DATE: April 10, 2006
TO: All Vendors
FROM: Ruth Gray, Buyer
State Purchasing Bureau
RE: Questions and Answers for RFP Number 1270Z1
to be opened May 24, 2006
Following are the questions submitted and answers provided for the above mentioned
Request For Proposal. The questions and answers are to be considered as part of the
Request For Proposal.
1. Need new census, in excel or text format, The RFP has been amended to include a
with DOB, Gender, Zip Codes, Coverage revised Attachment 13.
Tier, Health Plan breakout (if more than
2. Can we get a large claims file? Or are These are the large claims files the State has
the 3 claims files (1 from Mutual of received from BCBSNE and Mutual of Omaha.
Omaha and 2 from BCBS) all we‟re going No other files are available.
3. Section M, page 30 of the RFP says we Bidder may either save the RFP document in
need to photocopy the question, not Word and type the response underneath the
retype it. We‟re not sure what that question or may photocopy the questions and
means. Can we simply type our type or handwrite the responses underneath
response in Word format underneath the the questions.
4. If you have a Table of Contents for how Proposal response structure should mirror that
you‟d like your binders to be set up of the RFP.
please share it with us.
5. Please describe the process to fund the As indicated on page 40, Section C, Item 2;
initial claims. Is Contractor expected to “…The State shall have a minimum of three (3)
pay the claims initially and submit a business days to pay contractor after receipt
report of claims for reimbursement? and approval of the invoice…”, therefore the
contractor will initially be expected to fund the
6. Please confirm that proposals should be Please reference Section II. Procurement
sent to State of Nebraska Purchasing Procedures, G. Submission of Proposals for
Bureau, Attn: Ruth Gray, 301 Centennial instructions on submitting a proposal
Mall South, Mall Level, Lincoln, NE response.
7. Are the State of Nebraska‟s health plans Since the State‟s health plans are self-insured,
considered ERISA plans or exempt from the State is subject to ERISA, but also follow
State laws? State statutes regarding health insurance.
8. Employee Census: Is a complete census See answer to question #1.
available listing Date of Birth, Gender,
Zip code, and dependent enrollment
status (i.e. Employee, Employee + 1,
Employee + Children, Family, etc.) by
vendor (BCBS or Mutual of Omaha) and
plan type (PPO, POS, and HMO)?
9. Large Claim Information: The Large Blue Select = HMO product.
Claim information from BCBS appears to
Blue Choice = POS product.
be for two separate plans/groups. What
is the difference between these
10. Employee/Employer Contributions: What By statute the employee pays 21% of the
are the current employee contribution premium and the State pays 79%.
amounts, by vendor (BCBS or Mutual of
The RFP has been amended to include
Omaha/plan (PPO, POS, HMO)? How
Attachment 27 for current health plan
will the State determine the "premium
equivalent" for vendors plans in order to
set the employer/employee contribution The State‟s contracted actuarial consultant will
levels in a self-funded environment? assist in determining the “premium equivalent”
for vendor plans self-funded by the State.
11. Blue Select Guide to Health Benefits Provider.
(Attachment 6): Page 15- Notification
and certification Requirements section
states, “If you fail to provide notification of
the admission, allowable charges for all
covered services associated with that
stay may be reduced by 25%.Benefits for
all services which are determined to be
not medically necessary will be denied. If
this is an HMO who will be responsible
for the penalty? Provider or Member?
12. PPO Booklet (Attachment 8): Page 31- The State will cover childhood immunizations
Deductible section under Exceptions through age six.
States Waiver of the Deductible: The
Deductible is waived for Covered
Services in connection with: services for
Childhood Immunization for eligible
dependent children through age six. On
the Schedule of benefits it states Child
immunizations (under age 6). Please
confirm if it is under or through age six.
13. Glossary of Terms: Primary Care No.
Physician (PCP): Regarding the
following sentence: “in a managed care
organization, a primary care physician is
accountable for the health services of
enrollees including referrals, procedures
and hospitalization?” Can this be
changed from “is accountable” to “may be
accountable” since many carriers no
longer have gatekeeper requirements?
