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Memorial Hermann Indemnification Agreement

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Memorial Hermann Indemnification Agreement Powered By Docstoc
					                                                          City of Beaumont
                                                        Request for Proposal
                                 Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


                                                       PROPOSAL INSTRUCTIONS


Commodity or Services Requested:                        Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA

Proposal Closing/Opening Time:                          Thursday, June 3, 2010 @ 2:00 P.M.

Proposal Opening Location:                              City Clerk's office, 801 Main, Room 125, Beaumont, TX 77701




The RFP and timeline should be reviewed in its entirety. Any questions should be submitted within the deadline; a Q&A Addendum will be released to
all carriers interested in submitting a proposal.

Proposals should be completed in the format provided within this file ("Attachments" spreadsheet). Proposals not completed in this format may be
disqualified for non-compliance.

When completing the questionnaires, answers should be summarized in short format and not exceed the allotted space within the cell(s) provided. DO
NOT add extra rows/columns--work with the allotted space. Additional information in carrier format may be submitted along with the "Attachments"
spreadsheet if a carrier would like to include "more detailed" information.

When completing the rates (for fully insured rates), enter the employee count by tier where noted. The "Assumptions" section should also be
completed.




    Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                                        Prepared: 11/14/2010
                                                                         1                               Worksheet: Tab1-Proposal Instructions
                                                      City of Beaumont
                                                    Request for Proposal
                             Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


                    Carrier Name




        Note: All listed tabs in this RFP file, highlighted below, must be completed, signed, and
        returned as part of your proposal, in order for your quote to be considered.


              Tab Name                                                                     Description
        Tab 1       Proposal Instructions            Proposal Instructions
        Tab 2       Proposal Checklist               Proposal Checklist
        Tab 3       Vendor Information               Vendor Information
        Tab 4       Exh Review Vendor Sign           Exhibit Review Sign Off
        Tab 5       General Questionnaire            General Questionnaire
        Tab 6       Performance Guarantee            Performance Guarantees
        Tab 7       Medical Questionnaire            Medical Questionnaire
        Tab 8       Med-Rx Proposed-Benefits         Proposed Medical Plan Design
        Tab 9       Med Deviations-Variations        Proposed Medical -- Deviations/Variations
        Tab 10      Med Proposed-FI Rates            Proposed Fully Insured Medical Rates
        Tab 11      Med Proposed-SF Fees             Proposed Self-Funded Administration Fees
        Tab 12      Med Proposed-SL Fees             Proposed Stop Loss Fees
        Tab 13      Med Proposed-Net Disc&Geo        Medical Network Discounts and Geo Access Results
        Tab 14      Med Disruption Analysis          Medical Disruption Analysis
        Tab 15      Den Questionnaire                Dental Questionnaire
        Tab 16      DPPO Proposed-Benefits           Proposed Dental Plan Design
        Tab 17      Den Deviations-Variations        Proposed Dental -- Deviations/Variations
        Tab 18      Den Proposed-FI Rates            Proposed Fully Insured Dental Rates
        Tab 19      Den Proposed-SF ASO Fees         Proposed Self-Funded Dental ASO Fees
        Tab 20      Den Proposed-Net Disc&Geo        Dental Network Discounts and Geo Access Results
        Tab 21      Den Disruption Analysis          Dental Disruption Analysis
        Tab 22      FSA Questionnaire                FSA Questionnaire
        Tab 23      FSA Proposed-Services            Proposed FSA Plan Design
        Tab 24      FSA Deviations-Variations        Proposed FSA -- Deviations/Variations
        Tab 25      FSA Proposed-Fees                Proposed FSA Fees
        Tab 26      COBRA Questionnaire              COBRA Questionnaire
        Tab 27      COBRA Prop-Services              Proposed COBRA Services
        Tab 28      COBRA Proposed-Fees              Proposed COBRA Fees


                    Please provide as part of the proposal the following:
                    -- Current directory (Medical-PCPs, SCPS, and Mental Health/Substance Abuse providers; Dental-General Dentists,
                    Orthodontists, and other providers)
                    -- Sample experience reports
                    -- Sample plan documents, plan literture, forms, reports, and denial
                    forms/letters to employees
                    -- Sample implementation schedule and enrollment procedures

                    Signature:
                    Printed Name & Title:
                    Date:




Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                                      Prepared: 11/14/2010
                                                                            2                            Worksheet: Tab2-Proposal Checklist
                                                      City of Beaumont
                                                    Request for Proposal
                             Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA




Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                  Prepared: 11/14/2010
                                                            3                        Worksheet: Tab2-Proposal Checklist
                                                       City of Beaumont
                                                     Request for Proposal
                              Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


      Carrier Name


      Primary Contact Information
                      Consultant Name

                      Title

                      Address (Street, City, State, Zip)

                      Phone #

                      Fax #

                      Email


      Secondary Contact Information
                      Name

                      Title

                      Address (Street, City, State, Zip)

                      Phone #

                      Fax #

                      Email



      Coverages to be Quoted (Please mark an "x" to all plan types that apply.)
                      Medical

                      Stop Loss

                      Dental

                      FSA

                      COBRA



      Signature:
      Printed Name & Title:
      Date:




Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                    Prepared: 11/14/2010
                                                             4                        Worksheet: Tab3-Vendor Information
                                                       City of Beaumont
                                                     Request for Proposal
                              Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


      Carrier Name


                                                  EXHIBIT REVIEW SIGN-OFF


I acknowledge that I have reviewed the RFP in its entirety, including the Client Specifications (in Word
format) and all information in the Exhibits file (Excel format). I have also reviewed the RFP timeline
within the Client Specifications, which includes important dates that are relevant to this RFP.

I acknowledge I have reviewed and included all Addendums, if applicable, in my proposal.

Failure to submit my proposal in the manner the RFP states and within the indicated date and time will
result in disqualification of my proposal.




Signature:
Printed Name & Title:
Date:




 Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                    Prepared: 11/14/2010
                                                             5                    Worksheet: Tab4-Exh Review Vendor Sign
                                                           City of Beaumont
                                                         Request for Proposal
                                  Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


                                                        GENERAL QUESTIONNAIRE
The following questionnaire must be completed.
      Organizational Strength                                                    Response




 1      Provide the name and address of your company.




        Describe the history and ownership of your
 2
        company.




 3      How long in business under current name?




 4      Is your company publicly traded?




     Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                        Prepared: 11/14/2010
                                                                  6                    Worksheet: Tab5-General Questionnaire
                                                           City of Beaumont
                                                         Request for Proposal
                                  Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


                                                          GENERAL QUESTIONNAIRE
The following questionnaire must be completed.




        What is your market capitalization/financial
 5
        strength?




        What is your company's A.M. Best rating? Please
 6
        also provide your Dunn & Bradstreet number.




               Account Management                                                 Response




        Give the name and title of the person(s) with
        whom overall responsibility for planning,
 5
        supervising, and performing the day-to-day
        administrative services for the Client will be.




        Will the Client have a dedicated Account
        Manager? If so, where are they located and
 6
        what are their standard hours? Will they have a
        back-up contact?




     Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                        Prepared: 11/14/2010
                                                                    7                  Worksheet: Tab5-General Questionnaire
                                                           City of Beaumont
                                                         Request for Proposal
                                  Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


                                                             GENERAL QUESTIONNAIRE
The following questionnaire must be completed.




        Please provide a summary list of all
 7      administrative services your firm will perform for
        our group.




        In the event of contract termination, discuss the
 8      transition process. Include penalties, number of
        days notice, etc.




                  Customer Service                                                   Response




        Are all customer service conversations
 9      documented and/or retained for proof of
        compliance?




     System Processes and Technology                                                 Response




        What payroll software/systems has your
 10
        company worked with?




     Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                           Prepared: 11/14/2010
                                                                       8                  Worksheet: Tab5-General Questionnaire
                                                        City of Beaumont
                                                      Request for Proposal
                               Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


                                                           GENERAL QUESTIONNAIRE
The following questionnaire must be completed.




      Does the platform allow clients access to reports
 11
      during and after enrollments?




      What services will your company provide the
 12   client for ongoing maintenance and support after
      enrollment?




                  Client Specific                                                  Response




      Describe the vendor/city’s responsibilities at the
 13
      beginning of each year and at year end process.




      Describe how the benefit system integrates with
 14   the payroll system. Will benefit election changes
      update payroll deductions?




  Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                         Prepared: 11/14/2010
                                                                     9                  Worksheet: Tab5-General Questionnaire
                                                        City of Beaumont
                                                      Request for Proposal
                               Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


                                                         GENERAL QUESTIONNAIRE
The following questionnaire must be completed.




      Can benefit plans be set up so only a specific
 15
      group of employees are eligible for them?




      Can benefit cost changes be future dated for a
 15
      future year with in the current year?




      When changes occur, are premiums
 16   automatically updated for age and salary benefit
      calculation?




      Does the system produce Employee Benefit
 17   Statements and if so does it include the City’s
      cost of benefits?




  Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                     Prepared: 11/14/2010
                                                                  10                Worksheet: Tab5-General Questionnaire
                                                        City of Beaumont
                                                      Request for Proposal
                               Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


                                                           GENERAL QUESTIONNAIRE
The following questionnaire must be completed.




      Describe the vendor/city’s responsibilities at the
 17
      beginning of each year and at year end process.




 18   Describe the online benefits enrollment process.




 19   What password controls are utilized?




      Please provide a sample online benefit
 19
      enrollment implementation plan.




  Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                     Prepared: 11/14/2010
                                                                    11              Worksheet: Tab5-General Questionnaire
                                                        City of Beaumont
                                                      Request for Proposal
                               Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


                                                              GENERAL QUESTIONNAIRE
The following questionnaire must be completed.




      What staff will be offered in the field to assist
 20
      employees during annual enrollment?




