Disability Insurance Request for Proposal by pwd12838

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									                                         Request for Proposal
                                                   for
                           Group Medical, Dental, Life and Disability Insurance
                               for Crane County Employees and Retirees


I.        General Requirements:
          Crane County is interested in obtaining proposals for Group Medical, Dental, Life and Disability
          insurance for both active employees and retirees. Crane County will accept proposals for the
          following:

                  A Partially Self-Funded for medical and dental with $30,000 Individual
                  Specific Deductible and a 125% Aggregate stop loss. Specific Deductible
                  covers Medical only. Medical, dental and the prescription drug card are
                  to be covered under the Aggregate. Life/AD&D and Disability Income will
                  only be considered on a fully insured basis.

II.       Product Information:
          Complete product information and descriptive literature shall be submitted with the proposal.
          Information submitted shall be sufficiently detailed to substantiate that the products offered meet
          or exceed the specifications. All vendors are hereby put on notice that all information submitted
          according to this requirement will be incorporated by reference in the contract document arising
          out of vendor's response, and may be subject to express contract warranties.

III.   Proposal Cost Errors:
          Vendors are expected to thoroughly examine the specifications and all instructions. Preparation
          of cost extensions shall be at the vendor's risk. In the event a vendor errors in any cost extension,
          the vendor's unit price shall prevail.

IV.       Proposal Closing Date:
          Proposals must be received by Crane County no later than August 26, 1999, at I 0:00 A.M.
          Requests for extensions of the closing date or time will not be granted. Proposals arriving late or
          unsealed will not be considered. Vendors should allow sufficient mailing time to insure the timely
          receipt of proposals. All proposals must be submitted as originals since company officials’
          signatures are required.

                  PROPOSED RATES MUST BE SUBMITTED ON OFFICIAL FORMS
                  FURNISHED BY CRANE COUNTY. ONE ORIGINAL FULL PROPOSAL AND 7
                  COPIES OF THE RESPONSE TO THE QUESTIONS, RATES PAGES AND
                  SUMMARY OF BENEFITS WILL BE REQUIRED.

          Address all sealed proposals to:                   Mindy Edmiston
                                                             Crane County Auditor
                                                             P.0. Box 667
                                                             Crane, Texas 79731

          They must be clearly marked "Employee Benefit Program Proposal"

V.        Proposal Opening Date and Time:
          Proposals will be opened in the Crane County Commissioners Courtroom, Crane County
          Courthouse, Crane, Texas on September 1, 2000, at 10:00 A.M. Crane County intends to protect
          its right to negotiate with Vendors and will not make the proposals available to the public until after
          the contract award.

VI.       Submission of Vendor Contracts:




                                                   Page 1 of 17
        A proposal must include proposed contract forms that the Vendor intends to use during contract
        negotiation. However, in making a contract award, Crane County shall not be bound by any
        proposed contractual language but shall instead be free to negotiate terms and conditions as
        necessary. Crane County may, however, reject any proposals where proposed contractual terms
        are deemed unreasonable.

VII.    General Information:
        This information is included in the specifications. Please note the requirements of all Vendors
        regarding financial statements and professional liability, fiduciary bond and agent E&O
        documentation. Any proposal submitted without this documentation will not be considered.

VIII.   Questions:
        Please respond to all questions in the specifications and General Information. Use the Response
        Page provided in the specifications to address these issues.

IX.     Need for Additional Information:
        If additional information is needed or questions to any of the specifications or enclosed
        information is required, please state needed information or questions in writing and mail
        them to the address on the previous page, or fax them to 915-558-1185.




                                              Page 2 of 17
                                      GENERAL INFORMATION

NOTE: ANY DEVIANCE FROM SPECIFICATIONS MUST BE CLEARLY MARKED AND ADDRESSED
IN THE PROPOSAL. A RESPONSE PAGE HAS BEEN PROVIDED AND MUST BE USED TO
ADDRESS THE QUESTIONS ASKED AS WELL AS DEFINE THE DEVIANCE FROM THE
SPECIFICATIONS.


1)    All proposals must be submitted for an October 1, 2000, effective date.

