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November 5, 2018 To Whom It May Concern: The City of Cleveland, through its Director of Human Resources is soliciting proposals from qualified firms interested in providing self-insured medical, prescription, fully insured dental, fully insured vision, basic life insurance, supplemental life insurance, voluntary life insurance, and worksite benefit coverage for the City. If your firm is interested, please submit to the City no later than 12:00 noon, Eastern Time, on Friday November 23, 2018, an original and (2) complete duplicates of your proposal in hard copy and an electronic copy on flash drive. Submit the proposals in separate sealed envelopes, marked appropriately on the outside and, if possible, enclosed in one package. No proposals will be accepted after that date and time unless the City extends the deadline by a written addendum. Sealed proposals may be mailed or delivered to the address below and must be identified on the outside of the envelope(s) as: “Response to RFP to Provide: medical, prescription, fully insured dental, fully insured vision, basic life insurance voluntary life insurance, and worksite benefit coverage for The City of Cleveland” Attention: Robert Ryan, Human Resources Department City of Cleveland 601 Lakeside Avenue Room 121 Cleveland, Ohio 44114 If proposals are hand-delivered, proposals should be addressed as above and taken to Robert Ryan, Cleveland City Hall, 601 Lakeside Avenue, Room 121, Cleveland, Ohio 44114. Faxed or E-Mailed submissions will not be entertained. The City reserves the right to reject any or all proposals or portions of them, to waive irregularities, informalities, and technicalities, to re-issue or to proceed to obtain the service(s) desired otherwise, at any time or in any manner considered in the City’s best interests. The Director may, at his/her sole discretion, modify or amend any provision of this notice or the RFP. Deadline for questions or written requests for clarification is Friday, November 12th, 2018 and must be submitted in writing to:

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Kim Stika, Account Executive The Fedeli Group

5005 Rockside Road Fifth Floor - Suite 500

P.O. Box 318003 Independence, OH 44131-8003

kstika@thefedeligroup.com

The selected provider will be notified as soon as practical after analysis of all proposals required in compliance with this request. The City reserves the right to review details of services with potential vendors to ensure system compatibility prior to contract award. The City may conduct finalist meetings at which point you will be notified. Should the City accept any proposals, the effective date of coverage shall be April 1, 2019.

It is our hope that this RFP will be self –explanatory, however if you need additional information, please call or email me at (216) 643-6968 or kstika@thefedeligroup.com. Sincerely, Kim Stika Account Executive, Benefits Division The Fedeli Group

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City of Cleveland Medical & Dental RFP Table of Contents Scope of Services.…………………………………………………………………….……...5 Background and History………………………………………………………….…….…6 Project Schedule and Deliverables………………………………………………….….7 Proposal Requirements ……………………………………………..…………………….7 Qualifications for Proposal………………………………………………………………13 Proposal Contents…................................................................................…14 Proposal Evaluation; Selection Criteria………………………………………………...17

General Information ……………………………………..……………………………….….19

Funding Information ………………………………………………………………….……..21

Medical Benefits……………….. ……………………………………………………………..23

Prescription Drug Benefits………………………………………………………………….23

Dental Benefits………………………………………………………………………….………23

Vision Benefits………………………………………………………………………………….23

Life (Voluntary Life) Benefits………………………………………………………….…..23

Worksite Benefits………………………………………………………………….…………..23

Medical Questionnaire ……………………………………………………….……………..25

Dental Questionnaire……………….…………………………………………………..……41

Prescription Questionnaire………………………………………………………….……..44

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Voluntary (Worksite) Benefits Questionnaire...........……………………………47

Voluntary Insurance Programs ………………….………………………………….…49

Life Insurance Questionnaire……………………………………………………………52

Exhibits:

A. Carrier Benefit Summaries

B. Experience

• Additional information available upon request.

C. Rates

D. Census

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Scope of Services The City of Cleveland is seeking self-insured proposals for their comprehensive Medical and Prescription Drug plan. In addition, the city will accept proposals for Dental, Vision, Life Insurance, Supplemental Life Insurance, Voluntary Life Insurance, and Work Site programs as set forth in more detail below in the Description of Services. The City will consider independent stop loss options as well. If approved, we expect that transition to the selected vendor will commence on April 1, 2019. The City would prefer a financial arrangement that includes:

• Medical – self-funded plans with a multi-year administrative fee guarantees or a one-year fee with a second-year cap.

• Prescription Drug – a multi-year contract with the option of pass through or reinvested rebates.

• Dental – Fully-insured(current) and self-insured options with multi-year rate or administration guarantees.

• Vision – Fully-insured with a four-year rate guarantee • Life Insurance, AD&D, Voluntary Life, Voluntary AD&D, Dependent Life – multi-

year rate guarantee with annual open enrollment and guarantee issue levels matching current.

• Voluntary Benefits – Disability, Accident, Critical Illness, Universal Life The organization selected will provide the following services:

1. Vendor will work with the City to develop policies and procedures relative to the operation of the various benefit programs. Vendor will consult with the City to publicize the new vendor and benefits to employees (e.g. supervisors and to all employees).

2. Vendor will supply employer with all brochures and literature regarding the available programs as part of the cost of administering the program. 3. Vendor will cooperate with City’s payroll and HRIS vendor to establish and maintain EDI feeds for eligibility management and reconciliation.

4. Vendor will assist with employee education efforts, annual open enrollment meetings and participation in all city-wide health fairs. 5. Vendor will work with employees to help them make conscious decisions on their medical plan that may result in a cost savings to the employee and the City. 6. Vendor will provide quarterly utilization reports and work closely with The Fedeli Group to produce reports that will help the City track usage and cost savings possibilities.

a. Vendor will provide Ad Hoc reports to assist in understanding cost drivers.

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b. Vendor will provide claims reporting to consultant’s claims analytics vendor as requested. Vendor will offset cost of per employee per month fee.

7. Vendor will provide a dedicated customer service line and representative for City employees to call with questions and or concerns. 8. Please indicate any Wellness dollars you will provide for the City annually for the following:

a. Annual General Wellness Program b. Biometric Screening Event c. Wellness Newsletter d. Wellness Incentives for participants e. Disease management promotional information f. Other

9. Vendor will make sure that the City’s plans comply with any and all changes mandated by the Affordable Care Act. The City reserves the right to modify the scope of services at any time before execution of a contract to add, delete, or otherwise amend any item(s), as it deems necessary, in its sole judgment, and in the best interest of the City.

Background and History The City of Cleveland (the City) is seeking proposals for the Medical, Prescription Drug, Dental, Vision, Life/AD&D, Voluntary Life/AD&D, Dependent Life, and Worksite Benefit programs. The purpose of this Request for Proposal is to gather information from your organization relative to the City’s required scope of service and key selection criteria. Organizations selected as finalists may be expected to address more detailed issues regarding financial and other specifics of their organization and operations. These same finalists may be expected to participate in interviews with the City.

The City’s objective is to: 1) offer a comprehensive benefit program to employees, 2) retain valued employees by offering high level benefits, and 3) offer cost effective solutions for employees and the City. The City’s current Medical vendors are Medical Mutual of Ohio and Anthem. Prescription drug benefits are administered through CVS Health with Health Action Council. The City’s fully-insured Dental vendor is Cigna. Vision is insured through EyeMed. All life insurance benefits are through MetLife. Worksite Benefits (including Universal Life) are offered through Trustmark. The total number of employees participating in City benefit programs is approximately 6,400.

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The City invites proposals from qualified insurers and administrators. Project Schedule and Deliverables The City has established the following list that the vendor will be required to provide as deliverables. The City reserves the right to modify the list of deliverables at any time before execution of a contract to add, delete, or otherwise amend any report or other deliverable, as it deems necessary, in its sole judgment, and in the best interest of the City.

