas service area.

    For purposes of this question, please define the North Texas area as follows: Counties of Collin, Dallas,
    Denton, Ellis, Erath, Hood, Hunt, Johnson, Kaufman, Palo Pinto, Parker, Rockwall, Somervell, Tarrant,
    Wise in the Total Column. In addition, please disclose the specific provider count for the Counties of
    Collin, Dallas, Denton, Parker and Denton, the sum of which is included in the Total Column.

    You may count multiple offices or addresses for an individual provider separately in your response to
    this question.

    (Respond on Excel spreadsheet plus hard copy directories)



                Specialty          TOTAL –       Collin    Dallas   Denton    Parker     Tarrant
                                     15         County     County   County    County     County
                                   Counties

     Behavioral Health Facility

     Psychiatrists - MDs

     Psychologists - PhDs

     Masters Level Clinicians



14. Will you commit to recruiting other key providers who are critical to the current PEBC covered
    membership, if they are not already part of your network? What timetable and guarantees can you
    provide?

    Response:

                                Page 27 of RFP No. 2011-001
                           RFP FOR MENTAL HEALTH BENEFITS


15. What processes do you have in place to improve provider compliance with evidence-based medicine?

     Response:



16. Identify the Medical Director who will be involved with the PEBC, including his/her working location, the
    length of time he/she has been employed by your organization, and his/her Board Certification specialty.

     Response:



17. The current PEBC plan design requires pre-authorization of any and all MH/SA services other than the first
    3 EAP visits. To access the EAP, the member must contact MHN. Give a brief overview of your standard
    pre-authorization processes. Can you support the current PEBC model?

     Response:



18. Describe your care management approach for all levels of care for mental health and substance abuse
    treatment. Please be specific in terms of initial admission and concurrent review along with requests for
    outpatient services.

     Response:



19. Describe your ability to coordinate and deliver on-site crisis services and Critical Incident Stress
    Management (CISM) services and debriefing at the request of the PEBC, including:

     a. Do you provide these services directly, or do you use subcontractors?

     b. Can you provide CISM services within a 24- to 72- hour turnaround?

     c. What are your response times for telephonic versus on-site CISM?

     d. Briefly describe how your firm defines “on-site crisis services and Critical Incident Stress Management
        services” including any minimum attendance requirements.

     Response:


B.   REFERENCES (10 points)

20. Provide three current client references, similar in size and complexity to the PEBC, for self-funded MH/SA

                               Page 28 of RFP No. 2011-001
                     RFP FOR MENTAL HEALTH BENEFITS


benefits administration services. At least one reference must be from a public sector client (e.g., city,
county, university, etc.) preferably in Texas. Complete the reference information for each of the three
references you provide. By responding to this request, the vendor (1) authorizes the PEBC to contact
the employers to discuss the services the vendor has provided for these employers; (2) authorizes the
employers to provide such information to the PEBC; and (3) agrees to release the PEBC and its Employer
Groups from any liability from the employer’s actions.

a. Reference 1: Public Sector Client

      Customer name and address:
       Response:


      Contact person’s name, title, e-mail address and telephone number:
       Response:


      Services provided and years performed:
       Response:


      Number of covered employees / covered members:
       Response:


b. Reference 2:

      Customer name and address:
       Response:


      Contact person’s name, title, e-mail address and telephone number:
       Response:


      Services provided and years performed:
       Response:


      Number of covered employees / covered members:
       Response:



c. Reference 3:

      Customer name and address:
                          Page 29 of RFP No. 2011-001
                           RFP FOR MENTAL HEALTH BENEFITS


            Response:


           Contact person’s name, title, e-mail address and telephone number:
            Response:


           Services provided and years performed:
            Response:


           Number of covered employees / covered members:
            Response:


21. Provide one client reference for an organization, either similar in size or complexity to the PEBC, who has
    terminated similar services (self-funded MH/SA benefits administration) within the last 18 months. Please
    provide, if possible, a client that terminated services following a competitive bid or request for proposal
    process, and not due to merger/acquisition. By responding to this request, the vendor (1) authorizes the
    PEBC to contact the employer to discuss the services the vendor has provided; (2) authorizes the
    employer to provide such information to the PEBC; and (3) agrees to release the PEBC and its Employer
    Groups from any liability from the employer’s actions.

     a. Reference 1: Terminated Client

           Customer name and address:
            Response:


           Contact person’s name, title, e-mail address and telephone number:
            Response:


           Services provided and years performed, including termination date:
            Response:


           Number of covered employees / covered members:
            Response:



22. Provide one client reference, current or recent, for the Account Manager you plan to assign to the PEBC.
    By responding to this request, the vendor (1) authorizes the PEBC to contact the employer to discuss
    the services the vendor has provided; (2) authorizes the employer to provide such information to the
    PEBC; and (3) agrees to release the PEBC and its Employer Groups from any liability from the employer’s
    actions.
                                Page 30 of RFP No. 2011-001
                          RFP FOR MENTAL HEALTH BENEFITS


     a. Reference 1: Account Manager Reference

           Customer name and address:
            Response:


           Contact person’s name, title, e-mail address and telephone number:
            Response:


           Services provided and years performed:
            Response:


           Number of covered employees / covered members:
            Response:

C.     PRICING AND PERFORMANCE GUARANTEES (30 points)

 23. Complete the table below with your actual and projected trend rates used for your self-funded MH/SA
     customers.

     Response:



              Location                           Self-funded MH/SA

                                       2010 Actual              2011 Projected

       North Texas area

       National

 24. Complete the table below with your current average MH/SA network discount percentages from billed
     charges (billed charges are defined as provider submitted charges less ineligible charges before
     application of fee schedules and contracted reimbursement provisions) without weighting data for
     employer utilization patterns.

     Response:

                   Location                           MH/SA Network

                                              North Texas             National



                              Page 31 of RFP No. 2011-001
                         RFP FOR MENTAL HEALTH BENEFITS



                  Location                               MH/SA Network

                                             North Texas               National

      Inpatient Facility MH/SA

      Outpatient Facility MH/SA

      Professional/Physician

      TOTAL



25. CPT Code Negotiated Rates

    Using the spreadsheet included in this RFP (Question 25 CPT), please complete the chart provided below
    with your current (2011) outpatient negotiated/allowable rate for the North Texas 3-digit zip codes
    shown.

    (Respond on Excel spreadsheet; chart shown below for reference))



                  CPT Code                                   3-digit Zip Code

                                          750      751      752        760        761    762

      90806 – Psychiatrists (MDs)

      90806 – Psychologists (PhDs)

      90806 – Masters Level Clinicians

      90862 – Psychiatrists (MDs)



26. Provide your average, negotiated inpatient facility psychiatric daily reimbursement rate (excluding
    chemical dependency and detoxification) for the North Texas (Dallas/Fort Worth) area.

    Response:



27. Please outline your proposed network discount guarantees. Note that any proposed performance
    guarantees may not result in additional fees due from or payable by the client.


                                 Page 32 of RFP No. 2011-001
                           RFP FOR MENTAL HEALTH BENEFITS


     Response:



28. Complete the chart on the enclosed spreadsheet, Question 28 Fees, providing a single, 24 month
    administrative fee for self-funded MH/SA plan administration (for EPO and PPO medical plan
    participants), and a separate capitated EAP rate for a 3-visit model for active employees only, beginning
    on January 1, 2012 and ending December 31, 2013. All fees/rates should be provided on a Per
    Employee/Retiree Per Month basis (PEPM) and must be guaranteed/fixed for a minimum of 2 years and
    disclosed if guarantee can survive the entire five year period (including renewal period of three years).
    Fees cannot be contingent on minimum membership participation by group. The fees proposed must be
    “mature”, including 12 months of runout claims administration should the contract terminate. Please
    note that additional administrative fees are not allowed. Additional fees that are known up-front, such as
    start-up or implementation fees, should be built into the proposed fees/rates, unless they are specifically
    excluded as a special service and outlined in the next question below (Question 29).

     These administrative fees will apply for each PEBC Employer Group, regardless of the size of the
     individual group.

     Please note that ASO fees may not be dependent upon a percentage of savings. While performance
     guarantees related to network savings are acceptable (see Question 27), your proposed ASO fee for
     MH/SA administration must be a stand-alone, pre-set, flat maximum monthly fee that will be
     budgeted for and paid by the client.

     (Respond on Excel spreadsheet)


29. On the enclosed spreadsheet, please complete Question 29 (shown below), confirming whether or not the
    proposed MH/SA administrative fees and capitated EAP rates, proposed above in Question 28, include the
    following services. If No, please provide an explanation of the extra service and the cost of that service.

     (Respond on Excel spreadsheet)



                            Service                            Included in MH/SA Fees?
                                                             Yes/No (if No please outline)

      Start-up or Implementation Fees (incl. data file
      set-up, banking set-up, etc.)

      MH/SA Claims Fiduciary Liability – handle 1st
      level appeals

      MH/SA Claims Fiduciary Liability – handle 2nd
      level and External appeals process



                                Page 33 of RFP No. 2011-001
                    RFP FOR MENTAL HEALTH BENEFITS



Case Management (beyond that included in
Question 28) or non-network claims negotiations

Collection and Reimbursement of Claim
Overpayments

ERRP format claims data provided on a quarterly
basis for all early retirees and their enrolled
dependents, regardless of ERRP threshold

Subrogation

Interfacing with medical carrier (UHC)

Regular provision of information for stop-loss
carrier

Ad-hoc reporting (per hour)

Other:

Other:



                          Service                            Included in Capitated EAP Rate?
                                                               Yes/No (if No please outline)

Up to three (3) face-to-face counseling sessions per
member, per incident, each year at no cost to the member

Telephonic clinical counseling available 24 hours/day, 7
days/week, at no cost to the member

Telephonic counseling for childcare and eldercare as
shown in Section 3.1.2 of this RFP

Telephonic counseling for financial services as shown in
Section 3.1.2 of this RFP

Telephonic counseling for legal services as shown in
Section 3.1.2 of this RFP

Telephonic counseling for identity theft recovery as shown
in Section 3.1.2 of this RFP



                         Page 34 of RFP No. 2011-001
                          RFP FOR MENTAL HEALTH BENEFITS



      Telephonic counseling for daily living services as shown in
      Section 3.1.2 of this RFP

      Online counseling and access to referrals

      Up to 21 hours per year of onsite training (e.g., brown bag
      lunches) per Employer Group

      Other




30. Please confirm the administrative fees proposed include 12 months of run-out claims administration (i.e.,
    they are mature fees) should your contract to provide services terminate.

     Response:


31. Please provide the name, title, telephone number and email address for the actuarial/financial personnel
    responsible for preparation of this administrative fee.

     Response:

     Name: _______________________

     Title: _______________________

     Telephone: ___________________

     Email: _______________________



32. Performance Guarantees: Performance guarantees are required if selected as the network/claims
    administrator for the PEBC. Such guarantees apply to each PEBC Employer Group and will include the
    following:


                    Performance Standard                       Measurement            Amount at Risk (per
                                                                Frequency            PEBC member group)
      Claims Administration
      99% of clean claims processed within thirty (30)              Quarterly
      days

      Financial Accuracy of paid claims of 99.0%                    Annually

                               Page 35 of RFP No. 2011-001
                          RFP FOR MENTAL HEALTH BENEFITS



                   Performance Standard                      Measurement           Amount at Risk (per
                                                              Frequency           PEBC member group)

      Maximum Penalty Per Year – Claims Admin                  Annually
      Telephone Calls
      Vendor’s average time in queue (waiting time)            Quarterly
      cannot exceed 30 seconds

      Vendor’s average abandonment rate cannot                 Quarterly
      exceed 2%

      Maximum Penalty Per Year                                 Annually
      Communications
      Confirmation that no employee communications             Annually
      were released without prior PEBC Executive
      Director approval

      Annual Enrollment - providing access to Website          Annually
      (provider search) and electronic materials
      Data Management
      Confirmation that data records are updated               Quarterly
      within 24 business hours of receipt

      Audit comparisons completed within ten               Up to 3 times each
      business days of receipt                                    year

      Timely delivery of plan reports (final content and       Quarterly
      schedule to be confirmed during Implementation)

      Maximum Penalty Per Year – Data Management               Annually

      TOTAL AMOUNT AT RISK                                    ANNUALLY

    Please confirm your willingness to agree to these Performance Standards and Measurement
    Frequency, and provide the Amounts at Risk that will become a part of each PEBC Employer Group’s
    contract.

    Response:



33. Please describe any innovations or approaches unique to your organization for which you can quantify
    results, generating short- or long-term cost savings, which could benefit the PEBC and its covered
    membership. The PEBC may request further details on these programs for vendors selected as finalists.
                              Page 36 of RFP No. 2011-001
                           RFP FOR MENTAL HEALTH BENEFITS


     Response:



D.     ADMINISTRATION, CUSTOMER SERVICE, AND ORGANIZATIONAL INFORMATION (30 points)

General Information

34. Define the organization(s) that are participating in your proposal and explain the relationship of any
    material subcontracted service (e.g., outside contracting for Critical Incident debriefing in the North Texas
    area.) For each subcontracted service, provide the length of time the current arrangement has been in
    place, and explain how the service is integrated into your systems and processes.

     Response:



35. Provide a brief overview of the ownership of your company, including the number of years you have been
    in business and the nature of the financial relationship (e.g., publicly traded on major stock exchange,
    privately held by whom, any holding company arrangements, etc.) Be sure to specifically address:

     a. Type of organization or incorporation (for profit, not-for-profit, etc.)

     b. Publicly or privately owned

     c. State of incorporation

     d. Number of years in business

     e. Provide a copy of your Certificate of Authority or registration to conduct business within the State of
        Texas

     Response:



36. Provide a copy of a valid license for performing third party administration services for medical (MH/SA)
    claims in the State of Texas for your organization.

