{"text_format":"3","workbook":"xlsx","n_sheets":14,"sheets":["Health Questionnaire","Plan Design - HDHP PPO wHSA","Plan Design Explanation","Rate Exhibit - HDHP PPO wHSA","Stop Loss Questionnaire","Rate Exhibit - Stop Loss ","Rate Exhibit - ASO Fees","Geo Access","Top Physicians-Provider Disrupt","Medical Plan 1 Provisions","Financials","Rx - Top 50 Spend","Officer","Explanation"],"not_rendered":{"images":2,"external_links":15,"defined_names":2753},"read":"whole","date_system":"1900"}

{"sheet":"Health Questionnaire","index":0,"n_rows":262,"n_cols":12,"rows_kept":262,"merged":[[4,2,4,5],[9,2,9,5],[63,2,63,5],[97,2,97,5],[160,2,160,5],[251,2,251,5]]}
[]
[null,null,"Request for Health Insurance (ITN) for the St. Johns River Water Management District (the \"District\")"]
[null,null,"Health Insurance Questionnaire"]
[]
[null,null,"To Vendor:  Use Column F to provide a brief explanation. However if the length of the explanation is greater than 400 characters, you must use the \"Explanation\" worksheet to provide your detail explanation.",{"$nulls":8},"Yes"]
["",{"$nulls":10},"No"]
["","","MEDICAL ITN ","Answer Format","Response","Explanation"]
[null,null,"Vendor confirms that all requirements set forth in the ITN will be met (including mandatory minimum qualifications) and has attached all required items. ","drop down box"]
[]
[null,null,"General Information - Not Rated"]
[]
["I. ","","General Information ","Answer Format","Response","Explanation"]
["1.","","Legal Company Name","text"]
["2.",null,"Parent Co. Legal Entity Name","text"]
["3.",null,"d/b/a (Name in Marketplace) ","text"]
["4.",null,"Year Established/Incorporated  ","Month Day, Year"]
["5.",null,"NAIC Code ","numeric"]
["6.",null,"Industry Classification  ","text"]
["7.",null,"FEIN (Federal Employer Identification Number)  ","text"]
["8.",null,"Tax Status  ","text"]
["9.",null,"Tax payer ID Number for liable underwriting source","text"]
["10.",null,"Public or Privately-Held  ","drop down box"]
["11.",null,"Ownership/Controlling Interest Structure ","text"]
["12.",null,"Location(s) where employees will be assigned to provide services described in this ITN. ","text"]
["13.",null,"List the number and percentage of employers of similar size to the District that your organization currently contracts with directly for Medical coverage.","text"]
["14.",null,"Are you authorized to do business in the State of Florida? ","drop down box"]
["15.",null,"How many subcontractors will provide administrative services should your organization be awarded this business?","numeric"]
["16.",null,"Please include a list of subcontractors used for customer service, claims administration, network access, disease management, and any other services within an Exhibit titled \"[Vendor] Subcontractors\" in your response that includes the following information:\n  * Year Established/Incorporated\n  * NAIC Code\n  * Specify services to be provided","Included/Not Included"]
["17.",null,"Home Office Location","text"]
[null,"a.","Address Line #1","text"]
[null,"b.","Address Line #2","text"]
[null,"c.","City","text"]
[null,"d.","State","text"]
[null,"e.","Zip","text"]
[null,"f.","Web Address","text"]
["18.",null,"All claim records and eligibility data used by the Vendor in its role as claim administrator shall remain the property of the District as Plan Sponsor and Plan Administrator.","drop down box"]
["19.",null,"Vendor agrees to monitor federal and state legislation affecting the delivery of medical benefits under the plan and to report to the District  on those issues in a timely fashion prior to the effective date of any mandated plan changes.","drop down box"]
["20.","","Vendors agrees to provide electronic copies of plan materials, including SBCs, SPDs, Certificates of Coverage, and other plan materials.  ","drop down box"]
["21.",null,"Vendors confirms the capability for providing the District with a link to the Vendor's website to obtain plan information, including Certificates of Coverage, SBCs, and benefit summaries.","drop down box",null," "]
[]
["II. ","","Contacts","Answer Format","Response","Explanation"]
["","","Please indicate Vendor contact, should there be any questions concerning submitted responses."]
