Request for Proposal: Association Health Plan

Oct 3, 2018|Uncategorized

REQUEST FOR PROPOSAL

MONTANA CHAMBER OF COMMERCE’S
HEALTH BENEFIT PROGRAM

This document is a Request for Proposal (“RFP”) from carriers interested in becoming a carrier for the Montana Chamber of Commerce’s Health Benefits Program, which is intended to be an association health plan as permitted under federal regulation 29 C.F.R. Section 2510.3-5, issued June 21, 2018.

I. INTRODUCTION

The Montana Chamber of Commerce wishes to provide an association health plan for its members effective January 1, 2019. Enrollment in this plan will be offered to all full-time permanent employees of participating employers, as well as sole proprietors. You are invited to respond to this RFP if you are interested and are willing to meet all terms and conditions.

We are exploring with this RFP the possibility to package Life, AD&D, Medical, Dental, and Disability insurance. Carriers may quote on any or all coverages. However, the full package of medical plans requested must be offered if submitting a medical proposal. The market potential is approximately 30,000 participating employers and sole proprietors totaling more than 350,000 employees. We desire to offer the members a unique plan of benefits and services that will be unrivaled in our state.

II. SUBMISSION REQUIREMENTS

Please submit your response by email or U.S. Mail (4 copies, please) to the address listed in Section IV. The deadline to respond is October 19, 2018. Because of our tight timeline, we will accept responses in segments as they are prepared.

Please indicate your intention to respond as soon as possible.

This timeline will enable the Chamber to evaluate materials as they are received and speed up the process for everyone. Please clearly mark your response as REQUEST FOR PROPOSAL – MONTANA CHAMBER HEALTH BENEFIT PROGRAM. All information presented by the Chamber in this RFP and any information that is subsequently disclosed by the Chamber should be considered strictly confidential and privileged. Information should not be released to external parties without the written consent of the Chamber.

III. QUESTIONNAIRE

The purpose of these questions is to assist the Chamber in determining if your firm is likely to be willing and able to put together – on its own, or in partnership with others – the type of flexible program that the Chamber envisions could best serve the needs of members of the Montana Chamber of Commerce.

We would also welcome any other information and suggestions you may choose to provide.

  1. Show and explain your benefit features and limitations. Please include specimen contract for the types of plans you are bidding.
  2. Show Dental plans available along with accompanying underwriting rules.
  3. Do you offer Life, Dependent Life, AD&D, and Disability on your own or in conjunction with a selected carrier? Do you offer combined billing?
  4. Explain your disease management programs and wellness benefits, including hearing and vision and annual physicals. Are dependents covered for maternity?
  5. Is TMJ covered? If so, Elaborate.
  6. Do you cover alternative medicine? If so, Elaborate.
  7. How would shots and immunizations be covered under the program?
  8. Describe the additional services you will make a part of this plan. Such as Premium only Sec. 125, Employee Assistance Program, Nurse Hotline, etcetera.
  9. Describe any other value-added features that would be included to distinguish the Chamber program.
  10. Explain where you may be flexible in plan design, inner limits, exclusions, and limitations.
  11. Furnish your regular agent compensation plan and your proposed compensation for this plan. Include any bonus plan or another type of compensation in addition to the commission schedule.
  12. Would you agree to treat Chamber business, both now and in the future, the same as your other products for any sales contests, bonus plans, etc.?
  13. Will, you experience-rate the Chamber block of business and establish a reserve with any surplus?
  14. Are you willing to establish a separate loss fund for this program and keep the renewal separate from all other lines of business?
  15. Describe how your plans are currently marketed and how you would market the Chamber program.
  16. AHPs may distinguish between employer members based on factors other than a health factor, such as bona-fide employment-based factors, including geographic location, occupation, and industry. Age and gender are not considered health factors. What factors will be used  for computing rates?  Would the Chamber Choice plan be Composite or Age rated?
  17. We would like the booklet/certificate to qualify as a Summary Plan Description and plan document. Would you be able to comply? Would you also provide other ERISA and legally required plan documentation and compliance materials?
  18. Are you willing to personalize all plan materials with the Chamber logos?
  19. Is your billing system able to handle a multiple offering? What is the minimum company pool size which you would able to offer multiple offerings?
  20. Please provide the service area for the plan you are presenting.
  21. Recent changes by the U.S. Department of Labor are encouraging small employers and solo practitioners to participate in an AHP. Are you willing to allow solo practitioners to participate in the plan and what structural requirements would be needing to be made to make this option possible?
  22. Would you allow any carve-out groups? I.e., management only; officer, managers, and clerical; other definition that fits industry.
  23. Provide us with your participation and contribution requirements.
  24. Please furnish us with your group sales information for the years 2016, 2017, and preliminary information for 2018. Include product breakdown, number of cases, number of contracts, and average premium.
  25. In the event an employer’s chosen agent is not appointed by your firm, would you be willing to work with us on this point.
  26. Should the Chamber endorse more than one health carrier, would your proposal still be valid?
  27. Please describe your renewal methodology and how it would apply to this program.
  28. Please furnish details regarding the following:
    1. Network credentialing
    2. Quality control
    3. Accounting and billing
    4. Accuracy rate on claims; average payment turnaround time
    5. Customer service – avg. Wait, abandonment rate, etc.
    6. Your group marketing proposal process.
    7. corrective measures for when guidelines are not met in these areas?
    8. drug formularies used.
  29. Provide a sample package for the proposed reporting for the Chamber such as claims and other data reporting.
  30. Please furnish a copy of your most recent annual financial report and any interim reports for 2018.
  31. Please provide in the following format proposed plan descriptions for the various coverage options you would offer. Bidder must be willing to work with us and DOI on program enhancements.
PPO POS In-Network POS Out-of-Network Low-Cost Chamber Choice
Maximum
Deductible Options
Co-Insurance % Options
Maximum Liability – Employee Only
Maximum Liability – Family Aggregate
Office Visit Co-Pay

IV. RFP RESPONSE PROCESS

a. DEADLINE: RESPONSES TO THIS RFP ARE DUE BY

October 19th, 2018

b. ADDRESS:

Please send your response and any questions to:

Daniel C. Brunell
Montana Chamber of Commerce
P.O. Box 1730
Helena, MT 59624-1730

c. DISPOSITION OF MATERIALS

The Montana Chamber of Commerce will retain materials submitted in response to this RFP. Unless otherwise required by law, Montana Chamber of Commerce will treat all information presented as confidential.

Posted: October 3, 2018 at 12:30 PM.

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