ANTI-COLLUSION CERTIFICATION - DOC

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					        REQUEST FOR COMPETITIVE SEALED PROPOSALS
                     RFCSP-0311-EHB



            FOR:      Employee Health Benefits Plan

DESCRIPTION:          Proposals for Employee Group Health Benefits (including
                      Dental) and Prescription Drug
                      Fully-Funded-Medical Program
                      Self-Funded-Third Party Administrative Services
                      Prescription Drug Service
                      Stop Loss Reinsurance
                      Alternate Plan Submissions


    PROPOSAL          Friday, March 25, 2011
    DEADLINE:         2:00 p.m.



Request for Competitive Sealed Proposals for the above will be received by the
San Benito Consolidated Independent School District (SBCISD) ATTN: Ms.
Emma McCall, Business Manager, at the Administration Building located at 240
North Crockett Street, San Benito, Texas 78586.

Interested prospective vendors may obtain specifications and information by
accessing our website at: www.sbcisd.net Prospective vendors must adhere to
the proposal form requirements included therein as prospective vendors
response to this request. If prospective vendors are unable to access our
website or need additional information prospective vendors may contact Mr.
Adrian Garcia, Purchasing Agent, SBCISD, 240 North Crockett Street, San
Benito, Texas 78586, telephone number (956) 361-6390.

This RFCSP is reserved, as the interest of the SBCISD may require, SBCISD to
reject any or all proposals, and to waive any formalities in proposals received and
accept the proposal most advantageous to the SBCISD.




Antonio G. Limon
Superintendent of Schools
San Benito CISD
       SAN BENITO CONSOLIDATED INDEPENDENT SCHOOL DISTRICT
                              RFCSP-0311-EHB
              EMPLOYEE HEALTH BENEFITS - GROUP HEALTH
          (Including MEDICAL; DENTAL and PRESCRIPTION DRUG)
                           A Fully Funded Proposal
                     Third Party Administrative Services;
                         Prescription Drug Services
                           Stop Loss Reinsurance
                         Alternate plan Submissions



                  GENERAL CONDITIONS AND REQUIREMENTS


                                     SECTION 1
1.1   Scope
      The intent and scope of SBCISD is to engage Prospective vendors to propose a
      fully-funded proposal, a self-funded proposal for a third party administrative
      services, prescription drug services, and/or Stop Loss Reinsurance proposal.

1.2   Facts and Statistics
      At present SBCISD operates 11 elementary schools, 3 middle schools, 1 ninth
      grade academy and 1 high school. The SBCISD employs approximately 1700
      employees.

1.3   Terms of Services/Contract
      It is the desire of SBCISD to enter into a two-year contract with the successful
      proposer. At the discretion of SBCISD it will have the option of a third year
      renewal.


                                  SECTION 2
                             GENERAL INFORMATION

2.1   Release Date
      Request for Competitive Sealed Proposals specifications will be available on our
      website: www.sbcisd.net or on March 8, 2011 from Mr. Adrian Garcia,
      Purchasing Agent, SBCISD, 240 Crockett, San Benito, TX 78586.

2.2   Proposals May Be Withdrawn Before Proposal Due Date/Time
      Proposals may be withdrawn at any time prior to the proposal due date / time.
      Alteration made before due date must be initialed by Prospective vendor
      guaranteeing authenticity of said alteration. Alterations that are not initialed by
      the Prospective Vendor shall be rejected by the SBCISD.

2.3   Prospective Vendors to Apprise Themselves of All Available Information
      Prospective vendors should thoroughly examine these RFCSP documents.
      SBCISD believes the information in said RFCSP documents accurately reflects
      the SBCISD Employee Benefit Plan and its claim experience; however, SBCISD
      does not guarantee the accuracy of said RFCSP document information and
      advises prospective vendors to verify the accuracy of this information.

2.4   Proposals Should Be In Conformance with the Specifications
      Care should be taken to match the requested plan designs as closely as
      possible. The Request for Competitive Sealed Proposals specifications are
      not intended to be restrictive, but Proposals, not in conformance to the
      specifications, will not be considered unless such nonconformance is explained
      in detail. General discussion and plan comparison of competing proposals will
      be in regard to the specified in-force benefits. Proposals that are not submitted
      as a “no loss no gain” proposal should be clearly identified and marked on each
      page of the proposal as follows: “ALTERNATIVE PROPOSAL”. The prospective
      vendor’s failure to mark said proposal as instructed shall be considered a waiver
      and the proposal shall be deemed in accordance with these specifications.

2.5   The Prospective Vendors Is Responsible to Verify Information
      Due care has been exercised in the preparation of these specifications, and the
      information is believed to be substantially correct. However, the responsibility for
      verification of all information presented herein shall rest solely on the prospective
      vendor.

                                   SECTION 3
                           CONDITIONS OF PROPOSALS

3.1   Preparation of Proposals
      All information required by the proposals form shall be furnished.

3.2   Alternate Proposal- Request for Proposal
      Alternate Proposals will be considered. All alternate Proposals should be clearly
      marked as instructed in Part 2; Paragraph 2.4 above. Prospective vendors are
      encouraged to be creative and to present their most competitive coverage and
      pricing.

3.3   Requirements and Qualifications of Prospective Vendor
      Prospective vendor shall possess the following experience and licenses:
      a) Prospective vendors that respond to the Third Party Administrative Services
         portion of this RFCSP must submit a copy of the prospective vendor’s Texas
         Third Party Administrator license.

      b) Prospective vendor warrant the prospective vendor is duly qualified, capable,
         bondable business entity, and has not filed for bankruptcy, and the
         prospective vendor is not in receivership; nor contemplates bankruptcy and /
         or receivership

      c) Prospective vendor must have previous experience within the State of Texas,
         and will furnish references within their proposals to substantiate this
         experience.
      All questions prior to the closing date should be directed by e-mail to:

                                     San Benito CISD
                                        Adrian Garcia
                                     Purchasing Agent
                                   Phone: (956) 361-6390
                                  Email: agarcia@sbcisd.net
             Faxed, written questions are requested as well as contact person phone
             number for response. Inquiries should make reference to specific section
             numbers in Request for Competitive Sealed Proposals
      d) All questions asked in the RFCSP will be used in making a selection and
         should be addressed by section and number on attached vendor response
         forms. Finalists may be required to respond to additional questions during the
         evaluation process.
         h)Prospective Vendors must include a copy of the prospective vendor’s
         current errors & omissions insurance policy’s declaration page and the
         successful prospective vendor must furnish a certificate of insurance in favor
         of SBCISD that provides SBCISD with a thirty (30) day notice of change,
         modification or cancellation of said errors & omissions insurance policy.
         Prospective vendors offering third party administrative services and stop loss
         reinsurance in the prospective vendor’s proposal must include both third party
         administrative services errors & omissions and insurance agent’s errors &
         omissions insurance.