["1.","","Primary Contact"]
["","a.","Name","text"]
["","b.","Title","text"]
["","c.","Address","text"]
["","d.","City","text"]
["","e.","State","text"]
["","f.","Zip","text"]
["","g.","Phone Number","text"]
["","h.","Fax Number","text"]
["","i.","E-mail Address","text"]
["2.","","Secondary Contact "]
["","a.","Name","text"]
["","b.","Title","text"]
["","c.","Address","text"]
["","d.","City","text"]
["","e.","State","text"]
["","f.","Zip","text"]
["","g.","Phone Number","text"]
["","h.","Fax Number","text"]
["","i.","E-mail Address","text"]
[]
[null,null,"Organization, Experience and Qualifications"]
[]
["III.","","LEGAL/CONTRACTUAL CONSIDERATIONS","Answer Format","Response","Explanation"]
["1.","","Vendor has complied with all federal and State of Florida insurance department regulatory requirements for all products and services being offered in this quote in which the District has employee and retiree participants.  These laws include, without limitation: the Patient Protection and Affordable Care Act, the Genetic Information Nondiscrimination Act, Consolidated Omnibus Budget Reconciliation Act of 1985, Health Insurance Portability and Accountability Act, Newborns' and Mothers' Health Protection Act, Mental Health Parity Act, The Mental Health Parity and Addiction Equity Act of 2008, and the Women's Health and Cancer Rights Act.","drop down box",null," "]
["","a.","If the answer to the preceding question is \"no\",  for all products and services quoted in this ITN for which the required state insurance department regulatory requirements have not been met, please specify the applicable product. ","text"]
["2.",null,"Vendor will act as plan fiduciary, if requested.","drop down box"]
[null,"a.","Vendor carries a fiduciary bond as any arrangements where you serve as fiduciary. Provide details on the fiduciary bond that you carry.","text"]
[null,"b.","Vendor will act as the final claims appeal fiduciary for the plans of the District, if requested. If not, describe why you would be unwilling to agree to this request.","drop down box"]
["3.","","Vendor agrees to (i) accept liability for claim processor negligence and fraud and (ii) provide necessary legal defense in the event of litigation  related to claims processing and adjudication disputes, including all costs inuring thereto.","drop down box",null," "]
["4.","","Vendor must administer benefits on a discontinuance and replacement basis (sometimes referred to as a \"no loss/no gain\" basis) for eligible employees (and dependents) participating in the current plans on the effective date and to unconditionally provide continuous coverage to all participants enrolled on the program effective date.  ","drop down box"]
["5.","","Any participants not actively at work due to sickness or illness on the program effective date will be covered.","drop down box"]
["6.",null,"Vendor will accept responsibility for determining whether each prescription drug benefit offered is considered \"creditable coverage\" for purposes of Medicare.","drop down box"]
["7.",null,"Vendor will be responsible for providing legally mandated notices such as Women's Health and Cancer Rights Act, etc…","drop down box"]
[]
["IV.",null,"Privacy and Confidentiality","Answer Format","Response","Explanation"]
["1.",null,"Vendor agrees to comply with the HIPAA privacy regulations issued by the Dept. and Health and Human Services and any comparable state laws not preempted under HIPAA.","drop down box"]
["2.",null,"Vendor agrees to mitigate, to the extent practicable, any harmful effect that is known to Vendor of a use or disclosure of PHI by Vendor in violation of the requirements of the federal privacy rule.","drop down box"]
["3.",null,"Vendor agrees to ensure that any agent, including a subcontractor, to whom it provides PHI received from, or created or received by Vendor agrees to the same restrictions and  conditions that apply to Vendor with respect to such information and agrees to penalties if breached.   ","drop down box"]
["4.",null,"Vendor agrees to (i) implement administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of the electronic PHI that it creates, receives, maintains, or transmits, (ii) report to the plan sponsor any security incident (within the meaning of 45 CFR § 164.304) of which Vendor becomes aware, and (iii) ensure that any Vendor employee or agent, including any subcontractor to whom it provides PHI received from, or created or received by Vendor agrees to implement reasonable and appropriate safeguards to protect such PHI.","drop down box"]
["5.",null,"Please describe your system security policy and how data will be secured.","text"]
["6.",null,"In the event of a data breach that resulted from a non District error, what efforts would Vendor undertake to cover this risk?","text"]
[]
["V.","","Administration Requirements","Answer Format","Response","Explanation"]
["1. ",null,"Please confirm Vendor is willing to draft the Certificates and SBCs accurately and in compliance with ACA and provide to the District by specified date in advance of Open Enrollment.","drop down box"]
[null,"a.","Please describe the HIPAA administration services offered.","text"]
["2.",null,"For fully insured proposals, please confirm there will not be a minimum deposit or pre-funding requirement. ","drop down box"]
["3.",null,"Please confirm that vendor will be able to work with the District's third party COBRA administrator (currently Medcom).","drop down box"]
["4.",null,"To the extent permitted under state law, no fault auto insurance, governmental plans coordination and negligent third party subrogation will be administered by Vendor. ","drop down box"]
["5.",null,"Will Vendor agree to provide an implementation credit of $50,000 payable for quality review of plan design and transition/disruption prior to 10/1/19?  As the selected Vendor, you agree to pay the cost of this review up to $50,000.","drop down box"]
["6.",null,"For fully insured proposals, vendor agrees to accept monthly premium payments  based on a self-bill invoice and payment generated from the District without reconciliation requirements.","drop down box"]
[null,null,"Vendor agrees to accept payments via ACH from the District.","drop down box"]
["7.",null,"Vendor agrees to provide the District with a benefits and financial contract renewal at a minimum of 180 days prior to the effective date.","drop down box"]
["8.",null,"Briefly describe the types of standard communication materials available and whether there are charges for those materials.","text"]
[]
[null,null,"Customer Service and Technology Capabilities"]
[]
[null,"VI.","Account Management","Answer Format","Response","Explanation"]
["1.",null,"Please confirm that a dedicated implementation manager will be assigned to the District.","drop down box"]
[]
[null,"VII.","Benefit Eligibility and Open Enrollment Support","Answer Format","Response","Explanation"]
["1.",null,"Please confirm that vendor will be able to accept weekly electronic eligibility file feeds from the ADP Workforce Now, the District's HRIS.","drop down box"]
["2.",null,"Please confirm that health plan identification cards (ID cards) are issued to participants within five (5) business days of receipt of data and prior to January 1, for the 2020 plan year.","drop down box"]
["3.",null,"Please describe the training you will provide to the District staff.","text"]
[]
[null,"VIII.","Medical Claims Administration and Customer Service","Answer Format","Response","Explanation"]
["1.",null,"Describe the effectivess of the following operations:"]
[null,"a.","Customer Service Center","text"]
[null,"b.","Claims Processing Center","text"]
["2.",null,"Please answer the following questions as they relate to Claims Processing based on the most current 12 month reporting period (we are requesting actual results)"]
[null,"a.","Indicate Current Reporting Period","text"]
[null,"b.","Claim payment accuracy (number of correct payments divided by number of payments) ","text"]
[null,"c.","Claim processing accuracy (number of claims processed with 100 percent accuracy divided by number of claims) ","text"]
[null,"d.","Financial accuracy (dollars paid correctly divided by total dollars paid) ","text"]
[null,"e.","Average turnaround time:\n   i) x% in 10 business days (14 calendar days);\n   ii) x% in 20 business days (30 calendar days)","text"]
["3.",null,"What mechanisms are available for participants to contact customer service?","text"]
["4.",null,"Can you comply with primary and secondary payer requirements for Medicare?","drop down box",null," "]
["5.",null,"Please describe your multi-lingual capabilities.","text"]
["6.",null,"Please describe your grievance process.","text"]
[]
[null,"IX.","Performance Guarantees","Answer Format","Response","Explanation"]
["1.",null,"Please indicate whether Vendor offers performance guarantees for any of the following services.  If so, please explain."]