     Response:




                                 Page 37 of RFP No. 2011-001
                          RFP FOR MENTAL HEALTH BENEFITS


37. Have there been any changes in your organization’s ownership structure (e.g., merger, acquisition, etc.)
    in the last 24 months, or are any contemplated or expected? If so, please describe them in detail and
    address the impact these changes may have related to the provision of services as described in this RFP.

     Response:



38. Describe any pending litigation that could impact your provider network(s) or your ability to provide
    service to the PEBC and the PEBC Employer Groups.

     Response:



39. Describe any notifications to Health and Human Services (HHS) by your firm or your parent company in
    connection with breach of confidential data (include date and number of records), including your firm’s
    corrective action taken and current status if not resolved.

     Response:



40. Do you currently, or have you recently (within the last two years) provided any PEBC Employer Group
    benefit plan services through a self-funded or fully-insured arrangement, even if through an affiliated or
    acquired company? If you answered yes, please answer the following questions.

     a.    List all types of Plans contracted (HMO, PPO, Senior Supplement, Medicare Advantage) and the last
           date for which you provided coverage.

     b.    Who is/was the senior account manager for that block of business?

     c.    Is your firm still providing these services? Why or why not?

     d.    Explain why (or why not) the PEBC should refer to this experience and relationship as an indicator
           of future success with your firm.

     Response:



41. In the past 12 months, have you had any workforce reductions/consolidations, or are you planning, any
    workforce reductions/consolidations that could affect your organization’s ability to provide services as
    proposed?

     Response:



                               Page 38 of RFP No. 2011-001
                           RFP FOR MENTAL HEALTH BENEFITS


42. Provide a copy of the most recent audited financial statement, including auditor’s notes, for your
    organization. Please provide a copy of the statement and auditor’s notes only – not the full annual report.

     Response:



43. Please respond to the following regarding your MH/SA administration book of business for self-funded
    customers only:

     a.      Number of self-funded MH/SA plan administration customers

     b.      Total number of covered members in your self-funded MH/SA plan administration programs

     c.      Number of customers with more than 10,000 covered employees nationally

     d.      Number of customers with more than 10,000 employees based in the North Texas area (i.e., with
             account management, customer service and claim administration assigned to your North Texas
             service teams)

     Response:



44. Describe your experience advising plan sponsors and administering benefit plans for organizations such as
    the PEBC, which are not subject to ERISA, and not subject to all Texas Department of Insurance
    regulations, but which are subject to other legislation (e.g., Public Health Service Act, Texas Serious
    Mental Illness required benefits, health care reform.) Please disclose if the organization elected to
    exempt the plan from the requirements of Title XXVII of the PHS Act including parity in the application of
    certain limits to mental health benefits.

     With regard to this issue, please address:

     a.    Legal/compliance resources available

     b.    Training for Account Managers specifically regarding legislation/compliance and benefit design

     c.    Provide examples of other similar customers (non-ERISA, self-insured) with whom you currently
           work.

     Response:



45. Provide an organizational chart identifying the personnel who will be responsible for the administration
    and management of your organization’s contract with the PEBC, on behalf of the PEBC Employer Groups.

     Response:

                                Page 39 of RFP No. 2011-001
                             RFP FOR MENTAL HEALTH BENEFITS




46. Please clearly identify the senior level person in your organization who would be assigned to work with
    the PEBC Executive Director, as well as the key day-to-day contact for working with the PEBC day-to-day
    items (if different). Provide each person’s years of service with your organization as well as the total
    number of accounts directly managed.

     Response:



47. Occasionally PEBC service providers are contacted by interested third parties (e.g., the media) requesting
    information about the PEBC and its member groups. Please confirm your agreement not to disclose any
    information about the PEBC’s covered population or utilization, even in aggregate, with any outside third
    parties. Press releases or any other communications or requests must be pre-approved by the PEBC
    Executive Director.

     Response:


Plan Design


48. The current medical and MH/SA plan designs are shown in Appendix A.

     a.       Are you able to administer the PEBC EAP and MH/SA plan designs exactly as currently written, in all
              states (note: this is notwithstanding any plan design changes that may be required as a result of
              health care reform)? Please specify Yes or No.

     b.       Identify any current PEBC plan design provisions or specifications that you cannot administer, or
              which would require special or manual processing with your system, in particular with regard to
              the following procedures:
              - EAP visit definitions
              - Inpatient Hospital copays – per day copays with maximum limits
              - Preauthorization requirements
              - Exclusions
              Please be sure to list any plan design provisions or specifications also in Section 13.Signatures-4,
              “Deficiencies and Deviations” Form, providing your alternative approach in detail, including any
              cost impact.

     Response:



49. In the event the PEBC added a consumer-driven or account-based medical plan (such as an HRA) in the
    future, describe the resources and experience you have to support this type of plan design.

     Response:
                                  Page 40 of RFP No. 2011-001
                           RFP FOR MENTAL HEALTH BENEFITS




50. Please describe transition benefits and the process you would follow (in detail, based on the current plan
    designs) for those plan participants in a course of treatment prior to January 1, 2012 and through
    completion of a course of treatment beyond January 1, 2012. Please disclose if you are willing to provide
    a financial transition allowance (if applicable) and describe.

     Response:



Claims Administration and Customer Service

51. From what office location will claims be paid?

     Response:



52. For the claims office that will be processing claims for the PEBC, provide the following statistics for all
    claims paid by the vendor for calendar year 2010.




   Measurement                                          Company Standard                  2010 Actual

   Claims payment accuracy

   Claims processing accuracy

   Financial accuracy

   Average turnaround time

   Percentage of claims processed within 10
   business days of receipt

   Percentage of claims received electronically
   (EDI)

   Auto-adjudication percentage


 53. Do you outsource any claim payment or customer/member services function overseas?

     Response:

                                Page 41 of RFP No. 2011-001
                           RFP FOR MENTAL HEALTH BENEFITS




54. What is the lag between when you receive an eligibility update file and when the information is "online"
    in member services and claims?

     Response:



55. The PEBC provides links to certain portions of vendor websites via its information website. Please confirm
    links can be provided via the PEBC website. Describe your current website capabilities (links potential) for
    employees and employers. Include:

     a.    What is your website address?

     b.    Do you maintain your website in-house, or is your website outsourced? To whom?

     c.    How often do you update your online provider directory?

     d.    Please complete the chart below with currently operational capabilities that would be available to
           PEBC membership.

     Response:



                         Website capabilities                             Currently operational?
                                                                                  Yes/No

      Can members access the full provider directory?

      Can members search for a provider by name?

      Can members print a map to a provider’s office?

      Do you offer a live chat with a nurse?

      Can members see their specific benefit plan?

      Can members submit out-of-network claims?

      Can members check claim status and view EOBs?

      Can members access legal consultation services?

      Can members access financial consultation services?




                                Page 42 of RFP No. 2011-001
                             RFP FOR MENTAL HEALTH BENEFITS



                        Website capabilities                             Currently operational?
                                                                                 Yes/No

      Does the site have a self-assessment tool that addresses
      depression?

      Does the site have a self-assessment tool that addresses
      alcohol/drug abuse?




56. Provide the following regarding your customer service/member services phone line and team:

     a.    Office location

     b.    Hours of operation

     c.    Confirm you will provide a toll-free number. Will this number be unique to the PEBC?

     d.    Confirm the line is available 24 hours/day and 365 days/year, with no busy signals

     e.    Will the PEBC have the ability to customize the phone tree?

     f.    Will you provide warm transfers to other PEBC vendors (e.g., UHC)?

     Response:



57. Do you record all calls to customer/member services? When are these calls purged?

     Response:



58. Confirm that you have specific, written procedures for handing emergency calls both during and after
    hours. Do you have special procedures for handling cases of potential violence?

     Response:



59. Please provide the following statistics for the customer/member services site that will service the PEBC
    account:

     Response:


                                Page 43 of RFP No. 2011-001
                               RFP FOR MENTAL HEALTH BENEFITS



  Measurement                                              Company Standard                       2009 Actual

  Call abandonment rate

  Average speed to answer (in seconds)

  First call resolution rate

  Member satisfaction rate *

* Defined as the combined percentage responding “Completely Satisfied” or “Very Satisfied” on customer
satisfaction surveys. Neutral responses should not be counted.

60. EAP - Do you presume eligibility for EAP services for all members that contact you? If not, how is eligibility
    handled?

     Response:



61. EAP - What are the minimum qualifications for those answering calls to the EAP? Please confirm that only
    clinicians may make referrals under your model.

     Response:



62. EAP - Is follow-up provided on all EAP and work/life cases? If yes, please describe how the follow-up is
    completed and by what level of staff.

     Response:



63. EAP - Please provide information on how your EAP legal and financial counseling services work. Please be
    sure to indicate the number of telephone and in-person counseling sessions available for both legal and
    financial counseling sessions, as well as the length of each session. Are there any instances where
    additional costs would apply?

     Response:



64. EAP - Please provide information describing the turn-key EAP services your organization provides which
    are included in the EAP PEPM rate. Please include any limits or additional pricing information.

     Response:

                                  Page 44 of RFP No. 2011-001
                          RFP FOR MENTAL HEALTH BENEFITS




65. Describe your ability to coordinate services with the PEBC’s current medical plan and prescription drug
    providers, UHC and Express Scripts, respectively, including:

     a.    Coordination of high-cost inpatient cases

     b.    Coordination of cases with depression as a co-morbidity

     c.    Coordination with disease management programs

     Response:



66. Explain the process used by customer/member services to assist members in locating a specialty provider
    who is able to assist with needed care if emergency care or a specialty provider is needed. Under what
    circumstances, if any, do you use "non-contract" providers to provide services to members?

     Response:



67. EAP – Currently, each PEBC Employer Group receives up to 21 hours of onsite training annually (e.g.
    brown bag lunches) on a variety of topics at no additional cost. Please confirm your ability to provide
    onsite training services on a regular basis as requested. Please also supply a list of the various topics
    available for this purpose noting those circumstances where additional cost may apply.

     Response:



68. EAP - Describe the value-added, no cost resources and tools you can make available with regard to
    wellness programs for PEBC Employer groups.

     Response:



69. The PEBC requires Employer plan management reports in electronic format (Excel or text file and .pdf)
    with a hard-copy printed version. Please provide a list of your standard Employer plan management
    reports. Specify the frequency of production and availability following the close of the reporting
    period, and confirm that the information can be provided in Excel or text file and .pdf.

     a.    Reports for the EAP

                             EAP Reports                                       Included?


                                 Page 45 of RFP No. 2011-001
                           RFP FOR MENTAL HEALTH BENEFITS



                              EAP Reports                                       Included?

      Open and closed case by type of problem

      Number of face-to-face sessions

      Book of business/peer group comparisons on all
      reporting

      Follow-up provided

      Supervisory referrals

      Number of hits to the website

      Utilization of work/life resources




     b.    Reports for self-funded MH/SA benefits – please list standard reports and provide frequency



                           MH/SA Reports                                        Included?

      Comprehensive utilization statistics for inpatient,
      alternative levels of care, and outpatient (ALOS,
      days/visits per 1000, etc.)

      Reporting on readmission rates

      Reporting on percentage of enrollees terminating
      treatment prior to completion of treatment plan

      Book of business/peer group comparisons on all
      reporting

     Response:



70. Do you offer on-line reporting functionality? Is there an additional fee for this service?

     Response:




                               Page 46 of RFP No. 2011-001
                          RFP FOR MENTAL HEALTH BENEFITS


71. Please confirm your willingness to take 100% financial responsibility for your own claims processing
    mistakes (e.g., if you pay claims on a member whose coverage has been terminated and forwarded to you
    in a timely manner and the claim was funded by the PEBC Employer Group.)

     Response:



72. Any refunds due to claims processing should not be credited against administrative fees; they must be
    returned to the applicable PEBC employer group via check accompanied by a report showing the claim
    number, amount, date of service, and applicable member. Please confirm your agreement to administer
    this arrangement.

     Response:



73. Please clearly confirm whether or not you can accommodate each of the funding/banking arrangements
    listed below, and identify any additional costs to administer the program in that manner, if applicable:


     a.    Each PEBC Employer Group owns the positive pay disbursement bank account with vendor’s check
           stock, branded with the PEBC logo and the Employer group name, and the vendor agrees to provide
           reconciled bank account documents on a monthly basis, including but not limited to outstanding
           and void checks.

     b.    Vendor owns the individual PEBC Employer Group positive pay disbursement bank account with
           vendor’s check stock, branded with the PEBC logo and the Employer group name, and vendor
           agrees to provide reconciled bank account documents on a monthly basis, including but not limited
           to outstanding and void checks.

     c.    Vendor funds and releases checks on vendor owned positive pay disbursement account, and the
           PEBC Employer Group funds presented checks only on a daily or weekly basis. Vendor agrees to
           fund positive pay checks in advance of reimbursement and must be prepared to fund claims from
           vendor’s resources for a period up to two weeks before PEBC Employer Group reimbursement is
           made.

     d.    Other (explain arrangement)

     e.    Please confirm you can provide a check register/electronic report in advance of check release for all
           options.

     f.    Please describe any security and fraud-prevention features built into your check release and cash
           management process.

     Response:



                               Page 47 of RFP No. 2011-001
                          RFP FOR MENTAL HEALTH BENEFITS


74. The PEBC Executive Director must approve any and all communication materials distributed to PEBC
    covered members prior to their release. Confirm your ability and willingness to meet this standard.
    Note that it will be a Performance Guarantee standard for the PEBC.

     Response:



75. Comment on your organization’s HIPAA compliance. Is your organization fully compliant with the HIPAA
    Privacy, Security, Breach Notification, and other regulations?