                    References                                                         Response
                                                                                      Current Clients

                                                          1
      Please provide three references of current
      clients and two references of clients you           2
      have lost in the past two years. Ideally,
      these references would be similar in size to
      the Client. (Include name, phone number,            3
 21   email address., and years of service)
                                                                                      Former Clients

                                                          1

                                        Reason for leaving:

                                                          2

                                        Reason for leaving:




  Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                                Prepared: 11/14/2010
                                                                       12                      Worksheet: Tab5-General Questionnaire
                                                        City of Beaumont
                                                      Request for Proposal
                               Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


                            MINIMUM VENDOR REQUIREMENTS QUESTIONNAIRE
The following questionnaire must be completed. Proposals must be clearly explained and any exceptions
or deviations to specific requirements clearly identified. If you are unable to meet a condition please give
                                              an explanation.

      SPECIFIC REQUIREMENT                                         CONFIRMATION OR EXPLANATION

    Vendor shall assist in plan communication and
    enrollment of active employees and retirees.
    Vendor will assist with annual enrollment
    meetings with employees who work around the
    clock in various work locations throughout the
    City of Beaumont. Annual enrollment during
  1 October/ November is the period each year
    when people insured under the City’s benefit
    plans can enroll or change plans. Vendor will
    provide at least two trained staff members to
    help support the annual enrollment meetings
    which will be held at various locations and shift
    times throughout the City.




    No loss/no gain: No covered employee or
    covered dependent shall lose or gain benefits as
    a result of a vendor change. All actively at work
    and non-confinement provisions must be
  2
    expressly waived for the initial enrollment for
    covered employees and covered dependents
    who have already satisfied the limitations under
    the current plan.




    Administrator must be able to maintain eligibility
    files and receive updates from City as required.
    Administrator will make benefit eligibility
    available online to City staff with appropriate
    measures to protect the confidentiality and
  3
    integrity of the information and access to it. The
    administrator must provide City staff the ability
    to enter and update eligibility. The initial
    eligibility information must be completed by the
    vendor.




  Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                      Prepared: 11/14/2010
                                                              13               Worksheet: Tab6-Minimum Vendor Requirement
                                                           City of Beaumont
                                                         Request for Proposal
                                  Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


                            MINIMUM VENDOR REQUIREMENTS QUESTIONNAIRE
The following questionnaire must be completed. Proposals must be clearly explained and any exceptions
or deviations to specific requirements clearly identified. If you are unable to meet a condition please give
                                              an explanation.

         A monthly employee eligibility/census report by
         group (including COBRA) must be provided for
         each type of plan administered. These reports
         must include the following information:


         Employee and dependent names – last, first and
         middle


         Employee unique ID# and gender


 4       Employee and dependent date of birth


         Employee address including city, state and zip
         code


         Effective date of coverage


         Termination date


         Coverage status (EO, E1, etc. with totals for
         each group)




         Vendor must agree to attend monthly update
     5
         and quarterly review meetings at the City.




     Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                         Prepared: 11/14/2010
                                                                 14               Worksheet: Tab6-Minimum Vendor Requirement
                                                        City of Beaumont
                                                      Request for Proposal
                               Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


                            MINIMUM VENDOR REQUIREMENTS QUESTIONNAIRE
The following questionnaire must be completed. Proposals must be clearly explained and any exceptions
or deviations to specific requirements clearly identified. If you are unable to meet a condition please give
                                              an explanation.

    Vendor that is awarded a contract must develop,
    print and make available a customized summary
    plan document (SPD) booklet and plan network
    directories to plan members, i.e., employees,
    retirees, COBRA participants. Booklets and
    directories shall be provided to the member at
    the time of initial enrollment and thereafter for
    new hires or other new members. Summary plan
    document and updated network directory shall
  6
    be provided to members when changes occur.
    SPD shall be reviewed and approved by the City.
    Vendor will provide enrollees, prospective
    enrollees, and providers access to current
    information or network providers via a
    searchable online directory. Detail additional
    cost for printing booklets, directories for
    employees, retirees, COBRA participants
    on the attachment rate sheet.




    The vendor must provide a single point of
    contact account manager and local contact
  7 medical and dental representative. This person
    shall be available through a toll-free telephone
    number and a direct telephone number.




    The vendor that is awarded a contract must
    contractually agree to provide “run-out” claims
    processing services at a level of service and
  8
    price that are comparable to pre-termination
    services, for up to 12 months at termination of
    the new agreement.




  Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                      Prepared: 11/14/2010
                                                              15               Worksheet: Tab6-Minimum Vendor Requirement
                                                        City of Beaumont
                                                      Request for Proposal
                               Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


                            MINIMUM VENDOR REQUIREMENTS QUESTIONNAIRE
The following questionnaire must be completed. Proposals must be clearly explained and any exceptions
or deviations to specific requirements clearly identified. If you are unable to meet a condition please give
                                              an explanation.




     The vendor that is awarded a contract must
     agree to transmit test data to a new vendor no
     less than 30 days prior to the termination of a
   9
     contract and to provide a final verified transition
     data file to the new vendor within 30 days after
     the termination date.




     The vendor that is awarded a contract must
  10 provide the City with monthly cost reports by
     section (fire, police, civilian, etc.)




     The vendor, at its own cost, must provide
     routine distribution of ID cards, including
     printing, mailing, and postage. The Vendor, at its
     own cost, will provide ID cards directly to the
     participant’s (employees, retirees, COBRA
     members) home address for (1) the initial
     enrollment of the plan, (2) future new hires, (3)
     members who change coverage category and
     (4) replacement of lost cards or extra cards
  11 required. The information to be printed on each
     ID card will include, at a minimum, the
     participant’s name and unique identification
     number (not social security number), plan name,
     the vendor name and toll free customer service
     number. The vendor must mail ID cards to
     participant home addresses within ten working
     days after receiving the initial enrollment
     information and within five working days of
     receiving any change request.




  Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                      Prepared: 11/14/2010
                                                              16               Worksheet: Tab6-Minimum Vendor Requirement
                                                        City of Beaumont
                                                      Request for Proposal
                               Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


                            MINIMUM VENDOR REQUIREMENTS QUESTIONNAIRE
The following questionnaire must be completed. Proposals must be clearly explained and any exceptions
or deviations to specific requirements clearly identified. If you are unable to meet a condition please give
                                              an explanation.
     The vendor that is awarded a contract must
     capture member and dependent information
     from enrollment materials and maintain it
     throughout the term of the contract. The City
     requires access to an on-line computer based
     updating of the eligibility data. Eligibility
     software must comply with the confidentiality
     and security provisions of federal law. The cost
     for this service should be included as part of the
     rate and should provide the following
12
     capabilities:
     In-house maintenance of participants’
     eligibility/census;

     Ability to run standard eligibility/census reports
     and

     Automatic update or electronic transfer of
     eligibility data to the vendor
     provider/administrator.




     Properly staffed and supervised
     customer/member service representatives must
     be available to plan participants via a 1-800
  13 number. Vendor will have a Web site available
     24 hours everyday giving enrollees secure online
     access to information on their claims and
     providing secure e-mail.




     The vendor that is awarded a contract shall
     provide and maintain networks of qualified
     providers that provide quality services on a cost-
     effective basis for the health and dental plans
     during the term of the contract. Each proposer
     must ensure that the providers continue to meet
     licensing, selection, and screening criteria and
  14 that required liability insurance is maintained.
     Each proposer must confirm in its response that
     its proposed network will remain under
     agreement throughout this proposal process.
     Subsequent to submission, any material changes
     must be brought to the City’s attention
     immediately. Failure to do so may eliminate the
     proposal from consideration.




  Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                      Prepared: 11/14/2010
                                                              17               Worksheet: Tab6-Minimum Vendor Requirement
                                                        City of Beaumont
                                                      Request for Proposal
                               Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


                            MINIMUM VENDOR REQUIREMENTS QUESTIONNAIRE
The following questionnaire must be completed. Proposals must be clearly explained and any exceptions
or deviations to specific requirements clearly identified. If you are unable to meet a condition please give
                                              an explanation.


     Dental rates quoted should be based on the
     current three tier structure: employee only,
     employee and one dependent, and employee
     and two or more dependents in addition to a
     four tier structure: employee only, employee and
  15 child, employee and spouse, and employee and
     family. Administrative fees should be a
     composite rate. Once the City decides what rate
     structure (three or four tier) will be implement,
     payment will be remitted based on the monthly
     enrollment (self billed).




       Vendor will provide fully-funded equivalency for
  16
       all plan tier coverages each year.




     The vendor awarded a contract will develop and
     provide a summary handout/overview of plan
  17
     benefits for initial annual enrollment, employee
     orientation and ongoing annual enrollment.




  Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                      Prepared: 11/14/2010
                                                              18               Worksheet: Tab6-Minimum Vendor Requirement
                                                        City of Beaumont
                                                      Request for Proposal
                               Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


                            MINIMUM VENDOR REQUIREMENTS QUESTIONNAIRE
The following questionnaire must be completed. Proposals must be clearly explained and any exceptions
or deviations to specific requirements clearly identified. If you are unable to meet a condition please give
                                              an explanation.
      The selected vendor shall provide the entire
      COBRA administration process. The City will
      provide notification of new hires, dependent
      changes, and terminations to the selected
      vendor who will then be responsible for all other
      aspects of the process, including but not limited
      to the following:

      employee/dependent to home address
      notification for medical, drug and dental
      benefits; (general COBRA notice, COBRA
      election notice, notice of unavailability of
18
      COBRA coverage, COBRA termination notice
      before end of maximum coverage period)


      certificate of coverage for HIPAA compliance;


      billing and premium collection for medical, drug
      and dental benefits; and

      mail identification cards and informational
      materials to the member’s home; provide
      monthly COBRA eligibility listing to City.




      The selected vendor shall provide an actuarial
      determination of COBRA rates/premiums to the
 19   City on an annual basis but not later than August
      1 of each year, the cost to be included a part of
      the administration rate.




      All services offered/provided must be clearly
      identified/explained. All costs must be fully
 20   detailed and summarized with exceptions or
      deviations to specific requirements clearly
      enumerated.




  Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                      Prepared: 11/14/2010
                                                              19               Worksheet: Tab6-Minimum Vendor Requirement
                                                        City of Beaumont
                                                      Request for Proposal
                               Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


                            MINIMUM VENDOR REQUIREMENTS QUESTIONNAIRE
The following questionnaire must be completed. Proposals must be clearly explained and any exceptions
or deviations to specific requirements clearly identified. If you are unable to meet a condition please give
                                              an explanation.




      A specimen contract, summary plan description,
      network directories showing access to Texas
 21   providers, and sample eligibility/cost reports
      shall be included in the proposal.




      Provide strict adherence to the applicable
      sections of the IRS Code and Health Insurance
 21   Portability and Accountability Act of 1996
      (HIPAA) regulations.




      The identification (ID) cards and directories, etc.
      for the initial enrollment must be received by
      each participant not later than two weeks prior
      to the effective date of the contract (January 1,
 22   2011). The summary plan document (SPD) must
      be developed and submitted to each participant
      not later than March 1, 2011 unless another
      date has been agreed upon by the City.




  Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                      Prepared: 11/14/2010
                                                              20               Worksheet: Tab6-Minimum Vendor Requirement
                                                           City of Beaumont
                                                         Request for Proposal
                                  Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


                                                          PERFORMANCE GUARANTEES
The following questionnaire must be completed.
            Administration                                                         Response
        Please include a draft of your Standard
        Administrative Services Agreement. In the draft
        agreement, please include performance
        guarantees that you are willing to implement.
        -- Description of the metrics


        -- Associated monetary risks

 1
        -- Guarantees during plan implementation

             How do you report the items back to
               the client?

             The guarantees are as of when?

             Can you guarantee the
               implementation of the file transfer?
        Provide the standards for the following
        performance indicators and define each.

        -- Service index (claim turnover)

        -- Daily average claims processed per claims
           examiner
 2
        -- Financial/non-payment accuracy


        -- Overall accuracy


        -- Number of times claim "touched" to resolve




     Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                         Prepared: 11/14/2010
                                                                    21                Worksheet: Tab6-Performance Guarantees
                                                           City of Beaumont
                                                         Request for Proposal
                                  Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


                                                          MEDICAL QUESTIONNAIRE
The following questionnaire must be completed.
Medical Health Carriers are required to respond to all requests for information contained in this
questionnaire. All responses must be provided on a diskette and respond in a brief, bulleted format. This
questionnaire will be scored; therefore, it is necessary that you provide concise answers. Your responses
to the questions should be based on your current proven capabilities. Should there be instances where
certain questions are not applicable to your organization or its operations, please so indicate. If you are
selected to administer the Client's employee benefit plans, your responses to the questionnaire will be
considered part of your contractual responsibilities. You are also requested to return the indicated
exhibits as part of your proposal.

             Organizational Strength                                              Response




        How many clients do you currently in force for
 1
        this line of coverage?




                  Customer Service                                                Response




        Please provide your customer service hours,
        days of operation, time zone. Do you have
        dedicated employees/unit to handle larger
 2
        accounts in the call center? What is the
        experience level of your company’s customer
        service department?




        Is your customer service unit bilingual? How
        often are your team members trained on the
        lines of coverage supporting? What are your
 3
        hours of customer service unit--after hours? Is
        your customer service unit outsourced? If so,
        what country?




     Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                       Prepared: 11/14/2010
                                                                   22                  Worksheet: Tab7-Medical Questionnaire
                                                           City of Beaumont
                                                         Request for Proposal
                                  Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


                                                             MEDICAL QUESTIONNAIRE
The following questionnaire must be completed.




        Does your company archive the actual
 4
        enrollment forms?




        Does your company provide a customized 1-800
 5      number to handle questions related to product
        offerings during the enrollment period?




        Are all customer service conversations
 6      documented and/or retained for proof of
        compliance?




     System Processes and Technology                                                 Response



        What are the various methods information can
        be transmitted and how often? Can the platform
        be fully customized to capture all feeds, and
 7      upload to various payroll and eligibility systems?
        State how you process and verify the eligibility
        information. Identify any information you would
        require in paper format.




     Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                          Prepared: 11/14/2010
                                                                      23                  Worksheet: Tab7-Medical Questionnaire
                                                           City of Beaumont
                                                         Request for Proposal
                                  Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


                                                             MEDICAL QUESTIONNAIRE
The following questionnaire must be completed.




        Do you have online enrollment/eligibility
        capabilities? For updating? If so, how long does
 8
        it take before the change / addition / deletion is
        effective?




        What online benefit systems has your company
 9
        worked with?




        Describe your process for handling retroactive
 10
        enrollment and cancellations.




     Demonstrated Qualifications/Exp                                                 Response




        Has your network been reviewed and accredited
        by an external agency in industry organization
 11
        (NCQA, AAPPO, JCAHO, etc.?) If so, please
        describe.




     Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                          Prepared: 11/14/2010
                                                                      24                  Worksheet: Tab7-Medical Questionnaire
                                                        City of Beaumont
                                                      Request for Proposal
                               Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


                                                          MEDICAL QUESTIONNAIRE
The following questionnaire must be completed.
        Implementation Process                                                    Response



      What initial information is required from the
      employer for implementation? Is a checklist
      available to provide to the client? Explain in
 12   detail the steps you anticipate will be needed to
      ensure a smooth implementation. Include a
      timetable of events from the effective date and
      including the Open Enrollment process.




      Who will be assisting in the implementation
 13   process? What will occur during the
      implementation process?




      Will you have field representatives available for
 14   group meetings? What is standard timeframe for
      meeting notifications for travel purposes?




      Standard turnaround time for new group
 15
      processing? New enrollees?




  Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                       Prepared: 11/14/2010
                                                                   25                  Worksheet: Tab7-Medical Questionnaire
                                                        City of Beaumont
                                                      Request for Proposal
                               Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


                                                   MEDICAL QUESTIONNAIRE
The following questionnaire must be completed.




 16   Do you track dependent eligibility?




 17   How will terminations be handled?




      Is any function of the claims process
 18
      outsourced?




      What is your standard turnaround time for
 19
      claims payment?




  Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                    Prepared: 11/14/2010
                                                              26                    Worksheet: Tab7-Medical Questionnaire
                                                        City of Beaumont
                                                      Request for Proposal
                               Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


                                                            MEDICAL QUESTIONNAIRE
The following questionnaire must be completed.




      In the event of contract termination, discuss the
 20   transition process. Include penalties, number of
      days notice, etc.




       How do you recommend the Client handle
      transition of care issues? Be specific with respect
 21
      to pregnancy, hospitalization, chronic/terminal
      illness, mental health and prescription drugs.




      Are you willing to customize communications,
      such as ID cards and SPDs? Do you agree to
      allow the Client to pre-approve any
 22
      communication to employees that would reach a
      significant portion of the Client's population?
      Individualized communications are excluded.




      Will your organization provide the Client with
 23   hard copies of provider directories for employees
      or administration? If so, how often.




  Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                    Prepared: 11/14/2010
                                                                     27             Worksheet: Tab7-Medical Questionnaire
                                                        City of Beaumont
                                                      Request for Proposal
                               Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


                                                               MEDICAL QUESTIONNAIRE
The following questionnaire must be completed.




      What information is available through your
 24
      website for the members and the group?




      Are participants required to select a primary
      care physician? What medical specialties are
      included as PCPs? What is the process for
 25
      changing PCPs and how often is it allowed? Can
      family members select different medical groups
      and PCPs?




      How will billing be set-up? Does your company
 26   offer self-bill or electronic billing? Is any function
      of the billing process outsourced?




      Please summarize what programs you are
      offering to the Client that help control cost
      (utilization review, case management, condition
 27   management, high performance networks, etc.).
      How many of these services are currently
      measuring savings? What is the percentage of
      savings?




  Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                       Prepared: 11/14/2010
                                                                        28             Worksheet: Tab7-Medical Questionnaire
                                                        City of Beaumont
                                                      Request for Proposal
                               Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


                                                         MEDICAL QUESTIONNAIRE
The following questionnaire must be completed.
 Administrative/Technical Capabilities                                           Response




      Do you have the ability to handle claims
 28   administration on a local, regional and national
      level?




      Describe in detail your procedure for conducting
      audits of your claims processing units. Include
 29   who conducts the audit, what is reviewed during
      the audit, and how often the audits are
      conducted.




      Describe the overpayment recapture process
 30
      and the impact on the Client's experience.




 Provider Network/Utilization Mgmt                                               Response




      Describe the organizational structure of your
      national and regional managed care program.
 31   Briefly describe any key corporate or regional
      managed care staff that would be instrumental
      in servicing our account.




  Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                      Prepared: 11/14/2010
                                                                  29                  Worksheet: Tab7-Medical Questionnaire
                                                        City of Beaumont
                                                      Request for Proposal
                               Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


                                                           MEDICAL QUESTIONNAIRE
The following questionnaire must be completed.




      Identify any changes to your provider contracts
 32   or contracting strategies that you anticipate over
      the next three years.




      Do you have the ability to profile physician for
 33   prescribing patterns, administrative efficiencies,
      and/or quality of care? If yes, please describe.