3.4   Rejection of Proposals
      SBCISD may reject any or all Proposals whenever it is deemed in the best
      interest of to do so. SBCISD may also waive informalities or irregularities in any
      Proposal. SBCISD also reserves the right to accept or reject any portion of the
      proposal at its own discretion. Receipt of any proposal shall, under no
      circumstances, obligate SBCISD to accept the lowest proposal. The award of
      the contract shall be made to the responsible prospective vendor, whose
      proposal is determined to be the best evaluated offer, taking into consideration
      the relative importance of price, quality, service and other evaluation factors and
      the selection criteria set forth in Section II herein. If prospective vendors consider
      any portion of prospective vendors proposal to be confidential information and
      that disclosure of its contents to competing prospective vendors would be
      detrimental to prospective vendor’s company, the prospective vendor must
      clearly identify those portions.
      It is the responsibility of the responding prospective vendor to separate all
      information the prospective vendor considers to be confidential and to
      place such confidential information on separate sheets of paper, each
      clearly labeled as follows: "CONFIDENTIAL INFORMATION". The identified
      portions will be protected from disclosure to the extent possible under the law.

3.5   Request for Competitive Sealed Proposal Process
      Request for Competitive Sealed Proposal will be opened so as to avoid
      disclosure of each proposal’s contents to competing prospective vendors.
      Proposals shall not be made public during the process of negotiation if SBCISD
      chooses to negotiate with prospective vendors. However, all proposals shall be
      open for public inspection after the award of the contract, except for any bona-
      fide trade secrets and/or confidential information contained in the proposal that
      has been identified “CONFIDENTIAL INFORMATION” as provided in Part 3;
      Paragraph 3.4 of this RFCSP.

3.6   Third Party Administrators and / or Insurance Agents
      Third party administrators and / or insurance agents are required to provide a
      copy of third party administrator and / or insurance agent’s current errors &
      omissions insurance policy’s declarations page with each proposal submitted.
      Third party administrator and / or insurance agent’s errors & omissions insurance
      policy claim retention shall not be higher than $5,000 per claim and provide a
      minimum of $1,000,000 per claim limit of liability. A copy of the said Errors &
      Omissions policy must be included with each proposal.                Third party
      administrators and insurance agents must provide three (3) references on the
      Reference Form included in this RFCSP. Prospective vendors must have a
      minimum of five (5) years experience for the portion of the RFCSP that the
      prospective vendor is submitting a proposal.

3.7   Insurance Carriers
      Insurance carriers may provide proposals on either a direct (without an insurance
      agent) or indirect (with an insurance agent) basis. Third Party Administrators may
      only name ONE agent on proposal if naming an agent. Insurance agent
      commissions and/or servicing fees must be fully disclosed in said proposal.

3.8   Request for Clarification or Objection to RFCSP Specifications
      If a prospective vendor is in doubt as to the meaning of the RFCSP specifications
      or other proposal documents or any part thereof, the prospective vendor may
      submit in writing, at least five (5) days prior to proposal deadline, a request for
      clarification or objection to:
            Adrian Garcia                                   Glenn Hillyer
           Purchasing Agent                or          Insurance Consultant
            San Benito CISD                           Email: ghillyer@msig.net
         Email: agarcia@sbcisd.net
      All requests for information or objection shall be made in writing and the
      prospective vendor submitting said request shall be responsible for prompt
      delivery. Any interpretation of the Request for Competitive Sealed Proposals, if
      made, will be made by Addendum duly issued to all prospective vendors by the
      SBCISD. A copy of such Addendum will be mailed or delivered to each
      prospective vendor receiving the RFCSP. SBCISD will not be responsible for any
      other explanation or interpretation of the proposed made or given prior to the
      award of the contract. Any objections to the specifications requirements as set
      forth in this Request for Competitive Sealed Proposals must be filed in writing
      with Ms. Emma McCall, Business Manager on or before five (5) days prior to the
      proposal due date.

                             SECTION 4
           PUBLIC ADVERTISEMENT AND PROPOSAL/BID DEADLINE

4.1   Request for Competitive Sealed Proposal
      SBCISD will advertise for Request for Competitive Sealed Proposal in whatever
      publications SBCISD deems necessary to obtain the most qualified applications.
      In addition, SBCISD will have this "Request for Competitive Sealed Proposal" on
      its website: www.sbcisd.net

4.2   Required Response Format and Contents
      This Request for Competitive Sealed Proposal (RFCSP) consists of EIGHT
      (8) specific subject areas. Prospective vendors are required to complete
      specification information area #1; #6; and #7 and the optional specification
      information area (#2; #3; or #4) that the prospective vendor is proposing. The
      following specific subject areas must be completed by all prospective vendors
      that are submitting a proposal to this RFCSP:

      a) Specification Information Area #1 – Prospective Vendor’s cover letter (Page 6)
         and Anti-Collusion Certification Submission Form (Page 27)

      b) Specification Information Area #2 (Optional) – Fully Insured Proposal

      c) Specification Information Area #3 (Optional) – Prescription Drug Services

      d) Specification Information Area #4 (Optional) – Third Party Administrative
         Services

      e) Specification Information Area #5 – Prospective Vendor/Client References
         (page 12) and Cancelled Client References (page 13)

      f) Specification Information Area #6 – Vendor’s Qualifications (page 7)

      g) Specification Information Area #7 – Professional Liability and Texas License(s)
         1. Professional Liability Errors & Omissions Insurance (Insert copy of
            Prospective Vendor’s insurance policy declaration page)
         2. Texas License(s)-(Insert copy of Prospective Vendor’s Texas professional
            license).


      Prospective vendors are encouraged to submit their proposal in a binder
      with each section tabbed.

4.3   Overview of RFCSP Specific Subject Areas
      Specific Information Area # 1. - Cover Letter and Anti-Collusion
                                       Certification Submission Form
      Prospective vendors RFCSP will include the prospective vendor’s cover letter at
      the beginning of the proposal. The prospective vendor’s cover letter shall
      provide a brief summary of the information presented in the RFCSP; names,
      telephones, e-mail addresses, company’s website and fax numbers of persons
      authorized to provide any clarification required of the proposal submitted. The
      cover letter should include the name of the persons authorized to conduct final
      RFCSP negotiations.
      Prospective vendors must use, complete and execute the enclosed Anti-
      Collusion Certification Submission Form.
      Proposals that do not include the complete and execute the enclosed Anti-
      Collusion Certification Submission Form shall be deemed to be rejected by the
      SBCISD.
      Specific Information Area #2 – Fully Insured Proposal Response Form
      Specific Information Area #3 – Prescription Drug Services
                                    Proposal Response Form
      Specific Information Area #4 – Third Party Administrative Services
                                     Proposal Response Form

      Specific Information Area #5 – Vendor References and Cancelled Client
                                     References
      Specific Information Area #6 – Prospective Vendor’s Qualifications
            Qualification Data
             a)      Relative Financial Data
             b)      Provider Network, Pharmacy Network if applicable
             c)      Quality of Reports – Submit Samples
             d)      Plan Administration (Employee ID Cards, Booklets, etc.) –
                     Submit Samples
             e)      Efficiency of Claims Administration
             f)      Ability to enroll, commence and service the plan
             g)      Copies confirming license to perform in the State of Texas
             h)      Statements stating that the prospective vendor has not filed for
                     bankruptcy and that prospective vendor is not in receivership.
      Specific Area #7 – Prospective Vendor’s Professional Liability Insurance
      Prospective vendor is required to include a copy of the prospective vendor’s
      errors & omission insurance policy’s declaration page with each proposal
      submitted.

