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A. Price Proposal
1. *Exam Fee Allowance: $_____________ per 12 months
2. *Maximum Lens/Contact Allowance: $_____________ per 12 months
3. *Maximum Frame Allowance:
a. $______________ per 12 months
b. $______________ per 24 months
*Offerors may provide multiple copay options for the City to consider.
4. List additional benefits, such as lasik, and additional fees associated with the additional benefits.
5. Provide any Rate Guarantees available.
6. List all potential fees to the City for additional services, such as initial start up fees, education, communication and
material fees. If pricing is not provided, it will be assumed to be a free benefit to the City.
7. Document Offeror’s acceptance of responsibility for financial losses incurred due to inaccurate data provided to the City of
Tucson. Employee’s accounts will not be back billed for premiums lost due to inaccurate reporting.
8. Does your firm have a City of Tucson Business License? ______Yes ______No
If yes, please provide a copy of your City of Tucson Business license.
B. Method of Approach
Network and Provider Information
1. Describe the structure, composition and size of your network.
2. What is your individual doctor retention rate? If your network includes corporate-owned stores, what is the turnover rate
for doctors at those locations?
3. Do you require optometrists to be Diagnostic Pharmaceutical Agent (DPA)/Therapeutic Pharmaceutical Agent (TPA)
4. Please provide an overview of your credentialing program, including:
a. Credentialing standards (i.e., NCQA, Joint Commission, URAC, CARF, etc.) followed by your program.
b. Do you use primary source verification?
c. Number of full-time employees dedicated to the credentialing process.
d. Re-credentialing process; how frequently and by whom?
e. Description of any situations where delegated credentialing has been revoked from your company within the last
5. Using Pima County, provide a GeoAccess report detailing the percentage that meet the following access criteria (do not
1. Urban: 5 network optometrists/ophthalmologists within 5 miles
2. Suburban: 5 network optometrists/ophthalmologists within 10 miles
3. Rural: 5 network optometrists/ophthalmologists within 20 miles
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6. Are there any states or geographic areas within the U.S. where you have less than adequate access to network providers
according to the standards defined in the above question? If so, what are your plans to add providers?
7. Are providers required to maintain professional liability coverage? In what amount? (Please clarify specific to per
occurrence or aggregate limits.)
8. Describe how your organization communicates with and supports its providers.
9. Are all listed network providers full-service (i.e., provide both exams and dispense eyewear at their listed location)?
10. Describe your relationship with optical laboratories.
Benefit Plan Design
11. Describe the process/procedures members must follow to access routine vision care in your network.
12. Describe the coverage available under your proposed plan.
13. Describe specifically the components of a comprehensive eye exam given by your organization’s network doctors.
14. Are members limited to a specified frame selection? Do members receive better pricing on a specialized frame selection
or based on the type of provider they choose? Are members encouraged to purchase from a selection of private labeled or
15. Which brands/manufacturers are available to patients for lens options?
16. Does your organization offer any disease management or wellness programs?
17. Confirm coverage will be on a guaranteed issue basis.
18. Describe your policy regarding continuation of coverage during a leave of absence (medical, family medical, military).
19. Will policies be mailed to employees’ home addresses?
20. State if Offeror prefers a calendar or fiscal (July 1 – June 30) plan year.
21. Describe your customer service:
a. Hours of operation
c. Representative training
d. Average tenure
e. Number of customer service representatives employed by your organization
22. Do you monitor and tape calls?
23. Provide your performance standards and actual results for the last year for:
a. Average speed of answer
b. Abandonment rate
c. Call blockage
24. Provide the following information for the last year:
a. Number of calls
b. Average length of call
c. Percentage of calls requiring follow-up
d. Percentage of calls totally handled via IVR
25. Describe your voice response system (IVR), including:
a. Structure of the IVR
b. Options and timeframes for callers to move from the IVR to an operator
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c. Services callers can access via the IVR
d. Frequency data is updated on the IVR
26. How does your organization conduct member satisfaction surveys? What is the sample size and frequency? Please be
specific, and provide the most current results concerning overall satisfaction on a 5 point scale.