[null,"a.","Claim processing ","drop down box"]
[null,"b.","Eligibility/enrollment processing","drop down box"]
[null,"c.","Customer service","drop down box"]
[null,"d.","Data analysis and reporting","drop down box"]
[null,"e.","Account management","drop down box"]
[]
[null,"X.","System Integration & Website Capabilities","Answer Format","Response","Explanation"]
["1.",null,"Are all of your internal systems integrated? (e.g., claims payment, eligibility, enrollment, customer service, utilization management, case management and disease management)","drop down box"]
["2.",null,"Please confirm you agree to interface with (e.g., sending to and/or receiving from) the District's FSA/HSA vendor (currently Health Equity).","drop down box",null," "]
["3.",null,"Do you charge separate fees to send or receive data to other vendors of the District? Please specify.","drop down box",null," "]
["4.",null,"Describe the internet tools and capabilities available for members and the plan sponsor.","text"]
["5.",null,"Please identify which of the following services are currently available on your website for members."]
[null,"a.","Update eligibility or change/add dependents.","drop down box"]
[null,"b.","Request additional or replacement ID cards.","drop down box"]
[null,"c.","Print ID cards directly from site.","drop down box"]
[null,"d.","Access historical health data.","drop down box"]
[null,"e.","Take a health risk assessment.","drop down box"]
[null,"f.","Provider directories (standard).","drop down box"]
[null,"g.","Provider quality information.","drop down box"]
[null,"h.","Provider cost information.","drop down box"]
[null,"i.","Provider selection where users enter search criteria.","drop down box"]
[null,"j.","Rx formularies added online","drop down box"]
[null,"k.","Prior Authorization","drop down box"]
[null,"l.","Treatment cost estimator","drop down box"]
[null,"m.","Plan design information","drop down box"]
[null,"n.","Wellness resources","drop down box"]
["6.",null,"Please specify the tools available to the District via the employer portal of your organization's website."]
[null,"a.","Access to claims data.","drop down box"]
[null,"b.","Access to member-specific coverage information.","drop down box"]
[null,"c.","Account level delegate rights.","drop down box"]
[null,"d.","Eligibility verification.","drop down box"]
[null,"e.","On-line eligibility maintenance.","drop down box"]
[null,"f.","Real-time secure access to information for the District.","drop down box"]
[null,"g.","Request ID cards.","drop down box",null," "]
["7.",null,"What on-line tools are available for members to assist members in determining the cost or quality of providers, facilities, or a particular service?","text"]
[]
[null,null,"Plan Construction: Network Pricing, Cost Containment and Management Strategies"]
["",""]
["XI.","","Network Management & Prescription Formularies","Answer Format","Response","Explanation"]
[null,null,"What is the actuarial value of the plan you are proposing?","text"]
["1.",null,"What is the name of the network your organization has proposed for the District?","text"]
["2.",null,"What year was this network established?","text"]
["3.",null,"What network management services will be delivered by a subcontractor, wholly owned subsidiary or other outside organization? (Include any leased network arrangements.)","text"]
["4.",null,"If you use leased networks to service this account, are the leased discounts loaded into your claims system?","drop down box"]
["5.",null,"How often will you notify members of changes in your provider network? How will members be notified?","text"]
["6.",null,"Describe how your network will provide access and accommodation for active and retired members that reside or travel outside of Florida.","re"]
["7.",null,"Do you foresee any significant provider contracts coming up for negotiation in the next three years based on the District locations?","drop down box"]
["8.",null,"What are your current arrangements and incentives for directing members to ACOs and Patient Centered Medical Homes?","text"]
["9.",null,"Does your organization offer high-performance networks? If so, provide a brief description.","text"]
["10.",null,"Vendor agrees to provide regular updates to prescription drug formularies, including disruption details and outreach for members who are impacted by formulary changes.","drop down box",null," "]
[null,"a.","How often is the Vendor's formulary updated?","text"]
[null,"b.","How are changes communicated to the District and to impacted members?","text"]
[null,"c.","What formulary changes are expected to occur in the Vendor's formulary the next 18 months?","text"]
[null,"d.","Are there limitations on selected pharmaceutical therapies? If so, please describe.","text"]
[null,"e.","Are there limitations on utilization of formularies? If so, please describe.","text"]
[null,"f.","Please describe how you handle the transfer of prior authorization records, email scripts, and step therapy records from prior carrier?","text"]
[{"v":11,"d":"11."},null,"How frequently are Medical and Rx claims accumulators exchanged for the satisfaction of the HDHP annual deductible and out-of-pocket maximums?","text"]
[{"v":12,"d":"12."},null,"What are your average pharmacy rebates PEPM?","text"]
[]
[]
[null,"XII.","Reporting Capabilities ","Answer Format","Response","Explanation"]
["1.",null,"Vendor agrees to provide monthly paid claims and enrollment reports by group and plan type to the District as part of your standard reporting package. Costs for standard reports should be included in the quote provided. If you disagree, please explain.","drop down box"]
["2.",null,"Vendor agrees to meet with the District  on a semi-annual basis (at minimum) to review claim experience, plan progress, service-related issues, etc. Review will include an Executive Summary and plan recommendations based on the District utilization. If you disagree, please explain.","drop down box"]
["3.",null,"Do you provide online access to reporting tools for the District and any authorized vendors (e.g. actuarial consultants)?","text"]
["4.",null,"Do you provide ACA reporting and filing?  If yes, please describe your full capabilities and any associated pricing.","drop down box"]
["5.",null,"Can you provide ad hoc reports at no additional cost? ","drop down box"]
["6.",null,"Please provide an electronic copy of each report within the standard reporting package (use sample data). Name the file: \"[Vendor] Sample Reporting Package\"","drop down box"]
["7.","","Indicate whether you will provide the District with a monthly claims report containing the following information:"]
["","a.","Administrative/Network Fees (if applicable)","drop down box"]
["","b.","Capitation (if applicable)","drop down box"]
["","c.","Claims exceeding $50,000 with diagnosis","drop down box"]