      The prospective vendor agrees by prospective vendor’s submission of this
      RFCSP proposal that if prospective vendor is awarded the RFCSP contract, the
      prospective vendor will provide SBCISD a certificate of insurance that evidences
      prospective vendor’s professional liability errors & omissions insurance and said
      errors & omissions insurance shall not be cancelled, alter or changed without 30
      day prior written notice to SBCISD.
      Prospective vendors must include a copy of the prospective vendor’s Texas
      professional license(s) for either third party administrator and / or insurance
      agent.
4.4   Prospective vendors must submit an original RFCSP proposal and 4 copies of
      prospective vendor’s RFCSP proposal.


                                     SECTION 5
                                 SELECTION CRITERIA

5.1   General
      This Request for Competitive Sealed Proposal (RFCSP) is an approved method
      of Texas competitive bidding statutes. A request for competitive sealed proposal
      changes the nature of a proposal and prices may be negotiated after proposals
      are opened and before the proposals are made public. Changes in prices of
      goods and services are not negotiable in Texas competitive bidding statutes;
      however, a request for competitive sealed proposal allows negotiation with
      prospective vendors to obtain the best value at the best price.
      The RFCSP proposals will be evaluated by specific criteria. The SBCISD shall
      use the following selection criteria to select the prospective vendor that offers the
      best value to SBCISD. The scores assigned to each selection criteria are
      indicated in the selection criteria and scores chart attached herein.
      Each criteria area is assigned a score from 1 and may range up to the maximum
      points as indicated in the assigned point column. The scores of each criteria
      area will be totaled for each proposal. The proposal receiving the highest criteria
      areas total score will be considered to be the proposal which offers the best
      value for the SBCISD.
      After determining the prospective vendor that offers the best value to the
      SBCISD, the SBCISD may discuss with the selected prospective vendor options
      for cost reduction. If the SBCISD is unable to reach a contract agreement with
      the selected prospective vendor, the SBCISD shall terminate further discussions
      and proceed to the next prospective vendor in the order of the selection rankings
      until a contract agreement is reached or all proposals are rejected. It is the
      intent of the SBCISD to award this contract i.e. Group Medical, Dental, Stop
      Loss Reinsurance, Prescription Drug to one Third Party Administrator and
      one Pharmacy Benefit Manager. Proposals for Pharmacy Benefit Managers
      may be submitted separately for consideration. Third Party Administrators
      should also submit bids for Group Health Pharmacy Benefit Administrators
      to be considered, and alternate benefits submitted.
      The award of contract, if over $25,000.00, will require approval by the Board of
      Trustees


5.2   Procedures/Steps
      It is the intent of SBCISD to follow these procedures/steps to award contract:
             a) All proposals received will be open and proposer name read aloud.
             b) Evaluation Committee will evaluate proposals, summarize, and rank
                the proposals as to the best value proposal to the SBCISD.
             c) Superintendent reviews the evaluation committees reports and directs
                the next step.
             d) At the Superintendent's direction, negotiation/discussion of changes in
                the nature of proposals and in prices begins.
             e) After negotiations/discussions are complete, the Superintendent
                prepares the recommendation to the Board of Trustees for contract
                approval.
             f) Board of Trustees act on Superintendent's recommendation.
             g) Contract is awarded.
5.3   Score Chart
      The Evaluation Committee will include, but will not be limited to the items listed
      below:
                                                             Max Pts.             Score
          a) Relative financial stability
             and reputation of the offered                          10
          b) Compliance to Plan Document                            10
          c) Pricing                                                30
          d) Provider Network                                       10
          e) Quality of Report                                       5
           f) Plan Administration & Claims
              (Employee ID Cards, Booklets, etc)                    10
          g) Administration Flexibility                             10
          h) Ability to enroll and service the plan                 10
          i)   Results of Reference Inquiries                        5



                                      SECTION 6
                               HISTORICAL BACKGROUND

      The SBCISD has self-funded their employee benefit plan for more than fifteen
      (15) years. The SBCISD has a full-time Insurance Coordinator. It is important to
      the SBCISD that employees and their eligible dependents can continue to
      access local hospitals through a PPO Network.


                                    SECTION 7
                                 BENEFIT SPECIFICATIONS

      It is the intention of SBCISD to maintain, as much as possible, the current benefit
      levels as described in the Section II of these specifications. Please base
      prospective vendor’s proposal on the current level of benefits. Clearly indicate
      any deviations in benefits in prospective vendor’s proposal and mark the
      proposal as instructed in Part 2, paragraph 2.4. Prospective vendors are
      encouraged to be creative and to present their most competitive pricing proposal
      utilizing the current benefit structure as a basis.


                                    SECTION 8
                                 FUNDING SPECIFICATIONS

      SBCISD wishes to obtain a fully funded employee benefit plan proposal and/or a
      self-funded employee benefit plan proposal for group medical coverage.
                                   SECTION 9
                          REVIEW AND EVALUATION COMMITTEE

       A review and evaluation committee composed by those person(s) designated by
       the SBCISD’S Superintendent will evaluate all proposals received on or before
       the due date and due time. Proposals received after the due date and or due
       time will be returned to the prospective vendor as a rejected proposal to the
       SBCISD’S RFCSP.

                                       SECTION 10
                                  PLAN OPERATING DATA

10.1   The following attachments are an integral part of these specifications:
       a) The Schedule of Claims vs. Contributions

       b) Number of Covered employees by month for the past 36 months and
          Contribution and Participation.


       c) The Listing of Large Claims Report over $50,000.00


       d) The current Third Party Administrator is: Blue Cross Blue Shield of Texas.
       e) The current stop loss deductible amount is $100,000.00 and the contract
          period is September 1, 2010 to 8/31/2011. However, SBCISD is requesting
          the stop loss proposals reinsurance policy period September 1, 2011 to
          September 30, 2012
       f) The aggregate does include dental, subject to a maximum amount of $750.00
          and prescription drugs are included in the stop loss reinsurance policy’s
          coverage.

       g) Third Party Administrator fees

       h) Two years of Medical Claims

       i)   Schedule of Benefits

       j)   Prescription Claims

       k) Cobra Service change

       l)   Dental Benefits Data
                     SPECIFICATION INFORMATION AREA NO. 5

         SAN BENITO CONSOLIDATED INDEPENDENT SCHOOL DISTRICT
                                RFCSP-0311-EHB
                EMPLOYEE HEALTH BENEFITS - GROUP HEALTH
            (Including MEDICAL; DENTAL and PRESCRIPTION DRUG)
                             A Fully Funded Proposal
                       Third Party Administrative Services;
                           Prescription Drug Services
                             Stop Loss Reinsurance

                            VENDOR/CLIENT REFERENCES

Please list a minimum of 3 references of current clients for which a similar service is
provided. Other cities or institutions with similar benefits are preferred. Include address,
name of contact person and telephone number. Also provide references of two (2)
clients who have recently canceled coverage with prospective vendors and prospective
vendor’s version of why they cancelled (Schedule B).