     Response:



76. The PEBC serves as the Plan Administrator (not the ERISA definition) for the self-funded medical plans for
    each of the PEBC Employer Groups. Thus, as Plan Administrator, the PEBC Executive Director is entitled to
    receive Protected Health Information (“PHI”) as defined under HIPAA statutes for health care operations
    purposes, without an authorization from the covered employee. Please confirm your understanding of
    these provisions and your willingness to share PHI with the PEBC Executive Director as needed and
    requested for health care operations purposes.

     Response:


Required Provisions and Forms

77. Confirm your agreement to meet the following Contractual requirements of this RFP (see Section 2 for
    more detail):



                     Contractual Requirements                           Meets PEBC Requirement
                                                                                Yes/No

      Two year contract (January 1, 2012 – December 31,
      2013) with PEBC optional 3-year extension (without rate
      increase)

      Firm carries Professional Liability insurance meeting ALL
      the requirements in Section 2

      Contract WILL NOT contain a Binding Arbitration
      provision

      PEBC Member Groups may terminate contract with 180
      days notice


                                Page 48 of RFP No. 2011-001
                                 RFP FOR MENTAL HEALTH BENEFITS



                            Contractual Requirements                           Meets PEBC Requirement
                                                                                       Yes/No

            Selected vendor may not terminate contract during the
            contractual term

            Selected vendor may not assign contract

            Contract will contain language consistent with the
            Indemnification provisions in Section 2.2.5 of this RFP

            Payment grace period of 45 days

            Selected vendor will sign the Letter of Understanding
            shown in Appendix D of this RFP

            Selected vendor will sign the PEBC Business Associate
            Agreement as shown in Appendix E of this RFP



      78. If applicable, complete the Historically Underutilized Businesses Only form (13.Signatures - 1) and attach a
          copy of your HUB certification. Does this form apply to you?

           Response: Yes/No



     79. Complete and sign the Certificate of Compliance Page (13. Signatures - 2).



      80. Complete and sign the Signature Page (13. Signatures - 3).



      81. Complete and sign the Deficiencies and Deviations Form (13. Signatures - 4) clearly identifying any
          deviations to the requirements of this RFP.



      82. Complete and sign the Disclosure of Third-Party Payments (13. Signatures - 5), clearly identifying any
          payments to be made to other organizations as a result of this contract.


E.   REQUEST FOR INFORMATION – AUTISM BENEFITS (0 points)
     Note: This Section seeks information on how your organization manages benefits and services requested
     for treatment of autism and related conditions, including applied behavioral analysis therapy (ABA). Your
     responses to this section will not count towards the scoring of the RFP. These questions are designed to

                                      Page 49 of RFP No. 2011-001
                           RFP FOR MENTAL HEALTH BENEFITS


gather current information on what major MH/SA managed care organizations and their self-funded, non-
federal governmental employer clients (who are not subject to ERISA) are doing with regard to managing
these cases, and to examine the specific plan design in connection with that coverage. If you do not have
any self-funded, non-federal governmental clients, please disclose and do not respond to this section. If the
client also elects to exempt its plan from the requirements of Title XXVII of the PHS Act including parity in
the application of certain limits to mental health benefits, please indicate. If you have clients in this
category, we appreciate your response. You should not assume or conclude that the PEBC groups will cover
additional services in connection with questions asked in this Section. This information is requested for
informational purposes only.

Please see Section 11.8 of this RFP for information on public records requests which may include your
responses to this section of the RFP. You are not required to disclose your client’s name when responding
to this RFP. Please be aware of the potential for public records requests, in particular if you include
customer-specific examples in your responses.

The State of Texas has mandated coverage of ABA therapy (with age limits, etc.) for those plans which are
under State oversight, such as a fully-insured HMO plan, but that mandate does not apply to self-funded
governmental plans such as those offered by the PEBC. To reiterate, the PEBC is also not subject to ERISA,
and all PEBC Employer Groups elect to exempt the plan from the requirements of Title XXVII of the PHS Act
including parity in the application of certain limits to mental health benefits.

The PEBC currently covers the following services related to Autism Spectrum Disorder (ASD):
     Office Visits
     Speech Therapy
     Physical Therapy
     Occupational Therapy
     Prescription Drug Management.

The PEBC medical plan excludes coverage for educational services. Examples of services that are not covered by
the PEBC medical plans include:
     Sensory integration
     Applied behavioral analysis (ABA)
     Lovaas therapy
     Music therapy.

When answering the questions below, please respond in connection with coverage connected to a group
similar to the PEBC (e.g. self-funded, non-federal governmental plan, not subject to ERISA, and elects to
exempt the plan from the requirements of Title XXVII of the PHS Act including parity in the application of
certain limits to mental health benefits). If you do not have a self-funded client that fits this description,
please provide information for the closest match client available, disclosing the type of client. You are not
required to disclose your client’s name when responding to this RFP.

 83. What is your organization’s standard or recommended approach to covering pervasive development
     disorders? We are requesting specific language describing services typically covered and not covered,
     including any coverage or cost limitations.

      Response:
                                Page 50 of RFP No. 2011-001
                          RFP FOR MENTAL HEALTH BENEFITS




84. What is your organization’s standard or recommended approach regarding treatments often
    recommended for ASD, including ABA? Please provide a copy of your clinical policy or practice
    bulletin, along with a summary of how and by whom that document was prepared.

     Response:



85. Please provide any cost information you have collected on providing coverage for ABA and/or similar
    therapies (per unit, per 15 minutes, per visit, etc.)

     Response:



86. Do you have self-funded MH/SA customers (similar to PEBC) that have chosen to cover ABA and/or
    other autism therapies on a voluntary basis (meaning the customer made the decision; not because of
    a legislative requirement)? If so,

     a.    What percentage of your self-funded clients nationally cover ABA therapy?

     b.    What percentage of your self-funded clients headquartered in Texas cover ABA therapy?

     c.    How is ABA coverage distinguished from other educational services in your claim and other
           systems, since specific CPT codes do not exist?

     d.    What has been the annual cost history and cost projections for customers electing to cover ABA
           therapy?

     Response:



87. Please provide examples, as specific as possible, of the benefit plan design for customers which have
    voluntarily chosen to cover ABA therapy. For example: What copays/coinsurance apply? Are there
    limits on the number or cost of services? Is pre-authorization required? Do age limits apply? Are
    members required to use certain providers? What exclusions continue to apply? Case studies or
    specific customer examples would be extremely helpful if available.

     Response:



88. Do you have contracted network providers for ABA and/or similar treatment therapies as part of your
    network in North Texas? Your national network? If so,


                              Page 51 of RFP No. 2011-001
                         RFP FOR MENTAL HEALTH BENEFITS


    a.    What are the credentialing standards for these providers?

    b.    What level of network discounts (on a percentage basis) are you typically able to achieve from
          these providers?

    Response:



89. What alternatives, approaches or other resources do you offer to members requesting coverage for
    ABA and/or similar therapies?

    Response:



90. Are there any other factors other than those mentioned above which your ASO customers considered
    regarding plan design related to covering pervasive developmental disorders?

    Response:




                             Page 52 of RFP No. 2011-001
                                      RFP FOR MENTAL HEALTH BENEFITS



13. SIGNATURES - 1
   HISTORICALLY UNDERUTILIZED BUSINESSES, MINORITY OR WOMEN-OWNED OR DISADVANTAGED
                                   BUSINESS ENTERPRISES

Historically Underutilized Businesses (HUBs), minority or women-owned or disadvantaged businesses enterprises
(M/W/DBE) are encouraged to participate in the RFP process. Representatives from HUB companies should identify
themselves and submit a copy of their Certification.

NCTCOG recognizes the certifications of both the State of Texas Program and the North Central Texas Regional
Certification Agency. Companies seeking information concerning HUB certification are urged to contact:

                           State of Texas HUB Program
                           Texas Comptroller of Public Accounts
                           Lyndon B. Johnson State Office Building
                           111 East 17th Street
                           Austin, Texas 78774
                           (512) 463-6958
                           http://www.window.state.tx.us/procurement/prog/hub/

Local businesses seeking M/W/DBE certification should contact:

                           North Central Texas Regional Certification Agency
                           624 Six Flags Drive, Suite 100
                           Arlington, TX 76011
                           (817) 640-0606
                           http://www.nctrca.org/certification.html

Proposer must include a copy of its minority certification documentation as part of this RFP.

If your company is already certified, attach a copy of your certification to this form and return it with the proposal.


Indicate all that apply:
                           ______Minority-Owned Business Enterprise
                           ______Women-Owned Business Enterprise
                           ______Disadvantaged Business Enterprise




                                          Page 53 of RFP No. 2011-001
                                    RFP FOR MENTAL HEALTH BENEFITS


13. SIGNATURES - 2                       CERTIFICATE OF COMPLIANCE

Equal Opportunity Clause: (applies to federal contractors and sub-contractors for contracts of $10,000 or more) –
Contractor is aware and fully informed of its responsibilities under Executive Order 11246, as amended, and agrees
to be bound by its provisions

Affirmative Action Compliance Program: (applicable to federal contractors and sub-contractors for contracts of
$50,000 or more, if contractor has 50 or more employees) – Contractor certifies to NCTCOG and to the United States
government that since NCTOCG is a federal contractor, proposer will, if appropriate: a) file with the appropriate
federal agency a complete and accurate report on Standard Form 100 (EEO-1) within 30 days after the signing of this
certificate (unless such a report has been filed in the last 12 months), and continue to file such reports annually, on
or September 30,or as otherwise provided by law or regulations; and b) develop and maintain a written affirmative
action compliance program in accordance with the regulations of the Office of Federal Contract Compliance
Programs promulgated under Executive Order 11246, as amended.

Employment of the Disabled: (applicable to federal contractors and sub-contractors for contracts of $10,000 or
more – Executive Order 11758) – Contractor acknowledges that if applicable, it is bound by the Affirmative Action
for Disabled Workers Clause set forth in Section 60-741.4 of Title 41 C.F.R., promulgated under Section 503 of the
Rehabilitation Act of 1973 and that the clause is incorporated by reference into this Certificate of Compliance.

Employment of Disabled Veterans and Veterans of the Vietnam Era and Veterans Serving Active Duty During a
War or in a Campaign or Expedition for Which a Campaign Badge Has Been Authorized: (applicable to federal
contractors and subcontractors for contracts of $25,000 or more). Contractor acknowledges that if applicable, it is
bound by the Affirmative Action for Disabled Veterans of the Vietnam Era Clause, as set forth in Section 60-250.4 of
Title 41 C.F.R., promulgated under the Vietnam Era Veterans’ Readjustment Assistance Act of 1974 and the Veterans
Employment Opportunity Act of 1998 and that the clause is incorporated by reference into this Certificate of
Compliance.

General: Contractor understands and agrees that this Certification does not create any enforceable rights
hereunder for any firm, organization, or individual. The undersigned agrees that the provisions of this Certificate of
Compliance are hereby incorporated in every non-exempt contract or purchase order between NCTCOG and
Contractor currently in force, or that may be issued during a one-year period from the date of execution of this
Certificate.


_____________________________________                                     ___________________________________
Contractor’s name                                                         Authorized Signature

_____________________________________                                     ___________________________________
Address                                                                   Printed name

_____________________________________                                     ___________________________________
                                                                          Title of Authorized Representative

_____________________________________
Date of Execution

                                         Page 54 of RFP No. 2011-001
                                     RFP FOR MENTAL HEALTH BENEFITS


13. SIGNATURES - 3                                SIGNATURE PAGE

The undersigned agrees this proposal becomes the property of the PEBC after the official opening.

The undersigned agrees, if this proposal is accepted, to furnish any and all items/services upon which prices are offered,
at the price(s) and upon the terms and conditions contained in the Specifications. The period for acceptance of this
Proposal will be 180 calendar days unless the contractor notes a different period.

The undersigned affirms that he/she is duly authorized to execute this proposal, that this proposal has not been
prepared in collusion with any other contractor, nor any employee of the PEBC, the NCTCOG, the Counties of Tarrant,
Dallas, or Denton, Parker County nor the NTTA, and that the contents of this proposal have not been communicated to
any other contractor or to any employee of the PEBC, the NCTCOG, the Counties of Tarrant, Dallas or Denton, Parker
County nor the NTTA prior to the official opening of this proposal.

The contractor hereby assigns to purchaser any and all claims for overcharges associated with this proposal which arise
under the antitrust laws of the United States, 15 USCA Section 1 et seq., and which arise under the antitrust laws of the
State of Texas, Tex. Bus. & Com. Code, Section 15.01, et seq.

The undersigned, being of management level, affirms and declares that they have read and understand the
specifications and any attachments contained in this proposal package, and further affirms and declares that this
proposal is executed and signed by contractor/proposer with full knowledge and acceptance of the provisions of the
products or services described, proposed schedule and special needs and conditions as stated, which will be made of
part of the contract.


NAME AND ADDRESS OF COMPANY:                               AUTHORIZED REPRESENTATIVE:
___________________________________                        Signature ___________________________
___________________________________                        Date _______________________________
___________________________________                        Name ______________________________
___________________________________                        Title _______________________________

Contact Name _______________________                       Telephone __________________________
Telephone __________________________                       FAX ______________ E-mail ___________
Fax ______________ E-mail_____________

COMPANY IS:
Business included in a Corporate Income Tax Return?                ______YES       ______NO
_____Corporation organized and existing under the laws of the State of __________________
_____Partnership consisting of __________________________________________________
_____Individual trading as ______________________________________________________
_____Principal offices are in the city of ____________________________________________


                                          Page 55 of RFP No. 2011-001
                                    RFP FOR MENTAL HEALTH BENEFITS


13. SIGNATURES - 4                  DEFICIENCIES AND DEVIATIONS FORM

Following is a listing of ALL deficiencies and deviations from the requirements and/or provisions as outlined in this
Request for Proposals. Please reference the specific section, question and/or page number to which the deviation
or deficiency applies. Unless specifically listed here, your proposal will be considered to be in FULL compliance with
the RFP. Contractor assumes the responsibility of identifying all deficiencies and deviations and if not identified, all
requirements of the RFP stipulated must be fulfilled at no additional expense to the PEBC or the NCTCOG.