[null,"d.","Claims paid by $ amount increments","drop down box"]
[null,"d.","IBNR reporting","drop down box"]
[null,"e.","Monthly enrollment counts by Plan.","drop down box"]
["","f.","Paid Claims by Plan","drop down box"]
["","g.","Premiums (if applicable)","drop down box"]
[null,"h.","Runout and reserves","drop down box",null," "]
["8.","","Indicate whether you will provide the District with a monthly general claim utilization reports by major line of coverage identifying: "]
["","a.","Claims eligible","drop down box"]
["","b.","Claims submitted","drop down box"]
["","c.","Deductible and coinsurance application","drop down box"]
["","d.","Ineligible expenses","drop down box"]
[null,"e.","Net benefits paid by Plan in and out of network","drop down box"]
["","f.","Payment reductions due to network negotiated rates","drop down box"]
["9.","","Indicate whether you will provide the District with a monthly general claim utilization report that will show separate experience for:"]
[null,"a.","COBRA Participants","drop down box"]
[null,"b.","Dependents","drop down box"]
[null,"c.","Employees","drop down box"]
[null,"d.","Retirees","drop down box"]
["10.",null,"Electronic format of claims data.","drop down box"]
["11.",null,"Employee contested claims separated by denial reason.","drop down box"]
["12.","","Network savings reports for each plan and network offered.","drop down box"]
["13.","","Most-utilized hospitals and physicians reports.","drop down box"]
["14.",null,"Utilization of High Performance Networks, ACOs, and PCMH","drop down box"]
[]
[null,"XIII.","Medical Utilization, Claims & Disease Management Programs","Answer Format","Response","Explanation"]
["1.",null,"Describe your medical utilization management program.","text"]
["2.",null,"Describe your case management program.","text"]
["3.",null,"Describe your disease management programs.","text"]
["4.",null,"Describe wellness program components (HRA, on or off-site biometric screening, health coaching, etc.) and identify costs, if any, for each.","text"]
["5.",null,"In addition to the allocation for a formal wellness program, Vendor agrees to an initial $100,000 wellness allowance, then $50,000 annual vendor funding thereafter to support the District-directed wellness initiatives.","text"]
["6.",null,"Describe the reporting capabilities for identifying health risk factors or participant compliance with preventive guidelines on a group-wide basis.","text"]
["7.",null,"Describe the capabilities or tools available to assist in the administration of the District's wellness program, such as the ability to track participant's progress and provide reports.","text"]
["8.",null,"List the conditions managed in your disease management program "]
[null,"a.","Asthma","drop down box"]
[null,"b.","Cancer","drop down box"]
[null,"c.","Congestive Heart Failure (CHF)","drop down box"]
[null,"d.","COPD","drop down box"]
[null,"e.","Coronary Artery Disease (CAD)","drop down box"]
[null,"f.","Depression","drop down box"]
[null,"g.","Diabetes","drop down box"]
[null,"h.","End Stage Renal Disease (ESRD)","drop down box"]
[null,"i.","Gastro Esophageal Reflux Disorder (GERD)","drop down box"]
[null,"j.","Hepatitis","drop down box"]
[null,"k.","Hyperlipidemia","drop down box"]
[null,"l.","Hypertension","drop down box"]
[null,"m.","Low Back Pain","drop down box"]
[null,"n.","Metabolic Syndrome","drop down box"]
[null,"o.","Osteoporosis","drop down box"]
[null,"p.","Pain Management","drop down box"]
[null,"q.","Peptic Ulcer Disease (PUD)","drop down box"]
[null,"r.","Peripheral Artery Disease (PAD)","drop down box"]
[null,"s.","Telemedicine","drop down box"]
["9.",null,"Do you offer a 24/7 Nurseline?  If so, please provide a brief overview of the program.","drop down box"]
["10.",null,"Do you offer any type of telemedicine benefit?  If so, please provide a brief overview of the program.","drop down box"]
[]
[]
[null,null,"Plan Design and Cost"]
[]
[null,"XIV.","Additional Information Regarding Premium Quote","Answer Format","Response","Explanation"]
["1",null,"For the Fully Insured Medical Plan renewal, will the Vendor provide the proposed underwriting factors that will be used in the proposal and subsequent plan year renewals. ","drop down box"]
[null,"a.","ACA Fees","numeric"]
[null,"b.","Retention","numeric"]
[null,"c.","Trend","numeric"]
[null,"d.","Pooling point","numeric"]
["2",null,"How will claims in excess of the pooling point be treated in subsequent renewals?","text"]
[3,null,"The District currently utilizes 2 tier (Employee or Family).  The District may  consider 4 tier rate structure, please identify any challenges, advantages or disadvantages that the District may face if a decision is made to change from the current 2 tier structure to a 4 tier structure.","text"]
["4",null,"Will you provide a profit sharing program that  shares excess profit with the District? If so, provide details about how the program would work.","drop down box"]

{"sheet":"Plan Design - HDHP PPO wHSA","index":1,"n_rows":32,"n_cols":5,"rows_kept":32,"merged":[[3,1,3,2],[3,3,3,4],[28,0,28,4],[31,0,31,4]]}
[{"$f":"'Health Questionnaire'!C2","v":"Request for Health Insurance (ITN) for the St. Johns River Water Management District (the \"District\")"}]
["Plan Provisions for Medical Plan: ","BlueOptions PPO 3160/3161 w/HSA"]
[]
[null,"Inforce Plan",null,"Vendor Response"]
["Plan Benefits","In Network ","Out of Network","In Network ","Out of Network"]
["Annual Deductible - Individual",{"v":1400,"d":"$1,400"},{"v":2800,"d":"$2,800"}]
["Annual Deductible - Family",{"v":2800,"d":"$2,800"},{"v":5600,"d":"$5,600"}]
["Out-of-Pocket Limit - Individual",{"v":2800,"d":"$2,800"},{"v":5600,"d":"$5,600"}]
["Out-of-Pocket Limit - Family",{"v":5600,"d":"$5,600"},{"v":11200,"d":"$11,200"}]
["Coinsurance (member pays)",{"v":0.2,"d":"20%"},"20% - 50%"]
["Preventive Care"]
["Physician Care Office Visits"]
["PCP","Ded + 20%","Ded + 40%"]
["Specialist","Ded + 20%","Ded + 40%"]
["Hospital Services"]
["Inpatient Hospital","Ded + 20%","Ded + 40%"]
["Outpatient Hospital","Ded + 20%","Ded + 40%"]
["Emergency Services"]
["Emergency Room","Ded + 20%","Ded + 20%"]
["Urgent Care","Ded + 20%","Ded + 20%"]
["Retail (30-day supply)*"]
["Generic","Ded + $10 Copay","In Network Ded + 50%"]
["Preferred Brand","Ded + $50 Copay","In Network Ded + 50%"]
["Non Preferred Brand","Ded + $80 Copay","In Network Ded + 50%"]
["Mail Order (90-day supply)"," "]
["Generic","Ded + $20 Copay","In Network Ded + 50%"]
["Preferred Brand","Ded + $100 Copay","In Network Ded + 50%"]
["Non Preferred Brand","Ded + $160 Copay","In Network Ded + 50%"]
["*Deductibles are waived for drugs listed on HSA Preventive Drug List (copays still apply)"]
[]
[]
["Any deviations in Vendor Response from Inforce Plan should be noted in \"Plan Design Explanation\" tab in this worksheet."]