1.     ENTITY ____________________________________________________

       CONTACT         ____________________________________________________

       TELEPHONE       ____________________________________________________

       LOCATION        ____________________________________________________

       NUMBER OF EMPLOYEES            ________________________________________



2.     ENTITY ____________________________________________________

       CONTACT         ____________________________________________________

       TELEPHONE       ____________________________________________________

       LOCATION        ____________________________________________________

       NUMBER OF EMPLOYEES            ________________________________________



3.     ENTITY ____________________________________________________

       CONTACT         ____________________________________________________

       TELEPHONE       ____________________________________________________

       LOCATION        ____________________________________________________

       NUMBER OF EMPLOYEES            ________________________________________
                 SPECIFICATION INFORMATION AREA 5

      SAN BENITO CONSOLIDATED INDEPENDENT SCHOOL DISTRICT
                             RFCSP-0311-EHB
             EMPLOYEE HEALTH BENEFITS - GROUP HEALTH
         (Including MEDICAL; DENTAL and PRESCRIPTION DRUG)
                          A Fully Funded Proposal
                    Third Party Administrative Services;
                        Prescription Drug Services
                          Stop Loss Reinsurance


                     CANCELLED CLIENT REFERENCES



1.   ENTITY     ____________________________________________________

     CONTACT    ____________________________________________________

     TELEPHONE ____________________________________________________

     LOCATION   ____________________________________________________

     REASON CANCELED       ________________________________________



2.   ENTITY     ____________________________________________________

     CONTACT    ____________________________________________________

     TELEPHONE ____________________________________________________

     LOCATION   ____________________________________________________

     REASON CANCELED       ________________________________________



3.   ENTITY     ____________________________________________________

     CONTACT    ____________________________________________________

     TELEPHONE ____________________________________________________

     LOCATION   ____________________________________________________

     REASON CANCELED      ______________________________________
         SAN BENITO CONSOLIDATED INDEPENDENT SCHOOL DISTRICT
                                RFCSP-0311-EHB
                EMPLOYEE HEALTH BENEFITS - GROUP HEALTH
            (Including MEDICAL; DENTAL and PRESCRIPTION DRUG)
                             A Fully Funded Proposal
                       Third Party Administrative Services;
                           Prescription Drug Services
                             Stop Loss Reinsurance

                   EMPLOYEE HEALTH BENEFITS-FULLY FUNDED

                                    PROPOSAL FORM

I. The San Benito CISD prefers a two-year proposal with a third year District option based on
the specifications attached herein. Quote must be based on the estimated total insurable
employees of 1,700. For your information below is the total insured for the 2010-2011 year.
   Employee           Medical High     Medical Low          Medical Low        Total Number
Classification      Plan              Plan                  Plan Cobra        of Employees
Employee Only              37               942                  2                 981
Employee +
Spouse                      0                79                  0                  79
Employee + 1
Child                       1               110                  0                 111
Employee + 2
Children                    2                79                  0                  81
Employee + 3
Children                    0                24                  0                  24
Employee +
Family                      0               123                  0                 123

A. Fixed Premium for the First Year $____________________________

B. A Fixed Premium for Second Year            $____________________________

C. Optional: Premium for Third Year $____________________________

II.    Describe Financial Stability of Insurance Company:

Rating Firm                                   Rating                  Date of Rating

A.M. Best Co.                                 _________               _____________

Duff & Phelps Credit Rating Co.               _________               _____________

Moody's Investors Service, Inc.               _________               _____________

Standard & Poors Corp.                        _________               _____________

Is the Insurance Company authorized to do business in Texas? _____Yes _____No

III.   Provide a minimum of Three Client References: (Preferably Texas School Districts,
       Use Schedule A to provide these three (3) client references).
 SAN BENITO CONSOLIDATED INDEPENDENT SCHOOL DISTRICT
                      RFCSP-0311-EHB
        EMPLOYEE HEALTH BENEFITS - GROUP HEALTH
    (Including MEDICAL; DENTAL and PRESCRIPTION DRUG)

          EMPLOYEE HEALTH BENEFITS-FULLY FUNDED

                         PROPOSAL FORM



IV. Prospective vendors are required to provide three (3) Cancelled Client
    References. Use Schedule be to provide these Cancelled Client Reference

V. Prospective vendors must submit four sets of prospective vendor’s proposal,
   as indicated in Section 4.2, Required Response Formal and Contents, of the
   General Conditions and Requirements Section.
         SAN BENITO CONSOLIDATED INDEPENDENT SCHOOL DISTRICT
                                   RFCSP-0311-EHB
                 EMPLOYEE HEALTH BENEFITS - GROUP HEALTH

                  EMPLOYEE HEALTH BENEFITS-FULLY FUNDED




                                  PROPOSAL FORM



THE UNDERSIGNED PROSPECTIVE VENDOR SUBMITS THE ABOVE PROPOSAL
FOR THE ABOVE ITEM.

The prospective vendor has read the RFCSP requirements, conditions, and
specifications which are an integral part of the terms of this RFCSP.

The prospective vendor’s signature certifies the accompanying proposal is not the result
of, or affected by any unlawful act of collusion with another person or company engaged
in the same line of business or commerce or any act of fraud punishable under current
Texas codes. Furthermore, the prospective vendor understands fraud and collusion are
crimes under the Statue Law, and can result in fines, prison sentences, and civil awards.

The prospective vendor hereby certifies that the prospective vendor is authorized to sign
as a Representative for the Firm:




Name of
Firm:________________________________Signature:_________________________

Name of Prospective Vendor’s
Firm:__________________________________________________________________

Address:_____________________________ Name of Individual: __________________
____________________________________

Title:____________________________

Telephone:____________               Date:________________

Fax No:____________________          E-Mail:___________________________________

Website:______________________________________
        SAN BENITO CONSOLIDATED INDEPENDENT SCHOOL DISTRICT
                           RFCSP-0311-EHB
              EMPLOYEE HEALTH BENEFITS - GROUP HEALTH



                                SELF FUNDED
                     THIRD PARTY ADMINSTRATIVE SERVICES

                                  PROPOSAL FORM


I.     The San Benito CISD prefers a two -year proposal with a third year District option
       based on the specifications attached herein. Quote must be based on the
       estimated total insurable employees of 1,700. For your information below is the
       total insured for the 2010-2011.