      Identify the percentage of physicians that are
 34                                                        If quoting more than one type of plan, complete nos. 20 and 21 for each plan.
      reimbursed by the following methods:




      Primary Care Physician                                                    [Insert Type of Medical Plan, i.e., PPO, HMO, etc.]
      Salary
      Discounted fee for service w/withhold
      Fee for service w/bonus
      Fee schedule
      Capitation
      Capitation w/withhold
      Capitation w/bonus
      Percentage discount
      Other (specify):
      Total
      Specialist                                                                [Insert Type of Medical Plan, i.e., PPO, HMO, etc.]
      Salary
      Discounted fee for service w/withhold
      Fee for service w/bonus
      Fee schedule
      Capitation
      Capitation w/withhold
      Capitation w/bonus
      Percentage discount

  Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                                                  Prepared: 11/14/2010
                                                                              30                                  Worksheet: Tab7-Medical Questionnaire
                                                        City of Beaumont
                                                      Request for Proposal
                               Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


                                                          MEDICAL QUESTIONNAIRE
The following questionnaire must be completed.
      Other (specify):
      Total




      Enter the percent of inpatient hospitals that are
 35
      reimbursed by the following methods:




      Inpatient Hospitals                                           [Insert Type of Medical Plan, i.e., PPO, HMO, etc.]
      Discount
      Per Diem
      Capitation
      DRG Case Rates
      Global Fees
      Other (specify):
      Total




      Under what circumstances would you be willing
      to expand or reduce the network (service area
 36
      and additional hospitals and/or physicians) on
      the Client's behalf?




  Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                               Prepared: 11/14/2010
                                                                   31                          Worksheet: Tab7-Medical Questionnaire
                                                        City of Beaumont
                                                      Request for Proposal
                               Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


                                                        MEDICAL QUESTIONNAIRE
The following questionnaire must be completed.




      Does your current network include providers in
 37   the xxx area? If no, are you willing to expand
      your network to include those area doctors?




      Identify the hospitals that are considered in-
 38   network within the Jefferson County area and
      within a 50-mile radius.




      What percent of the primary care physicians are
 39   on staff at each network hospital and are
      participating in the network?




      How many primary care physicians are included
 40   in the Jefferson County network? How many are
      accepting new patients?




  Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                    Prepared: 11/14/2010
                                                                 32                 Worksheet: Tab7-Medical Questionnaire
                                                        City of Beaumont
                                                      Request for Proposal
                               Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


                                                   MEDICAL QUESTIONNAIRE
The following questionnaire must be completed.




      How many specialists are included in the
 41
      Jefferson County network?




 42   How many acute care hospitals?




  Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                    Prepared: 11/14/2010
                                                              33                    Worksheet: Tab7-Medical Questionnaire
                                                        City of Beaumont
                                                      Request for Proposal
                               Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


                                                         MEDICAL QUESTIONNAIRE
The following questionnaire must be completed.
  Wellness, Medical Plan Design/Cost                                             Response




      Please provide the Client with a brief summary
      of why your proposed medical program is the
      most innovative, cost effective, and best suited
 43
      for the Client and its employees. Be sure to
      describe any unique characteristics that set you
      apart from other carriers.




      Describe in detail how you will support the
      Client’s efforts to promote Wellness for
      employees and any costs and projected savings
      associated with those services. Specifically
 44
      indicate whether you are proposing any
      dedicated wellness resources (personnel,
      communication, education and physical fitness
      services).




  Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                      Prepared: 11/14/2010
                                                                  34                  Worksheet: Tab7-Medical Questionnaire
                                                          City of Beaumont
                                                        Request for Proposal
                                 Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


       Carrier Name


       Please note that you must complete plan design information in the following requested
       format in order for your quote to be considered. Enter only those plan design elements that
       are included in your quoted rates. Please confirm that you can duplicate and administer
       the current plan design. If not, please indicate differences on Medical-
       Deviations/Variations.
                                                     COMPLETE THIS TAB FOR EACH PLAN QUOTED.
Proposed Medical Plan Design
                                                                      In-Network                    Out-of-Network
Deductible (CYD)
       Per Participant
       Family
Out-of-Pocket Maximum
       Per Participant
       Family

Is the deductible included in the Out-of-Pocket Maximum?                           Yes o   No   o

Does in-network or out-of-network deductible/ coinsurance
                                                                                   Yes o   No   o
cross apply?

  If so, please describe.

Lifetime Maximum

Coinsurance

Physician Visit

Diagnostic Services (for lab and radiology/x-ray)

Advanced Diagnostic Services (CT Scans, Pet Scans,
MRI)

How are in-network diagnostic services handled in a
Physician's office? (i.e., included in physician copay,
deductible/ coinsurance, etc.)

Hospital Inpatient

Emergency Room

Urgent Care

Outpatient Surgery

Preventive Care




    Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                                 Prepared: 11/14/2010
                                                                       35                       Worksheet: Tab8-Med Proposed-Benefits
                                                        City of Beaumont
                                                      Request for Proposal
                               Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


       Carrier Name


       For any benefits you cannot duplicate or administer, per the in force SPD, please indicate
       on this tab. Please clearly note the differences.


Proposed Medical -- Deviations/Variations




  Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                     Prepared: 11/14/2010
                                                              36                  Worksheet: Tab9-Med Deviations-Variations
                                                       City of Beaumont
                                                     Request for Proposal
                              Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


        Carrier Name

        Please note that you must complete rate information in the following requested format
        in order for your quote to be considered.

                                                       COMPLETE THIS TAB FOR EACH PLAN QUOTED.
Proposed Fully Insured Medical Rates

Are retirees included in fully insured rates?             Yes o   No    o


Quote rates in the following tier structure(s):           2-Tier o3-Tier o4-Tier o



                                          EE Counts           Proposed Medical Rates

Employee Only                                     xx
Employee + Spouse                                 xx
Employee + Child(ren)                             xx
Employee + Family                                 xx
Monthly Premiums                                                         $0
Annual Premiums                                                          $0



                                          EE Counts           Proposed Medical Rates

Employee Only                                     xx
Employee + One                                    xx
Employee + Family                                 xx
Monthly Premiums                                                       #VALUE!
Annual Premiums                                                        #VALUE!


Assumptions

Employer Contribution (i.e., 75%, 50%)
Rate Guarantee
Participation Requirements
Commissions                                                                            Net
Other




 Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                                   Prepared: 11/14/2010
                                                                            37                   Worksheet: Tab10-Med Proposed-FI Rates
                                                          City of Beaumont
                                                        Request for Proposal
                                 Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


        Carrier Name


        Please note that you must complete plan design and rate information in the following
        requested formats in order for your quote to be considered. Enter only those plan design
        elements that are included in your quoted rates. List any optional coverages (along with
        the approximate percentage increase to the rates) under Optional Available Riders.


Proposed Self-Funded Administration Fees
                                                              2010              2011                   2012
Enrollment Assumptions
        Employees
        Dependents


Administrative Fee Breakdown (PEPM)                           2010              2011                   2012
Claims Processing
Utilization Management
Network Administration / Access Fee
Enrollment / Eligibility System Access
Schedule A Preparation
Hard Copy Directories / Fulfillment
Booklet and Contract Drafting
Booklet / Hard Copy SPD Printing & Distribution
Initial ID Cards / Replacement Cards
Banking Charges / Fees
Standard or Electronic Reporting
Subrogation
Centers of Excellence
Individual Case Management
24-Hour Nurse / Information Line
Physician Review
Employee Statements
Other (Please list)
    1
    2
    3
    4
TOTAL PEPM (Sum of Rows 16 thru 37)
TOTAL ANNUAL PREMIUMS




    Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                         Prepared: 11/14/2010
                                                                38                     Worksheet: Tab11-Med Proposed-SF Fees
                                                         City of Beaumont
                                                       Request for Proposal
                                Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA

                                                    Other Set-Up, If Aplicable
Initial Set-Up Charges (Enter amount)
Required Banking Deposit                                                         Yes o   No     o
Fee Guarantee (Yes / No)
Guarantee Caveats


Assumptions

Rate Guarantee
Commissions                                                                                         Net
Other




   Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                                Prepared: 11/14/2010
                                                                     39                       Worksheet: Tab11-Med Proposed-SF Fees
                                                      City of Beaumont
                                                    Request for Proposal
                             Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA

       Specific                                           Requested          Option 1              Option 2
       Enrollment Assumptions
               Employee Only
               Employee + Dependent(s)
       Total Employees
       Terms
               Contract Type (Incurred Mos/Paid Mos)        Paid/12           12/15                  18/15
               Deductible                                  $150,000          $150,000              $150,000
               Covered Benefit                              Medical           Medical               Medical
               Maximum Reimbursement                      $1,000,000        $1,000,000            $1,000,000
       Premiums
               Employee Only
               Employee & Family
               Composite
       Monthly Premiums
       Annual Premiums


       Aggregate                                          Requested          Option 1              Option 2
       Terms
               Contract Type (Incurred Mos/Paid Mos)        Paid/12           12/15                  18/15
               Covered Benefit                              Medical           Medical               Medical
               Aggregate Corridore                          125%              125%                   125%
       Aggregate Claim Liability & Run-off
               Employee Only
               Employee & Family
               Composite
       Other Provisions
               Average Claim Value
               Minimum Point of Attachment
       Premiums
               Employee Only
               Employee & Family
               Composite
       Monthly Premiums
       Annual Premiums




Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                    Prepared: 11/14/2010
                                                            40                    Worksheet: Tab12-Med Proposed-SL Fees
                                                      City of Beaumont
                                                    Request for Proposal
                             Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


        Carrier Name


        Please note that you must this information in the following requested formats in
        order for your quote to be considered. Enter only the networks that are included in
        your quoted rates.


                                                 COMPLETE THIS TAB FOR EACH PLAN QUOTED.
Medical Network Discounts
Please provide your organization's self reported discounts within the xx area for:
Hospital Inpatient                                                          %
Hospital Outpatient                                                         %
Physician                                                                   %



Geo Access Results

Please provide full detailed reports for the medical GEO access within your formal proposal.

                                                              Primary Care                                    Acute Care
                       Measurement                                                      Specialists
                                                               Physicians                                      Hospitals

# of Employees / Zip Codes Evaluated
Providers
# of Providers
# of Locations
X Providers within X Miles                                        2 / 10                  2 / 15                 1 / 20
% of Employee WITH access                                                   %                      %                      %
# of Employees WITH access
% of Employee WITHOUT access                                                %                      %                      %
# of Employees WITHOUT access


Average distance to 2 providers for employees
WITH desired access

Average distance to 2 providers for employees
WITHOUT desired access




Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                                       Prepared: 11/14/2010
                                                                       41                      Worksheet: Tab13-Med Proposed-Net Disc&Geo
                                                      City of Beaumont
                                                    Request for Proposal
                             Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA




Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                    Prepared: 11/14/2010
                                                            42              Worksheet: Tab13-Med Proposed-Net Disc&Geo
                                                      City of Beaumont
                                                    Request for Proposal
                             Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


         Carrier Name

         Please note that you must complete the disruption analysis for each network
         quoted in the following requested formats in order for your quote to be
         considered.