        ________________________________                                   _____________________________
        Proposing Company                                                  Signature of Authorized Representative


         ________________________________
         Date




                                         Page 56 of RFP No. 2011-001
                                    RFP FOR MENTAL HEALTH BENEFITS


13. SIGNATURES - 5                DISCLOSURE OF THIRD-PARTY PAYMENTS

Following is an itemization of parties who will receive payment from our company if we are the successful
contractor. Please indicate the party involved (i.e., agent) and the amount of the proceeds each will receive if this
proposal is successful.




        ________________________________                                  _____________________________
        Proposing Company                                                 Signature of Authorized Representative


         ________________________________
         Date




                                         Page 57 of RFP No. 2011-001
                                  RFP FOR MENTAL HEALTH BENEFITS


APPENDIX A
                                          CURRENT PLAN DESIGNS


Please base your proposal on the current plan designs, although there may of course be plan adjustments made due
to health care reform or other legislation. Any deviations from the current design which you cannot administer
must be clearly listed in the Questionnaire, Section 12, Question 48, AND in Section 13.Signatures – 4, on the
“Deficiencies and Deviations Form”.

The following information is provided in this section:
 Quick Reference Guide – EPO Medical Plan – 2011 (full medical and MH/SA plan design for EPO plan)
 Quick Reference Guide – PPO Medical Plan – 2011 (full medical and MH/SA plan design for PPO plan)
 Summary Plan Description text – Managed Care Plans




                                      Page 58 of RFP No. 2011-001
                                       RFP FOR MENTAL HEALTH BENEFITS



                                      A Quick Reference Guide To
                                       EPO Medical Plan Benefits
                          Revised for the Plan Year Beginning January 1, 2011
Please note: only one copay will be required for covered services performed on the same date by the same provider. Keep
in mind that this section is only a quick reference summary of benefits of the EPO Plan provided for your convenience.
You should rely on the EPO Plan Booklet (Summary Plan Description) for additional details concerning any benefits listed
below. Care is coordinated through your Primary Care Physician (“PCP”), although referrals to specialists are not required.
Services are covered only if provided by in-network providers, and there are no out-of-network benefits, except in an
emergency situation. Always check the EPO Plan Booklet for notification requirements which may apply.

                                                                                         In-Network
 COVERED SERVICE                                                    (coinsurance is based on Network Allowable Amounts)
 (must be Medically Necessary)
                                                                         You Pay                         Plan Pays
                                                                                                       (after copays)
 PHYSICIAN SERVICES
    Office Visits
      - PCP (Family Practice, General Practice, Internal                 $25 copay                          100%
          Medicine, Pediatrics, OB/GYN for well woman care
          only)
      - Specialist                                                       $30 copay                          100%

    Hospital (Inpatient/Outpatient) Professional Fees        No copay (hospital admission or               100%
                                                              outpatient surgery copay applies)

 PREVENTIVE SERVICES – subject to health care reform
 rules for covered preventive services and billing. If your
 provider bills an Office Visit separately and in certain
 other cases, the applicable copay shown above will
 apply.
    Adult Health Assessments and Immunizations                              $0                             100%
     (age 18 and older)
    Well Child Care and Childhood Immunizations                             $0                             100%
     (birth through age 17)
    Annual Well Woman Examination                                           $0                             100%
     (1 per year, includes pap smear)
    Routine Screening Mammography                                           $0                             100%
     (1 per year, age 35 and older)
    Routine Prostate Screening                                              $0                             100%
     (1 per year)
    Routine Screening Colonoscopy                                           $0                             100%

    Routine Speech and Hearing Exam                                         $0                             100%
     (1 per year in doctor’s office only)
    Preventive Minor Lab/X-ray                                              $0                             100%

 ALLERGY CARE SERVICES
    Testing and Evaluations                                             $25 PCP /                          100%
                                                                       $30 Specialist



                                            Page 59 of RFP No. 2011-001
                                     RFP FOR MENTAL HEALTH BENEFITS


                                                                                       In-Network
COVERED SERVICE                                                    (coinsurance is based on Network Allowable Amounts)
(must be Medically Necessary)
                                                                        You Pay                         Plan Pays
                                                                                                      (after copays)
   Injections and Serum                                       $25 PCP / $30 Specialist (or                100%
                                                                    actual cost if less)

MATERNITY SERVICES
   Prenatal and Postnatal Visits                            $25 PCP / $30 Specialist copay                100%
                                                                         st
                                                                    for 1 visit only
   Delivery in Hospital                                    $200 copay per day, limit $800 per             100%
                                                                       admission
   Newborn Care in Hospital                                    0% for admission at birth                  100%

OUTPATIENT SERVICES
   Outpatient Surgery (including physician/professional        $300 copay per procedure                   100%
    services, facility charges, and all related surgical
    services)
   Lab & X-rays (performed by a physician’s office,                    $25 PCP /                          100%
    participating laboratory or radiological provider)                $30 Specialist
    -    Minor non-preventive
    -    Major diagnostic (CT, PET, MRI, Nuclear)
   Diagnostic Scopic procedures, Radiation Oncology, IV                  10%                              90%
    Chemotherapy, Dialysis, IV Infusion, Diagnostic
    Mammograms
   Rehabilitation Services and Therapy (Physical,                      $25 PCP /                          100%
    Occupational and Speech Therapy only, limited to 60               $30 Specialist
    visits per calendar year for all therapy combined)

INPATIENT HOSPITAL SERVICES
   Inpatient Care (semi-private room & board, surgery,     $200 copay per day, limit $800 per             100%
    physician and professional services, medications, lab              admission
    & x-ray, anesthesia and therapy)

EMERGENCY MEDICAL SERVICES
   Emergency Room Services                                            $100 copay                          100%
    (Copay waived if admitted)
   Urgent Care Center                                                 $30 copay                           100%

   Physician Services in Emergency Room                                   $0                              100%

   Ambulance Services – Emergency                                         $0                              100%

SKILLED NURSING, HOME HEALTH & HOSPICE
SERVICES
   Skilled Nursing Facility                                              10%                              90%
    (up to 60 days paid by the Plan per calendar year)
   Home Health Care                                                      10%                              90%
    (up to 120 days paid by the Plan per calendar year)
   Hospice                                                               10%                              90%



                                          Page 60 of RFP No. 2011-001
                                       RFP FOR MENTAL HEALTH BENEFITS


                                                                                          In-Network
COVERED SERVICE                                                      (coinsurance is based on Network Allowable Amounts)
(must be Medically Necessary)
                                                                          You Pay                           Plan Pays
                                                                                                          (after copays)
   Custodial Care                                                                        Not covered

OTHER SERVICES
   Durable Medical Equipment                                                10%                                90%

   Prosthetic Devices (when medically necessary)                            10%                                90%

   Family Planning Services
     - Office visits                                               $25 PCP / $30 Specialist                     100%
     - All other services                                              10% outpatient                     90% outpatient

   Infertility Services (up to $20,000 lifetime maximum
    benefit. Infertility drug therapies are not covered.
    Refer to the Exclusions and Covered Medical Services
    and Expenses sections of the Plan booklet.)
     - Office visits                                               $25 PCP / $30 Specialist                     100%
     - All other services                                              10% outpatient                     90% outpatient

   Chiropractic Care                                                     $30 copay                             100%
    (limited to 20 visits per calendar year)

MAXIMUM OUT-OF-POCKET
(Note that Copays do not apply towards the Maximum
Out-of-Pocket)
   Per Year - Per Individual                                                                 $1,750
   Per Year - Per Family                                                                     $3,500
ANNUAL PLAN MAXIMUM                                             $2,000,000 per individual combined for the EPO and PPO Plans

LIFETIME PLAN MAXIMUM                                                                    Does Not Apply

DEDUCTIBLES                                                                              Does Not Apply

COINSURANCE (for other services not specified above)                               You pay 10%, Plan pays 90%

PREEXISTING CONDITION LIMITATIONS                                                        Does Not Apply

MENTAL HEALTH SERVICES                                                               MHN National Network
   Outpatient Visits                                          Up to 3 EAP visits free, then $25                100%
    (20 visits per calendar year)                                           copay

   Inpatient Hospital Days and Day Treatment (30 days         $200 copay per day, limit $800 per               100%
    inpatient or 60 day treatment days per calendar year)                 admission

   Chemical Dependency / Substance Abuse (limited to
    3 episodes of care per lifetime)
     - Outpatient Visits                                       Up to 3 EAP visits free, then $25                100%
       (20 visits per calendar year)                                        copay
     - Inpatient Hospital Days and Day Treatment (30 days      $200 copay per day, limit $800 per               100%
       inpatient or 60 day treatment days per calendar year)              admission

                                               Page 61 of RFP No. 2011-001
                                    RFP FOR MENTAL HEALTH BENEFITS


                                                                          In-Network
COVERED SERVICE                                        (coinsurance is based on Network Allowable Amounts)
(must be Medically Necessary)
                                                           You Pay                           Plan Pays
                                                                                           (after copays)
   Serious Mental Illness                                         Covered as any other illness

PHARMACY                                                    Express Scripts Nationwide Network
                                                           You Pay                            Plan Pays
   Retail (30-day supply)
        Generic                                            $15 copay                      100% after copay
        Preferred brand name                               $25 copay                      100% after copay
         Non-preferred brand name                          $50 copay                      100% after copay
   Mail Order (90-day supply)
        Generic                                            $30 copay                      100% after copay
        Preferred brand name                               $50 copay                      100% after copay
        Non-preferred brand name                          $100 copay                      100% after copay




                                       Page 62 of RFP No. 2011-001
                                       RFP FOR MENTAL HEALTH BENEFITS



                                       A Quick Reference Guide To
                                          PPO Medical Plan Benefits
                             Revised for the Plan Year Beginning January 1, 2011
Please note: Deductibles and coinsurance apply to most services. You must satisfy the deductible before
coinsurance applies, unless the service is subject to a copay. Only one copay will be required for covered
services performed on the same date by the same provider. Keep in mind that this section is only a quick
reference summary of benefits of the PPO Plan provided for your convenience. You should rely on the PPO
Plan Booklet (Summary Plan Description) for additional details concerning any benefits listed below. Always
check the PPO Plan Booklet for notification requirements which may apply.

                                                         In-Network                                 Out-of-Network
 COVERED SERVICE                              (coinsurance is based on Network             (coinsurance is based on allowable
 (must be Medically Necessary)                       Allowable Amounts)                                amounts*)
                                                You Pay               Plan Pays                 You Pay              Plan Pays

 DEDUCTIBLES
 Per Year - Per Individual                                  $250                                           $500
 Per Year - Per Family                                      $500                                          No limit

 COINSURANCE (applies after you meet            You pay 20%, Plan pays 80%                      You pay 40%, Plan pays 60%
 the Deductible)
 MAXIMUM OUT-OF-POCKET
 Per Year - Per Individual                                  $2,750                                        No limit
 Per Year - Per Family                                      $5,500                                        No limit

 ANNUAL PLAN MAXIMUM                                 $2,000,000 per individual combined for the PPO and EPO Plans
 LIFETIME PLAN MAXIMUM                                                         Not applicable

 PREEXISTING CONDITION LIMITATIONS                                             Not applicable

 PHYSICIAN SERVICES
    Office Visits
      - PCP (Family Practice, General          $25 copay                100%                     40%                   60%
       Practice,   Internal  Medicine,
       Pediatrics, OB/GYN for well
       woman care only)
      - Specialist                             $30 copay                100%                     40%                   60%

    Hospital (Inpatient/Outpatient)              20%                    80%                     40%                   60%
     Professional Fees

 PREVENTIVE SERVICES - subject to           (Note: If your provider bills an Office
 health care reform rules for covered        Visit separately and in certain other
 preventive services and billing             cases, the applicable copay shown
                                                       above will apply.)