A. The City reserves the right to add related services as needed.

B. Unless otherwise expressly provided, the term of the Agreement shall begin

upon its date of execution and, unless extended by City or unless sooner canceled or terminated under the provisions of the Agreement, shall expire when all required deliverables have been submitted to and approved by the Director and all other Services have been satisfactorily performed and accepted by the Director (“Term”).

Proposal Requirements

i. Submission of Proposal

Each vendor shall submit its proposal(s) in the number, form, and manner, and by the date and time and at the location required in the section, Introduction and Background above.

a. Each Proposer shall provide all information requested in this Request for Proposal. The proposer must organize its proposal package to address each of the elements in this RFP. The proposer should carefully read all instructions and requirements and furnish all information requested. If a Proposal does not comply with all terms, conditions, and requirements for submittal, the City may consider it unacceptable and may reject it without further consideration.

b. The City wishes to promote the greatest feasible use of recycled and

environmentally sustainable products and to minimize waste in its operations. To that end, all proposals should comply with the following guidelines: Unless absolutely necessary, copies should minimize or eliminate use of non-recyclable or non re-usable materials. Materials should be in a format permitting easy removal and recycling of paper. A proposer should, to the extent possible, use products consisting of or containing recycled content in its proposal including, but not limited to, folders, binders, paper clips, diskettes, envelopes,

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boxes, etc. Do not submit any or a greater number of samples, attachments or documents not specifically requested.

c. If you find discrepancies or omissions in this RFP or if the intended

meaning of any part of this RFP is unclear or in doubt, send a written request for clarification or interpretation to Kim Stika at The Fedeli Group 5005 Rockside Road Independence, Ohio 44131 no later than November 7th, 2018. Requests for clarification or interpretation may be submitted via e-mail to kstika@thefedeligroup.com.

ii. The City’s Rights and Requirements

a. The Director, at her sole discretion, may require any Proposer to

augment or supplement its proposal or to meet with the City’s designated representatives for interview or presentation to further describe the Proposer’s qualifications and capabilities. The requested information, interview, meeting, or presentation shall be submitted or conducted, as appropriate, at a time and place the Director specifies.

b. The City reserves the right, at its sole discretion, to reject any proposal that is incomplete or unresponsive to the requests or requirements of this RFP. The City reserves the right to reject any or all proposals and to waive and accept any informality or discrepancy in the proposal or the process as it may be in the City’s best interest.

iii. Proposal as a Public Record

Under the laws of the State of Ohio, all parts of a proposal, other than trade secret or proprietary information and the fee proposal may be considered a public record which, if properly requested, the City must make available to the requester for inspection and copying. Therefore, to protect trade secret or proprietary information, the Proposer should clearly mark each page - but only that page - of its proposal that contains that information. The City will notify the proposer if such information in its proposal is requested, but cannot, however, guarantee the confidentiality of any proprietary or otherwise sensitive information in or with the proposal. Blanket marking of the entire proposal as “proprietary” or “trade secret” will not protect an entire proposal and is not acceptable.

iv. Cleveland Area Business Code

Requirements: The Mayor’s Office of Equal Opportunity (OEO) waived the Cleveland Area Business Code requirements for this contract due to the nature of the services provided, and the availability of certified City of Cleveland vendors. However, the City still encourages the use of City

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of Cleveland MBE/FBE/CSB vendors on the contract wherever practical.

Locate certified City of Cleveland contractors on the OEO B2GNow contract compliance monitoring system - www.cleveland.diversitycompliance.com

v. Term of Proposal’s Effectiveness

By submission of a proposal, the Proposer agrees that its proposal will remain effective and eligible for acceptance by the City until the earlier of the execution of a final contract or 180 calendar days after the proposal submission deadline

vi. Execution of a Contract

The Successful Proposer shall, within ten (10) business days after receipt of a contract prepared by the City Director of Law, exclusive of Saturdays, Sundays and holidays, execute and return the contract to the City together with evidence of proper insurance and intent to conform to all requirements of the contract. Attached hereto or which are a part hereof and all applicable federal, state and local laws and ordinances prior to or at the time of execution of the contract.

vii. “Short-listing”

The City reserves the right to select a limited number (a “short list”) of Proposers to make an oral presentation of their qualifications, proposed services, and capabilities. The City will notify the Proposers selected for oral presentations in writing.

viii. Proposer’s Familiarity with RFP; Responsibility for Proposal

By submission of a proposal, the Proposer acknowledges that it is

aware of and understands all requirements, provisions, and conditions in and of this RFP and that its failure to become familiar with all the requirements, provisions, conditions, and information either in this RFP or disseminated either at a pre-proposal conference or by addendum issued prior to the proposal submission deadline, and all circumstances and conditions affecting performance of the services to be rendered by the

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successful proposer will not relieve it from responsibility for all parts of its Proposal and, if selected for contract, its complete performance of the contract in compliance with its terms. Proposer acknowledges that the City has no responsibility for any conclusions or interpretations made by Proposer on the basis of information made available by the City. The City does not guarantee the accuracy of any information provided and Proposer expressly waives any right to a claim against the City arising from or based upon any incorrect, inaccurate, or incomplete information or information not otherwise conforming to represented or actual conditions.

ix. Anticipated Proposal Processing

The City anticipates it will - but neither promises nor is obligated to - process proposals received according to the following schedule:

i. Issue Request For Proposals November 5, 2018 ii. Deadline for Submitting Questions November 12, 2018 iii. Deadline for Submitting Proposal November 23, 2018

x. Interpretation

Neither the City nor its consultant is responsible for any explanation, clarification, interpretation, representation or approval made concerning this RFP or a Proposal or given in any manner, except by written addendum. The City will mail, e-mail, or otherwise deliver one copy of each addendum issued, if any, to each individual or firm that requested and received a RFP. Any addendum is a part of and incorporated in this RFP as fully as if originally written herein.

Qualification for Proposal Each Proposer, regardless of the form of its business entity, must meet the following requirements. Failure to meet all requirements may be cause for rejection of a proposal. If Proposer is a partnership or a joint venture, at least one general partner or constituent member must meet the requirements. Each Proposer must:

i. Be authorized to conduct business in the State of Ohio, County of

Cuyahoga and the City of Cleveland.

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ii. Possess or demonstrate it qualifies for all applicable licenses,

certificates, permits, or other authorizations required by any governmental authority, including the City, having jurisdiction over the operations of the Successful Proposer and the proposed services.

iii. Submit with its proposal at least five (5) written, verifiable, references dated within the last three months from clients for which the Proposer has rendered services substantially similar to those sought by this RFP, and recommending Proposer for selection for such services.

Insurance: The Successful Proposer, at its expense, shall at all times during the term of the contract resulting from this RFP, maintain the following insurance coverage. The insurance company(ies) providing the required insurance shall be authorized by the Ohio Department of Insurance to do business in Ohio.

i. Professional liability insurance with limits of not less than

$1,000,000.00 for each occurrence and subject to a deductible for each occurrence of not more than $25,000.00 per occurrence and in the aggregate, and if not written on an occurrence basis, shall be maintained for not less than two (2) years after satisfactory completion and written acceptance of the services under the contract.

ii. Workers’ compensation and employer’s liability insurance as

provided under the laws of the State of Ohio.

iii. Statutory unemployment insurance protection for all of its employees.

iv. Such other insurance coverage(s) as the City may reasonably

require.

Proposal Contents Each proposal shall include the following parts in the below order. Please separate and identify each part by tabs for quick reference. Each proposal should be organized so as to facilitate its evaluation.