 Employee         Medical High      Medical Low         Medical Low     Total Number of
Classification   Plan              Plan                 Plan Cobra        Employees
Employee Only          37               942                  2                981
Employee +
Spouse                   0                 79                 0                79
Employee + 1
Child                    1                110                 0                111
Employee + 2
Children                 2                 79                 0                81
Employee + 3
Children                 0                 24                 0                24
Employee +
Family                   0                123                 0                123



II.    Please include Administrative Fees in Questionnaire. (It must be part of this
       proposal form)

III.   Is the Third Part Administrator authorized to do business in Texas?
                            _____Yes _____No


IV.    Provide a minimum of Three Client References: (Preferably Texas School
       Districts, Use Schedule A to provide these three (3) client references).


V.     Prospective vendors are required to provide three (3) Cancelled Client
       References. Use Schedule be to provide these Cancelled Client References.
       SAN BENITO CONSOLIDATED INDEPENDENT SCHOOL DISTRICT
                                RFCSP-0311-EHB
               EMPLOYEE HEALTH BENEFITS - GROUP HEALTH


                               SELF FUNDED
                    THIRD PARTY ADMINSTRATIVE SERVICE

                                PROPOSAL FORM




VI.   Prospective vendors must submit four sets of prospective vendor’s proposal, as
      indicated in Section 4.2, Required Response Formal and Contents, of the
      General Conditions and Requirements Section.
         SAN BENITO CONSOLIDATED INDEPENDENT SCHOOL DISTRICT
                                   RFCSP-0311-EHB
                 EMPLOYEE HEALTH BENEFITS - GROUP HEALTH


                                 SELF FUNDED
                      THIRD PARTY ADMINSTRATIVE SERVICE

                                  PROPOSAL FORM

THE UNDERSIGNED PROSPECTIVE VENDOR SUBMITS THE ABOVE PROPOSAL
FOR THE ABOVE ITEM.

The prospective vendor has read the RFCSP requirements, conditions, and
specifications which are an integral part of the terms of this RFCSP.

The prospective vendor’s signature certifies the accompanying proposal is not the result
of, or affected by any unlawful act of collusion with another person or company engaged
in the same line of business or commerce or any act of fraud punishable under current
Texas codes. Furthermore, the prospective vendor understands fraud and collusion are
crimes under the Statue Law, and can result in fines, prison sentences, and civil awards.

The prospective vendor hereby certifies that the prospective vendor is authorized to sign
as a Representative for the Firm:



Name of
Firm:________________________________Signature:_________________________

Name of Prospective Vendor’s
Firm:__________________________________________________________________

Address:_____________________________ Name of Individual: __________________
____________________________________

Title:____________________________

Telephone:_______________________           Date:________________

Fax No:____________________          E-Mail:___________________________________

Website:______________________________________
        SAN BENITO CONSOLIDATED INDEPENDENT SCHOOL DISTRICT
                                    RFCSP-0311-EHB
                 EMPLOYEE HEALTH BENEFITS - GROUP HEALTH


                           PRESCRIPTION DRUG SERVICES

                                    PROPOSAL FORM


ASSUMPTIONS:

   The Drug Card Service Proposal must be based on the following benefits:

$5 Generic
$15 Formulary
$25 Non-Formulary


   The SBCISD prefers a two year with an additional three year District Option.
   Proposal based on one of the following criterion:

       A fixed fee for the entire policy period.

   Quote must be based on the estimated total insurable employees of 1,700. For your
   information below is the total insured for the 2010-2011 year.


 Employee          Medical High       Medical Low      Medical Low       Total Number
Classification    Plan               Plan              Plan Cobra       of Employees
Employee Only           37                942               2                981
Employee +
Spouse                     0                 79             0                79
Employee + 1
Child                      1                110             0                111
Employee + 2
Children                   2                 79             0                81
Employee + 3
Children                   0                 24             0                24
Employee +
Family                     0                123             0                123




The SBCISD must receive renewal fees at least ninety (90) days prior to the agreed
renewal date.
         SAN BENITO CONSOLIDATED INDEPENDENT SCHOOL DISTRICT
                                   RFCSP-0311-EHB
                 EMPLOYEE HEALTH BENEFITS - GROUP HEALTH


                          PRESCRIPTION DRUG SERVICES




                                  PROPOSAL FORM

THE UNDERSIGNED PROSPECTIVE VENDOR SUBMITS THE ABOVE PROPOSAL
FOR THE ABOVE ITEM.

The prospective vendor has read the RFCSP requirements, conditions, and
specifications which are an integral part of the terms of this RFCSP.

The prospective vendor’s signature certifies the accompanying proposal is not the result
of, or affected by any unlawful act of collusion with another person or company engaged
in the same line of business or commerce or any act of fraud punishable under current
Texas codes. Furthermore, the prospective vendor understands fraud and collusion are
crimes under the Statue Law, and can result in fines, prison sentences, and civil awards.

The prospective vendor hereby certifies that the prospective vendor is authorized to sign
as a Representative for the Firm:



Name of
Firm:________________________________Signature:_________________________

Name of Prospective Vendor’s
Firm:__________________________________________________________________

Address:_____________________________ Name of Individual: __________________
____________________________________

Title:____________________________

Telephone:_______________________           Date:________________

Fax No:____________________          E-Mail:___________________________________

Website:______________________________________
        SAN BENITO CONSOLIDATED INDEPENDENT SCHOOL DISTRICT
                                  RFCSP-0311-EHB
                 EMPLOYEE HEALTH BENEFITS - GROUP HEALTH
              (Including MEDICAL; DENTAL and PRESCRIPTION DRUG)


                             STOP LOSS REINSURANCE

                                  PROPOSAL FORM


I.     Stop Loss Premiums and Aggregate Factors



Note: Estimated number of insurable employees for the 2010-2011 year
       1,700
Specific Premium:     Current Cost           Proposed Cost
Single                          43.16
Family                         121.54
Aggregate Premium:
Composite Rate                   1.45
Aggregate Factors:
Single
Family



II.    Describe Financial Stability of Insurance Company:


Rating Firm                                Rating               Date of Rating

A.M. Best Co.                              _________            _____________

Duff & Phelps Credit Rating Co.            _________            _____________

Moody's Investors Service, Inc.            _________            _____________

Standard & Poors Corp.                     _________            _____________

Is the Insurance Company authorized to do business in Texas? _____Yes _____No


III.   Provide a minimum of Three Client References: (Preferably Texas School
       Districts, Use Schedule A to provide these three (3) client references).