2)    All benefits are to include 24-hour coverage of both the employees and their covered dependents,
      excluding Workman's Compensation.

3)    The benefit period will be calendar year with a fourth quarter carryover.

4)    Life/AD&D are provided for by the employer. The life amount for each employee is $20,000.00
      paid for by the employer. Each employee also has the option of purchasing an additional
      $20,000.00 paid for by the employee. Employees participating in the “Additional Life” program are
      noted on the census with an “AL” to the far right of the page.

5)    The employer pays I 00% of the employee only cost for all lines of coverage.

6)    HealthCare Benefits, Inc. is our current claims administrator. We have been with them since
      11/01/93.

7)    We are accepting partially self funded proposals. Stop-Loss contracts should be based upon a
      12/12, 18/12, 24/12, or Paid basis.


8)    The proposal must include a prescription drug card. The card company must be currently
      accepted at all Crane Pharmacies, at least 90% of the pharmacies in the Midland/Odessa area
      and 80% of the pharmacies statewide in Texas.

9)    Renewal information must be furnished no later than 45 days prior to the renewal date.

10)   All proposals must be in compliance with Texas Legislature House Bill 2 mandated Serious
      Mental and Nervous Benefits.

11)   The policy adopted must meet all current and future State and Federal laws.

12)   Personal interviews may be requested of those proposers who appear to be the most responsive
      to our needs and requirements. Please specify the name and telephone number of the person or
      persons to be contacted in the event your firm is selected for an interview.

13)   The "Actively at Work" clause must be waived for all employees, retirees, and their dependents on
      initial enrollment.

14)   Each proposal must meet the specifications as outlined.

15)   We have included a current census, Schedule of Coverage for both the medical and the dental
      plan, 2 years claims experience and large claims information in these specifications. Experience
      for the Disability coverage is also included.

16)   You shall not under penalty of law, offer any gratuities, or favors, or anything of monetary value to
      any employee or consultant or elected official of our group for the purpose of influencing favorable
      disposition toward either your or any other proposal submitted hereunder.


                                               Page 3 of 17
17)   You will not engage, in any manner, in any practices with any other proposer(s) which may restrict
      or eliminate competition or otherwise restrain trade. Violation of this instruction will cause your
      proposal to be rejected.

18)   The employees listed on our census as Life only are covered as a dependent under their spouse's
      membership. Both husband and wife work for the County.

19)   Quote a $30,000.00 Specific Deductible and 125% Aggregate. Medical only under the Specific.
      Medical, Dental, and Prescriptions under the Aggregate.

20)   Use the form provided in the specifications for the Annual Cost Projection. Note: that if your
      program's PPO Access rate is based on a percentage of savings that amount must be
      disclosed on the Annual Cost sheet.

21)   Although cost is a component of our selection criteria, it will not be the only factor in our decision
      process. Reinsurance contracts, reinsurance carrier rating, TPA referrals and ability to service
      our account, agent's knowledge and ability to service our account, and PPO network's ability to
      save on claims will be evaluation points in our selection. Crane County's selection does not have
      to be made on the lowest proposal and the Commissioner's Court reserves the right to reject any
      or all proposals.

22)   Please quote current medical, dental, and prescription benefits label "Current Plan" and the
      alternate medical, dental, and prescription benefits label "Proposed Plan". Claims experience is
      based upon the current medical, dental, and prescription benefits. The Proposed Plan is a plan
      the Commissioners Court will consider implementing effective October 1, 2000.




                                               Page 4 of 17
                                             QUESTIONS


1)    Will your firm provide for COBRA administration? If so, what is the cost?

2)    Does your firm provide a toll free number so our employees can call you directly to check the
      status of a pending claim and verify benefits.

3)    Approximately how many groups and covered persons does your firm presently serve?

4)    Please list the reinsurance company's rating with BEST, Moodys and/or Standard and Poor.

5)    Do you have special contracts with providers in this area that will provide discounts or savings? If
      so, please explain what percentage of savings we can expect on hospital charges and physician
      charges. Please be specific. Actual reports of existing groups of approximately our size would be
      well received.

6)    What is the name of the proposed PPO Network? Please furnish a Provide Directory for the West
      Texas region.