A. Cover Letter: The cover letter shall identify and introduce the Proposer and

provide other general information about Proposer’s business organization including, at least, in one or more attachments or in the Proposal, Proposer’s

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name, principal address, federal ID number, telephone and facsimile numbers, and e-mail address. If a corporation, provide the state of incorporation, and the full name, title, and experience of each high level corporate officer. If the Proposer is not an Ohio corporation, please state whether or not the Proposer is qualified to do business in the State of Ohio as a foreign corporation. A foreign corporation must provide evidence, prior to execution of a contract, that is qualified to do business in the State of Ohio or it must register with the Ohio Secretary of State. If the Proposer is a sole proprietorship, state the name of the proprietor doing business. If a partnership, state the full name, address and other occupation, if any, of each partner; whether the partner is a general or limited partner, and whether active or passive; state each partner’s experience and the proportionate share of the business owned by each partner. If a joint venture, state the name of each firm participating in the joint venture and each principal officer of each firm; each officer’s experience and the proportionate share of the joint venture owned by each joint venture partner.

B. Executive Summary: The Executive Summary should provide a complete and concise summary of Proposer’s background, area(s) and level(s) of expertise, relevant experience and ability to meet the requirements of this RFP. The Executive Summary should briefly state why Proposer is the best candidate for the engagement. The Summary should be organized so it can serve as a stand-alone summary apart from the remainder of the proposal.

C. Exceptions: Proposer shall itemize any exceptions it has to the RFP. If it

has no exceptions to or deviations from any part of this RFP, it shall so state on an “Exceptions” page. If no deviations or exceptions are identified, Proposer understands that if the City accepts the Proposer’s proposal, it must comply with and conform to all of the requirements of the RFP.

D. Qualifications: In the Qualifications section, each Proposer should state in

detail its qualifications, and experience, and how its services and/or products are unique and best suited to meet the requirements and intent of this RFP. Proposer may include as much information as needed to differentiate its services and product(s) from other Proposers. At a minimum, please include, the following:

How Proposer meets or exceeds qualifications;

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i. A description of the nature of the firm’s experience in providing the service(s) and/or product(s) sought by this RFP and state the number of persons currently employed for such purpose;

ii. The total number of such engagements and the clients comparable

to the City for which the firm has provided like or similar services within the last five (5) years;

iii. The name, location, and date of all Proposer’s agreements for like

services that have been terminated, canceled, or suspended prior to completion of the engagement or expiration of the full term within the past five (5) years, and any judgment terminating, or any pending lawsuits or unresolved claims or disputes for damages or termination of such agreements within the past five (5) years; and

iv. The names and addresses of at least three (3) references for the

firm’s professional capabilities. Include the name, e-mail address, and telephone number of a contact person.

E. Proposed Services:

i. Proposer shall describe in detail how Proposer’s management and operating plan for delivery of the services for the engagement or project will achieve the intent and goal(s) of the RFP. In its response to this sub-section, Proposer shall provide or describe:

a. An organizational chart specific for the proposed engagement

or project; b. Resumes of key management personnel c. An operational plan describing in detail how Proposer will

achieve the intent and purpose(s) of the engagement or project;

d. If applicable, a detailed description of the professional services/training to be provided;

e. Trouble shooting/follow-up protocols; f. Project management tools to be used in implementation

ii. Description of Completed Project: Proposer shall submit a

detailed description of the engagement or project, as completed for submission.

iii. Environmental Sustainability: Describe how the proposed

services/project/solution incorporated environmental sustainability

F. Financial Information: The Proposer shall include the following financial information:

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i. Balance sheet and income statement for the last two (2) fiscal years, prepared in accordance with generally accepted accounting principles, reflecting the current financial condition of the Proposer. If a publicly held corporation, the Proposer should provide in lieu of the foregoing: consolidated financial statements as submitted to the Securities and Exchange Commission (“SEC”) on Form 10K, the most recent Form 10Q, and any Forms 8K filed with the SEC in the last 12 months. Owners of closely-held corporations must submit a personal financial statement, current to within 6 months of the proposal date;

ii. Ownership of the Proposer. If the Proposer is a corporation and its outstanding stock is held by fewer than 10 persons, the name and residence address of each shareholder and his/her shares of outstanding stock must be listed.); and

G. Proposers Affidavit: Proposer shall submit with its proposal an affidavit

stating that neither it nor its agents, nor any other party acting for it has paid or agreed to pay, directly or indirectly, any person, firm or corporation any money or valuable consideration for assistance in procuring or attempting to procure the contract proposed to result from its proposal, and further agreeing that no such money or reward will be paid.

H. Additional Required Documents: Proposer shall complete, execute, and

return with its proposal the following documents, blank copies of which are attached to this RFP:

i. The Office of Equal Opportunity Notice to Bidders and

Schedules;

ii. Federal Form W-9 including Taxpayer Identification Number;

iii. Non-Competitive Bid Contract Statement for Calendar Year 2018

Proposal Evaluation; Selection Criteria

A. Evaluation Methodology. The City department/division issuing this RFP will evaluate each proposal submitted. The department will present its recommendations to the City Board of Control (“Board”). The Board may, but shall not be obligated to, entertain formal presentations. The Board may approve one or more contracts to one or more firms. The City will only consider proposals that are received on or before the proposal submission deadline, and which meet all the requirements of this RFP. The City reserves

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the right to request a “best and final offer” from Proposers meeting the minimum requirements.

B. Scoring of Proposals. The City will score each Proposal in each of the

following categories:

i. Experience and Staff

ii. Program Management Plan

iii. Proposed Services

iv. Performance Guarantees

v. Proposed Fees

vi. Sustainability

vii. Schedule/Timeline

The ratings are not intended or to be interpreted as a reflection of a Proposer’s professional abilities. Instead, they reflect the City’s best attempt to quantify each Proposer’s ability to provide the services sought by the City and to meet the specific requirements of this RFP, for comparison purposes.

C. Disqualification of a Proposer/Proposal: The City does not intend by this RFP to prohibit or discourage submission of a proposal that is based upon a Proposer’s trade experience in relation to the nature or scope of work, services, or product(s) described in this RFP or to prescribe the manner in which its services are to be performed or rendered.

The City will not be obligated to accept, however, significant deviations from

the work or services sought by this RFP, including terms inconsistent with or substantially varying from the services or the financial and operational requirements of the RFP, as determined solely by the City. The City reserves the right to reject any proposal that does not furnish or is unresponsive to the information required or requested herein. The City reserves the right to reject any proposal or to waive or to accept any deviation from this RFP or in any step of the proposal submission or evaluation process so as to approve the award of the contract considered in the City’s best interest, as determined in the City’s sole discretion.

Although the City prefers that each Proposer submit only one proposal including all alternatives to the proposal that the Proposer desires the City to consider, it will accept proposals from different business entities or combinations having one or more members in interest in common with another Proposer. The City may reject one or more proposals if it has reason to believe that proposers have colluded to conceal the interest of one or more parties in a proposal, and will not consider a future proposal from a participant in the collusion. In addition, the City will not accept a proposal from or approve a contract to any Proposer that is in default as surety or

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otherwise upon an obligation to the City or has failed to perform faithfully any previous agreement with the City, or is currently in default under any agreement with the City.

The City reserves the right to reject any or all proposals. Failure by a Proposer to respond thoroughly and completely to all information and document requests in this RFP may result in rejection of its proposal. Further, the City reserves the right to independently investigate the financial status, qualifications, experience, and performance history of a Proposer.

The City reserves the right to cancel the approval or authorization of a contract award, with or without cause, at any time before its execution of a contract and to later enter into a contract that varies from the provisions of this RFP, if agreed to by another Proposer.