                                                    COMPLETE THIS TAB FOR EACH PLAN QUOTED.
Medical Disruption Analysis
                                                                                                                 In Network?
            Provider Code                              Provider Name                   City and State
                                                                                                                    (Y/N)
   1.            640523657                             CHRISTUS HOSPITAL                 BEAUMONT, TX

   2.            640523657                             CHRISTUS HOSPITAL                 BEAUMONT, TX
                                          MEMORIAL HERMANN BAPTIST BEAUMONT
   3.            57310455                                                                BEAUMONT, TX
                                                      HOSPITAL
   4.            17728034                           THE METHODIST HOSPITAL               HOUSTON, TX
                                          MEMORIAL HERMANN BAPTIST BEAUMONT
   5.            57310455                                                                BEAUMONT, TX
                                                      HOSPITAL
   6.            569869586                        MD ANDERSON CANCER CENTER              HOUSTON, TX

   7.            815572832                  THE MEDICAL CTR OF SOUTHEAST TX LP         PORT ARTHUR, TX

   8.            628918645                          MEM HERMANN HOSPITAL                 HOUSTON, TX

   9.            17728034                           THE METHODIST HOSPITAL               HOUSTON, TX

  10.       260752583978001                           CREIGHTON ST JOSEP                  OMAHA, NE

  11.            815572832                  THE MEDICAL CTR OF SOUTHEAST TX LP         PORT ARTHUR, TX

  12.            845953862                         TEXAS CHILDRENS HOSPITAL              HOUSTON, TX

  13.            95480482                        BEAUMONT BONE JOINT INSTITUTE           BEAUMONT, TX

  14.            530933751                        KATE DISHMAN REHAB HOSPITAL            BEAUMONT, TX

  15.            49303065                    QUEST DIAGNOSTIC CLINICAL LAB INC            IRVING, TX

  16.            16353033                          KINDRED HOSPITAL HOUSTON              HOUSTON, TX
                                          THE ENDOSCOPY CENTER OF SOUTHEAST
  17.            445458479                                                               BEAUMONT, TX
                                                        TEXAS LP
                                         BIOTRONICS KIDNEY CENTER OF BEAUMONT
  18.            241710260                                                               BEAUMONT, TX
                                                          INC
  19.            162049180                   BEAUMONT SURGICAL AFFILIATES LLC            BEAUMONT, TX

  20.            538650116                       FOUNDATION SURGICAL HOSPITAL            BELLAIRE, TX

  21.            85361120                         TEXAS ORTHOPEDIC HOSPITAL              HOUSTON, TX

  22.            20909037                         DIAGNOSTIC HEALTH BEAUMONT             BEAUMONT, TX

  23.            568574588                              KESHAVA REDDY                    BEAUMONT, TX

  24.            845953862                         TEXAS CHILDRENS HOSPITAL              HOUSTON, TX

  25.            569869586                        MD ANDERSON CANCER CENTER              HOUSTON, TX



Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                              Prepared: 11/14/2010
                                                                           43            Worksheet: Tab14-Med PPO Disrupt Analysis
                                                        City of Beaumont
                                                      Request for Proposal
                               Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


      Carrier Name


      Please note that you must complete the disruption analysis for each network quoted in
      the following requested formats in order for your quote to be considered.


                                                      COMPLETE THIS TAB FOR EACH PLAN QUOTED.
Medical Disruption Analysis
                                                                                                                      In Network?
         Provider Code                                   Provider Name                      City and State
                                                                                                                         (Y/N)
 1            640523657                                  CHRISTUS HOSPITAL                      BEAUMONT, TX

 2            640523657                                  CHRISTUS HOSPITAL                      BEAUMONT, TX

 3            323783341                      CLEAR LAKE REGIONAL MEDICAL CENTER                 WEBSTER, TX

 4             57310455               MEMORIAL HERMANN BAPTIST BEAUMONT HOSPITAL                BEAUMONT, TX

 5             57310455               MEMORIAL HERMANN BAPTIST BEAUMONT HOSPITAL                BEAUMONT, TX

 6            569869586                             MD ANDERSON CANCER CENTER                   HOUSTON, TX

 7            569869586                             MD ANDERSON CANCER CENTER                   HOUSTON, TX

 8             6804024                                      OPTIONCARE                          BEAUMONT, TX

 9            241710260                 BIOTRONICS KIDNEY CENTER OF BEAUMONT INC                BEAUMONT, TX

 10            95480482                            BEAUMONT BONE JOINT INSTITUTE                BEAUMONT, TX

 11           640523657                                  CHRISTUS HOSPITAL                      BEAUMONT, TX

 12           815572832                       THE MEDICAL CTR OF SOUTHEAST TX LP            PORT ARTHUR, TX

 13           815572832                       THE MEDICAL CTR OF SOUTHEAST TX LP            PORT ARTHUR, TX

 14            20909037                             DIAGNOSTIC HEALTH BEAUMONT                  BEAUMONT, TX

 15           189744206                            SOUTHWEST AIR AMBULANCE SERV                  EL PASO, TX

 16           845953862                              TEXAS CHILDRENS HOSPITAL                   HOUSTON, TX

 17           698464723                      CHRISTUS DUBUIS HOSPITAL BEAUMONT                  BEAUMONT, TX

 18           162049180                        BEAUMONT SURGICAL AFFILIATES LLC                 BEAUMONT, TX

 19            5946155                              CLARUS IMAGING BEAUMONT LP                  BEAUMONT, TX

 20           374549392                                 SAVITHRI BONTHALA                       WEBSTER, TX
                                          HEALTHSOUTH REHABILITATION HOSPITAL OF
 21            99254116                                                                         BEAUMONT, TX
                                                        BEAUMONT
 22            17728034                               THE METHODIST HOSPITAL                    HOUSTON, TX

 23           197372245                                      ERWIN LO                           BEAUMONT, TX

 24            57310455               MEMORIAL HERMANN BAPTIST BEAUMONT HOSPITAL                BEAUMONT, TX

 25           856455988                                   CURTIS THORPE                         BEAUMONT, TX




  Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                               Prepared: 11/14/2010
                                                                             44            Worksheet: Tab14a-Med HMO Disrupt Analys
                                                           City of Beaumont
                                                         Request for Proposal
                                  Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


                                                         DENTAL QUESTIONNAIRE
The following questionnaire must be completed.

Dental Carriers are required to respond to all requests for information contained in this questionnaire. All
responses must be provided on a diskette and respond in a brief, bulleted format. This questionnaire will
be scored; therefore, it is necessary that you provide concise answers. Your responses to the questions
should be based on your current proven capabilities. Should there be instances where certain questions
are not applicable to your organization or its operations, please so indicate. If you are selected to
administer the Client's employee benefit plans, your responses to the questionnaire will be considered
part of your contractual responsibilities. You are also requested to return the indicated exhibits as part of
your proposal.


             Organizational Strength                                             Response




        How many clients do you currently in force for
 1
        this line of coverage?




        How long have you been providing dental
 2
        administration?




                          General                                                Response




 3      Location of Claim Payment Operations




     Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                       Prepared: 11/14/2010
                                                                  45                     Worksheet: Tab15-Den Questionnaire
                                                          City of Beaumont
                                                        Request for Proposal
                                 Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA




       Will you provide annual actuarial services to
4
       provide COBRA rates for participants?




                 Customer Service                                               Response




       Please provide your customer service hours,
       days of operation, time zone. Do you have
       dedicated employees/unit to handle larger
5
       accounts in the call center? What is the
       experience level of your company’s customer
       service department?




       Is your customer service unit bilingual? How
       often are your team members trained on the
       lines of coverage supporting? What are your
6
       hours of customer service unit--after hours? Is
       your customer service unit outsourced? If so,
       what country?




       Does your company archive the actual
7
       enrollment forms?




    Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                      Prepared: 11/14/2010
                                                                46                      Worksheet: Tab15-Den Questionnaire
                                                          City of Beaumont
                                                        Request for Proposal
                                 Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA




       Does your company provide a customized 1-800
8      number to handle questions related to product
       offerings during the enrollment period?




       Are all customer service conversations
9      documented and/or retained for proof of
       compliance?




    System Processes and Technology                                             Response



       What are the various methods information can
       be transmitted and how often? Can the platform
       be fully customized to capture all feeds, and
10     upload to various payroll and eligibility systems?
       State how you process and verify the eligibility
       information. Identify any information you would
       require in paper format.




       Do you have online enrollment/eligibility
       capabilities? For updating? If so, how long does
11
       it take before the change / addition / deletion is
       effective?




    Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                      Prepared: 11/14/2010
                                                                47                      Worksheet: Tab15-Den Questionnaire
                                                       City of Beaumont
                                                     Request for Proposal
                              Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA




     What online benefit systems has your company
12
     worked with?




     Describe your process for handling retroactive
13
     enrollment and cancellations.




            Providers/Networks                                               Response




     Can employees nominate their dentist to
     become part of your network? Do you actively
     pursue member recommendations? What % of
14
     member referrals join the network? What is the
     average timeframe from referral to network
     contract?




     Do you provide directories? If so, how frequently
15   are provider directories updated? How often are
     website directories updated?




 Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                   Prepared: 11/14/2010
                                                             48                      Worksheet: Tab15-Den Questionnaire
                                                       City of Beaumont
                                                     Request for Proposal
                              Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA

        Implementation Process                                               Response



     What initial information is required from the
     employer for implementation? Is a checklist
     available to provide to the client? Explain in
16   detail the steps you anticipate will be needed to
     ensure a smooth implementation. Include a
     timetable of events from the effective date and
     including the Open Enrollment process.