IV.    Prospective vendors are required to provide three (3) Cancelled Client
       References. Use Schedule be to provide these Cancelled Client Reference
      SAN BENITO CONSOLIDATED INDEPENDENT SCHOOL DISTRICT
                              RFCSP-0311-EHB
                EMPLOYEE HEALTH BENEFITS - GROUP HEALTH
            (Including MEDICAL; DENTAL and PRESCRIPTION DRUG)

                          STOP LOSS REINSURANCE

                               PROPOSAL FORM


V.   Prospective vendors must submit four sets of prospective vendor’s proposal, as
     indicated in Section 4.2, Required Response Formal and Contents, of the
     General Conditions and Requirements Section.
         SAN BENITO CONSOLIDATED INDEPENDENT SCHOOL DISTRICT
                            RFCSP-0311-EHB
               EMPLOYEE HEALTH BENEFITS - GROUP HEALTH


                             STOP LOSS REINSURANCE


                                  PROPOSAL FORM

THE UNDERSIGNED PROSPECTIVE VENDOR SUBMITS THE ABOVE PROPOSAL
FOR THE ABOVE ITEM.

The prospective vendor has read the RFCSP requirements, conditions, and
specifications which are an integral part of the terms of this RFCSP.

The prospective vendor’s signature certifies the accompanying proposal is not the result
of, or affected by any unlawful act of collusion with another person or company engaged
in the same line of business or commerce or any act of fraud punishable under current
Texas codes. Furthermore, the prospective vendor understands fraud and collusion are
crimes under the Statue Law, and can result in fines, prison sentences, and civil awards.

The prospective vendor hereby certifies that the prospective vendor is authorized to sign
as a Representative for the Firm:



Name of
Firm:________________________________Signature:_________________________

Name of Prospective Vendor’s
Firm:__________________________________________________________________

Address:_____________________________ Name of Individual: __________________
____________________________________

Title:____________________________

Telephone:_______________________           Date:________________

Fax No:____________________          E-Mail:___________________________________

Website:______________________________________
     SAN BENITO CONSOLIDATED INDEPENDENT SCHOOL DISTRICT
                            RFCSP-0311-EHB
            EMPLOYEE HEALTH BENEFITS - GROUP HEALTH
        (Including MEDICAL; DENTAL and PRESCRIPTION DRUG)
                         A Fully Funded Proposal
                   Third Party Administrative Services;
                       Prescription Drug Services
                         Stop Loss Reinsurance


                     ANTI-COLLUSION CERTIFICATION
                           SUBMISSION FORM

Important Note: The prospective vendor’s failure to include the completed and
executed ANTI-COLLUSION CERTIFICATION SUBMISSION FORM disqualifies
the proposal.
 The undersigned certifies that:
   This Proposal was exclusively developed and prepared without collusion with any
   competing proposer.
   The content of this Proposal has not and will not knowingly be disclosed to any
   competing or potential competing proposer prior to the opening date, time and
   place specified.
   No act to persuade any person, partnership or corporation to submit or withhold a
   Proposal has been made.
   The undersigned warrants having a complete understanding regarding the
   accuracy of the statements in this certificate and the penalties applicable to the
   Prospective vendor and signatory representing the Prospective Vendor.
   Affiant, further states their officers, employees or agents have not, and will not
   attempt to lobby, directly or indirectly, the Board of Trustees of the San Benito
   Consolidated Independent School District between proposal submission date and
   award by the Board of Trustees of the San Benito Consolidated Independent
   School District.

Company Name: ____________________________________________________
Address of Company__________________________________________________

Name of Agent:    ____________________________________________________

 Authorized Signature:   ______________________________________________

Signatory Name and Title (Printed): ______________________________________

Telephone:               ______________________________________________

Date:                    ____________________________
         SAN BENITO CONSOLIDATED INDEPENDENT SCHOOL DISTRICT
                            RFCSP-0311-EHB
               EMPLOYEE HEALTH BENEFITS - GROUP HEALTH

                     THIRD PARTY ADMINISTRATIVE SERVICES
                                     QUESTIONNAIRE

The following questionnaire must be completed by prospective vendors that are
proposing Fully-funded, Third Party Administrative services, Prescription Drug
Services, and Stop Loss Reinsurance for the SBCISD Employee Health Benefit
Plan.

The SBCISD requires that the firm selected to provide administrative services should
illustrate a successful record of experience in handling these types of programs. We
prefer to have the service provided on a local basis. The following questionnaire is
provided to ascertain the qualifications of each firm. You must complete this
questionnaire. Each question or statement must be answered as failure to do so
may withdraw your proposal from consideration. This Questionnaire is part of your
RFCSP as indicated in Section IV of the General Requirements and Conditions Section.

     SELF-FUNDED MEDICAL QUESTIONNAIRE (To be answered by TPAs and
                             Carriers)

1.      Describe your most recent Medical ASO business.

       DESCRIPTION                        TEXAS                         NATIONAL
Amount of ASO fees written
in most recent 12 month
period
Number of ASO group
policyholders
Total number of individuals
under group contracts




2.      Describe your claim payment services:
        Where will claims be paid?

        Is a toll free number available for checking status of claim?   Yes        No

        Can SBCISD Insurance Department speak directly to a claim examiner for
        questions related to payment of claims? Yes             No


3.      What is normal claim processing time?
4.    Number of claim processors at your location.

5.    Number of claim processors reserved for the SBCISD.

6.    What are the authority levels of the claims processors? Supervisors?

7.    Provide information on how you perform the following tasks:

      a. Monitor accumulators in your system (family deductibles, max OOP, lifetime
         max, deductibles, M&N max, chiropractic max)
         b. Track pending claims
         c. Monitor claims examiner performance
         d. Handle appeals from claimants
         e. Do you employ a medical advisor?

8.    How do you provide transition of care and treatment of patients who are being
      treated by a physician that is not in your network?

      a.     Maternity Coverage prior to the last trimester
             b.       Maternity Coverage in the last trimester
             c.       Ongoing cancer chemotherapy
             d.       Disabled employees
      e.     Hospitalized employees or dependents on the date of risk assumption.
             Since SBCISD medical plan is self-fund the date of risk assumption is the
             first day of the contract period. Specific and aggregate coverage may be in
             effect prior to the effective date based on the policy limits proposed.
      f.     Not actively at work employees on the effective date.
      g.     Employees on extended leave of absence.

9.    Describe process for appeal of a contested claim.

10.   Please indicate your process for handling subrogation claims? Is there a cost/fee
      associated with this service? Do you use an outside vendor? If so, who?

11.   Please define a “paid claim” as it pertains to your organization. (Please be
      specific as to when a claim is received, processed, paid and a check cut)?

12.   Please define a “clean claim” as it pertains to your organization.

13.   Does your claims system check for duplicate charges? What are the criteria used?

14.   Does your claims system check for bundling/unbundling of claims? What are the
      criteria used?

15.   What type of claim audit procedure is currently in place for the TPA/carrier?
      Please indicate the percentage of total claims audited.
16.   What is your claim audit accuracy percentage for the last year for the TPA/carrier?

17.   How is large case management handled? Where is it located? What happens in
      case an employee needs to access care outside the network? Out of area? At a
      Center of Excellence, such as MD Anderson Medical Center?