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GENERAL INFORMATION

Name of Account: City of Cleveland, Ohio 601 Lakeside Avenue Cleveland, OH 44114 Size of Account: Approximately 6,400 participating employees. Coverage’s Desired: Medical, Prescription, Dental, Vision, Life/AD&D,

Voluntary Life/AD&D, Dependent Life, Worksite Benefits Current Funding: Medical – Self-Insured Prescription Drug – Self-Insured Dental – Fully-Insured Vision - Fully-Insured Life Insurance - Fully-Insured Worksite Benefits - Fully-Insured Funding Desired: Self-Insured Medical, Prescription Drug, Dental (Fully

and Self-Insured), Vision, Life Insurance, Worksite Benefits.

Current Carrier: Medical – Anthem , Medical Mutual Prescription – CVS Health (Health Action Council) Dental - CIGNA Vision – EyeMed Life Insurance – MetLife Worksite - Trustmark Eligibility: First of the month following date of hire Medical Mutual Employee Contribution: $75.50 Single / $179.89 Family Anthem $96.36 Single / $225.16 Family Prescription $17.58 Single / $38.06 Family (CVS)

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Dental PPO $4.19 Single / $10.83 Family (CIGNA) DHMO $3.19 Single / $8.26 Family (CIGNA) Vision* $0.95 Composite (EyeMed) *Please note that there is no Vision coverage for AFSCME

Local 100 members. Note: School Guards have a separate plan design, but may elect any plan. School guards will pay the premium difference between the comprehensive medical plan and the plan they elect. Medical Mutual $1,000 Deductible $10.50 Single / $26.25 Family Buy up to: Medical Mutual $125.50 Single/$318.40 Family Anthem $248.12 Single/Family Not Available Dental $5.25 Single/$15.75 Family (CIGNA) Life Employee pays $2.82 per month For $15,000 Basic Life

Rate Guarantee Period: The City prefers a multi-year administrative fee guarantee Or a one year fee with a subsequent cap. Other options Will be considered. Effective Date: April 1, 2019 Commissions: Net of Broker / Consultant Commission.

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Funding Information

City of Cleveland, Ohio Effective April 1, 2019

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FUNDING INFORMATION

Medical Self-Funding with Stop Loss The City will accept Specific and Aggregate as well as Specific only proposals Please quote on a 12/18 contract basis. Please include prescription drug under Specific and Aggregate coverage. Please quote the Specific Stop Loss at $300,000, $350,000, $400,000 and

$500,000. The Aggregate corridor should be 120%. The Specific and Aggregate coverage should begin as soon as the Threshold is met.

It would be best if the Aggregate has monthly caps or a rolling Aggregate. Dental Fully Insured and Self-Insured PPO DHMO

Vision Fully Insured EyeMed

General Information Multiple year administrative quotes are strongly encouraged and will be accepted.

If a multiple year rate cannot be given, please provide second and third year rate cap guarantees if available.

All rates should be quoted on a Single/Family basis. Please indicate any Wellness dollars you will provide for the City annually. Please indicate if unused funds rollover.

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Plan Options Requested

City of Cleveland, Ohio Effective April 1, 2019

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MEDICAL Please match current Medical Mutual Plan for all full-time eligible employees. Please match current School Guard Plan for all school guards. DENTAL ALTERNATES: Please refer to Exhibit “Dental Plan Options) VISION ALTERNATES: Please refer to Exhibit “Vision Plan Options” LIFE INSURANCE, VOLUNTARY LIFE, DEPENDENT LIFE ALTERNATES: Please match current Medical Mutual Plan for all full-time eligible employees. Please match current School Guard Plan for all school guards.

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Medical

(Questionnaire, Plan Designs & Current Rates)

City of Cleveland, Ohio Effective April 1, 2019

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MEDICAL QUESTIONNAIRE

Note: A complete response to this questionnaire must accompany all Requests for Proposals. A response such as “See Proposal” is not sufficient unless there is proper reference to the specific section of the proposal addressing the question. Please be specific in your answers. Questions for All Plans

Answer all questions in this section

C OMP L I AN CE WIT H SP EC IF IC AT I ON S

1. Confirm that your proposal is as requested in Section 3, A through K of this RFP (Proposal Requirements). Please note any deviations clearly.

SC OP E OF SE RV IC ES

2. Confirm that your proposal is for a “full service” arrangement where your company

provides its standard services and list the services that you consider standard. 3. Identify where standard services differ for insured and self-insured arrangements. 4. Identify where standard services differ by plan.

A CC O UN T M AN AG E ME N T/R EFE REN C ES

5. Provide the name, address, and phone number of the person in charge of the group sales

and service and claim administration offices that will serve CITY OF CLEVELAND (indicate if this varies by location).

6. Identify the name, title, address, years of experience with your organization, and years of total related experience for the individuals who will be responsible for the following key roles on the CITY OF CLEVELAND account (indicate if this varies by location or plan):

• Account manager and any or all assistants • Eligibility specialist. • Implementation coordinator. • Day-to-day liaison with The Fedeli Group and CITY OF CLEVELAND. • Wellness Coordinator

• Underwriter (day-to-day contact). • Underwriting manager.

Group Sales and Service

Underwriting Services

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Claim Administration

• Customer service supervisor. • Claim administration supervisor. • Network management • Executive director. • Medical director. • Other.

6. Provide biographies for each of the team members identified in your response to the

preceding question. For the individuals listed under “Group Sales and Service,” indicate as a percent, how much of their time is dedicated to sales and how much of their time is dedicated to service.

7. Provide organizational charts for each of the group sales and service, underwriting, claim administration, and managed care network management organizations (from local to national level).

8. Provide three customer references for groups similar in size to CITY OF CLEVELAND.

Provide the following information for each reference:

• Customer name. • Individual contact name and title. • Address. • Phone number. • Coverage(s) with your company. • Effective date.

9. Account management is extremely important to CITY OF CLEVELAND. CITY OF

CLEVELAND has the following expectations about account management and customer service aspects:

• The account manager would be available for weekly (or as needed) meetings

during the implementation period leading up to April 1, 2019 effective date. • The account manager would maintain regular (at least monthly) contact with the

Fedeli Group as well as CITY OF CLEVELAND to resolve ongoing issues as needed.

Please confirm your willingness to comply with CITY OF CLEVELAND ’s expectations.

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A D M IN IS TR AT I VE R E QU IR EM E NTS

10. Describe your premium and administrative billing system. Be sure to explain how mid-month additions and terminations are handled with respect to back adjustments or credits.

11. Submit copies of your standard enrollment forms or screen prints, ID cards, and non-

network claim forms. 12. Submit a copy of your standard premium or administrative statement. 13. Submit a copy of your standard utilization reporting package. 14. Submit a copy of your standard Plan Document and summary plan description

(SPD)/booklet/ certificate of insurance/marketing/marketing materials.

a) Please confirm that you will administer the Plan(s) as described in the Plan Document and that the Plan Document is the responsibility of the Plan Sponsor.

b) Please confirm that you are or are not a Plan Fiduciary. If deemed a Plan Fiduciary that you accept all liability associated with being a fiduciary.