7)    Will your firm be willing to provide a representative to attend meetings to explain claims filing
      procedures, the schedule of coverage and the procedure for having a disputed claim reviewed?

8)    Is the "Actively at Work" provision waived for persons currently disabled?

9)    What date was your TPA or Trust incorporated? How many employees does your TPA or Trust
      directly employee?

10)   Agent's and TPA's are required to furnish a copy of E & 0 coverage and/or Professional Liability
      coverage. TPA's are required to furnish proof of fiduciary bonding and their most recent audited
      financial statement.




                                              Page 5 of 17
                                           RESPONSE PAGE

Please provide answers to the Questions on this page. If no deviations are noted it will be assumed that
your proposal duplicates benefits and contract provisions in their entirety.




                                               Page 6 of 17
                                              COSTPAGE
                                        Current Benefits 10-1-00

Type of Contract: ___________            Name of Carrier: _________________ Carrier Rating: _____

Assumptions: Medical            131 Total Employees 70 with Dependents
             Dental             89 Total Employees  64 with Dependents - Retirees not eligible

Specific Deductible: $30,000          Aggregate: 125%
Fixed Cost:

       Specific Stop Loss Deductible:

       $                        x        131            x 12 = $
               Rate                      # of employees

       $                        x        70              x 12 = $
               Rate                      # of dependents


       Aggregate Stop-Loss Premium:

       $                        x        131            x 12 = $
               Rate                      # of employees

       Administration Fee: (include all associated costs; ie, pre-certification, access fees)

       $                        x        131            x 12 = $
               Rate                      # of employees

AGGREGATE ATTACHMENT POINT CALCULATIONS:

       $                        x        131            x 12 = $
               Factor                    # of employees

       $                        x        70              x 12 = $
               Factor                    # of dependents

                             Annual Attachment Point      $
                             Total Annual Fixed Cost      $
   Estimated PPO Access Fee if percentage of savings(__%) $

                                MAXIMUM ANNUAL COST               $
                                START-UP FEE                      $




                                                Page 7 of 17
                                               COSTPAGE
                                        Alternate Benefits 10-1-00

Type of Contract: __________ __          Name of Carrier: ______________Carrier Rating: _________

Assumptions: Medical            131 Total Employees 70 with Dependents
             Dental             89 Total Employees  64 with Dependents - Retirees not eligible

Specific Deductible: $30,000          Aggregate: 125%
Fixed Cost:

       Specific Stop Loss Deductible:

       $                        x        131            x 12 = $
               Rate                      # of employees

       $                        x        70              x 12 = $
               Rate                      # of dependents


       Aggregate Stop-Loss Premium:

       $                        x        131            x 12 = $
               Rate                      # of employees

       Administration Fee: (include all associated costs; ie, pre-certification, access fees)

       $                        x        131            x 12 = $
               Rate                      # of employees

AGGREGATE ATTACHMENT POINT CALCULATIONS:

       $                        x        131            x 12 = $
               Factor                    # of employees

       $                        x        70              x 12 = $
               Factor                    # of dependents

                             Annual Attachment Point      $
                             Total Annual Fixed Cost      $
   Estimated PPO Access Fee if percentage of savings(__%) $

                                MAXIMUM ANNUAL COST               $
                                START-UP FEE                      $




                                                Page 8 of 17
                                        Rate Page
                                  Maximum Funding Liability


DENTAL:

Employee Only         _________________________________

Dependent Only_________________________________




__________________________________                         ________________________________
Signature of Official*                                     Name of Insurance Company


__________________________________                         ________________________________
Title                                                      Phone Number/Extension


__________________________________
Date


*Must be the signature of the authorized company representative.




                                           Page 9 of 17
                                         RATEPAGE
                              TERM LIFE / AD&D AND DISABILITY

TERM LIFE:

                                     EMPLOYER PAID                      VOLUNTARY

Life (per $1,000)                    $                                  $

AD&D (per $ 1,000)                   $                                  $

Dependent Life (Per Unit)            $


DISABILITY:

Employee (per $100)                  $




__________________________________                         ________________________________
Signature of Official*                                     Name of Insurance Company


__________________________________                         ________________________________
Title                                                      Phone Number/Extension


__________________________________
Date


*Must be the signature of the authorized company representative.