     Who will be assisting in the implementation
17   process? What will occur during the
     implementation process?




     Will you have field representatives available for
18   group meetings? What is standard timeframe for
     meeting notifications for travel purposes?




     Standard turnaround time for new group
19
     processing? New enrollees?




 Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                   Prepared: 11/14/2010
                                                             49                      Worksheet: Tab15-Den Questionnaire
                                                       City of Beaumont
                                                     Request for Proposal
                              Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA




20   Do you track dependent eligibility?




21   How will terminations be handled?




     Is any function of the claims process
22
     outsourced?




     What is your standard turnaround time for
23
     claims payment?




 Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                   Prepared: 11/14/2010
                                                             50                      Worksheet: Tab15-Den Questionnaire
                                                       City of Beaumont
                                                     Request for Proposal
                              Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA




     In the event of contract termination, discuss the
24   transition process. Include penalties, number of
     days notice, etc.




     Do you provide ID cards? How soon do
25   employees receive ID cards prior to the effective
     date of coverage?




     Are you willing to customize communications,
     such as ID cards and SPDs? Do you agree to
     allow the Client to pre-approve any
26
     communication to employees that would reach a
     significant portion of the Client's population?
     Individualized communications are excluded.




     Will your organization provide the Client with
27   hard copies of provider directories for employees
     or administration? If so, how often.




 Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                   Prepared: 11/14/2010
                                                             51                      Worksheet: Tab15-Den Questionnaire
                                                       City of Beaumont
                                                     Request for Proposal
                              Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA




     What information is available through your
28
     website for the members and the group?




     How will billing be set-up? Does your company
29   offer self-bill or electronic billing? Is any function
     of the billing process outsourced?




                   Plan Design                                               Response




     What schedule and percentage is your UCR data
     based upon? Is UCR based on the carrier's or
30   other data? If own data, is UCR based on ALL
     submitted charges or only network dentists
     charges?




     What is the basis for out-of-network benefits
     reimbursement:
31
     1) UCR, 2) network fee schedule, and 3) other?
     Please explain.




 Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                   Prepared: 11/14/2010
                                                              52                     Worksheet: Tab15-Den Questionnaire
                                                       City of Beaumont
                                                     Request for Proposal
                              Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA

               Claims Payment                                                Response




     What procedures are in place for insuring proper
32
     COB?




     For an ASO account, are you responsible for
33   overpayments? If not, how is the Client
     compensated for your errors?




     In the event that the relationship terminates,
34   how is work-in-process handled? What about
     members in the midst of orthodontia treatment?




     For an ASO account, are you willing to submit to
35
     audits conducted by the Client or its agents?




 Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                   Prepared: 11/14/2010
                                                             53                      Worksheet: Tab15-Den Questionnaire
                                                       City of Beaumont
                                                     Request for Proposal
                              Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA




     Are claim forms necessary for all services? Any
36
     services?




     How long do you maintain dental claims
37
     records?




 Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                   Prepared: 11/14/2010
                                                             54                      Worksheet: Tab15-Den Questionnaire
                                                          City of Beaumont
                                                        Request for Proposal
                                 Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


       Carrier Name


       Please note that you must complete plan design information in the following requested
       format in order for your quote to be considered. Enter only those plan design elements
       that are included in your quoted rates. Please confirm that you can duplicate and
       administer the current plan design. If not, please indicate differences on Dental-
       Deviations/Variations.
                                                     COMPLETE THIS TAB FOR EACH PLAN QUOTED.


Proposed Dental Plan Design
Is quoted plan an open or closed list of services?                                                                         Yes o     No o
       If a closed list, please provide a detailed list of covered services and any services not included.
How is your dental plan set up?                                                                              Calendar Year o   Plan Year o
       Is there a 4th quarter carryover provision?                                                                         Yes o     No o
What are your plan frequency limitations based on?                                               Calendar Year o     Consecutive Months o


                                                                           In-Network                            Out-of-Network
Deductible (CYD)
       Per Participant
       Family
Out-of-Pocket Maximum
(Per person, per calendar year)
Preventive
       Number of preventive cleanings covered
Basic Services
       Are composite fillings covered?
Major Services
Orthodontic Services
       Benefit Percentage
       Age Limitations
       Orthodontic Lifetime Maximum


Basis of reimbursement
UCR percentile, in-network fee schedule, or other fixed
dollar schedule?
       If UCR, what percentile?
What level of service is Periodontic services covered?
What level of service is Endodontic services covered?
What is the eligibility or benefit waiting periods for new
enrollees or late entrants?




    Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                                            Prepared: 11/14/2010
                                                                            55                           Worksheet: Tab16-DPPO Proposed-Benefits
                                                          City of Beaumont
                                                        Request for Proposal
                                 Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


Frequencies
Please provide frequency and service category (i.e., preventive, basic, major) for each service listed:
                                                                          Frequency                            Service Category
Periodic Oral Evaluation
Genetic test for susceptbility to oral diseases
Intraoral complete Series or Panoramic X-rays
Bitewing X-Rays
Dental Prophylaxis
Topical Flu
Bitewing X-Rays




    Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                                             Prepared: 11/14/2010
                                                                           56                             Worksheet: Tab16-DPPO Proposed-Benefits
                                                          City of Beaumont
                                                        Request for Proposal
                                 Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA

Dental Prophylaxis
Topical Fluoride Treatment
Sealants
Space Matainers
Periodontal Maintenance (Prophy)
Inlays and Onlays
Crowns
Endodontic endosseous implants
Dentures
Fixed Bridges


Plan Specific Questions
Major Services
Is treatment (crown/root canal) started prior to coverage eligible for benefits?                                          Yes o    No o
         Please explain how transfer of benefits are paid.
Orthodontic
Is coverage limited to active treatment or active treatment and retention?          Active Treatment o     Active Treatment & Retention o
Is treatment started prior to coverage eligible for benefits?                                                             Yes o    No o
         Please explain how transfer of orthodontic benefits are paid.
Plan Design
                                                                                                                         Yes o      No complex endo?)
Are endodontic and periodontal services combined or split into separate service categories (surgical and non-surgical perio, simple ando
         If separated, please list on the deviations/variations tab.
Are simple and surgical extractions combined or split into separate service categories?                                   Yes o    No o
Are "naturally functioning" or "asymptomatic" tooth provisions in effect?                                                 Yes o    No o
         If terms are defined, please list on the deviations/variations tab.
Out-of-Network Benefits




    Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                                            Prepared: 11/14/2010
                                                                               57                        Worksheet: Tab16-DPPO Proposed-Benefits
                                                        City of Beaumont
                                                      Request for Proposal
                               Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


       Carrier Name


       For any benefits you cannot duplicate or administer, per the in force SPD, please indicate
       on this tab. Please clearly note the differences.


Proposed Dental -- Deviations/Variations




  Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                     Prepared: 11/14/2010
                                                              58                 Worksheet: Tab17-Den Deviations-Variations
                                                       City of Beaumont
                                                     Request for Proposal
                              Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


        Carrier Name


        Please note that you must complete rate information in the following requested format
        in order for your quote to be considered.


                                                       COMPLETE THIS TAB FOR EACH PLAN QUOTED.
Proposed Fully Insured Dental Rates

Are retirees included in fully insured rates?            Yes o     No   o


Quote rates in the following tier structure(s):          2-Tier o3-Tier o4-Tier o


                                          EE Counts              Proposed Dental Rates
Employee Only                                     xx
Employee + Spouse                                 xx
Employee + Child(ren)                             xx
Employee + Family                                 xx
Monthly Premiums                                                          $0
Annual Premiums                                                           $0


Assumptions

Employer Contribution (i.e., 75%, 50%)
Rate Guarantee
Participation Requirements
Commissions                                                                              Net
Other




 Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                                   Prepared: 11/14/2010
                                                                            59                   Worksheet: Tab18-Den Proposed-FI Rates
                                                       City of Beaumont
                                                     Request for Proposal
                              Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


        Carrier Name

        Please note that you must complete plan design and rate information in the following
        requested formats in order for your quote to be considered. Enter only those plan
        design elements that are included in your quoted rates. List any optional coverages
        (along with the approximate percentage increase to the rates) under Optional
        Available Riders.


Proposed Self-Funded Dental ASO Fees
                                                      With $x,xxx Benefit                   With $x,xxx Benefit
Administrative Fees
        Employee Only                             $                         pepm     $                            pepm
        Employee + Spouse                         $                         pepm     $                            pepm
        Employee + Child(ren)                     $                         pepm     $                            pepm
        Employee + Family                         $                         pepm     $                            pepm

Other Fees
Startup                                           $                                  $
SPD (draft, production & distribution)            $                                  $
Reporting                                         $                                  $
Subrogation                                       $                                  $
Coordination of benefits                          $                                  $
Other fees                                        $                                  $


Assumptions

Employer Contribution (i.e., 75%, 50%)
Rate Guarantee
Participation Requirements
Commissions                                                                    Net
Other




 Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                                Prepared: 11/14/2010
                                                                60                       Worksheet: Tab19-Den Proposed-SF ASO Fees
                                                      City of Beaumont
                                                    Request for Proposal
                             Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


        Carrier Name


        Please note that you must this information in the following requested formats in
        order for your quote to be considered. Enter only the networks that are included in
        your quoted rates.


                                                 COMPLETE THIS TAB FOR EACH PLAN QUOTED.
Dental Network Discounts
Please provide your organization's self reported discounts within the Beaumont area for:
General Dentists                                                           %
Specialist Dentists                                                        %
Orthodontists                                                              %


How are discounts calculated?                                                     Average Charge oUCR Percentile o


Geo Access Results
Please provide full detailed reports for the medical GEO access within your formal proposal.