    Adult Health Assessments and
                                                   $0                   100%                     40%                   60%
     Immunizations
     (age 18 and older)




                                          Page 63 of RFP No. 2011-001
                                        RFP FOR MENTAL HEALTH BENEFITS


                                                              In-Network                       Out-of-Network
COVERED SERVICE                                   (coinsurance is based on Network     (coinsurance is based on allowable
(must be Medically Necessary)                            Allowable Amounts)                        amounts*)
                                                    You Pay                Plan Pays     You Pay              Plan Pays

   Well Child Care and Childhood                       $0                   100%          40%                  60%
    Immunizations
    (birth through age 17)
   Annual Well Woman Examination                       $0                   100%          40%                  60%
    (1 per year, includes pap smear)

   Routine Screening Mammography                       $0                   100%          40%                  60%
    (1 per year, age 35 and older)

   Routine Prostate Screening                          $0                   100%          40%                  60%
    (1 per year)

   Routine Screening Colonoscopy                       $0                   100%          40%                  60%

   Routine Speech and Hearing Exam                     $0                   100%          40%                  60%
    (1 per year in doctor’s office only)

   Preventive Minor Lab/X-ray                          $0                   100%          40%                  60%


ALLERGY CARE SERVICES
   Testing and Evaluations                         $25 PCP /                100%          40%                  60%
                                                  $30 Specialist

   Injections and Serum                         $25 PCP / $30               100%          40%                  60%
                                               Specialist (or actual
                                                  cost if less)

MATERNITY SERVICES
   Prenatal and Postnatal Visits                      20%                   80%           40%                  60%
   Delivery in Hospital                               20%                   80%           40%                  60%
   Newborn Care in Hospital                           20%                   80%           40%                  60%

OUTPATIENT SERVICES
   Outpatient Surgery (including all                  20%                   80%           40%                  60%
    related surgical services)
   Diagnostic Lab & X-rays (performed              $25 PCP /                100%          40%                  60%
    by a physician’s office, laboratory, or       $30 Specialist
    radiological provider)
    - Minor non-preventive
    - Major diagnostic (CT, PET, MRI,
      Nuclear)

   Diagnostic Scopic procedures,                      20%                   80%           40%                  60%
    Radiation Oncology, IV
    Chemotherapy, Dialysis, IV Infusion,
    Diagnostic Mammograms




                                              Page 64 of RFP No. 2011-001
                                       RFP FOR MENTAL HEALTH BENEFITS


                                                           In-Network                         Out-of-Network
COVERED SERVICE                                 (coinsurance is based on Network      (coinsurance is based on allowable
(must be Medically Necessary)                          Allowable Amounts)                         amounts*)
                                                  You Pay                 Plan Pays     You Pay                 Plan Pays

   Rehabilitation Services and Therapy           $25 PCP /                 100%          40%                     60%
    (Physical, Occupational and Speech          $30 Specialist
    Therapy only, limited to 60 visits per
    calendar year for all therapy
    combined)

INPATIENT HOSPITAL SERVICES
   Inpatient Care (semi-private room &             20%                     80%           40%                     60%
    board, medications, surgery, lab & x-
    ray, anesthesia and therapy)

EMERGENCY MEDICAL SERVICES
   Emergency Room Services                      $100 copay                 100%      $100 copay                  100%
    (Copay waived if admitted)
   Urgent Care Center                           $30 copay                  100%          40%                     60%
   Physician Services                              20%                     80%           40%                     60%
   Ambulance Services                              20%                     80%           40%                     60%

SKILLED NURSING, HOME HEALTH &
HOSPICE SERVICES
   Skilled Nursing Facility                        20%                     80%           40%                     60%
    (up to 60 days paid by the Plan per
    calendar year)
   Home Health Care                                20%                     80%           40%                     60%
    (up to 120 days paid by the Plan per
    calendar year)
   Hospice                                         20%                     80%           40%                     60%


   Custodial Care                                          Not covered                           Not covered

OTHER SERVICES
   Durable Medical Equipment                       20%                     80%           40%                     60%

   Prosthetic Devices (when medically              20%                     80%           40%                     60%
    necessary)
   Family Planning Services
     - Office visit                               $25 PCP /                 100%          40%                     60%
                                                $30 Specialist
     - All other services                           20%                     80%           40%                     60%

   Infertility Services (up to $20,000
    lifetime maximum benefit. Infertility
    drug therapies are not covered.
    Refer to the Exclusions and Covered
    Medical Services and Expenses
    sections of the Plan booklet.)

                                             Page 65 of RFP No. 2011-001
                                       RFP FOR MENTAL HEALTH BENEFITS


                                                              In-Network                         Out-of-Network
COVERED SERVICE                                   (coinsurance is based on Network       (coinsurance is based on allowable
(must be Medically Necessary)                            Allowable Amounts)                          amounts*)
                                                    You Pay                Plan Pays       You Pay              Plan Pays

     - Office visits                             $25 PCP / $30               100%            40%                    60%
                                                   Specialist
     - All other services                             20%                    80%             40%                    60%

   Chiropractic Care (limited to 20 visits        $30 copay                 100%            40%                    60%
    per calendar year)

MENTAL HEALTH SERVICES                                 MHN National Network

   Outpatient Visits                           Up to 3 EAP visits           100%            50%                    50%
    (20 visits per calendar year)              free, then $25 copay

   Inpatient Hospital Days and Day                   20%                    80%             40%                    60%
    Treatment (30 days inpatient or 60
    day treatment days per calendar
    year)
   Chemical Dependency /
    Substance Abuse (limited to 3
    episodes of care per lifetime)
    - Outpatient Visits                         Up to 3 EAP visits           100%            50%                    50%
      (20 visits per calendar year)            free, then $25 copay

    - Inpatient Hospital Days and Day                 20%                    80%             40%                    60%
      Treatment (30 days inpatient or 60
      day treatment days per calendar
      year)
   Serious Mental Illness                           Covered as any other illness           Covered as any other illness

PHARMACY                                        Express Scripts Nationwide Network                 Out-of-Network
                                                    You Pay              Plan Pays

   Retail (30-day supply)
                                                                                          You Pay network copays plus the
       Generic                                     $15 copay          100% after copay   difference between the non-network
       Preferred brand name                        $25 copay          100% after copay   pharmacy’s charge and the network
                                                                                                   allowed amount
       Non-preferred brand name                    $50 copay          100% after copay
   Mail Order (90-day supply)
       Generic                                     $30 copay          100% after copay             Not applicable
       Preferred brand name                        $50 copay          100% after copay             Not applicable
       Non-preferred brand name                   $100 copay          100% after copay             Not applicable




                                              Page 66 of RFP No. 2011-001
                                    RFP FOR MENTAL HEALTH BENEFITS


SUMMARY PLAN DESCRIPTION TEXT – Managed Care Plans

The 2011 SPDs have not yet been finalized due to the change to UHC for medical plan administration. The following
text regarding mental health and substance abuse benefits is an excerpt from the EPO Plan SPD. The text for the
PPO Plan is similar (EAP benefits are the same), but the PPO includes out-of-network benefits as outlined in the
Quick Reference Guide.

                                                  *   *   *   *   *

Mental Health and Substance Abuse Treatment
MHN administers the Plan’s mental health and substance abuse treatment benefits, including the Employee Assistance
Program.

The Employee Assistance Program (“EAP”)
The EAP offers two types of services to you and your family members:
   24-hour phone counseling for assessment and emergencies at no cost to you.
   Up to three face-to-face counseling sessions per member, per incident, each year at no cost to you.

To reach the EAP, call MHN. Counselors are available 24 hours a day, seven days a week. Please refer to your ID card,
check the PEBC website, or check with your Employer’s Human Resources Department for phone numbers.

When you call the EAP, your counselor may recommend face-to-face, short-term counseling as part of your action plan.
If you choose to take advantage of the EAP’s counseling services, you pay nothing for up to three sessions.

At any time during the three sessions, you and your counselor may decide that you require more than three sessions or
sessions with a counselor outside of the EAP. In some cases, you may continue to work with your EAP counselor (if they
participate in the network) when you require more than three sessions.

To receive the free counseling sessions, you must use the EAP’s network of preferred providers.

If you require services beyond the scope of the EAP, your EAP counselor may refer you for other mental health
treatment, as described below.

The EAP also has other services available to you and your family members. For more information about the EAP’s other
services, refer to your EAP pamphlet or call MHN at the number shown on your ID card.

Please note: while the EAP offers legal counseling services, you may not use this service for employment-related
matters.

The care you receive through the EAP is confidential. MHN provides information only to the provider who delivers your
treatment. In addition, MHN and your provider will not disclose any information to anyone without explicit written
instructions from you, except where required within federal and state guidelines.

Other Outpatient Mental Health Services


                                         Page 67 of RFP No. 2011-001
                                     RFP FOR MENTAL HEALTH BENEFITS



To receive benefits for other outpatient mental health treatment, you must have MHN pre-certify all care before you
receive it. The MHN network of providers must be used for in-network benefits to apply. It is your responsibility to
contact MHN for pre-certification.

When you see an in-network provider, the Plan covers outpatient treatment at 100% after you pay a $25 copay for each
visit. For out-of-network providers, the Plan pays 50%, and you pay 50% of eligible covered expenses. The Plan covers
up to 20 office visits per calendar year. The 20 visits can include individual treatment, couple visits, or family visits.

Inpatient/Day Treatment Mental Health Services
To receive benefits for inpatient or day treatment mental health services, you must contact MHN to pre-certify all care
before you receive it. If you fail to have your treatment pre-certified by MHN, no benefits will be paid. You will be
responsible for paying all costs incurred for the care you receive.

When you use in-network facilities for treatment pre-certified by MHN, you pay a $200 copay per day, up to $800
maximum. Benefits are limited to 30 inpatient days per calendar year for each covered person OR to 60 days of
treatment per calendar year for care and services provided by a psychiatric day treatment facility, crisis stabilization
unit, or residential treatment center for children. The Plan covers expenses for a semi-private room. Private room
charges are covered only when medically necessary and when MHN has pre-certified these charges.

If you have a mental health or substance abuse-related emergency admission, call MHN within 48 hours of the
admission to have the treatment approved. If you are unable to call, have a family member or a facility staff member
call MHN for you. If the admission is not medically necessary, the Plan pays no benefits for the treatment.

Substance Abuse/Chemical Dependency Treatment
To receive benefits for substance abuse or chemical dependency treatment, you must have MHN pre-certify all care
before you receive it. If you fail to have your treatment pre-certified by MHN, no benefits will be paid. You will be
responsible for paying all costs incurred for the care you receive.

For outpatient substance abuse treatment, the Plan covers 100% of expenses after you pay the $25 copay per visit to an
in-network provider. The Plan covers up to 20 office visits per calendar year. For inpatient treatment, the Plan covers
expenses for necessary care and treatment for detoxification and/or rehabilitation. You pay a $200 copay per day up to
$800 at in-network facilities. Benefits are limited to 30 inpatient days per calendar year for each covered person OR to
60 days of treatment per calendar year for care and services provided by a psychiatric day treatment facility, crisis
stabilization unit, or residential treatment center for children.

The Plan limits all substance abuse treatment (inpatient and outpatient combined) to three episodes of care in a
covered person’s lifetime.

Serious Mental Illnesses
As required by Texas State law, the Plan covers serious mental illnesses in the same manner as any other illness. This
means that the separate mental health care annual and lifetime maximums do not apply to treatment of a serious
mental illness.

Currently, these conditions are defined as “serious mental illnesses” under Texas State law:
   Schizophrenia;
                                          Page 68 of RFP No. 2011-001
                                    RFP FOR MENTAL HEALTH BENEFITS


   Paranoid and other psychotic disorders;
   Bipolar disorders (hypomaniac, manic, depressive, and mixed);
   Major depressive disorders (single episode or recurrent);
   Schizo-affective disorders (bipolar or depressive);
   Pervasive developmental disorders;
   Obsessive-compulsive disorders; and
   Depression in childhood and adolescence.

Benefits covered under this Plan may change in accordance with any changes made to the Texas State law.

                                          Exclusions and Limitations

    The EPO and PPO Medical Plans do not cover:

       Health services and care which are not medically necessary.

       Charges which exceed the Plan’s maximum benefit amounts.

       Expenses for inpatient admissions or alternative treatment (residential care, day treatment, partial day
        care) not authorized by the Utilization Review Manager or MHN.

       Care for which other coverage is required by Federal, State or Local Law to be purchased or provided
        through other arrangements including Workman’s Compensation, no fault auto insurance or similar
        legislation.

       Services provided for the care or treatment of any work-related injury or illness.

       Care for which you are not legally obligated to pay or charges made only because you have coverage under
        this Plan.

       Free services, free supplies, and charges covered by Medicare.

       Care or services you receive before Plan coverage begins or after it ends.

       Care that the Utilization Review Manager or MHN considers not to be medically necessary or appropriate
        for your condition.

       Care for family members who do not meet the Plan’s “dependent” definition.

       Care provided or paid for by federal government or its agencies; except for care provided by:
         the United States Veterans Administration, for a veteran with a disability which is not service-
            connected;
         a United States military hospital or facility, for a retiree (or dependent of a retiree) from the armed
            services;
         Care, treatment, services or supplies provided or paid for by any other governmental plan or law not

                                         Page 69 of RFP No. 2011-001
                                RFP FOR MENTAL HEALTH BENEFITS


        restricted to the government’s civilian employees and their dependents; or
       Medicaid.

   Care for an illness or injury which results from an act of declared or undeclared war or armed aggression.

   Care for an illness or injury incurred while on active duty or training in the Armed Forces, National Guard,
    or Reserves of any state or country.

   Services rendered by a physician or provider with the same legal residence as a covered person or who is a
    member of a covered person’s family including spouse, brother, sister, parent or child.

   Acupuncture treatment (except when used as an anesthetic agent for covered surgery), hypnotherapy,
    naturopathy, holistic or homeopathic care, aromatherapy, massage therapy and other forms of alternative
    medicine.

   Anti-smoking treatment or treatment for nicotine addiction.

   Appetite control, food addiction treatment, or eating disorder treatment (except for documented cases of
    bulimia or anorexia that present significant symptomatic medical problems) or any treatment of obesity,
    including surgery for morbid obesity.

   Care and treatment of the teeth and gums, except for oral surgery for tumors or jaw bone injuries and the
    initial stabilization of acute accidental injury to sound natural teeth as described earlier.

   Charges for duplication of medical records or completion of forms.

   Charges for missed or broken appointments.

   Chelation therapies except for acute arsenic, gold, mercury, or lead poisoning.

   Convenience, personal, or comfort items or services for you, your family, caretaker, physician, or other
    medical provider.

   Custodial care, respite care, developmental care, convalescent care, or domiciliary care.

   Devices used specifically as safety items or to affect performances primarily in sports-related activities; all
    expenses related to physical conditioning programs such as athletic training, body-building, exercise,
    fitness, flexibility diversion or general motivation;

   Disposable or consumable outpatient supplies.

   Durable medical equipment expenses over $500 that are not pre-certified by the Utilization Review
    Manager.

   Education, training (unless specifically allowed in the Plan booklet), or development of skills needed to
    cope with an injury or sickness. Examples of services that are not covered by the PEBC medical plans

                                     Page 70 of RFP No. 2011-001
                                RFP FOR MENTAL HEALTH BENEFITS


    include sensory integration, applied behavioral analysis (ABA) therapy, Lovaas therapy and music therapy.