27. How does your organization measure quality in its call center?
28. How does your call center accommodate non-English speaking and hearing impaired callers?
29. Describe the channels available to members to communicate with your customer service area.
30. Describe your organization’s member communication resources and support.
31. Describe your implementation plan an schedule for a January 1, 2010 effective date.
32. What standard reports are available and how frequently? Are there additional costs associated with any of these reports?
33. Are customized reports available through your organization’s web site?
34. Do you have an audit process that monitors the accuracy of claims paid? If yes, how often do audits occur and what are
35. Describe the accuracy standards of your claims processing facility. What were your results for the last year?
36. What percentage of claims are automatically adjudicated?
37. What is your claim rejection rate and how do you resolve claims that reject from the claims system?
38. What percentage of your claims can be submitted electronically? What percentage of your claims are submitted
39. How many vision care claims does your organization process annually?
40. What is the average tenure of your claims staff?
41. Over the last three years, what percentage of claims were for services from a network provider?
42. What is your average claims backlog?
43. Describe in detail your quality assurance and review program.
44. Please describe the specific grievance/resolution process for handling disputes from patients.
45. What performance standards are you willing to offer?
46. Describe the computer hardware, software and other systems that are used in the administration of your vision plan.
47. Describe the capabilities and information available on your organization’s web site. How many visits – not simply “hits”
– does your web site receive annually?
48. Describe your maintenance and backup procedures including daily backups, retention timetable and off-site backup
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49. Does your organization have a disaster contingency plan? How often is the plan tested offsite?
50. What are the service availability standards for your organization’s system network and web sites? What were the
performance results for the past 4 quarters?
51. Describe any significant hardware or software upgrades planned for the next two years.
52. Describe the physical protection of your facilities including access authorization to areas housing sensitive information
53. Describe the type of background checks your organization conducts on potential new employees.
54. Describe your organization’s approach to authorizing systems access, ID and password controls including information on
encryption, forced change/expiration of passwords and ID elimination when access is to be terminated.
55. Describe the system edits for identification of fraudulent claims.
56. Who owns the critical data (i.e., claims data, network data, etc.) within your organization and how is it secured? What
quality control measures do you have in place to ensure it remains secured? Are these processes audited? If yes, how
C. Qualifications and Experience
1. State the legal name and give a brief description of your organization, including:
a. Brief History
b. Date of Incorporation
c. Ownership/Parent Company/Public or Privately Held
d. Number of Employees
e. Corporate and Local Addresses
2. Describe the account team to be dedicated to the City, including team member locations that would service our account.
Provide the names, titles, resumes and phone numbers of all proposed key personnel who will services the City’s account.
Provide their respective qualifications and credentials and the capacity in which they will serve. Indentify the City’s main
point of contact within the organization.
3. What other businesses are you involved in? Describe their ownership and how they interact with your managed vision
4. Is any aspect of your business outsourced?
5. What is your organization’s vision care philosophy?
6. How long has your organization been administering vision plans? Describe your experience administering funded vision
plans for other entities similar to our organization.
7. What key attributes distinguish your organization from the competition?
8. How many groups and members (employees plus dependents) do you currently cover? What percentage of your
a. ASO coverage
d. Funded Exams and Materials
e. Funded Exams
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9. Do you have plans to acquire or merge with any other organizations within the next 12 months or have you done so within
the previous 12 months? If yes, please detail the status and impact it will have on the administration and delivery of the
10. Provide three client references similar in size (based on funded lives) and industry. Include contact name, title and phone
11. What awards/recognition has your organization received?
Licensure and Financial
12. Specific to your vision care business, are you licensed to conduct business in every state? What state agencies regulate
your organization? Provide the regulator’s findings and recommendations from the regulator that oversees your vision
care business operations.
13. Describe the financial condition of your company.
14. Provide your risk-based capital for your vision business. Does it exceed the minimum requirements of the entity that
regulates your vision business? If so, by how much?
15. Does your company underwrite risk business? (Detail if this varies by market or state). If an organization other than the
Offeror would be underwriting the risk, who? How long have they been your insurer? What is their AM Best rating?
Please answer the above question if your organization is underwriting