F I NA NC I AL

15. Complete the all quotation of services separately. 16. Provide an outline of all participation and other relevant assumptions you have made in

your rate quotations. 17. Do you require a minimum level of participation for any of the plans or locations? How

flexible are these requirements? 18. Claims and administration expense via ACH or Wire transfer? 19. Do you offer multi-year rate guarantees? If so, describe your offer. 20. Please include a copy of your most recent annual report. 21. Describe your organization’s current financial ratings from the major financial rating

agencies listed below. Have any of these ratings changed in the last 12 months? If so, what was the former rating and why did it change?

a. Bests’ b. Standard & Poor’s c. Moody’s d. Duff & Phelps

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Q U A L IT Y I MPR OV E ME N T ( QI ) IN DI C AT ORS

22. Please attach a list of routinely monitored quality indicators including:

• Organizational indicators • Clinical indicators • Outcome indicators • Process indicators

23. List the QI areas of focus for the last 12 months. Include the status and/or outcome of QI

activities for each area of focus. 23.a. Please provide a copy of the latest Statement on Standards Attestation Engagements (SSAE no. 16) replacing the former SAS 70. 24. Has your plan been reviewed by the NCQA? If yes, what is your accreditation status

(i.e., full three years, provisional, denied, or under review). If no, describe your intentions to become accredited. Is an initial review pending or scheduled? If your plan has been denied accreditation, please explain the reason for denial and the steps you have taken or will take to correct any deficiencies causing the denial.

25. Have you received any recommendations from NCQA? If yes, please list the

recommendations and the status of actions being taken/already taken to address and/or resolve the recommendation.

26. Describe your narrow network. 27. Describe any clinically integrated networks that you offer.

I N FO RM AT I O N MA N A GE ME N T, PRE SCR IP TI O N DR UG A ND C AR E

M A N AG EM E NT 28. Describe how responsibilities for information management are divided between the local plan and the corporate site (e.g., centralized database; local plan office access only through request to corporate office). 29. How do you identify when members go out-of-network for health care services? What

type of data is collected and retained for these members? 30. Do you have any integrated patient records for your managed care plan(s)? If yes,

please describe. 31. Do you provide performance reports to clinicians? How often? Please attach a sample

report. 32. Please attach a list of data elements collected for UM and QI activities. Please note

how frequently the data are assembled and reported back to UM and QI.

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32a. Describe the criteria and methods used to reach potential disease management patients. Please provide sample correspondence that is sent to associates. If telephonic, please relate all protocols.

32b. What is your success ratio in conversion of potential to enrolled in disease

management programs? What is/are the incremental improvement in cost outcome performance statistics when enrolled?

32c. Provide sample reports for changes in care gaps for your value-based cohorts/practices.

32d. How do you integrate the disease management and pharmaceutical compliance component? Whether integrated or in a carve-out PBM.

32e. Please discuss your interaction with primary and specialist physicians in your disease

management program. 32f. Do you coordinate your Wellness Program through the same nurses?

32g. Please outline your most successful wellness initiatives and the implementation steps.

32h. Is your wellness program web-based? If so, can employees not enrolled in the medical plan participate? Spouses? RX Questionnaire 32i. Please provide your current formulary. What is the basis of your formulary? Rebates,

efficacy, etc.? 32j. Do you provide full transparency? 32k. Do you provide for 90 day fills at retail with a higher AWP discount? 32l. Please provide the protocols for step therapy? 32m Is the medical and pharmacy eligibility in real time? If not, what is the batch timing? 32n. How often do you change formulary? 32o. Is the home delivery program monitoring and ordering available on-line? 32p. Describe your rebate sharing program with CITY OF CLEVELAND. 32q. Please provide pricing based on baseline AWP models as well as full transparent models. 32r. Do you block repackaged NDCs’? Brand and generic?

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32s. Please provide a list of all drug rebates attained and rebate types (market-share, administration, clinical, etc.)

32t. Do coupons effect deductibles and copays? 32u. Please indicate all protocols with conducting third-party claim audits.

33. Describe your data audit procedures, including the frequency with which audits are conducted. Please include your most recent reliability and validity findings, and how the results compare with your benchmarks for data integrity. 34. Describe how you conduct comparative performance analysis, including the frequency

with which it is conducted. Include in your response a list of all external sources routinely used in your comparative performance analysis.

PR O V ID ER N E TWO R K ACC ESS

35. The demographic data is provided in the census tab for your review. Please provide the

cursory geo-access report. A full and complete claim re-pricing file, provider specific will be forthcoming.

Number of

Providers Within X Miles

Number of Employees

Meeting Access Standards

Number of Network Providers

Number of employees in service area

N/A

Adult PCP 2/10

Pediatrics 2/10

Pharmacies 2/10

Hospitals 1/20

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Your table should show the total number of providers and provider locations, the total

number of employees measured, and the number of employees who meet the access standards. Exclude closed practices from your analysis. Please include information on the number of employees not meeting access standards.

36. Please describe your service area (e.g., counties) and attach the following:

• A list of all the five-digit zip codes of each service area for which you are

offering to CITY OF CLEVELAND.

37. Indicate any plans to expand your service areas for CITY OF CLEVELAND’s current locations.

38. Do you have the capability of providing the following services related to the benefits and

services covered under each plan at the location for which you are quoting:

a. Utilization review services. b. Surgical review services. c. Outpatient review services. d. Medical case management. e. MH/SA utilization review and case management services. f. Centers of excellence. g. Clinical integrated network

Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No

39. Will you be using any subcontracted vendors to provide any of the medical management

services or products listed in the preceding question for any plan at any location? 40. If your answer to the preceding question is yes, provide the name of each vendor and

specify each of the services that each vendor will be providing. 41. Have you developed exhibits that specify the protocols and/or procedures to be followed

in providing the services and products listed in Question 42?

• How many Value Based Agreements are in place with your national (core) network? • How many Accountable Care Organizations do you have? • How many members are covered by ACO’s or value-based contracts? • What percentage of total medical spend is tied to value-based agreements?

42. Are you willing to represent and warrant that:

a. You have performed an appropriate due-diligence review of each designated network

and are satisfied that your protocols and procedures are being and will be followed. b. You have performed an appropriate due-diligence review of your administrative and

operational capabilities to provide the services specified in this RFP. c. All providers are required by contract to carry minimum amounts of professional

liability insurance.

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d. You and each of your networks will maintain professional liability and errors-and-omissions insurance.

e. You and each designated network will remain in full compliance with all managed care arrangements, including those regarding provider reimbursement, while providing services and benefits to CITY OF CLEVELAND ’s plans and its participants.

f. You and/or the designated network provider contracts require all providers to (1) make their services available to CITY OF CLEVELAND ’s plans based on the reimbursement methodologies identified in this RFP process, including capitation, and (2) provide you with notice no less than 60 days before termination of their provider contract.

g. You will accept full responsibility for the performance of each affiliated or subcontracted medical management services vendor that you may use to meet any of your obligations to provide the medical management services and products specified in Question 43 to CITY OF CLEVELAND or its plan and that such vendors will be held to the same standards and requirements to which you agree.

h. You will follow the protocols and procedures specified in all the exhibits listed in these questions.

43. Are you willing to indemnify and hold CITY OF CLEVELAND harmless for a failure by

you, your networks, or the network providers to provide specifically identified managed care network and medical management services and benefits to participants under CITY OF CLEVELAND ’s plans, or the negligent provision of such services?

44. If CITY OF CLEVELAND were to award you its business, CITY OF CLEVELAND

would reserve the right to terminate the agreement at any time. How much advance notice would you require from CITY OF CLEVELAND in the event of contract termination?

45. Is your contract non-cancelable except for nonpayment of premiums? If not, under what

circumstances do you reserve the right to terminate the contract? If you were to initiate contract termination, confirm that you will agree to provide at least 120 days’ advance notification to CITY OF CLEVELAND.

46. If CITY OF CLEVELAND elects to contract a plan on a self-insured basis they may

conduct periodic third-party audits of claims administration, the manage care networks, and any other aspect of the plans that CITY OF CLEVELAND deems appropriate, at CITY OF CLEVELAND ’s expense. You will be required to cooperate in any third-party audits. Please confirm your willingness to comply with this requirement.