   Elective pregnancy termination (treatment for complications of pregnancy termination is covered).

   Expenses for any drug, device, procedure or treatment that are experimental, investigative, not proven safe
    and effective, or not provided in accord with generally accepted professional medical standards.
    Experimental or investigative expenses are defined as expenses for any drug, device, procedure or
    treatment that requires FDA approval, but for which such approval has not been granted, or expenses for
    any drug, device, procedure or treatment which has been conditionally approved by the FDA for limited
    diagnosis or treatment of conditions other than those for which the member is receiving service, supply or
    treatment.

   Expenses for reports, evaluations, including evaluations for employment, camp, insurance or sports
    participation, court-ordered testing, or examinations that are not medically necessary and not required for
    health reasons.

   Eyeglasses, contact lenses, and any other items or services for vision correction, subject to other Plan
    provisions.

   Fertility services, other than artificial insemination, for conception by artificial means and donor semen and
    donor eggs used for such services. Non-covered services include, but are not limited to, invitro-
    fertilization, ovum and embryo transplants, gamete intrafallopian transfer (“GIFT”), zygote intrafallopian
    transfer (“ZIFT”) and the cost of donor semen. Infertility drug therapies are not covered.

   Health services and associated expenses for cosmetic surgery or procedures including salabrasion, skin
    abrasion, procedures associated with the removal of tattoos or scars.

   Health services or any treatment related to sexual dysfunction, including prescription drugs (such as Viagra)
    and penile implants.

   Hearing aids, batteries, and fitting examinations.

   Orthopedic shoes, orthotics, or other supportive devices for the feet.

   Physical therapy, occupational therapy, or other rehabilitation services that exceed 60 days of treatment
    per episode of care on an inpatient basis, or that exceed 60 visits per calendar year on an outpatient basis.

   Prescription drug products for outpatient treatment except as described under “Prescription Drug Benefits”
    and except for infusion therapy and supplies necessary for therapy provided under the Home Health Care
    benefit.

   Prosthetic appliances not listed in the Plan booklet.

   Radial keratotomy or other radial keratoplasties.

   Reconstructive surgery, except to repair defects which result from surgery while covered under this Plan or

                                     Page 71 of RFP No. 2011-001
                                     RFP FOR MENTAL HEALTH BENEFITS


        for repair of congenital defects or birth abnormalities of newborn children, and except for reconstructive
        surgery for craniofacial abnormalities for dependent children younger than 18 years old covered under the
        Plan, when deemed medically necessary.

       Remedial education and evaluation, behavior training, and employment, vocational, or marriage
        counseling, except as may be covered under the EAP or mental health plan benefits.

       Routine foot care.

       Supplies and equipment not specifically listed in the Plan booklet.

       Surrogate parenting, non-medically necessary amniocentesis or ultrasound including procedures solely to
        determine the gender of a fetus, and reversal of surgical sterilization.

       Transportation (except for ground/air transportation as described in the Plan booklet).

       Transsexual surgery, sex transformations or any treatment or counseling related to this surgery.

       Treatment of adolescent behavior disorders, including conduct disorders and oppositional disorders, except
        as may be covered under the EAP or mental health plan benefits.

       Treatment of mental retardation and mental deficiency.


                      Third Party Payments/Subrogation and Right of Recovery

The Medical Plan will be subrogated to you or your eligible covered dependent's right of recovery against any person or
insurer in connection with injuries sustained by you or your dependent, whether or not the covered injury is the result of
an act or omission of a third party. This plan may exercise this right to the extent of the benefits provided under the plan
connected to those injuries. The Medical Plan will have a right of reimbursement from the proceeds of any full or partial
recovery whether by settlement, judgment, or otherwise for the reimbursement of medical costs paid by the Plan. The
plan’s rights of subrogation and reimbursement are not subject to the “made whole” doctrine and repayment must be
made to the plan even if you or your eligible dependent have not been fully compensated for any loss. Further, the
plan’s rights of subrogation and reimbursement are not subject to the “common fund” doctrine, and repayment to the
plan shall be made without reduction for attorney fees. This subrogation and reimbursement provision includes, but is
not limited to, any recovery from any individual or group automobile or liability insurance policy, including any
uninsured/underinsured motorist coverage and any personal injury protection coverage you or a covered dependent
may have. If the injured person is a minor, any amount recovered by the minor, the minor's trustee, guardian, parent or
other representative shall be subject to this provision regardless of whether the minor's representative has access to or
control of the recovered funds.

If you or a covered dependent is injured because of another party's act or omission, the plan will pay benefits for the
injury only if you and your dependent follow these rules:

        You must not take any action which would prejudice the plan's subrogation rights.


                                          Page 72 of RFP No. 2011-001
                                    RFP FOR MENTAL HEALTH BENEFITS


        You must cooperate in doing what is reasonably necessary to assist the plan in any recovery, including signing
        any documents requested by the plan and furnishing any information as requested by the plan.

If it becomes necessary for the Medical Plan to enforce its rights of subrogation and/or reimbursement by initiating any
action against you or your covered dependent, then you agree to pay the plan’s attorney fees and costs associated with
the action.

Right of Recovery

If for some reason a benefit is paid which is larger than the amount allowed by the plan, the plan has a right to recover
the excess amount from the person or agency that received it. The person receiving benefits must produce any
instruments or papers necessary to ensure this right of recovery, unless prohibited by law.




                                         Page 73 of RFP No. 2011-001
                                  RFP FOR MENTAL HEALTH BENEFITS


APPENDIX B
                           MEDICAL PAID CLAIM AND ENROLLMENT EXPERIENCE

Please see the attached Excel file “RFP MHSA Claims Information” for monthly paid claim and enrollment experience
which includes the information listed below

Note: The fully-insured HMO Plan was discontinued December 31, 2009, with the HMO population transitioned into
the self-funded EPO or PPO Plans effective January 1, 2010.

PEBC Self-funded Medical Plans
By PEBC Employer Group
Self-funded Claims
Employee Census by Month (does not include dependents)
For each calendar year 2007, 2008, 2009, 2010, and Q1 2011 and by Class/Month:
      Medical Claims by Month
      Prescription Drugs by Month
      Mental Health Claims by Month
      Total By Year

HMO Fully-insured Medical Plans
By PEBC Employer Group
Fully-insured Claims (HMO)
By Class and in Total
Employee Census by Month (does not include dependents)
For each calendar year 2007, 2008, 2009 and 2010 Run-out and by Class/Month:
     Medical Claims by Month (includes mental health claims through Magellan)
     Prescription Drugs by Month
     Total By Year

Parker County Only
Parker County joined the PEBC effective January 1, 2010. Claims data is provided in Pre-PEBC and PEBC 2010
format. Before joining the PEBC, the County offered an open-access PPO Plan only with both in-network and out-of-
network benefits via the Texas True Choice network. For purposes of this RFP only, assume the plan design was
comparable to the PEBC plans.

EAP Summary Statistics
Combined all PEBC Employer Groups
For each calendar year 2009 and 2010
Managed Care Census = sum of EPO/PPO Active Employees (see PEBC Self-funded Medical Plans above)
EAP Census 2009 = sum of EPO/PPO Active Employees plus HMO and medical plan OPT-Outs
EAP Census 2010 = sum of EPO/PPO Active Employees plus medical plan OPT-Outs
     EAP Clinical Cases
     EAP Employer Services
     EAP Health and Wellness
     EAP Life management Services
     EAP Clinical Face-to-Face Visits Compared to EAP Cases
     Managed Care Cases Opened (those exceeding EAP Cases)
                                       Page 74 of RFP No. 2011-001
                                   RFP FOR MENTAL HEALTH BENEFITS


        APPENDIX C
                                                      CENSUS

The attached file contains a current PEBC census at April 1, 2011 (Excel format) with the following data elements.


                Data Element                                            Format / Comments

                Column A - Entity Identifier               DC = Dallas County
                                                           DN = Denton County
                                                           PC = Parker County
                                                           TC = Tarrant County
                                                           TW = North Texas Tollway Authority

                Column B - Class                           AC = Active Employee
                                                           UR = Under-age-65 Retiree
                                                           CO = COBRA PQB

                Column C - Date of Birth                   YYYYMMDD

                Column D - Gender                          M = Male
                                                           F = Female

                Column E - Zip Code                        5 digit zip code

                Column F - Plan ID – Medical Plan          EPO = EPO Plan (Self-Funded)
                Selection                                  PPO = PPO Plan (Self-Funded)
                                                           OPT = Opt-Out with Comparable Coverage
                                                                 Through Another Source

                Column G - Coverage Tier Level             1 = Single Coverage
                                                           2 = Single + Spouse
                                                           3 = Single + Child(ren)
                                                           4 = Single + Family



                                           Historical Census Information

In addition to the current de-identified census, enclosed are 5 spreadsheets, one for each PEBC Employer Group,
providing historical census information for the past 5 years (2007 – 2011). Each spreadsheet is a “snapshot” census
providing enrollment counts as of April in the given year. These files begin with the name “App C – Historical
Census” and end with the abbreviation for the PEBC Employer Group name using the abbreviations shown in the
chart above.

                                        Page 75 of RFP No. 2011-001
                                   RFP FOR MENTAL HEALTH BENEFITS


The census information shown is separated using these parameters:
     By Class (Active, COBRA, Pre-age 65 Retirees)
     By Plan (HMO, EPO, PPO, OPT) – the HMO was discontinued effective December 31, 2009
     By Tier (Tier 1, Tier 2, Tier 3, Tier 4)

Each spreadsheet (one per PEBC Employer Group) contains the following worksheet tabs:
     Sequence 1 (Active Employees, COBRA participants, Pre-age 65 Retirees)
     Dependent Counts (does not include the Sequence 1 – but is provided by Tier)
     TOTAL LIVES: the sum of both tabs = total number of lives/membership

If there are any differences in census between the full de-identified census and the “snapshot” counts provided,
they are timing only and can be ignored.




                                        Page 76 of RFP No. 2011-001
                                RFP FOR MENTAL HEALTH BENEFITS


                    Sample File Layout for Ongoing Transfer of Eligibility Information

                              2011
                              PEBC        2011 PEBC    2011 PEBC BRIDGE 2 STANDARD              2011 PEBC BRIDGE 2 STANDARD
FIELD DESCRIPTION           LOCATION       LENGTH              DESCRIPTION                                 VALUES
RECORD-TYPE                    1-1             1      Literal                                  E
MASTER CARRIER CODE             2-5           4       Literal                                  A4 or Spaces

SUB-CARRIER-CODE                6-9           4       Literal                                  “PEB “ or Spaces
EMPLOYEE / RETIREE SSN         10-18          9       Employee / Retiree SSN (Sequence         9 digit numeric
                                                      1 SSN)
Reserved                       19-20          2
FILLER                         21-25          5
SEQUENCE MODIFIER              26-27          2       If accompanies 03 or greater             Alpha/numeric
                                                      sequence codes = Grandchild (GR)
SEQUENCE CODE                  28-29          2       Indicates Employee/Retiree/COBRA         01 = Employee; 02 = Spouse; 03-70
                                                      Member, Spouse or Dependent              = Dependent (seq 03-70 use GR seq
                                                      sequence number. Dependent               mod to indicate grandchild); ESI only
                                                      sequence number cannot be re-used        - 00 = Employee; 99 = Spouse or
                                                      once assigned. See Seq Modifier for      Dep; CMS Only: 01=self;
                                                      grandchildren (GR).                      02=spouse; 03=other
FILLER                         30-30          1       Spaces                                   Spaces
LAST NAME                      31-50         20       Last name                                Alpha
FIRST NAME                     51-60         10       First name                               Alpha
FILLER                         61-65          5       Spaces                                   Spaces
MIDDLE INITIAL                 66-66          1       Middle initial                           Alpha
ADDRESS LINE 1                67-106         40       Employee address                         Alpha Numeric
ADDRESS LINE 2                107-146        40       Employee Address                         Alpha Numeric
CITY                          147-161        15       City                                     Alpha
STATE                         162-163         2       State                                    Alpha - All caps
ZIPCODE                       164-172         9       Zip                                      Numeric (truncates at 5 digit) no
                                                                                               spaces, no dashes
Reserved                       173            1
Reserved                      174-185        12
Reserved                      186-193         8
Reserved                      194-201         8
Reserved                      202-202         1
DATE OF BIRTH                 203-210         8       Date of birth                            Alpha/Numeric - CCYYMMDD

GENDER                        211-211         1       Gender                                   Alpha /Numeric: M=Male; F=Female;
                                                                                               CMS ONLY: 0=unknown, 1=male;
                                                                                               2=female

BENEFIT EFFECTIVE DATE        212-219         8       Benefit coverage effective date is 1st   Alpha/Numeric CCYYMMDD
                                                      day of calendar month following
                                                      eligibility rules. Exception 1:
                                                      Newborns effective date of birth in
                                                      year of birth; Exception 2 Adoption
                                                      (or placed for adoption). This is not
                                                      the hire date. Also used for benefit
                                                      effective date following change of
                                                      status.