18.   SBCISD would like networks to have access to Centers of Excellence. How do
      you contract with the centers? Through your own network or another type of
      arrangement? How will our employees access for needed treatment?

19.   Do you own - or use a preferred vendor for utilization review, large case
      management, disease management and wellness?

20.   Have they earned URAC accreditation(s)?

21.   Please describe the qualifications of the staff involved in utilization
      management/case management/disease management determinations?

22.   How do you report savings resulting from your utilization review/case
      management/disease management/wellness activities?

23.   Please provide a copy of your Standard Performance Guarantees.

24.   Please provide performance measures and what financial risk-sharing you are
      prepared to offer to ensure acceptable performance.

25.   Please provide a sample ASO agreement.

26.   Describe your implementation process and provide a timeline.          What is the
      shortest time required for implementation?

27.   Is eligibility available online to the Human Resources staff? Can claims be
      viewed online by Human Resources staff? Is there a separate charge for this to the
      plan?

28.   Attach samples of your standard reporting package that is included in your quote
      and note the frequency of these reports. Please note if your paid claims numbers
      are based on paid or incurred claims figures.

29.   Attach sample reports that are available but not included in standard package.
      How are these requested and what is the cost if any?

30.   Is there a fee to produce ID cards? Do you produce in-house or use an outside
      vendor? If so, who?

31.   Please provide a sample ID card.
32.   As a vendor will you work with the SBCISD on wellness programs and initiatives
      (such as annual flu shots, allergy clinics, healthy pregnancies)? If so, include a
      suggested plan or sample plans you have used for other employers.

33.   How do you determine which members are "at-risk" Is this integrated with your
      claims system? Stop Loss carriers? Rx Vendor?

34.   Please describe the stoploss filing process that will be used for SBCISD.

35.   Who will be filing the stoploss claims and what experience does this person have
      in this area?

36.   Is your system set up to pend stoploss claims automatically so an audit can be
      performed prior to issuing a check? What is the turnaround time for this to
      happen?

37.   How do you incorporate Rx utilization into your program?

38.   Is a nurse/provider advisory toll free number available? Is there any associated
      cost?

39.   Please include a sample of your EOB. Are they personalized for the client?

40.   Does the EOB show charged amount, negotiated savings amount and paid
      amount? Can customized comments be added to the EOB by the claims
      examiner? Are there any options on the EOB that SBCISD can choose?

41.   How are check disbursements handled? Does SBCISD determine the frequency,
      etc?

42.   Describe how you would plan to set up the funding for the claims account.

43.   Will you provide on a quarterly basis banking reconciliation of claim reports?

44.   What is your preferred provider network?

45.   Do you have on-line access to network provider listings and locations to assist
      member with provider selection?

46.    Will you collaborate with SBCISD in preparing a detailed administrative manual
      including procedural information on all agreed upon plan administration and
      claims procedures?

47.   Does your eligibility system automatically update the Pharmacy Benefit Manager
      (PBM) system? If so, for which PBMs?
48.   Will you provide renewal and rate information 180 days prior to renewal? If not
      what is the earliest date renewal rate information will be made available?

49.   Do you provide COBRA/HIPAA administration? If so, is there an additional
      cost?

50.   Please describe in detail the services you provide regarding COBRA/HIPAA
      administration.

51.   Will you provide performance guarantees regarding COBRA/HIPAA
      billing/eligibility administration? If so, is there an additional cost?

52.   Will you agree to administer the San Benito Plan Document exactly as presented
      without and changes or deviations?

53.   Do you agree to SBCISD written approval to Plan Documents and Benefits
      changes prior to implementation?

54.   Do you agree to make plan changes and exceptions as directed in writing by
      SBCISD?

55.   Do you agree failure to provide written approval prior to implementation of Plan
      Document changes will result in a 25 % reduction in all fees?
                     MEDICAL PPO NETWORK QUESTIONNAIRE
                         (To be answered by TPAs and Carriers)

  1. The following CPT codes are intended to give an overall view of the charges SBCISD
     will incur for the services rendered. It is important to determine if the PPO provide
     you are proposing will provide the necessary discounts to protect SBCISD. All
     services are assumed to be delivered in the San Benito coverage area. HMO
     CONTRACTS ARE NOT ACCEPTABLE.
DEPT CPT       MOD   PROCEDURE
                                                                                     Allowance
E&M    99201   N/A   OFFICE/OUTPATIENT VISIT, NEW
E&M    99354   N/A   PROLONGED MD SVC 30-60 MIN OUT.P.
E&M    99381   N/A   PREVENTIVE VISIT, NEW, INFAN
E&M    99251   N/A   INITIAL INPATIENT CONSULT
RAD    74240   N/A   X-RAY EXAM UPPER GI TRACT
RAD    76091   N/A   MAMMOGRAM, BOTH BREASTS
RAD    75710   N/A   ANGIO EXTREME UNILAT - RAD S & I
SURG   49507   N/A   REPAIR, INGUINAL HERNIA
SURG   58240   N/A   VAG HYST
SURG   56341   N/A   CHOLECYSTECTOMY
SURG   47605   N/A   GALLBLADDER
SURG   25605   N/A   CLOSED REDUCT. RADIAL FRACTURE
SURG   33200   N/A   INSERTION OF PERMANENT PACEMAKER W/EPICARDIAL ELECTRODES
MED    96412   N/A   Chemo infusion 1-8 hrs.
MED    93000   N/A   ECG-ROUTINE W/12 LEADS; INTERP & RPT
MED    90782   N/A   Therapeutic injection


  This information will be considered proprietary and confidential.

                                       Involuntary                Voluntary
 1) Primary Care Physician
 2) OB/GYN
 3)Specialists (exclude OB/GYNs)


  2. What is your proposal network’s voluntary and involuntary provider turnover rate?

  3. SBCISD will need to be notified if a large provider group or a hospital in our service
     area drops out of the network. Will this present a problem?

  4. If SBCISD does any direct contracting with large providers, will you administer the
     contract provisions for paying claims?

  5. What provider network do you utilize in South Texas and contingent counties? Who
     owns the network?

  6. Finalist may be subject to re-pricing claims. Confirm you will cooperate fully in this
     process and give accurate data asked of you.
                PHARMACY BENEFITS QUESTIONNAIRE


•   Describe your therapeutic interchange program protocols. Does your program
    include any limitations, such as moving members from preferred brand to
    generic?

•   Does your therapeutic interchange program operate across therapies (considering
    moving from a brand without a generic to one with a generic)?

•   Is there a charge to the client for this therapeutic interchange program? Do you
    share in savings generated? Provide details.

•   Demonstrate recent 12-month savings generated by this therapeutic interchange
    program for two specific employer clients, describing details of the sources of
    these savings. If selected as a finalist, will you provide contact information for
    these clients?

•   What was the average change in first-year drug spend (PMPM) for new employer
    clients compared to the prior year, excluding plan changes that increase member
    cost, for years ending during a recent 12-month period?