I MP L EM EN T AT I ON

47. Provide a work plan timetable you would use to implement selected programs for CITY

OF CLEVELAND effective January 1, 2019. Include all key activities and indicate the person on your team who would be responsible. Key activities should include but not be limited to:

• Initial planning meeting. • Coordination with CITY OF CLEVELAND and The Fedeli Group staff.

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• Periodic update meetings. • Preparation of carrier administration systems. • Provider education. • Network development. • Enrollment meeting training. • Member services training. • Provider directory distribution. • Enrollment. • ID card production and distribution. • Benefit description production and distribution. • Assistance with the preparation of communication materials. • Participation in the training for the 2019 open enrollment meetings. • Attendance at the annual open enrollment meetings.

48. What specific claim records, eligibility, and other information would you need from the

current carrier(s) in order to effect conversion? In what format? What frequency? 49. What transition issues do you foresee as potential problem areas? How do you suggest

that they be addressed?

C OM M UN IC A TI ON S A N D EN RO LLM E NT

50. Describe the standard communication services your company will provide. These services should be included in the quoted rates. Provide samples of your standard materials, if not already included from Question 15 under the administrative requirements. Identify optional communication services that are available to CITY OF CLEVELAND and the cost for those services.

51. Describe your standard system for distributing printed materials to CITY OF

CLEVELAND employees. Is there any additional cost to CITY OF CLEVELAND? 52. How frequently are provider on-line directories updated? How do you notify participants

when a provider is added or deleted from the network? 53. Describe how your company can help in the enrollment process. What materials are

available to be distributed at enrollment meetings? Please include samples. Who is available to be present at employee enrollment sessions?

O T H ER

54. In the event your company is selected as a finalist, CITY OF CLEVELAND may want to

match utilization of providers for CITY OF CLEVELAND ’s employees to the providers in your network. Is your system able to match this data? What data are needed? Will you provide this match? What data do you require and in what format do you prefer to perform this analysis?

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55. At the City’s discretion, an audit of the accuracy of the TPA’s results will be performed via a randomly selected, statistically verifiable sample of claims by a qualified, independent third party. The results of the audit after appropriate review and comment by the TPA will be the final determinant of performance standard compliance. Results are to be reported monthly and penalties for missed performance standards will also be assessed on a monthly basis. Please confirm your acceptance of the following: Claim Turnaround Time Standard 95% of all claims processed in 30 calendar days Definition Claim turnaround time is calculated from the date the claim is received in the TPA’s office to the date it was processed. Adjusted claims are included in this calculation. Claim turnaround time will be measured and reported on a monthly basis for Client’s claims only. Financial Accuracy Standard 99.00% Accuracy Definition The Financial Accuracy of a universe of claims is the total dollars paid correctly divided by the total dollars paid, stated as a percentage. A statistically valid sample of the Client’s claims processed each month will be measured and reported on a monthly basis for the Client’s claims only. Processing Accuracy Standard 97.00% Accuracy Definition The Processing Accuracy of a universe of claims is the number of claims processed correctly divided by the number of claims audited. A statistically valid sample of the Client’s claims processed each month will be measured and reported on a monthly basis for the Client’s claims only. All payments made on behalf of the Plan to eligible Plan Participants and Providers, for approved services, shall be in accordance with the Plan Document and policies of the City. The TPA shall identify claims that have been incorrectly processed and initiate appropriate action to correct processing outcomes. The TPA shall notify the City by letter of any system errors that result in a potential Provider or Plan Participant overpayment or other incorrect payment and describe in detail the plan and deadlines for corrective action.

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The TPA shall provide the City with a monthly report of all overpayments, duplicate payments, and payments to the wrong payee reflecting the status of corrections, adjustments, and collections resulting from errors. Telephone Call Answer Time Standard 95% Answered within 30 seconds Definition Telephone Call Answer Time measures “live” calls only. Client’s call activity will be measured and reported on a monthly basis for the Client only. Telephone Drop/Abandonment Rate Standard Less than 3% Definition An abandoned call is defined as an individual hanging up once in the que. Client’s call activity will be measured and reported on a monthly basis for the Client only. 56. Please propose your administrative fees at risk. 57. What is the name and description of the code editing software used? 58. Have all of the CMS NCCI edits been incorporated into your coded editing software through customization?

a. If not, are you willing to incorporate all CMS NCCI edits into your software for Client within six months of implementation?

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59. Indicate the service targets and actual service levels for the office(s) that will process medical claims for CITY OF CLEVELAND ’s employees.

2016

Target

2016Actual

Results

2017

Target

2017 Actual Results YTD

Claim Turnaround

___% in ___ calendar days

___% in ___ calendar days

___% in ___ calendar days

___% in ___ calendar days

Claim Accuracy

# Dollar

_________%

_________%

_________%

_________%

# Processing

_________%

_________%

_________%

_________%

60. What was the rate of turnover among claim examiners at this claim office during 2016?

2017 - 2018 YTD?

N E T W ORK IN FO RM A T IO N

61. Is your PPO network:

a. Internally developed [Y/N]? b. Leased or rented [Y/N]?

62. What was your PPO’s total enrollment as of January 1, 2018:

a. Commercial? b. Medicare products? c. Medicaid products? d. Are these figures only for the PPO network for which you are completing this survey

(i.e., no combined HMO, POS, EPO, PPO membership figures)? [Y/N]? e. Are these figures only for the service area you identified by County? [Y/N]?

63. How many of each of the following providers were in your PPO network (including staff,

affiliated providers, and contracted providers):

a. Hospitals? b. Pharmacies? c. PCPs (General/Family Practice, Internal Medicine, Pediatrics)? d. OB/GYNs? e. All other specialists (excluding Psychiatrists)? f. Psychiatrists? g. Doctoral level Psychologists (Ph.D., Ed.D., Psy.D.)? h. All other licensed providers in the mental health profession? i. Chiropractors?

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64. Do you contract with an independent (not affiliated or subsidiary) vendor for:

a. Chiropractic [Y/N]? b. Disease management [Y/N]? c. Mental health [Y/N]? d. Prescription drugs [Y/N]? e. Podiatry [Y/N]? f. Utilization review [Y/N]?

65. Does the Network offer the following services:

a. Claims re-pricing [Y/N]? b. Customer service [Y/N]? c. Full claims processing [Y/N]? d. Network development/maintenance [Y/N]? e. Provider relations [Y/N]? f. Quality assurance [Y/N]? g. Reporting (e.g., utilization, financial) [Y/N]? h. Utilization management [Y/N]?

66. What is the overall PPO network discount achieved for the effected locations? A detailed

claim file(s) will be provided for all claims, by line item; for Plan Years 2016 and 2017. Please indicate the discount level that you will guarantee overall and by location.

67.a. Do you have any programs for negotiating non-network charges? Are there fees

associated with these negotiations? Are the negotiations based on aggregate procedure or per transaction?

b. CITY OF CLEVELAND may elect to carve-out distinct disease states that may or may not be in your proprietary network. The carve-out disease state will be thoroughly developed in the Plan Document. Confirm that there is no conflict of interest within your proprietary networks for such assignments.