{"sheet":"Plan Design Explanation","index":2,"n_rows":1141,"n_cols":9,"rows_kept":1141,"merged":[[6,0,6,1]]}
[{"$f":"'Health Questionnaire'!C2","v":"Request for Health Insurance (ITN) for the St. Johns River Water Management District (the \"District\")"}]
["Plan Design Explanation"]
[]
["Use this worksheet for specific Plan Design questions where you were directed to use this sheet to provide additional "]
["explanation."]
[]
["Explanations must be numbered to correspond to the question to which they pertain. All explanations must be brief and to the point."]
[]
["Section/ Question #","Explanation"]
{"$rows_empty":1130}
[{"$nulls":6},60,null,"What tools and methods are used to prevent hospital emergency room usage and hospital readmissions"]
[{"$nulls":8},"What tools and methods are used to prevent hospital emergency room usage and hospital readmissions"]

{"sheet":"Rate Exhibit - HDHP PPO wHSA","index":3,"n_rows":38,"n_cols":4,"rows_kept":38,"merged":[[3,1,3,2],[17,0,17,1],[18,0,18,1],[21,0,21,1],[22,0,22,1],[23,0,23,1],[28,0,28,1],[29,0,29,1],[30,0,30,1],[32,0,32,3],[35,0,35,1],[36,0,36,1],[37,0,37,1]]}
[{"$f":"'Health Questionnaire'!C2","v":"Request for Health Insurance (ITN) for the St. Johns River Water Management District (the \"District\")"}]
["Medical Plan:",{"$f":"'Plan Design - HDHP PPO wHSA'!B2","v":"BlueOptions PPO 3160/3161 w/HSA"}]
[]
[null,"Inforce Plan",null,"Vendor Response"]
["Class: All Employees/Retirees/Cobra","Lives","Monthly Rates","2 Tier Monthly Rates"]
["Employee Only",184,{"v":755.33,"d":"$755.33"}]
["Employee + Spouse"]
["Employee + Child(ren)"]
["Family",290,{"v":1653.66,"d":"$1,653.66"}]
["Annual Total",{"$f":"SUM(B6:B9)","v":474},{"$f":"SUMPRODUCT($B$6:$B$9,C6:C9)*12","v":{"v":7422505.4399999995,"d":"$7,422,505"}},{"$f":"SUMPRODUCT($B$6:$B$9,D6:D9)*12","v":{"v":0,"d":"$0"}}]
["Medical Monthly Cost",{"$f":"SUM(B10:B10)","v":474},{"$f":"SUMPRODUCT(B10:B10,C10:C10)","v":{"v":3518267578.56,"d":"$3,518,267,579"}},{"$f":"SUMPRODUCT(B10:B10*D10:D10)","v":{"v":0,"d":"$0"}}]
["Annual Cost",null,{"$f":"C11*12","v":{"v":42219210942.72,"d":"$42,219,210,943"}},{"$f":"D11*12","v":{"v":0,"d":"$0"}}]
[]
["Amount changed from Current",null,null,{"$f":"D12-C12","v":{"v":-42219210942.72,"d":"-$42,219,210,943"}}]
["% Change from Current",null,null,{"$f":"D12/C12-1","v":{"v":-1,"d":"-100%"}}]
[]
["Medical > Rate Information"]
["Rate Guarantee End Date "]
["Rates conform to all applicable state mandates."]