14. Glossary of Terms: Primary Care No.
Physician (PCP): Can the term
“generalist” be defined by specific
specialties to ensure that all responders
are including the same practice types in
15. Glossary of Terms: Specialist: No.
Regarding the following sentence: “Most
managed care plans require members to
get a referral from their primary care
physician before seeing a specialist.”
Can this be changed to “many managed
care plans require…” since many carriers
no longer have gatekeeper
16. Glossary of Terms: Specialist: Can the No.
definition for the term “specialist” be
defined by specific practice types to
ensure that all responders are including
the same practice types in response
17. Mandatory Contract Provisions: Item L. The State will not evaluate deviations from the
State of Nebraska Personnel Recruitment RFP specifications during the Question and
Prohibition: Is it possible to limit this by Answer period.
time? Example, within 10 years, „at any
time‟ seems really broad.
18. Mandatory Contract Provisions: Item Unit price shall mean the per employee per
MM: Changes in Scope/Change Orders: month ASO fee bid by the bidder.
Please define “unit price.”
19. Mandatory Contract Provisions: Item The State intends that there will be no
OO. Limitation of Liability. Please limitation.
elaborate on the intention of this clause.
20. Project Description and Scope of Work: The State does not fully understand the
Item E. Subrogation: Please clarify that question and therefore can not provide an
the State of Nebraska doesn‟t intend answer.
Contractors to be filing suit.
21. Project Description and Scope of Work: Yes.
Item I. Administration Transition.
Number 2: Can the word “returned” be
changed to “provided?” Carriers will be
required to maintain records sufficient to
satisfy Department of Insurance auditors
and other legal responsibilities.
22. Project Description and Scope of Work: The RFP is amended to include Attachment
Item K. Administration Provider Network: 28. Bidder must complete this attachment and
Number 2.a. For purposes of this return with response for each proposed
question, can the question list specific network.
provider types to be included in the ratio?
23. Provider Network: Item K 2 a. - Please Definition of a Primary Care Physician is
define Primary Care physicians- What provided on page ix of the “Glossary of
specialties are included? Terms”.
24. Provider Network: Item K 3 d. - Please Medical facilities are to include, but not limited
define other medical facilities, other than to hospitals, surgical, specialty, rehabilitation
acute care? hospitals as well as skilled nursing facilities.
25. Reimbursement: What time-frame 24 months.
should be used for the claim detail for the
discount and reimbursement data?
26. Reimbursement: Should carriers report Contracted amount.
"net" or "contracted rate" discounts and
rates? An example would be if the
provider's charge is $1000 and the
contracted rate is $600 and member
coinsurance is $100. Do carriers report
the $600 contracted rate which equates
to a 40% discount, or do carriers report
$500 ($600-$100) or a 50% discount,
which is "net" of member liability?
27. We are requesting a complete census. See answer to question #1.
The census should include the
following employee specific items: (1)
year of birth or age, (2) 5-digit zip code,
(3) coverage (tier) election, (4) plan
election, (5) gender, and (6)
active/cobra/retiree status and eligible
status. Census should be provided in an
28. We are requesting experience The State is not able to obtain this information
information including a minimum of two at this time.
years of monthly enrollment and claims,
on a paid basis, by plan and total.
29. In addition to the experience information, See answer to questions # 28.
is information available on draft or check
counts, or if unavailable, number of
transactions or claim handlings (please
included definition of transactions or
30. On page 10 of the RFP, Section F. The State will not enter into a contract which
Contingent Fees, we would like to clarify requires payment of a contingent fee, or is
this requirement to make sure we have a reasonably anticipated to result in the payment
clear understanding of the State's of a contingent fee of any kind whatsoever.
requirements. It would appear the State The State expects any administrative fees for
is requiring all administrative fees to be this service to be included in the bidder‟s per
charged on a per employee per month employee per month ASO fee. The State is
basis? Does that preclude a carrier from unable to respond to any hypothetical
offering programs that may provide situations. The State will not evaluate
savings where fees could be charged on deviations from the RFP specifications during
a percent of claims savings basis or on a the Question and Answer period.
per claim basis based on number of
claims that benefited from the program?