                                        Page 77 of RFP No. 2011-001
                               RFP FOR MENTAL HEALTH BENEFITS


BENEFIT END - EXPIRATION     220-227        8     Benefit coverage always ends last           Alpha/Numeric CCYYMMDD
DATE                                              day of calendar month. This is not
                                                  the employment termination date.
                                                  CMS ONLY: If coverage ongoing -
                                                  must populate with 99999999
Reserved                     228-235        8
COMPANY INDICATOR (1/1/05)   236-236        1     1 = Dallas County                           Alpha Numeric
                                                  2 = Tarrant County
                                                  3 = NTTA
                                                  4 = Denton County
                                                  5 = Unassigned
                                                  6 = Parker County

FILLER                       237-242        6     Spaces                                      Spaces
STATUS CODE                  243-244        2     AC = Active Employee                        Alpha
                                                  UR = Under age 65 Retiree
                                                  RT = Age 65 + Retiree
                                                  CO = COBRA Member

PLAN ID                      245-247        3     Medical Plans -EPO, PPO, OPT;
                                                  PSS; PSD; PMA; PMD
                                                  Dental Plans - ANT, PEB
                                                  Flex Plans - FXM, FXD, ERM, ERD,
                                                  FXW
                                                  Life - GLF, TLF, DGL
                                                  Note - not all plans are available to all
                                                  groups/classes
                                                  Vision - VIS

HICN                         248-259        12    CMS Only - populate all spaces              Spaces
                                                  required
FILLER                       260-262        3     Spaces                                      Spaces
Reserved                     263-264        2     "01" refers to "dependent or spouse"        Numeric (ESI)
                                                  coverage
FILLER                       265-266        2     ESI REQUIREMENT                             Spaces
FILLER                       267-304        38    Spaces                                      Spaces
Reserved                     305-307        3
Reserved                     308-327        20
Reserved                     328-337        10
Reserved                     338-338        1
Reserved                     339-345        7
Reserved                     346-352        7
FILLER                       353-383        31    Spaces                                      Spaces
Reserved                     382-388        7
Reserved                     391-399        9
FILLER                                            Spaces                                      Spaces
Reserved                     400-400        1
DEPENDENT SSN                401-409        9     Dependent SSN                               Numeric
MH ONLY; GROUP-CODE          410-415        6     Literal or Spaces                           PPO, EPO=004542; ELSE =004624

MH ONLY; PLAN GROUP          416-418        3     Literal or Spaces                           EPO = W44
                                                                                              PPO = W45
                                                                                              ELSE = 00X




                                       Page 78 of RFP No. 2011-001
                                    RFP FOR MENTAL HEALTH BENEFITS


MH ONLY; SUB GROUP                419-421        3     Literal or Spaces                       Dallas County:AC=001, RT=801,
                                                                                               UR=805, CO=901;
                                                                                               Tarrant County:AC=002, RT=802,
                                                                                               UR=806, CO=902;
                                                                                               NTTA:AC=003, RT=803, UR=807,
                                                                                               CO=903;
                                                                                               Denton County: AC=004, RT=804;
                                                                                               UR=808; CO=904;
                                                                                               Frisco: AC=005, RT=809, UR=810,
                                                                                               CO=905

MULTIPLE GROUP INDICATOR          422-423        2     TC = Tarrant County                     Alpha
                                                       DC = Dallas County
                                                       DN = Denton County
                                                       TW = North Texas Tollway Authority
                                                       PC = Parker County

CLERICAL-ERROR                    424-424        1     Y or Space - If populated, indicates    Alpha
                                                       the record should not have been sent
                                                       in the first place. Benefit effective
                                                       date and expiration date will = each
                                                       other. DO NOT PROCESS AS A
                                                       TERMINATED RECORD.

RETIREE TIER MODIFIER             425-426        2     Identifies correct Retiree premium.     Alpha, Numeric
                                                       See Retiree Modifier chart.

COBRA-FLAG                        427-427        1     Indicates individual is covered as      “Y” indicates COBRA; Spaces= Not
                                                       COBRA UDC                               Cobra
HOME-PHONE                        428-437        10    Home telephone number (ACTIVE           10 digit numeric; area code and
                                                       FIELD)                                  number
FILLER                              1            1     Spaces                                  Spaces
Reserved                          438-446        9
TIER-LEVEL                        448-449        2     Tier 01 = Subscriber (single)           Numeric; 01, 02, 03, 04
                                                       Tier 02 = Subscriber + Spouse
                                                       Tier 03 = Subscriber + Child(ren)
                                                       Tier 04 = Subscriber + Family

FILLER                            450-457        8                                             Date rate effective
FILLER                            458-462        5                                             Active, Retiree, COBRA
QMCSO-FLAG                        463-463        1     Y indicates sequence 3 or higher        Alpha
                                                       Medical Support Order.

ORIGINAL HIRE DATE (If retiree    464-471        8     CCYYMMDD-the actual hire date of        Alpha/Numeric CCYYMMDD
or COBRA - first coverage date)                        the Employee

Reserved                          472-479        8
Reserved                          480-491        12
Reserved                          492-492        1
MARITAL STATUS                    493-493        1     I = Single;                             Alpha
                                                       M = Married;
                                                       U = Unmarried/Unknown
Reserved                          494-494        1
SPONSORED/SURVIVING               495-495        1     Y or N                                  Alpha
SPOUSE/DEPENDENT FLAG

SSN ORIGINAL RETIREE OR           496-504        9     Must be populated if location 495       Numeric
EMPLOYEE OF                                            populated with Y
SPONSORED/SURVIVING
SPOUSE/DEPENDENT

Reserved                          505-513        9
Reserved                          514-522        9

                                            Page 79 of RFP No. 2011-001
                           RFP FOR MENTAL HEALTH BENEFITS


EMPLOYMENT TERMINATION   523-530        8     Date employment ends (not date    Alpha/Numeric CCYYMMDD
DATE                                          benefits end)
Reserved                  531           1
Reserved                 532-538        7
FILLER                   539-540        2     Spaces                            Spaces

Reserved                 541-547        7
Reserved                 548-549        2
Reserved                 550-556        7
Filler                    557           1     Spaces                            Spaces
Reserved                 558-565        8
Reserved                 566-573        8
Reserved                 574-581        8
FILE SENT DATE           582-589        8     Date record sent to PEBC Vendor   Alpha/Numeric CCYYMMDD
                                              (Bridge 2 & 4)
Reserved                 590-597        8

Reserved                 598-599        2
TRAILER                   600           1                                       “X”
TOTAL                                  600




                                   Page 80 of RFP No. 2011-001
                                  RFP FOR MENTAL HEALTH BENEFITS


APPENDIX D
                                         LETTER OF UNDERSTANDING
                                                  Between
                                                [Vendor] and
                                        [Each Specific PEBC Employer Group]

WHEREAS, this Letter of Understanding (“LOU”) is by and between [Vendor Name “Vendor”] and [PEBC
Employer Group “Group”], as a member of the Public Employee Benefits Cooperative of North Texas
(“PEBC”); and

WHEREAS, Vendor and the Group (collectively, the “Parties”) have determined to enter into an
Administrative Service Agreement (the “Agreement”) effective January 1, 2012 (the “Effective Date”) for the
Vendor to provide behavioral health administrative, network management, disease management and
utilization review services for the Group’s EPO and PPO Medical Plans (“the Plans”), which are self-funded
non-federal governmental plans not subject to the provisions of the Employee Retirement Security Act of
1974 (“ERISA”) as amended; and

WHEREAS, Vendor and the Group have determined to enter into an Agreement for provision of an Employee
Assistance Plan (EAP); and

WHEREAS, Vendor and the Group agree and understand that the Agreement will incorporate the Request for
Proposal (“RFP”) dated May 11, 2011, Vendor’s response to the RFP (including clarifying information provided
as part of the RFP process), and the required provisions set forth under Section 2 of the RFP dated May 11,
2010; and

WHEREAS, the Parties agree and understand that the purpose of this Letter of Understanding (LOU) is to
confirm that the services described in the RFP (including the terms and conditions of those services) timely
commence; and, further, that the Group shall approve and pay administrative fees as shown below and fund
claims in accordance with its internal approval process, until such time the Agreement is finalized and at
which time the provisions of the Agreement shall prevail; and

WHEREAS, pursuant to the RFP, until the Agreement is executed, the Parties agree and understand that the
RFP and the Vendor’s RFP response will serve as the Parties’ agreement and understanding regarding the
terms and conditions of the behavioral health administrative, network management, disease management,
and utilization review services for the Group’s self-funded medical plans; and further, shall be binding on the
Parties effective January 1, 2012; and

WHEREAS, the Parties agree and understand that this LOU is not intended to capture each of the terms to be
included in the final Agreement; and

WHEREAS, pursuant to the terms of the RFP, the Parties agree and understand that this LOU is not intended
by the Parties, nor does it, change the services, or the terms or conditions of those services as set forth in the
RFP, the Vendor’s response to the RFP (including other clarifying information provided as part of the RFP
                                       Page 81 of RFP No. 2011-001
                                 RFP FOR MENTAL HEALTH BENEFITS


process); and

WHEREAS, the Group appoints the Public Employee Benefits Cooperative of North Texas (“PEBC”) as Plan
Administrator, to serve as an agent of Group and authorized to act on behalf of Group in all aspects of plan
administration, including eligibility reporting, data management and transfer, billing, plan design, plan
management and operations, performance and savings guarantees, HIPAA privacy and security matters, and
other matters as required, except that the PEBC does not serve as a fiduciary of Group; and

WHEREAS, Exhibit A – Business Associate Addendum To Letter of Understanding is made a part of this LOU
and incorporated herein, ensuring compliance with the provisions of HIPAA, and allowing Vendor to release
Protected Health Information (“PHI”) to the PEBC per the terms of the Business Associate Addendum; and

WHEREAS, the Parties agree and understand that subsequent to this LOU being executed, the Parties will
continue in good faith to expedite, and to take such steps as necessary to enter into a signed Agreement;

NOW, THEREFORE, it is agreed that:

The Parties agree to the provisions described herein. Once the Agreement is negotiated and signed, all duties
required in this LOU terminate.

Mental Health/Substance Abuse Managed Care Administrative fees effective January 1, 2012 are:

EAP premium effective January 1, 2012 is:

The Parties agree to enter into this LOU as set forth herein, effective as of January 1, 2012.


The undersigned parties hereto have caused this Letter of Understanding to be executed in multiple originals
by their duly authorized officers, to be effective January 1, 2012.
Group                                             Vendor



 Authorized Signature                               Authorized Signature

 Print Name:                                        Print Name:


 Print Title:                                       Print Title:

 Date:                                              Date:


                                     Page 82 of RFP No. 2011-001
                                 RFP FOR MENTAL HEALTH BENEFITS


APPENDIX E
                                     BUSINESS ASSOCIATE AGREEMENT

      I. Definitions

      (a)     Business Associate. “Business Associate” shall mean [Vendor].

      (b)     Plan Sponsor. “Plan Sponsor” shall mean the [PEBC Employer Group].

      (c)     Individual. “Individual” shall have the same meaning as the term “individual” in 45 CFR 164.501 and
              shall include a person who qualifies as a personal representative in accordance with 45 CFR 164.502(g).

      (d)     Privacy and Security Rules. “Privacy Rule” shall mean the Standards for Privacy of Individually
              Identifiable Health Information at 45 CFR part 160 and part 164, subparts A and E. “Security Rule” shall
              mean the Security Standards for the Protection of Electronic Protected Health Information at 45 CFR
              part 64, subpart C.

      (e)     Protected Health Information. “Protected Health Information”, or “PHI” shall have the same meaning as
              the term ``protected health information'' in 45 CFR 160.103, limited to the information created or
              received by the Business Associate from or on behalf of the Plan.

      (f)     Required By Law. “Required By Law” shall have the same meaning as the term “required by law” in 45
              CFR 164.501.

      (g)     Secretary. “Secretary” shall mean the Secretary of the Department of Health and Human Services or his
              designee.

      (h)     Plan. “Plan” shall mean the applicable component of the [PEBC Employer Group] Self-funded Medical
              Plans for which [Vendor] provides administrative services, which is/are a Covered Entity(ies) subject to
              the Privacy and Security Rules, and the Breach Notification Rules.

      (i)     PEBC. “PEBC” shall mean the Public Employees Benefits Cooperative of North Texas, which acts as an
              agent of the Plan Sponsor as administrator of the Plan.

      (j)     Security Incident. “Security Incident” means the attempted or successful unauthorized access, use,
              disclosure, modification, or destruction of information or interference with system operations in an
              information system, as defined in §164.304 of the Security Rule.

      (k)     Administrative Safeguards. “Administrative Safeguards” are administrative actions, and policies and
              procedures, to manage the selection, development, implementation, and maintenance of security
              measures to protect electronic protected health information and to manage the conduct of the covered
              entity’s workforce in relation to the protection of that information.

      (l)     Physical Safeguards. “Physical Safeguards” are physical measures, policies, and procedures to protect a
              covered entity’s electronic information systems and related buildings and equipment, from nature and
              environmental hazards, and unauthorized intrusion.

                                      Page 83 of RFP No. 2011-001
                            RFP FOR MENTAL HEALTH BENEFITS



(m)     Technical Safeguards. “Technical Safeguards” means the technology and the policy and procedures for
        its use that protect electronic protected health information and control access to it.

(n)     Electronic Protected Health Information. “Electronic Protected Health Information” is protected health
        information that is (i) transmitted by electronic media; or (ii) maintained in electronic media.

(o)     Breach Notification Rules. “Breach Notification Rules” shall mean the Standards for Notification in the
        Case of Breach of Unsecured Protected Health Information at 45 CFR part 164 subpart D.

II. Obligations and Activities of Business Associate

(a)     Business Associate agrees to not use or disclose Protected Health Information other than as permitted
        or required by this BA Agreement, the Administrative Services Agreement (the Agreement) or as
        Required By Law.

(b)     Business Associate acknowledges that it is obligated to comply with the standards set forth in
        §§164.502(e) and 164.504(e) of the Privacy Rule in the same manner that such sections apply to the
        Plan. Business Associate further acknowledges that §§164.308, 164.310, 164.312, and 164.316 of the
        Security Rule apply to the Business Associate in the same manner that such sections apply to the Plan.