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68. Please complete the following

CPT Code Description Network

Fee Non-

Network 19120 Excision Lesion Breast 27130 Replacement Hip Total 27447 Replacement Knee Total 29881 Arthroscop Knee w/Partial Meniscect 43235 Endoscopy Upper GI Diagnose Complex 43239 Endoscopy Upper GI w/Biopsy 45378 Colonoscopy Postflex Diagnostic 45380 Colonoscopy Postflex w/BS/Specimen 45385 Colonoscopy Postflex w/Rem Polyp 49310 Laparoscopic Cholecystectomy 49311 Lap Cholecystect w/Cholangiography 58150 Hysterectomy Total 59400 Obstetric Care Total 59510 C-Section w/Anti- & Postpartum Care 63030 Evx IV Disk Lumbar 66821 Discission 2nd Cataract by Laser 66984 Rem Cataract Extracap w/Insert Lens 80019 Automated Multichannel > 18 Tests 88305 Surgical Pathology-Level IV 90060 Outpt Med Svc Estab Pt-Intermed Svc 90843 Psychotherapy, Medical 20-30 min 90844 Psychotherapy, Medical 45-50 min 92982 PTCA-Balloon, Single Vessel 93015 Test, Cardiovasc Stress-Complete 93307 Echocardiography, Real Time-Compl 93320 Echocardiography, Doppler-Complete 93549 Catheter HRT Rt+Lt+Coron+Ventric 97010 Phys Med-Hot or Cold Packs 97110 Phys Med-Therapeutic Exercises 97260 Manipulation-One Body Area 97530 Kinetic Activities-Initial 30 min 99160 Critical Care, Initial-First Hour 99202 Office/Outpat New Expanded Focus 99203 Office/Outpat New Detailed Moderate 99204 Office/Outpat New Comp Moderate 99205 Office/Outpat New Comp Complex 99212 Office/Outpatient Est Focused Minor 99213 Office/Outpat Est Expanded Focuses 99214 Office/Outpat Est Detailed Moderate 99215 Office/Outpat Est Comp Complex

Network Fees; Provide by Major (50 + Employees) Network Location Effected

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CPT Code Description Network

Fee Non-

Network 99223 Initial Hosp Care High Complexity 99231 Subsequent Hosp Care Low Complexity 99232 Subsequent Hosp Care Mod Complexity 99233 Subsequent Hosp Care Highly Complex 99238 Hospital Discharge Day Management 99244 Office Consult Comp Mod Complexity 99245 Office Consult Comp High Complexity 99283 Emerg Dept Vis Focused Mod Complex 99284 Emerg Dept Vis Sever Mod Complex 99291 Critical Care, First Hour

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Dental (Questionnaire, Current Plan Design and

Current Rates)

City of Cleveland, Ohio Effective April 1, 2019

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DENTAL QUESTIONNAIRE 1. Provide a summary of general dentists and specialists in the table format requested below: General Periodontist Endodontists Oral

Surgeon Pedodontists Orthodontists

2. What UCR percentile is used to process dental claims (60th, 70th, 80th, etc.)? 3. Do you own your network(s) or contract with other organizations?

3a. Do you have a DHMO product? 4. Do you offer a web page? If so, what is your web-site address? Does the web-site offer responses to frequently asked questions? Can a client update eligibility via the Internet? Is your directory available on line? 5. Please provide one directory in each of your RFP responses. 6. List the provider credentials that are primary source verified. 7. Briefly describe your dentist selection, credentialing and re-credentialing process. 8. Does your program use a dental consultant to deal with inappropriate patterns of dental treatment? 9. Please submit a copy of your provider contract. 10. What guarantees do you make to ensure that enrollees will not be balanced billed in excess of your contracted rates? 11. Describe your customer service capability. Where is your Customer Service Center located? What are the hours of operation? What are your capabilities to accommodate inquires for non-English speaking patients? 12. Will you be available for enrollment meetings? 13. Please provide an implementation plan with timelines, assuming the effective date is April 1, 2018 14. Do you charge for ID cards/enrollment materials/certificates?

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15. Please explain your renewal methodology, addressing administration/ retention, your target loss ratio and your average renewal for 2012. 16. Please include a copy of your HIPAA Privacy Policy, including your Notice of Privacy Practice, applicable Authorization Forms and a sample of your Business Associate Contract. 17. Please provide a copy of your proposed standard contract with the City. 18. Please provide the following information for two current and two former clients of similar size: Company Name Address Contact Person Telephone and/or email address

Dental 1. Please provide a thorough outline of your dental network. What is the average savings for Network services? 2. Please provide and ASO quote as well as fully-insured proposal.

3. What level of reimbursement do you process for non-network claims within your

DPPO? 4. How do you integrate incentive PPO and traditional dental? 5. What fraud prevention and detection protocols do your system follows? 6. Is your dental network owned or leased? Or a joint venture? 7. Is your billing system real-time or batch over night? Eligibility system? 8. Describe your dental account management and team. Please provide roles and responsibilities. 9. Do you offer a rollover benefit?

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Prescription Drug (Questionnaire, Current Plan Design and

Current Rates) Complete the following form regarding contracted or rebranded services (if not applicable, please indicate "this service provided internally" on the description line). 1. Claims Adjudication Description_________________________________________________________ Contracted Provider__________________________________________________ Date Service Commenced_____________________________________________ 2. Pharmacy Network Administration (Contracting, Payment, etc.) Description_____________________________________________________ Contracted Provider__________________________________________________ Date Service Commenced_____________________________________________ 3. Formulary Design, Content, and Composition Description_____________________________________________________ Contracted Provider__________________________________________________ Date Service Commenced_____________________________________________ 4. Formulary Rebate Administration Description_____________________________________________________

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Contracted Provider__________________________________________________ Date Service Commenced_____________________________________________ 5. Mail Service Pharmacy Description________________________________________________________ Contracted Provider__________________________________________________ Date Service Commenced_____________________________________________ 6. Can all service guarantees and performance agreements outlined in this RFP (and the subsequent contract) be applied to subcontractors? If not, please explain. 7. For all subcontractors mentioned above, outline payment methods and assurance that service will remain continuous throughout the contracted period. 8. For all subcontractors mentioned above, provide insurance documentation for services provided via primary vendor. 9. Outline methods of assuring insurance requirements are met and maintained by subcontractor on an ongoing basis. 10. What is the annual turnover rate of the Respondent staff over the past 12 months? 11. Confirm if single source generic drugs are reconciled in the generic or brand guarantee. 12. If single source generic drugs are not included with the generic guarantee, how many manufacturers are required until a drug is reconciled in the generic guarantee? Are there other caveats until a drug is considered a generic (i.e. exclusivity period)? 13. Ensure that any claim with a Generic indicator will be included in the Generic guarantee and any claim with a Brand indicator will be included in the Brand guarantee (as defined by Medispan). 14. Are rebates are being paid to the client and if so, how those rebates are being paid…(i.e. guaranteed rebates per all brand claims, brand formulary claims or rebateable claims)? 15. Are there days’ supply caveats associated with rebates? Can they be prorated based on a specific days’ supply? 16. Are rebates paid on specialty drugs? If yes, are the same rebates paid at mail & retail on specialty drugs?

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17. Does the pricing offer guarantee price points at a book of business/group level or to each individual client? Do you have an guarantee on all of your generic drugs or only a MAC guarantee? 18. How long is the term of the deal? Are there any termination rights for clients who seek to leave a long term three year deal early for any reason including but not limited to changes in ACA/healthcare reform? What recourse does the individual client have if this pricing is not deemed to be competitive with the marketplace in years 2 & 3 of a contract? 19. Is there a restricted retail network (if so, please provide a listing of major pharmacy exclusions) associated with this offer? 20. Is there an overall specialty guarantee? 21. Does mail pricing apply to all mail claims? 22. Will the member always pay the lower of U&C, ingredient cost, or co-pay at the retail counter?