Two examples follow: A. If a covered
person under the state's plan were to
utilize a provider that is outside of the
carrier's PPO network, however, where
the carrier had an arrangement whereby
the state plan could still take advantage
of discounts subject to a fee that could be
charged on a percent of savings basis, or
on a per claim basis, would this be
considered a contingent fee? B. If a
covered person incurred a claim with a
non-participating provider, and a program
was used where a professional
negotiation service negotiated a claims
savings with charges based on a percent
of savings, would this be considered a
contingent fee? In either example, the
state would only incur a charge if a
discount of savings were achieved? If
these are considered contingent fees by
the state, would the state then require
that any projected costs related to these
types of network access or programs be
incorporated into the per employee per
month administrative fee?
31. Is the State of Nebraska using a The State does not currently have a contract
consultant for this procurement? with an Actuarial Consultant, but a contract is
in the process of being awarded. The
language in the RFP states that the consultant
may “assist the State of Nebraska with the
RFP selection process… The assistance will
include analysis of the ASO fee, provider
discounts and saturation of provider networks
32. The State's RFP has allowed bidders to The State has an existing contract with a
quote on alternate plans in addition to Pharmacy Benefit Manager through 12/31/07.
current plans. One of the options of The current PBM has the ability to administer
interest by the State is a High Deductible a HDHP.
Health Plan (HDHP) with an HSA. Under
an HDHP plan, regulations require that
medical and prescription drug claims
both be subjected to the deductible under
the HDHP plan before any benefits are
payable. This requires both the health
plan carrier and PBM to accrue medical
and prescription drug claims toward the
combined HDHP plan deductibles and
out-of-pocket maximums. If a carrier has
already developed an interface with a
PBM to support this requirement, can a
carrier bid the HDHP plan option with a
packaged medical and prescription drug
plan that utilizes the carrier's PBM for
those employees who would select the
HDHP plan option?
33. The RFP describes 17,000 benefit- The previous census included temporary,
eligible, 15,000 subscribed to the State‟s State College, State Patrol employees as well
health plans, but the census file contains as employees not enrolled for benefits. The
approximately 23,000 listed. How many new census being provided in accordance with
subscribers are in each of the State of question #1 will not include these individuals.
Nebraska‟s health plans?
34. How many covered lives are in each of See answer to question #1.
the State of Nebraska‟s health plans?
35. What are the current incumbent‟s ASO BCBSNE = $34.18 PEPM.
Mutual of Omaha HMO = $27.13 PEPM.
Mutual of Omaha POS = $27.22 PEPM.
Mutual of Omaha PPO = $28.07 PEPM.
Mutual of Omaha Outstate HMO and POS =
36. Call volume. How many calls are The State is not able to obtain this information
received by each of the health plans? at this time.
37. Claims volume. How many claims are The State is not able to obtain this information
received by each of the health plans? at this time.
38. How many open enrollment meetings are Please reference page 27, Section IV, G. Item
held each year and during what time of #7 for information regarding open enrollment
39. Please describe the level of disease The State does not currently have disease
management provided by each of the management in place.
40. Please identify where the Mandatory Proposal response structure should mirror that
Contract provisions should be placed in of the RFP.
responding to the RFP? In the Technical
Proposal under Technical Approach?
41. Please confirm the State will handle The State is responsible for collecting all
billing for the health plans. premiums.
42. Page 40. D. Please identify what section Proposal response structure should mirror that
the alternative terms and conditions are of the RFP.
to be found in a response – under
43. The RFP states the proposed network Yes.
must be accepted by an organization
such as NCQA, JCAHO, etc. Is URAC
44. Pertaining to the Request for CPT Code The State does not fully understand the
Allowances, should allowances be question and therefore can not provide an
separated by professional and technical answer.