                       Measurement                          General Dentists       Specialist Dentists      Orthodontists

# of Employees / Zip Codes Evaluated
Providers
# of Providers
# of Locations
X Providers within X Miles                                        2 / 10                   2 / 15               1 / 20
% of Employee WITH access                                                  %                        %                    %
# of Employees WITH access
% of Employee WITHOUT access                                               %                        %                    %
# of Employees WITHOUT access


Average distance to 2 providers for employees
WITH desired access

Average distance to 2 providers for employees
WITHOUT desired access




Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                                       Prepared: 11/14/2010
                                                                      61                       Worksheet: Tab20-Den Proposed-Net Disc&Geo
                                                      City of Beaumont
                                                    Request for Proposal
                             Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


           Carrier Name


           Please note that you must complete the disruption analysis for each network quoted in the
           following requested formats in order for your quote to be considered.


                                                    COMPLETE THIS TAB FOR EACH PLAN QUOTED.
  Dental Disruption Analysis
                                                                                                                   In Network?
               Provider Code                            Provider Name                  City and State
                                                                                                                       (Y/N)
     1          0000742048323                        WEAVER/RICHARD E DDS              BEAUMONT, TX
     2          0000760382551                         CASCIO/GERARD A DDS              BEAUMONT, TX
     3          0000760357336                         BAXLEY/WILLIAM K DDS             BEAUMONT, TX
     4          0000760675414                       COPLEY HARPER/REBA DDS             BEAUMONT, TX
     5          0000141860826                     BEAUMONT DENTAL ASSOCIATES           BEAUMONT, TX
     6          0000742101849                       MATHERNE/ROBERT C DDS              BEAUMONT, TX
     7          0000451028736                          ROSE/FRANK R DDS                BEAUMONT, TX
     8          0000760065161                         COLEMAN/ALAN B DDS               BEAUMONT, TX
     9          0000760618962                           DUKE/ANDY B DDS                BEAUMONT, TX
    10          0000760522395                    COURVILLE BESS PARTNERSHIP DDS        BEAUMONT, TX
    11          0000760628321                    K DILEO & E GREEN DILEO DDS PC         ORANGE, TX
    12          0000760230188                         CITRANO/RONALD DDS               BEAUMONT, TX
    13          0000746176002                          BITAR/KAMAL C DDS               BEAUMONT, TX
    14          0000464154420                        HAGLER/TIMOTHY H DDS                VIDOR, TX
    15          0000760505666                          LUMBERTON DENTAL                 LUMBERTON
    16          0000760437652                         NELAMS/H DAVID DDS                LUMBERTON
    17          0000462713976                       ARGUELLES/ALANNA K DDS             BEAUMONT, TX
    18          0000741677616                         LEAVINS/JERRY D DDS                VIDOR, TX
    19          0000741745935                     DRS LAUGHLIN & PHILLIPS DMD          BEAUMONT, TX
    20          0000742144454                         WARE/EDWARD M DDS                BEAUMONT, TX
    21          0000263322621                        OLSON/KATHERINE E DDS             BEAUMONT, TX
    22          0000201249597                         SCOTT/GEORGE G DDS                PORT ARTHUR
    23          0000760212883                        BOSTWICK/PHILLIP A DDS            BEAUMONT, TX
    24          0000454802239                         DYER/CHARLES E DDS               BEAUMONT, TX
    25          0000320178544                     BARTLETT/MICHAEL SCOTT DDS          PORT NECHES, TX




Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                                Prepared: 11/14/2010
                                                                           62                 Worksheet: Tab21-DenDisruption Analysis
                                                           City of Beaumont
                                                         Request for Proposal
                                  Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


                                           FLEXIBLE SPENDING ACCOUNT (FSA) QUESTIONNAIRE
The following questionnaire must be completed.

Flexible Spending Account (FSA) carriers are required to respond to all requests for information contained
in this questionnaire. All responses must be provided on a diskette and respond in a brief, bulleted format.
This questionnaire will be scored; therefore, it is necessary that you provide concise answers. Your
responses to the questions should be based on your current proven capabilities. Should there be instances
where certain questions are not applicable to your organization or its operations, please so indicate. If
you are selected to administer the Client's employee benefit plans, your responses to the questionnaire
will be considered part of your contractual responsibilities. You are also requested to return the indicated
exhibits as part of your proposal.


                  Your Organization                                              Response




        How long have you been providing FSA
 1
        administration?




        How many clients do you currently in force for
 2      this line of coverage? What is the average
        number of employees per plan?




                       Plan Design                                               Response




        How is discrimination testing performed? How
 3
        often is this done?




     Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                       Prepared: 11/14/2010
                                                                 63                      Worksheet: Tab22-FSA Questionnaire
                                                          City of Beaumont
                                                        Request for Proposal
                                 Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA




       Please provide a list of all services that your
4
       company would provide.




Implantation / Account Management                                               Response



       What initial information is required from the
       employer for implementation? Is a checklist
       available to provide to the client? Explain in
5      detail the steps you anticipate will be needed to
       ensure a smooth implementation. Include a
       timetable of events from the effective date and
       including the Open Enrollment process.




       Who will be assisting in the implementation
6      process? What will occur during the
       implementation process?




       Provide descriptions of staff who will direct and
       provide services for the Client's account. Is there
7
       a dedicated account manager assigned for the
       client/consultant?




    Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                      Prepared: 11/14/2010
                                                                64                      Worksheet: Tab22-FSA Questionnaire
                                                          City of Beaumont
                                                        Request for Proposal
                                 Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA




       Will you have field representatives available for
8      group meetings? What is standard timeframe for
       meeting notifications for travel purposes?




       Standard turnaround time for new group
9
       processing? New enrollees?




       Please list all descriptive literature, enrollment
       forms, direct deposit forms, other essential
10     forms used for intial set-up, during the year and
       during annual enrollment that will be provided to
       the Client.




11     How will terminations be handled?




    Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                      Prepared: 11/14/2010
                                                                65                      Worksheet: Tab22-FSA Questionnaire
                                                       City of Beaumont
                                                     Request for Proposal
                              Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA




     In the event of contract termination, discuss the
12   transition process. Include penalties, number of
     days notice, etc.




     How will billing be set-up? Does your company
13   offer self-bill or electronic billing? Is any function
     of the billing process outsourced?




     Customer Service and Reports                                            Response

     Are utilization reports available? At what
     frequency? Will the Client receive reports
     necessary for the administration of the Flexible
     Spending Account Plan including a.) periodic
     report by employee showing amounts credited
14
     to the employee’s account, the amount paid
     from the account and the account balance; b.)
     end of plan year report showing, by employee,
     amounts left unexpended? What is the cost for
     customized reports?




15   Are your standard reports available online?




 Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                   Prepared: 11/14/2010
                                                              66                     Worksheet: Tab22-FSA Questionnaire
                                                       City of Beaumont
                                                     Request for Proposal
                              Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA




     How often are statements sent to the employee
16   indicating claims received, payments made, and
     the account balance?




     Please provide your customer service hours,
     days of operation, time zone. Do you have
     dedicated employees/unit to handle larger
17
     accounts in the call center? What is the
     experience level of your company’s customer
     service department?




     Is your customer service unit bilingual? How
     often are your team members trained on the
     lines of coverage supporting? What are your
18
     hours of customer service unit--after hours? Is
     your customer service unit outsourced? If so,
     what country?




19   What languages and TDD services are available?




 Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                   Prepared: 11/14/2010
                                                             67                      Worksheet: Tab22-FSA Questionnaire
                                                       City of Beaumont
                                                     Request for Proposal
                              Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA

     Communications and Web Tools                                            Response




     Is the Internet access available to employees
     and employer? What are your online capabilities
20
     for employees? Can the employee view the
     balance online?




     Provide the description of how the Client
     employees will receive information on their Flex
21   plans. What will be the effective date of when
     employees can access information regarding
     plan.




     What types of employee communication pieces
22
     are available?




     Are communication pieces customized with client
23
     logo/information?




 Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                   Prepared: 11/14/2010
                                                             68                      Worksheet: Tab22-FSA Questionnaire
                                                       City of Beaumont
                                                     Request for Proposal
                              Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA




     Is someone available to attend an enrollment
24
     health fair in the Fall?




 Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                   Prepared: 11/14/2010
                                                             69                      Worksheet: Tab22-FSA Questionnaire
                                                      City of Beaumont
                                                    Request for Proposal
                             Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


         Carrier Name


         Please note that you must complete plan design information in the following
         requested format in order for your quote to be considered. Enter only those plan
         design elements that are included in your quoted rates. Please confirm that you can
         duplicate and administer the current plan design. If not, please indicate differences
         on EAP-Deviations/Variations.


Proposed FSA Services
                                                                               Services
Debit Card?                                                                 Yes o   No    o
Plan Documents?                                                             Yes o   No    o
Discrimination Testing?                                                     Yes o   No    o
Employee Communication Materials?                                           Yes o   No    o
Reporting (Please list standard and any other reports)
     1
     2
     3
     4
     5




Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                   Prepared: 11/14/2010
                                                            70                      Worksheet: Tab23-FSA Prop-Services
                                                        City of Beaumont
                                                      Request for Proposal
                               Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


       Carrier Name


       For any benefits you cannot duplicate or administer, per the in force SPD, please indicate
       on this tab. Please clearly note the differences.


Proposed FSA -- Deviations/Variations




  Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                     Prepared: 11/14/2010
                                                              71                 Worksheet: Tab24-FSA Deviations-Variations
                                                       City of Beaumont
                                                     Request for Proposal
                              Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


        Carrier Name


        Please note that you must complete rate information in the following requested format
                              in order for your quote to be considered.