[]
["Describe underlying rate assumptions:"]
["a) Minimum enrollment assumptions"]
["b) Minimum employer contribution levels"]
["c) Enrollment deviations +/- 15%:"]
["d) Pooling Point"]
["e) Risk sharing arrangement"]
[]
["HSA Reimbursement Account Fee "]
["Account Set-Up Fee (per account)"]
["Monthly Service Charge"]
["Debit Card (per card)"]
[]
["Rate Caveats"]
[]
["HIPAA/COBRA Services "]
["Account Set-Up Fee (per account)"]
["COBRA Service Charge (PEPM or Per participant)"]
["HIPAA Service Charge"]

{"sheet":"Stop Loss Questionnaire","index":4,"n_rows":96,"n_cols":5,"rows_kept":96,"merged":[[0,0,0,4],[1,0,1,1],[10,0,11,0],[10,1,11,1],[12,0,14,0],[12,1,14,1],[15,0,17,0],[15,1,17,1],[18,0,20,0],[18,1,20,1],[21,0,23,0],[21,1,23,1],[26,0,27,0],[26,1,27,1],[28,0,31,0],[28,1,31,1],[32,0,33,0],[32,1,33,1],[34,0,36,0],[34,1,36,1],[37,0,39,0],[37,1,39,1],[40,0,42,0],[40,1,42,1],[43,0,45,0],[46,0,48,0],[46,1,48,1],[49,0,51,0],[49,1,51,1],[52,0,54,0],[52,1,54,1],[55,0,57,0],[55,1,57,1],[58,0,60,0],[58,1,60,1],[62,0,64,0],[62,1,64,1],[65,0,68,0],[65,1,68,1],[69,0,71,0],[69,1,71,1],[72,0,74,0],[72,1,74,1],[75,0,77,0],[75,1,77,1],[78,0,81,0],[78,1,81,1],[83,0,85,0],[83,1,85,1],[86,0,89,0],[86,1,89,1],[92,0,95,0]]}
[{"$f":"'Health Questionnaire'!C2","v":"Request for Health Insurance (ITN) for the St. Johns River Water Management District (the \"District\")"}]
["Stop Loss Questionnaire"]
[]
["Stop Loss Provider Name:"]
["Date Completed:"]
["Responses Effective Through:",null,"(sample answer: 01/01/2020)"]
[]
[]
[null,"Stop Loss Questionnaire","Answer Format"," ","Response"]
[{"v":1,"d":"1."},"Explain your ownership structure in detail","text","Please explain:"]
[{"v":2,"d":"2."},"How long has your organization been in business for stop loss insurance?","text","Year established:"," "]
[null,null,"text","Additional Information:"," "]
[{"v":3,"d":"3."},"Has your company done business under other names? If yes, please provide historical background information. Identify any interests your organization may have with associated vendors (claims administrators, brokerage firms, managed care firms, etc.)","drop down box","Yes/No"]
[null,null,"text","If yes, please explain:"]
[null,null,"text","Additional Information:"]
[{"v":4,"d":"4."},"Have you ever been suspended from writing this line of coverage?","drop down box","Yes/No"]
[null,null,"text","If yes, please explain:"]
[null,null,"text","Additional Information:"]
[{"v":5,"d":"5."},"Is your organization licensed to do business in all 50 states and U.S. territories?  If no, identify the states/territories in which you are currently licensed.","drop down box","Yes/No"]
[null,null,"text","If yes, please explain:"]
[null,null,"text","Additional Information:"]
[{"v":6,"d":"6."},"What percentage of the risk does your company assume? If less than 100%, please identify additional reinsurer(s) and the respective percentage of assumed liability.","number","%"," "]
[null,null,"text","If less than 100%, please explain:"]
[null,null,"text","Additional Information:"]
[{"v":7,"d":"7."},"Who has final claim decision-making authority with respect to specific and aggregate claims?","text"]
[null,"Incentive management and fulfillment ","drop down box"]
[{"v":8,"d":"8."},"How many stop loss clients do you currently have in your block of business and what is the annualized premium?","number","# of Clients:"]
[null,null,"number","Annualized Premium:"]
[{"v":9,"d":"9."},"What percentage of your block of business is with Blue Cross Blue Shield, UnitedHealth Group, Cigna, Aetna (BUCA's)?","number","BCBS:"]
[null,null,"number","UHC:"]
[null,null,"number","Cigna:"]
[null,null,"number","Aetna:"]
[{"v":10,"d":"10."},"What industries (if any) does your company consider to be \"ineligible\" and what is your minimum group size? Please list.","text","Ineligible Industries:"]
[null,null,"number","Minimum Group Size:"]
[{"v":11,"d":"11."},"Do you offer a pharmacy only policy?","drop down box","Specific: Yes/No"]
[null,null,"drop down box","Aggregate: Yes/No"]
[null,null,"text","Additional Information:"]
[{"v":12,"d":"12."},"Claims covered period: Do you agree to offer a Paid claims covered period? If yes, under what criteria?","drop down box","Yes/No"]
[null,null,"text","If no, please explain:"]
[null,null,"text","Additional Information:"]
[{"v":13,"d":"13."},"Formal Disclosure: Will you agree to no client signature required at new business or renewal?","drop down box","Yes/No"]
[null,null,"text","If no, please explain:"]
[null,null,"text","Additional Information:"]
[{"v":14,"d":"14."},"We require that your organization work directly with our broker/consultant rather than the claims administrator (TPA/Carrier) on such things as:","drop down box","Agree/Disagree"]
[null,"    Ø Renewals\n    Ø Specific & Aggregate contract concerns","text","If disagree, please explain:"]
[null," Ø Plan Document/SPD adoption/approval\n    Ø Plan amendments","text","Additional Information:"]
[{"v":15,"d":"15."},"Waive Active at Work: On new business and renewals, do you agree to waive actively at work for covered employees and dependents per the employer's plan document other than any lasers put in place on new business?","drop down box","Agree/Disagree"]
[null,null,"text","If disagree, please explain:"]
[null,null,"text","Additional Information:"]
[{"v":16,"d":"16."},"If a new division/entity is acquired during the contract year, do you agree to waive the actively at work, dependent non-confinement and pre-existing condition limitation provisions for the newly acquired employees, their dependents, spouses, domestic partners, FMLA, retirees (if applicable), and Cobra beneficiaries?","drop down box","Agree/Disagree"]
[null,null,"text","If disagree, please explain:"]
[null,null,"text","Additional Information:"]
[{"v":17,"d":"17."},"Firm Rate Guarantee: Will you commit to a rate guarantee more than 3 months prior to effective date?","drop down box","Yes/No"]