45. Since there is currently more than one Although the State will not accept tiered ASO
vendor being offered to the state fees based on enrollment, the State would
employees, will you reconsider allowing allow for tiered ASO fees based on the plan
tiered pricing on the ASO fees? design. For example, a different ASO fee
would be allowed for an HMO plan than for a
46. Please verify if the State will allow us to See answer to question #45.
offer tiered ASO fees or not based on
47. Please provide the current carriers ASO See answer to question 35. The State does
and stop loss fees. not currently have stop loss coverage.
48. Please confirm that all fees should be Yes, Per Employee Per Month.
submitted as a Per Employee Per Month
fee, not a percent of savings or a
contingency fee basis. Also, if there are Yes.
additional fees, for example reporting,
this should be listed in the "other"
category at the bottom of attachments 23,
24, 25, and 26 with the PEPM fee listed
out as well for 2007, 2008, and 2009.
49. What are the current administrative fees Please see answer to question #35
being charged to the State to administer
their health plan?
50. The State indicated in the RFP that The State did revisit this subject and the
bidders could not impose, and the State language will remain as written in the RFP
would not accept, enrollment guarantees document.
(minimum or maximum) or fees based on
the number of enrollees in a plan(s).
Inclusion of this type of caveat would be
cause for rejection of all or that portion of
the bid. However, during the pre-
proposal meeting attended last week, the
State did mention during the meeting that
this question could be submitted again to
revisit this issue. So will the State accept
enrollment guarantees (minimum or
maximum) or fees based on the number
of enrollees in a plan(s)?
51. Employee Census: A complete census is Please see answer to question #1.
requested to include date of birth,
gender, dependent status, and location
(zip code) for each individual. Many
carriers use this demographic information
and geographic information to develop
specific stop loss rates.
52. Current Vendor Enrollment: Can you Please see answer to question #34.
please provide us the current year and
prior year monthly enrollment broken out
by each vendor and plan?
53. Employer Contributions: What are the Please see answer to question #10.
current employer premium amounts for
BCBS and Mutual of Omaha by plan,
PPO, POS, HMO?
54. Employee Contributions: What are the Please see answer to question #10.
current employee premium amounts for
BCBS and Mutual of Omaha by plan,
PPO, POS, HMO?
55. Funding Mechanism: What is the current The State does not fully understand the
funding mechanism (insured, ASO, etc.) question and therefore can not provide an
for the current coverage‟s? What are the answer.
current rates/fees applicable to the
current coverage‟s? Are any other fees
applicable (vendor, report, % of savings,
network access, etc.)?
56. Contract Award: Item A5 (last paragraph) Yes.
on page 23 indicates the State may
award the contract to multiple bidders.
Clarification is requested regarding
multiple awards by coverage (PPO, POS,
HMO, etc.) may be made or whether
there could be for example, multiple
awards within each coverage such that
multiple bidders would be awarded
administration of PPO coverage, POS
coverage, HMO coverage, etc.
57. Networks: We need clarification on the See answer to question #33.
census. Census (attachment 13) has a
total of 23,109 lives. RFP says there are
17,000 eligible employees.
58. Networks: RFP states that proposed Yes.
network must be accredited by an
organization such as NCQA, JCAHO, etc.
Will a network without accreditation be
59. Utilization Review: Questionnaire - Can See answer to question #3.
we type the questions into the document
in Word format?
60. Stop Loss: Can a census with coverage See answer to question #1.
tiers be provided? (EO, ES, EC, and EF)
61. Stop Loss: Are large claim reports The State is not able to obtain this information
available for 2003, 2004, and 2006 (to at this time.
62. Stop Loss: Monthly Enrollments by Plan The State is not able to obtain this information
for 2003-2005? at this time.
63. Pricing: Will the State accept tier pricing No.