                                           Page 10 of 17
               CLAIMS EXPERIENCE
                 9-1-97 TO 6-30-00
          Medical, Dental, and Prescription


MONTH   CLAIMS
09/97   $ 96,859.53
10/97   $ 81,642.13
11/97   $ 15,750.40
12/97   $ 32,868.22
01/98   $ 75,681.93
02/98   $ 32,483.84
03/98   $ 25,856.83
04/98   $ 53,277.18
05/98   $ 30,624.31
06/98   $ 38,113.37
07/98   $103,071.80
08/98   $ 43,248.96
Total   $629,478.50

09/98   $ 45,065.97
10/98   $ 62,424.61
11/98   $ 17,545.49
12/98   $ 42,982.43
01/99   $ 31,428.75
02/99   $ 24,786.25
03/99   $ 36,342.28
04/99   $ 58,411.86
05/99   $ 73,919.03
06/99   $ 55,188.28
07/99   $ 52,868.61
08/99   $ 54,541.67
Total   $555,505.23

09/99   $ 56,480.09
10/99   $137,690.17
11/99   $ 28,443.64
12/99   $ 58,813.07
01/00   $ 58,066.90
02/00   $ 56,611.18
03/00   $ 64,539.23
04/00   $ 80,124.25
05/00   $ 40,547.88
06/00   $ 66,166.27
Total   $647,482.68




                      Page 11 of 17
                                         Crane County

                                   Large Claims Information

                                        9-1-97 to 6-30-00


Lage Claims 9-1-97 to 10-31-98

$25,444.12      Deceased
$17,062.79      Deceased

Large Claims 11-1-98 to 6-30-99

$24,599.05    Lung Cancer
$26,009.77    Diabetes, Blood Pressure, Kidney problems

Large Claims 7-1-99 to 6-30-00

$16,039.11    Gall Bladder
$26,799.20    Cancer – Deceased
$18,220.30    Eye Problems
$16,582.91    Cancer
$36,187.09    Double Knee Replacement
$17,397.08    Auto Accident




                                           Page 12 of 17
                              Crane County

                           Disability Experience


7/1/99 – 6/30/00   premiums: $13,121       paid claims: $2,739

7/1/98 – 7/1/99    premiums: $13,086       paid claims: $1,300

7/1/97 – 7/1/98    89 lives (average)      77% loss ration
                   premiums: $11,707       paid claims: $8,965

7/1/96 – 7/1/97    89 lives (average)      381% loss ration
                   premiums: $12,788       paid claims: $48,717




                                Page 13 of 17
                                            CURRENT BENEFITS

                                      Schedule of Disability Insurance

This schedule shows the benefits, amounts of insurance, waiting periods and maximum amounts which
apply to coverages for which employees are insured under the Group Plan.

Employee Weekly Loss of Time

Weekly Benefit:                     60% of an employee’s weekly earnings rounded to the nearest dollar, if
                                    not already a multiple thereof, to a maximum weekly benefit of $750.00

Waiting Period During Disability:
                Due to Accident            89 Days
                Due to Sickness            89 Days

Maximum Benefit Period for Each Disability:
             Due to Accident          104 weeks *
             Due to Sickness          104 weeks *

                  * Benefits for pre-existing conditions will be limited to a maximum of 26 weeks.

In no event will this benefit, together with similar benefits provided in any other group, franchise policy, or
benefit plan, including statutory and/or self-insured plans, exceed 60% of the employee’s weekly earnings.

Earnings mean an employee’s earnings exclusive of bonus, overtime pay or other special forms of
remuneration. In the case of weekly earnings, it refers only to those earnings for a normal work week not
exceeding forty hours.




                                                  Page 14 of 17
   Insert 7 page
EMPLOYEE CENSUS




   Page 15 of 17
      Insert 3 page
CURRENT MEDICAL BENEFITS




       Page 16 of 17
        Insert 3 page
ALTERNATE MEDICAL BENEFITS




        Page 17 of 17

								
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