[null,null,"text","If no, please explain:"]
[null,null,"text","Additional Information:"]
[{"v":18,"d":"18."},"Laser Policy: Do you agree to offer a \"no new lasers\" at renewal option?  If yes, please provide details including additional cost.","drop down box","Yes/No"]
[null,null,"text","If yes, please explain:"]
[null,null,"text","Additional Information:"]
[{"v":19,"d":"19."},"Rate Cap Guarantee at Renewal: Will you offer a rate cap at renewal? If yes, please provide details including any additional cost.","drop down box","Yes/No"]
[null,null,"text","If yes, please explain:"]
[null,null,"text","Additional Information:"]
[{"v":20,"d":"20."},"What fees will be considered as part of claims? (Ex. Shared savings fees, negotiated savings, state surcharges, etc.)","text","Please explain:"]
[{"v":21,"d":"21."},"Will you allow \"non-covered\" alternative care, if approved by your case managers or negotiated as part of an out of network cost negotiation?","drop down box","Yes/No"]
[null,null,"text","If no, please explain:"]
[null,null,"text","Additional Information:"]
[{"v":22,"d":"22."},"Do you offer advance funding or quick pay options for stop loss claims? If yes, please provide details including any additional cost.","drop down box","Specific: Yes/No"]
[null,null,"drop down box","Aggregate: Yes/No"]
[null,null,"text","If yes, please explain:"]
[null,null,"text","Additional Information:"]
[{"v":23,"d":"23."},"Dividend Eligible: Do you offer the potential for a client dividend? If yes, please explain and note any additional costs. (Include any renewal requirements.)","drop down box","Yes/No"]
[null,null,"text","If no, please explain:"]
[null,null,"text","Additional Information:"]
[{"v":24,"d":"24."},"Changes in Rates and Terms: Do you agree to no change in rates or terms unless the nature of the risk is impacted by 15% or more from changes in enrollment, benefits, networks, and/or claim administrators?","drop down box","Agree/Disagree"]
[null,null,"text","If disagree, please explain:"]
[null,null,"text","Additional Information:"]
[{"v":25,"d":"25."},"Specific Coverage Maximums: Do you agree to an unlimited specific coverage maximum?","drop down box","Agree/Disagree"]
[null,null,"text","If disagree, please explain:"]
[null,null,"text","Additional Information:"]
[{"v":26,"d":"26."},"When do you require notification of a specific claim?","text","% of Specific Deductible, or"]
[null,null,"text","Amount of Claim, or"]
[null,null,"text","Other, please explain"]
[null,null,"text","Additional Information:"]
[{"v":27,"d":"27."},"How often do you require aggregate claim reporting information?","text"," "]
[{"v":28,"d":"28."},"BUCA Reconciliation: Will you commit to reconcile issues with BUCA's?","drop down box","Yes/No"]
[null,null,"text","If no, please explain:"]
[null,null,"text","Additional Information:"]
[{"v":29,"d":"29."},"Who are your preferred TPA's? Will you commit to reconcile issues with them?","text","Preferred TPA's:"]
[null,null,"drop down box","Yes/No"]
[null,null,"text","If no, please explain:"]
[null,null,"text","Additional Information:"]
[{"v":30,"d":"30."},"Do you offer any special contract provisions or features as listed above (please include potential cost)?","text","Details:"]
[null,"HEALTHCARE REFORM RELATED"]
[{"v":31,"d":"31."},"External Review Appeals","text","Please explain:"]
[null,"Under health care reform, non-grandfathered plans must include an external review option. A claim filed in a timely manner (consistent with the requirement of the stop loss policy) and denied by the claim administrator is subject to appeal. A claim properly incurred and adjudicated (denied) in one coverage period and subsequently appealed by the participant, including an external review, could easily extend beyond that coverage period."]
[]
[null,"How does your organization address claims that were denied in one coverage period and paid in another coverage period?"]

{"sheet":"Rate Exhibit - Stop Loss ","index":5,"n_rows":37,"n_cols":3,"rows_kept":37,"merged":[[0,0,0,6],[1,1,1,2]]}
[{"$f":"'Health Questionnaire'!C2","v":"Request for Health Insurance (ITN) for the St. Johns River Water Management District (the \"District\")"}]
["Stop Loss Carrier:"," "]
[]
[null," "]
["Class: All Employees/Retirees","Lives"]
["Single",184]
["Family",290]
["Total",{"$f":"SUM(B6:B7)","v":474}]
[" "]
[]
["Specific Stop Loss","REQUESTED PARAMETERS","QUOTED\nPARAMETERS"]
["Specific Deductible",{"v":125000,"d":"$125,000"}]
["Annual Maximum","Unlimited"]
["Contract Basis","12/12"]
["Covered Benefits","Medical & Rx"]
["RATES"]
["Single Rate"]
["Family Rate"]
["Composite Rate"]
["Specific Monthly Premium",null,{"$f":"(C17*$B$6)+(C18*$B$7)","v":{"v":0,"d":"$0"}}]
["Specific Annual Premium",null,{"$f":"C20*12","v":{"v":0,"d":"$0"}}]
[]
["Aggregate Stop Loss","REQUESTED PARAMETERS","QUOTED\nPARAMETERS"]
["Specific Deductible",{"v":125000,"d":"$125,000"}]
["Aggregate Maximum",{"v":1000000,"d":"$1,000,000"}]
["Contract Basis","12/12"]
["Covered Benefits","Medical & Rx"]
["Corridor",{"v":1.2,"d":"120%"}]
["RATES"]
["Single Factor"]
["Family Factor"]
["Composite Factor"]
["Annual Attachment Point",null,{"$f":"((C30*$B$6)+(C31*$B$7))*12","v":{"v":0,"d":"$0"}}]
["Minimum Attachment Point",null," "]
["Aggregate Rate PEPM"]
["Run-In Limit"]
["Monthly Aggregate Accommodation"]

{"sheet":"Rate Exhibit - ASO Fees","index":6,"n_rows":29,"n_cols":3,"rows_kept":29,"merged":[[0,0,0,6],[1,1,1,2]]}
[{"$f":"'Health Questionnaire'!C2","v":"Request for Health Insurance (ITN) for the St. Johns River Water Management District (the \"District\")"}]
["Administrative Services Provider/TPA: "," "]
[]
[null," "]
["Class: All Employees/Retirees","Lives"]
["Single",184]
["Family",290]
["Total",{"$f":"SUM(B6:B7)","v":474}]
[" "]
["RATES"]
["Administration Fee"," "]
["Network Fee"," "]
["Disease Management"," "]
["Wellness"," "]
["Other"," ","(Must enter an amount. If N/A use \"0\"."]