(c)     Business Associate hereby represents that any Protected Health Information it shall seek from the Plan
        shall be the minimum necessary, as set forth in the Privacy Rule, for the Business Associate’s stated
        purposes in its agreements with the Plan Sponsor and acknowledges that the Plan shall rely upon such
        representation with respect to any request by the Business Associate for PHI.

(d)     With respect to the use, disclosure, or request of Protected Health Information, Business Associate shall
        limit such PHI, to the extent practicable, to the limited data set as defined in 45 CFR §164.514(e)(2), or if
        needed, to the minimum necessary to accomplish the intended purpose of such use, disclosure, or
        request, respectively.

(e)     Business Associate agrees to use appropriate safeguards to prevent use or disclosure of the Protected
        Health Information other than as provided for by this Agreement. Business Associate further agrees to
        implement appropriate administrative, physical and technical safeguards that reasonably and
        appropriately protect the confidentiality, integrity, and availability of Electronic Protected Health
        Information that it creates, receives, maintains, or transmits on behalf of Plan Sponsor. Such safeguards
        are to be consistent with the safeguards described in the Security Rule at §§164.308 through 164.312.

(f)     Business Associate agrees to mitigate, to the extent practicable, any harmful effect that is known to
        Business Associate of a use or disclosure of Protected Health Information by Business Associate in
        violation of the requirements of this BA Agreement.

(g)     Business Associate agrees to report to the Plan Sponsor and the PEBC, on behalf of the Plan, any use or
        disclosure of Protected Health Information not provided for by this BA Agreement of which it becomes
        aware. Business Associate agrees to report to the Plan Sponsor and the PEBC, on behalf of the Plan
        Sponsor, any Security Incident of which it becomes aware, except that for the purposes of this
        Agreement a Security Incident shall not include any “scans” or “pings” that are stopped by the Business
                                  Page 84 of RFP No. 2011-001
                          RFP FOR MENTAL HEALTH BENEFITS


      Associate’s firewall. Business Associate shall notify the Plan Sponsor and the PEBC:

      (1)     Promptly and without unreasonable delay upon the Business Associate’s becoming aware of
              any use or disclosure of the Plan’s PHI or ePHI, not provided for by this Agreement or otherwise
              required by law, or

      (2)     Promptly and without unreasonable delay, but in no event more than forty-eight (48) hours of
              confirming any Security Incident involving the Plan’s ePHI.

(h)   Business Associate agrees to ensure that any agent, including a subcontractor, to whom it provides
      Protected Health Information received from, or created or received by Business Associate on behalf of
      the Plan, agrees to the same restrictions and conditions that apply through this BA Agreement to
      Business Associate with respect to such information. Business Associate shall further ensure that any
      such agent or subcontractor to whom Business Associate provides any such ePHI agrees in writing to
      implement reasonable and appropriate safeguards to protect such information; such safeguards are to
      be consistent with the safeguards described in the Security Rules at §§164.304 through 164.316.

(i)   Business Associate agrees to provide access, at the request of the Plan, and in a timely manner, to
      Protected Health Information in a Designated Record Set, including access to and transmission of PHI
      that is used or maintained as an electronic health record, to the Plan; to a representative of the Plan,
      including the PEBC or the Plan Sponsor, as directed by the Plan; or to an Individual in order to meet the
      requirements under 45 CFR 164.524, as amended.

(j)   Business Associate agrees to make any amendment(s) to Protected Health Information in a Designated
      Record Set that the Plan directs or agrees to pursuant to 45 CFR 164.526, as amended, at the request of
      the Plan or an Individual, and in a timely manner.

(k)   Business Associate agrees to restrict disclosures of PHI, at the request of the Plan or an individual, and
      in a manner designated by the Plan, in a timely manner, in accordance with §164.522 of the Privacy
      Rule, as amended, when the Plan or the individual notifies the Business Associate of the request.

(l)   Business Associate agrees to make internal practices, books, and records, including policies and
      procedures, documentation of safeguards, and Protected Health Information, relating to the use and
      disclosure of Protected Health Information received from, or created or received by Business Associate
      on behalf of, the Plan available to the Plan, or to the Plan’s designated representative, including the
      PEBC, or to the Secretary, in a timely manner or as otherwise designated by the Secretary, for purposes
      of the Secretary determining the Plan’s compliance with the Privacy and Security Rules.

(m)   Business Associate agrees to document such disclosures of Protected Health Information and
      information related to such disclosures as would be required for the Plan to respond to a request by an
      Individual for an accounting of disclosures of Protected Health Information in accordance with 45 CFR
      164.528, as amended.

(n)   Business Associate agrees to provide to Plan, or its representative as directed by the Plan, including the
      PEBC, or an Individual, in a timely manner, information collected in accordance with Section II.m. of this
      BA Agreement during the six (6) years preceding the date of the request, or three (3) years with respect
      to a request for an accounting of payment, treatment or health care operations (except for disclosures
                               Page 85 of RFP No. 2011-001
                          RFP FOR MENTAL HEALTH BENEFITS


      occurring before the effective date of this Agreement), to permit the Plan to respond to a request by an
      Individual for an accounting of disclosures of Protected Health Information in accordance with 45 CFR
      164.528, as amended, including with respect to an accounting of disclosures through an electronic
      health record.

(o)   Following the discovery of a Breach of unsecured PHI, Business Associate shall notify the Plan and the
      PEBC of such Breach. The term “Breach” has the meaning set forth in 45 CFR §164.402.

      (1) A Breach shall be treated as discovered by the Business Associate as of the first day on which such
          Breach is known to the Business Associate or, by exercising reasonable diligence, would have been
          known to Business Associate. Business Associate shall be deemed to have knowledge of a Breach if
          the Breach is known, or by exercising reasonable diligence would have been known, to any person,
          other than the person committing the Breach, who is an employee, officer, or other agent of
          Business Associate.

      (2) Except as otherwise provided for in the Breach Notification Rules, Business Associate shall provide
          the notification to the Plan and the PEBC promptly and without unreasonable delay; provided,
          however, that in no case shall the notification be made later than ten (10) calendar days after the
          discovery of a Breach. The notification shall include, to the extent possible, the following
          information:

          (i) identification of each individual whose unsecured PHI has been, or is reasonably believed by
               Business Associate to have been, accessed, acquired, used or disclosed during the Breach;

          (ii) the date of discovery of the Breach;

          (iii) description of the information Breached;

          (iv) any steps the individuals should take to protect themselves;

          (v) the steps Business Associate (or its agent) is taking to investigate the Breach, mitigate losses,
              and protect against future Breaches; and

          (vi) a contact person and telephone number for more information.

      (3) At the same time that Business Associate notifies the Plan and the PEBC of the Breach, or as
          promptly thereafter as information becomes available to Business Associate, Business Associate
          shall provide the Plan with any other available information that the Plan is required to include in its
          notification to the individual.

      (4) If requested by the Plan or the PEBC, Business Associate shall, in accordance with §164.404 of the
          Breach Notification Rules, notify the individuals whose PHI was involved in the Breach, or shall
          reimburse the Plan for any costs associated with the Plan making such notifications.

(p)   Business Associate shall not receive, directly or indirectly, any remuneration in exchange for any PHI of
      an individual, unless Business Associate has obtained from the individual, in accordance with §164.508
      of the Privacy Rule, a valid authorization that includes a specification that the PHI can be further
                               Page 86 of RFP No. 2011-001
                            RFP FOR MENTAL HEALTH BENEFITS


        exchanged for remuneration by the entity receiving the PHI of that individual.

III. Permitted Uses and Disclosures by Business Associate

A. General Use and Disclosure Provisions

Except as otherwise limited in this BA Agreement, Business Associate may use or disclose Protected Health
Information to perform functions, activities, or services for, or on behalf of, the Plan as specified in the
Agreement with the Plan Sponsor, provided that such use or disclosure would not violate the Privacy and
Security Rules if done by the Plan or the minimum necessary policies and procedures of the Plan.

B. Specific Use and Disclosure Provisions

(a)     Except as otherwise limited in this BA Agreement, Business Associate may use Protected Health
        Information for the proper management and administration of the Business Associate or to carry out
        the legal responsibilities of the Business Associate.

(b)     Except as otherwise limited in this BA Agreement, Business Associate may disclose Protected Health
        Information for the proper management and administration of the Business Associate, provided that
        such disclosures are Required By Law, or Business Associate obtains reasonable assurances from the
        person to whom the information is disclosed that it will remain confidential and used or further
        disclosed only as Required By Law or for the purpose for which it was disclosed to the person, and the
        person notifies the Business Associate of any instances of which it is aware in which the confidentiality
        of the information has been breached.

(c)     Except as otherwise limited in this BA Agreement, Business Associate may use Protected Health
        Information to provide Data Aggregation services relating to the health care operations of the Plan as
        permitted by 45 CFR 164.504(e)(2)(i)(B).

(d)     Business Associate may use Protected Health Information to report violations of law to appropriate
        Federal and State authorities, consistent with 45 CFR 164.502(j)(1).

IV. Obligations of Plan and Plan Sponsor

(a)     Plan Sponsor, on behalf of the Plan, shall notify Business Associate of any limitation(s) in its notice of
        privacy practices of the Plan in accordance with 45 CFR 164.520, to the extent that such limitation may
        affect Business Associate's use or disclosure of Protected Health Information. The Plan may meet this
        obligation by providing Business Associate with a copy of the Notice of Privacy Practices which the Plan
        produces in accordance with the Privacy Rule.

(b)     Plan Sponsor, on behalf of the Plan, shall notify Business Associate of any changes in, or revocation of,
        permission by Individual to use or disclose Protected Health Information, to the extent that such
        changes may affect Business Associate's use or disclosure of Protected Health Information.

(c)     Plan Sponsor, on behalf of the Plan, shall notify Business Associate of any restriction to the use or
        disclosure of Protected Health Information that the Plan has agreed to in accordance with 45 CFR
        164.522, to the extent that such restriction may affect Business Associate's use or disclosure of
                                 Page 87 of RFP No. 2011-001
                             RFP FOR MENTAL HEALTH BENEFITS


        Protected Health Information.

V. Permissible Requests by the Plan

The Plan shall not request Business Associate to use or disclose Protected Health Information in any manner
that would not be permissible under the Privacy and Security Rules if done by the Plan, except that Business
Associate may use and disclose protected health information for data aggregation and management and
administrative activities of Business Associate as provided herein.

VI. Term and Termination

(a)     Term. The Term of this BA Agreement shall be effective as of June 30, 2011, and shall terminate upon
        the later of (1) the termination of the Agreement; or (2) when all of the Protected Health Information
        provided by the Plan or Plan Sponsor to Business Associate, or created or received by Business
        Associate on behalf of the Plan, is destroyed or returned to the Plan or its representative, or, if it is
        infeasible to return or destroy Protected Health Information, protections are extended to such
        information, in accordance with the termination provisions in this Section.

(b)     Termination for Cause. Upon the Plan’s or Plan Sponsor's knowledge of a material breach by Business
        Associate, the Plan Sponsor, on behalf of the Plan, shall either:

        (1)     Provide an opportunity for Business Associate to cure the breach or end the violation and
              terminate this BA Agreement and the Agreement if Business Associate does not cure the breach or
              end the violation within the time specified by Plan Sponsor;

        (2) Immediately terminate this BA Agreement and the Agreement if Business Associate has breached a
            material term of this BA Agreement and cure is not possible; or

        (3) If neither termination nor cure is feasible, Plan Sponsor, on behalf of the Plan, shall report the
            violation to the Secretary.

(c)     Business Associate shall have the same obligations as the Plan, as provided for in Section VI (b) above,
        with respect to a material breach by the Plan.

(d)     Effect of Termination.

        (1) Except as provided in paragraph (2) of this section, upon termination of this BA Agreement or the
            Agreement, for any reason, Business Associate shall return to the Plan or its designated
            representative or destroy all Protected Health Information received from the Plan or the Plan
            Sponsor, or created or received by Business Associate on behalf of the Plan. This provision shall
            apply to Protected Health Information that is in the possession of subcontractors or agents of
            Business Associate. Business Associate shall retain no copies of the Protected Health Information.

        (2) In the event that Business Associate determines that returning or destroying the Protected Health
            Information is infeasible, Business Associate shall provide to the Plan notification of the conditions
            that make return or destruction infeasible. Business Associate shall extend the protections of this
            BA Agreement to such Protected Health Information and limit further uses and disclosures of such
                                 Page 88 of RFP No. 2011-001
                          RFP FOR MENTAL HEALTH BENEFITS


           Protected Health Information to those purposes that make the return or destruction infeasible, for
           so long as Business Associate maintains such Protected Health Information.

VII. Miscellaneous

(a)    Regulatory References. A reference in this BA Agreement to a section in the Privacy and Security Rules,
       or to the Breach Notification Rules, means the section as in effect or as amended.

(b)    Amendment. The Parties agree to take such action as is necessary to amend this BA Agreement from
       time to time as is necessary for the Plan to comply with the requirements of the Privacy and Security
       Rules under the the Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191, as
       amended, and the Health Information Technology for Economic and Clinical Health Act, part of the
       American Recovery and Reinvestment Act of 2009 (Pub. L. 111-5).

(c)    Survival. The respective rights and obligations of Business Associate under Section VI.(d) of this BA
       Agreement shall survive the termination of this BA Agreement.

(d)    Interpretation. Any ambiguity in this BA Agreement shall be resolved to permit the Plan to comply with
       the Privacy and Security Rules, and the Breach Notification Rules. The terms and conditions of this BA
       Agreement shall override and control any conflicting terms and conditions in any agreement between
       parties related to the Privacy and Security of PHI or ePHI.

(e)    Relationship of the Parties. The relationship between the Plan and Business Associate is that of
       independent contracting entities. Neither party is the agent or representative of the other, nor shall
       either party be liable for the acts or omissions of the other, its agents, or its employees.




                               Page 89 of RFP No. 2011-001

				
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