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Voluntary (Worksite) Benefits (Questionnaire, Current Plan Design and

Current Rates)

Scope of Services (Voluntary Programs)

1. The City of Cleveland requires that only products approved by the City can be sold to participants. Please confirm.

2. Please explain the insurance programs you are proposing for the City of Cleveland. Please see additional information and questions regarding the current voluntary programs at the end of this Request for Proposal and also include:

a. Schedule of Monthly Rates b. Complete Description of Benefits c. Complete Description of All Limitations & Exclusions d. Specimen Policy for Each Plan

3. Please provide a brief summary of your organization.

4. What is your company’s most current A. M. Best’s Rating?

5. Please provide a history of municipalities to whom you have provided voluntary benefits.

6. Is this a joint venture? Provide details.

7. Are you subcontracting? Provide details.

8. How long has your company provided voluntary benefits?

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9. Please identify at least five references of comparable size or industry, listing contact person and phone number. At least three must be municipalities.

10. Please provide sample employee communication services provided for voluntary benefits and explain your resources to support customized communications.

11. Describe your company’s reimbursement process.

12. Describe your company’s claims submission requirements.

13. Specify your company’s payment processing time between claims submission and policyholder reimbursement.

14. How will City of Cleveland employees access your company’s customer service?

15. Do you provide a toll-free number for employees telephonic inquiries?

16. Describe how you will accommodate the City of Cleveland workforce. Our employees work 24 hours a day, 7 days a week.

17. The City of Cleveland will continue onsite counseling services supported via a call center through a third-party firm. The City expects to incorporate enrollment on to the ADP enrollment platform. Please confirm you understand the enrollment methodology.

18. What additional employee services will your firm provide for City staff members?

19. Provide a time line for implementation.

20. The Voluntary Benefits program vendor must mail to participants’ homes any required W-2 or 1099 forms. Please confirm.

21. Will you be able to work with ADP as the City’s payroll vendor?

22. Please provide a summary report of all consumer complaints for your company

47

which have been filed with the Ohio Department of Insurance for the time period of September 1, 2017 through August 31, 2018. This report should include complaints related to billing, sales procedures and claims for policies your firm has issued for Short Term Disability, Critical Illness, Accident and Permanent Life coverages.

The City reserves the right to modify the scope of services at any time before execution of a contract to add, delete, or otherwise amend any item(s), as it deems necessary, in its sole judgment, and in the best interest of the City.

Current City of Cleveland Current and Requested Voluntary Insurance Programs

The City offers four voluntary programs through Trustmark Voluntary Benefit Solutions. These programs were implemented in 2013. The City may consider replacement of these programs. Current participation in these plans meets industry standards. List of current participants and participation rates will not be provided in this process. Current premium structures will not be provided in this process. Please propose your best available offer.

The four current and requested voluntary programs are:

1. Voluntary Short-Term Disability Coverage a. 7 day waiting period; 3 month/90 day waiting period b. 14 day waiting period; 3 month/90 day waiting period c. 14 day waiting period; 6 month/180 day waiting period

2. Voluntary Critical Illness Coverage 3. Voluntary Accident Coverage 4. Voluntary Permanent Life Insurance Coverage with Long-Term Care Benefits

Questions – Program Design

1. All programs are individually-owned, guaranteed renewable plans with issue age premiums. Explain how your proposed products are the same or differ.

2. Please provide the eligibility requirements for employee, spouse and dependents. 3. Please define eligibility for dependents for each plan.

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4. Please describe all pre-existing condition limitations for each plan. 5. Please describe any special features for each plan. 6. If portability is being requested, will ports be rates as part of the active group or

separately? 7. Please describe any available wellness benefits in detail.

• For short-term disability, please provide: 1. Please provide your full definition of disability, including employee’s own

occupation and any occupation or employment for wage or profit. 2. Please describe integration/coordination with other sources of income,

including sick leave, worker’s compensation and other sources of income. 3. Please confirm if for sick leave benefit coordination if disability benefits are

reduced only if sick leave benefits are received. 4. Please confirm how many plan options can be offered.

• For critical illness, please detail the percentage of spousal and dependent benefit available relative to the employee. Is the employee required to purchase coverage for the spouse and/or dependents to be eligible?

Questions – Premium Structures

1. Please provide all premium structures on a biweekly (26 pays per year) basis. 2. Please describe how policy renewal premiums will be calculated. How will

your firm manage them? 3. Please describe any rate guarantees. 4. If applicable, please indicate if rate changes will occur on policy anniversary

date of the following either an age bracket change due to age increase; a benefit change due to salary change (for short-term disability only) or both.

Questions – Underwriting

1. What is the minimum employee participation for each voluntary benefit? 2. What happens if the minimum participation requirement is not met? 3. Will medical underwriting be waived for current policyholders? If so, is the waiver

limited to a certain benefit level? 4. What is the underwriting is required for both current policyholders and non-

participants? 5. Please confirm if you offer perpetual guarantee issue. 6. Please provide copies of any applications with medical questions and evidence of

insurability forms that may be required and detail when these may apply.

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Questions –Replacement

1. Will your firm base the age of the policyholder on current age or age when first enrolled with Trustmark? If the latter, who would you account for this in regard to billing and ADP integration?

2. If there are any limitations on complete take-over for all current policyholders, please describe.

3. Will you allow current policyholders to increase benefits, up to guarantee issue limits?

Questions – Technology

1. Please describe your experience working with ADP as an enrollment tool. Please confirm if your company will cover costs associated with adding your benefits to ADP and/or provide a technology subsidy.

Questions – Billing

1. Please describe your billing process options in detail. Please review self-billing options.

2. Please describe how you send and receive files securely. 3. Please detail all file requirements and formats for payroll deduction, including change

files, and for billing purposes.

Questions – Claims

1. Please describe on-line options employees have for submitting claims. 2. Please describe required claims documentation for each program, including for

wellness claims, where applicable. Questions – Enrollment Method

1. What type of enrollment can you support: a. Combined with Core Enrollment on Employers HRIS? b. Call Center c. Carrier

2. Please indicate whether you will provide the following assistance:

a. Dedicated IT resources during implementation b. Cost subsidy associated with integration into employers core system c. If subsidies are provided, will they only available for Year 1? d. Do you require Social Security Numbers for file transfers?

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Life Insurance (Questionnaire, Current Plan Design and

Current Rates)

1. Provide a description of documents needed in order for claims to be filed?

2. Describe how claims are processed and timeline for claim payment.

3. Please describe your procedure for notifying members of approval or denial of voluntary life/AD&D coverage applied for in excess of the guaranteed issue limit.

4. Please provide three client references (preferably public entities) of a similar size.

5. Are there any open complaints on file against your company with the Ohio Department of Insurance?

6. Is your company currently involved in any litigation as a defendant over any life insurance benefit?

7. What is your time frame for providing renewal rates? The City may require renewals six months from the renewal date; please indicate any conflict with this requirement.

8. Will your company provide on-site enrollment assistance?

9. Will your company provide an ongoing annual open enrollment including GI?

10. Indicate the ratings given to your company by the following:

a. AM Best

b. Standard & Poor’s

c. Moody’s

d. Fitch

10a. Has there been any change in your ratings in the last 2 years? If yes, please explain.

11. Are there any pending agreements to merge or sell your company?

12. Within the last five years, has your firm ever defaulted on a contract to provide a group life insurance plan? Has your firm been involved in litigation regarding such contracts?

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13. Within the last five years, has your firm ever been removed or replaced as life insurance provider of a state or other public group life insurance plan with 5,000 or more employees? If yes, explain the circumstances.

14. Please provide three current client references, preferably public sector clients of the same size.

15. Identify key staff members who would have day-to-day contact with the City’s Human Resources staff. Identify their duties and their experience working with public sector clients.

16. Are you willing to pay a portion of the cost of printing annual open enrollment benefit guides for employees? This will be billed from The Fedeli Group.