•   Describe your protocols for managing specialty drug claims to achieve low cost to
    the client when one or more alternative therapies are available. List the products
    that you consider and those that you do not consider in this situation.

•   Describe the background, experience and training of your customer service
    representatives who answer the phone in your member call center, other than
    those dedicated to specific clients, and describe how these CSRs are prepared to
    meet the needs of diverse populations.

•   What is your overall generic dispensing rate for employer groups for 2009 to
    date?

•   Do members call different phone numbers for Customer Service and for your
    Specialty Pharmacy?

•   Describe the process for Spanish-speaking members to talk with a Spanish-
    speaking CSR.

•   Are CSR screens integrated for all claims, including specialty drug claims?

•   Are all claims subject to the same DUR edits, including specialty drug claims?

•   How do you alert a patient when a prior authorization is about to expire?

•   Is your AWP pricing based on a certain package size?
•   Do you offer MAC for mail service claims? If so, are the same MAC list and
    MAC pricing used for both retail and mail claims?

•   Is there a pricing difference between the charge for MAC claims to the client and
    the payment made to the pharmacy for these same claims?

•   How do you monitor and drive formulary compliance by members?

•   List all sources of pharmaceutical drug manufacturer revenue received by your
    organization and/or subsidiaries.

•   How do you promote generic utilization? Is there a cost to the client for these
    initiatives

•   What Is the pepm guarantee to SBCISD for formulary rebates?
      FULLY INSURED MEDICAL PPO QUESTIONNAIRE (To be answered by
                            Carriers only)

1.      What was your total PPO enrollment in South Texas:

               January 1, 2008               _______
               January 1, 2009               _______
               January 1, 2010               _______

        How is large case management handled? Where is it located? What happens in
        case an employee needs to access care outside the network? At a Center of
        Excellence, such as MD Anderson Medical Center?

        SBCISD would like networks to have access to Centers of Excellence. How do
        you contract with the Centers? Through your own network or another type of
        arrangement? How will our employees access for needed treatment?

        What is your voluntary and involuntary provider turnover rate?

                                             Voluntary              Involuntary
           Primary Care Physician            ________               ________
           OB/GYN’s                          ________               ________
           Specialists (exclude OB/GYN)      ________               ________

5.      Who maintains the provider network? Does the number of providers remain
        relatively stable?

6.      SBCISD expects to be notified if any hospitals or major provider groups drop out
        of network. How will this be handled? Do you have any contracts with hospitals
        in the Dallas area that will terminate in 2009?

7.      What is the average turnaround time for supplying ID cards directly to
        participants?

8.      Can I.D. cards and plan booklets be customized for SBCISD

9.      Is a 24 hour nurse advisory toll free number available? Is there any associated
        cost?

10.     As a vendor, will you work with SBCISD on wellness programs and initiatives
        (such as annual flu shots, allergy clinics, healthy pregnancies, and health fairs)?
        If so, provide a suggested plan or sample plans you have used for other
        companies. Also, please provide a list of your covered vaccines /immunizations
        and at what age? Are certain vaccines/immunizations covered for international
        travel? (i.e. Hepatitis A/B, MenImmune, TB Screen, etc.)

11.     Please confirm you offer state-mandated childhood immunization benefits.
12.   Please include a sample of your EOB.

13.   How many claims analysts, adjusters, etc. will be assigned to SBCISD’s account?

14.   Please provide the name, title, year of medical claims experience, and years with
      your organization on each individual who will work full or part time on
      SBCISD’s account.

15.   What is the minimum amount of experience your organization requires to process
      and release claims for payment with little to no supervision of the adjuster?

16.   What is the minimum acceptable processing and financial accuracy that is
      acceptable to you for all claims adjusters?

17.   Does your company auto-adjudicate any medical claims? (If yes, what percentage
      is currently being electronically paid?)

18.   What is your claims turnaround time goal? What percentage of your business is
      currently being processed within goal time? What is your organization doing to
      increase the percentage paid within goal time?

19.   What type of claim audit procedure is currently in place? Please indicate the
      percentage of total claims audited.

15.   What is your claim audit accuracy percentage for the last year?

16.   Does your claims system check for duplicate charges? What are the criteria used?

17.   Please indicate your process for handling subrogation claims.

18.   Describe the process for appeal of a contested claim.

19.   Please describe your procedure(s) for Co-ordination of Benefits when your plan(s)
      are considered as the secondary carrier.

20.   Attach samples of your standard reporting package that is included in your quote.
      Please note if your paid claims numbers are based on paid or incurred claims
      figures.

21.   Attach sample reports that are available but not included in standard package.
      How are these requested, and what is the cost?

22.   Will you provide a monthly paid claim summary?
23.   Will you collaborate with SBCISD in preparing a detailed administrative manual
      including procedural information on all agreed upon plan administration and
      claims procedures?

24.   Are eligibility/billing/reporting available on-line to Human Resources Staff?
                                            PRICING

      Please provide a detailed pricing proposal for your products and services. Include any
      and all standard and optional components, including setup fees, service fees,
      customization fees, employee vs. dependant usage fees, report costs, communications
      materials costs, upgrade or maintenance charges, etc.

                       Medical/Dental – Current and Proposed ASO Fees

                             First Year   Cost PEPM 2nd Year Cost PEPM        3rd Year Cost PEPM
Medical/Dental Claims
Administration
Network Access Fee
(HealthSmart)
Pre-Certification/ UR
Total Administrative Costs

Large Case Management
Fee
TPA Prescription Drug        Included
Administration Fee
Initial or Renewal Set up
fees
Miscellaneous Printing costs
(i.e. SPDs, etc.)
Miscellaneous or any other
fees not mentioned above:
Disease Managemnet
COBRA/HIPPA
Broker Fee
Subrogation
PPO Vendor Fee
Life Insurance Admn.
(Per/Ec/Mo)
PPO Directories
Bank Reconciliation
Stoploss Interface
   PPO Discount



      A 25% reduction in all fees will be assessed if agreed to PPO Discounts are not met.
                         Pharmacy Benefits Proposed ASO Fees


If you utilize a Prescription Benefit Manager provide the percentage cost savings for the
following:
                                          Retail                    Mail Order
Brand Formulary               Percent discount from AWP    Percent discount from AWP
Brand Non Formulary           Percent discount from AWP    Percent discount from AWP
Generic                       Percent discount from AWP    Percent discount from AWP
Dispensing fee per            $                            $
prescription
Administration fee per        $                            $
prescription




                             Medical Fully Insured Rates

High PPO                                                   Monthly Rate
Employee Only
Employee + Spouse
Employee + 1 Child
Employee + 2 Children
Employee + 3 Children
Employee + Family

Low PPO                                                    Monthly Rate
Employee Only
Employee + Spouse
Employee + 1 Child
Employee + 2 Children
Employee + 3 Children
Employee + Family

				
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