Proposed FSA Fees


                                                                                Proposed FSA Fees

FSA Administration Fee (PEPM)
Debit Card Fee (PEPM)
Implementation/Set Up Fee
Annual Renewal Fee
Employee Communication Material(Please List)
    1
    2
    3
    4
    5
Other (Please List)
    1
    2
    3
    4
    5
Monthly Premiums
Annual Premiums


Assumptions

Participation Requirements
Rate Guarantee
Commissions                                                                           Net
Other




 Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                    Prepared: 11/14/2010
                                                             72                     Worksheet: Tab25-FSA Proposed-Fees
                                                           City of Beaumont
                                                         Request for Proposal
                                  Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


                                                          COBRA QUESTIONNAIRE
The following questionnaire must be completed.
COBRA carriers are required to respond to all requests for information contained in this questionnaire. All
responses must be provided on a diskette and respond in a brief, bulleted format. This questionnaire will
be scored; therefore, it is necessary that you provide concise answers. Your responses to the questions
should be based on your current proven capabilities. Should there be instances where certain questions
are not applicable to your organization or its operations, please so indicate. If you are selected to
administer the Client's employee benefit plans, your responses to the questionnaire will be considered
part of your contractual responsibilities. You are also requested to return the indicated exhibits as part of
your proposal.

                  Your Organization                                              Response




        Please provide information about your company,
 1      including ownership and structure. How long
        have you been in business?




        Please describe any mergers, acquisitions, or
 2
        name changes in the last five years.




        Has your company been involved in litigation in
 3
        the past three years? If so, please describe.




     Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                        Prepared: 11/14/2010
                                                                  73                  Worksheet: Tab26-COBRA Questionnaire
                                                          City of Beaumont
                                                        Request for Proposal
                                 Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA




       Please provide your customer service hours/days
4
       of operation/time zone.




5      What is your organization's target market?




6      Location of COBRA Operations.




7      Number of years providing COBRA services.




    Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                       Prepared: 11/14/2010
                                                                74                   Worksheet: Tab26-COBRA Questionnaire
                                                          City of Beaumont
                                                        Request for Proposal
                                 Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA




       Which carriers do you share data feeds for
8
       eligibility?




                    Administrative                                              Response




       Describe your administrative process(include
       qualifying events notices, billing, premium
       payments, eligibility confirmation, coordination
9
       of benefits confirmation, disability extensions,
       conversions, cancellations, disbursement of
       premiums received, etc.)




       Please confirm your ability to customize letters
       sent to participants. Please also describe any
10
       associated additional fees related to
       customization.




       Please describe your reporting capabilities.
       Include the method by which the plan sponsor
11     and outsource vendor can request reports,
       delivery methods, timelines for ordering reports
       and any extra fees associated with reports.




    Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                       Prepared: 11/14/2010
                                                                75                   Worksheet: Tab26-COBRA Questionnaire
                                                       City of Beaumont
                                                     Request for Proposal
                              Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA




     Please provide samples of your reports available
     to the plan sponsor and outsource eligibility
     vendor. Please describe and label each sample,
12
     and indicate the format(s) available for each
     report. Please also indicate which reports are
     included in your standard reporting package.




     When are monthly reports available for the plan
     sponsor? How are requests for ad hoc reports
13
     handled and what is the typical turnaround time
     for additional reports requested?




     Does your website offer access to customized
14
     reports for COBRA on a real time basis?




     What payment options are available? Do you
15   offer online payment options? Do you offer the
     ability to pay via credit or debit card?




 Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                    Prepared: 11/14/2010
                                                             76                   Worksheet: Tab26-COBRA Questionnaire
                                                       City of Beaumont
                                                     Request for Proposal
                              Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA




     Please describe how your company insures and
16   monitors participant and plan sponsor
     confidentiality.




     Describe your system for protecting information
17
     and ensuring HIPAA compliance.




     Please describe your initial and ongoing training
     requirements for your customer service
18
     employees. How is performance tracked and
     monitored?




     Describe how your organization monitors and
     complies with changes in government
19
     regulations. Please provide and label samples of
     plan sponsor compliance and advisory materials.




 Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                    Prepared: 11/14/2010
                                                             77                   Worksheet: Tab26-COBRA Questionnaire
                                                       City of Beaumont
                                                     Request for Proposal
                              Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA




     What audit processes do you use to insure the
20
     accuracy and timeliness of data in your system?




     Please describe your emergency update and
21
     changes capability for both Client and their TPA?




     Can your process/system accommodate
     immediate changes to eligibility and enrollment?
22
     Can you also immediately confirm those changes
     to the vendor?




     How often do you send files to the vendors and
23   on what days of the week are those files sent?
     Can Client and/or consultant choose the days?




 Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                    Prepared: 11/14/2010
                                                             78                   Worksheet: Tab26-COBRA Questionnaire
                                                       City of Beaumont
                                                     Request for Proposal
                              Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA




     Please describe in detail your annual enrollment
     support capabilities. Will you partner with the
24
     Sample Client annual enrollment vendor to
     provide communications?




     Please describe, in detail, your transition plan for
25
     Sample Client.




     Please provide a proposed implementation plan
26
     and schedule.




     Will you provide a “test” environment in order
27
     for the client to test implementation?




 Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                    Prepared: 11/14/2010
                                                             79                   Worksheet: Tab26-COBRA Questionnaire
                                                       City of Beaumont
                                                     Request for Proposal
                              Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA




     Please provide and label a sample COBRA
28
     Service Agreement.




29   Please provide and label a sample BAA.




     Please provide and label a sample third party
30
     agreement.




     Please provide and label a sample
31
     indemnification agreement.




 Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                    Prepared: 11/14/2010
                                                             80                   Worksheet: Tab26-COBRA Questionnaire
                                                       City of Beaumont
                                                     Request for Proposal
                              Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA

                       COBRA                                                 Response




     Please list the standard services provided under
32
     COBRA administration.




     How is COBRA eligibility tracked? If the service
33   is provided through a different vendor, can you
     provide a COBRA eligibility interface?




     Please describe the process for handling
34   initial/general COBRA notifications and what
     data is required from the client?




     Please describe where and how your processes
35   for COBRA administration and services are
     documented and monitored.




 Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                    Prepared: 11/14/2010
                                                             81                   Worksheet: Tab26-COBRA Questionnaire
                                                       City of Beaumont
                                                     Request for Proposal
                              Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA




     Please provide a sample of your standard
     COBRA communication and administration
36   forms, including initial COBRA notices, COBRA
     rights, billing, past due, and termination forms.
     Please describe and label each sample.




     Can you accommodate reissuing any of these
37
     notices and forms?




     How are spouse and/or dependent records
     associated with the qualifying employee handled
38
     if only spouse and/or dependent elects COBRA
     coverage?




     How does your system differentiate between the
39
     various COBRA qualifying events?




 Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                    Prepared: 11/14/2010
                                                             82                   Worksheet: Tab26-COBRA Questionnaire
                                                       City of Beaumont
                                                     Request for Proposal
                              Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA




     How does your system handle secondary COBRA
40
     qualifying events?




     Describe your process for reviewing status
41
     changes, death, and divorce events?




     How does your system track and report
42
     severance arrangements?




     Describe your process for handling unpaid
43   premiums and related benefit coverages during
     the COBRA premium grace period.




 Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                    Prepared: 11/14/2010
                                                             83                   Worksheet: Tab26-COBRA Questionnaire
                                                       City of Beaumont
                                                     Request for Proposal
                              Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA




     What method is used to communicate elections,
44   changes and terminations and what is the
     frequency?




     Are transactions audited to ensure that all
45   transactions have been reported to the carrier
     accordingly?




     Describe your ability to transmit and receive
46   COBRA data electronically (eligibility and invoice
     reconciliation.)




     Describe how COBRA participants can contact
47   your organization with questions /issues/ or
     concerns.




 Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                    Prepared: 11/14/2010
                                                             84                   Worksheet: Tab26-COBRA Questionnaire
                                                       City of Beaumont
                                                     Request for Proposal
                              Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA




     Do you provide web access to view account
     status, enrollment, and premium payments?
48
     What participant friendly features are available
     on your website?




     Is any part of your COBRA administration
49   outsourced currently? If not, do you have any
     plans to outsource any portion in 2010?




 Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                    Prepared: 11/14/2010
                                                             85                   Worksheet: Tab26-COBRA Questionnaire
                                                      City of Beaumont
                                                    Request for Proposal
                             Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


        Carrier Name


        Please note that you must complete plan design information in the following
        requested format in order for your quote to be considered. Enter only those plan
        design elements that are included in your quoted rates. Please confirm that you can
        duplicate and administer the current plan design. If not, please indicate differences
        on COBRA-Deviations/Variations.


Proposed COBRA Services
                                                                               Services
Able to customize letters and reporting?                                    Yes o     No    o
Ability to receive and load a weekly new hire/term/QE report?               Yes o     No    o
Agree to allow Client to pull their own reports from system?                Yes o     No    o
Ability to provide annual enrollment support?                               Yes o     No    o
Allow payment via a bank draft or mail in check?                            Yes o     No    o
Ability to adjust COBRA premium schedule?                                   Yes o     No    o
Allow Client direct access to COBRA website?                                Yes o     No    o
Real Time updating?                                                         Yes o     No    o




Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                      Prepared: 11/14/2010
                                                               86                   Worksheet: Tab27-COBRA Prop-Services
                                                       City of Beaumont
                                                     Request for Proposal
                              Medical, Stop Loss, Dental, Flexible Spending Accounts, and COBRA


        Carrier Name


        Please note that you must complete rate information in the following requested format
        in order for your quote to be considered.


Proposed COBRA Fees


                                                                              Proposed COBRA Fees

Proposed Fees (PEPM)
COBRA Administration
Implementation Fee
Takeover Continuants Fee
Qualifying Event Fee
Monthly COBRA Participant Fee
Do you retain 2% of COBRA premium?
Open Enrollment Coordination Fee
Initial Rights to New Hires Fee
Any Other Additional Fees (Please list and describe)
    1
    2
    3
    4
    5


Assumptions

Length of Fee Guarantee
Commissions                                                                           Net
Other




 Holmes Murphy Associates, Inc. -- CONFIDENTIAL
                                                                                                   Prepared: 11/14/2010
                                                             87                  Worksheet: Tab28-COBRA Proposed-Fees

				
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Description: Memorial Hermann Indemnification Agreement document sample