["Other"," ","(Must enter an amount. If N/A use \"0\"."]
["Total Fees PEPM",{"$f":"SUM(B11:B16)","v":{"v":0,"d":"$0"}}]
["Monthly Fees ",{"$f":"B17*B8","v":{"v":0,"d":"$0"}}]
["Annual Fees",{"$f":"B18*12","v":{"v":0,"d":"$0"}}]
[]
[]
["HIPAA/COBRA Services "]
["Account Set-Up Fee (per account)"]
["COBRA Service Charge \n(PEPM or Per participant)"]
["HIPAA Service Charge"]
["HSA Reimbursement Account Fee "]
["Account Set-Up Fee (per account)"]
["Monthly Service Charge"]
["Debit Card (per card)"]

{"sheet":"Geo Access","index":7,"n_rows":62,"n_cols":5,"rows_kept":62}
[{"$f":"'Health Questionnaire'!C2","v":"Request for Health Insurance (ITN) for the St. Johns River Water Management District (the \"District\")"}]
["District Employees Meeting Access Standard"]
[]
["Instructions:"]
["a. Please indicate the Network Name for the corresponding medical/dental plan options."]
["b. Please provide the data requested below using the census zip codes provided in the ITN."]
["c. Please do not alter the access standards."]
["d. Please complete this worksheet for each Proposed Network (Vendors do not need to duplicate if the same network applies to mutiple plans)."]
[]
[null," "]
["HDHP PPO  w/HSA"]
[null,"Vendor Network Name","Vendor Network Name","Vendor Network Name","Vendor Network Name"]
["Primary Care Physicians"]
["Access Standard","2 providers within 10 miles","2 providers within 10 miles","2 providers within 10 miles","2 providers within 10 miles"]
["Total number of Providers in network"]
["Total number of employees reported",{"$f":"'Rate Exhibit - HDHP PPO wHSA'!B10","v":474},{"$f":"B16","v":474},{"$f":"B16","v":474},{"$f":"B16","v":474}]
["Percentage Meeting Access Standard"]
["Percentage NOT Meeting Access Standard",{"$f":"1-B17","v":{"v":1,"d":"100.0%"}},{"$f":"1-C17","v":{"v":1,"d":"100.0%"}},{"$f":"1-D17","v":{"v":1,"d":"100.0%"}},{"$f":"1-E17","v":{"v":1,"d":"100.0%"}}]
["Employees NOT Meeting Access Standard",{"$f":"B18*B16","v":474},{"$f":"C18*C16","v":474},{"$f":"D18*D16","v":474},{"$f":"E18*E16","v":474}]
["Average distance to 2 Providers - Employees without Access"]
["Average distance to 1 Provider - Employees without Access"]
[null,"Vendor Network Name","Vendor Network Name","Vendor Network Name","Vendor Network Name"]
["Specialists"]
["Access Standard","2 providers within 10 miles","2 providers within 10 miles","2 providers within 10 miles","2 providers within 10 miles"]
["Total number of Providers in network"]
["Total number of employees reported",{"$f":"B16","v":474},{"$f":"B26","v":474},{"$f":"B26","v":474},{"$f":"B26","v":474}]
["Percentage Meeting Access Standard"]
["Percentage NOT Meeting Access Standard",{"$f":"1-B27","v":{"v":1,"d":"100.0%"}},{"$f":"1-C27","v":{"v":1,"d":"100.0%"}},{"$f":"1-D27","v":{"v":1,"d":"100.0%"}},{"$f":"1-E27","v":{"v":1,"d":"100.0%"}}]
["Employees NOT Meeting Access Standard",{"$f":"B28*B26","v":474},{"$f":"C28*C26","v":474},{"$f":"D28*D26","v":474},{"$f":"E28*E26","v":474}]
["Average distance to 2 Providers - Employees without Access"]
["Average distance to 1 Providers - Employees without Access"]
[null,"Vendor Network Name","Vendor Network Name","Vendor Network Name","Vendor Network Name"]
["Pediatricians"]
["Access Standard","2 providers within 10 miles","2 providers within 10 miles","2 providers within 10 miles","2 providers within 10 miles"]
["Total number of Providers in network"]
["Total number of employees reported",{"$f":"B26","v":474},{"$f":"B36","v":474},{"$f":"B36","v":474},{"$f":"B36","v":474}]
["Percentage Meeting Access Standard"]
["Percentage NOT Meeting Access Standard",{"$f":"1-B37","v":{"v":1,"d":"100.0%"}},{"$f":"1-C37","v":{"v":1,"d":"100.0%"}},{"$f":"1-D37","v":{"v":1,"d":"100.0%"}},{"$f":"1-E37","v":{"v":1,"d":"100.0%"}}]
["Employees NOT Meeting Access Standard",{"$f":"B38*B36","v":474},{"$f":"C38*C36","v":474},{"$f":"D38*D36","v":474},{"$f":"E38*E36","v":474}]
["Average distance to 2 Providers - Employees without Access"]
["Average distance to 1 Providers - Employees without Access"]
[null,"Vendor Network Name","Vendor Network Name","Vendor Network Name","Vendor Network Name"]
["OB / GYN'S"]
["Access Standard","2 providers within 10 miles","2 providers within 10 miles","2 providers within 10 miles","2 providers within 10 miles"]
["Total number of Providers in network"]
["Total number of employees reported",{"$f":"B36","v":474},{"$f":"B46","v":474},{"$f":"B46","v":474},{"$f":"D46","v":474}]
["Percentage Meeting Access Standard"]
["Percentage NOT Meeting Access Standard",{"$f":"1-B47","v":{"v":1,"d":"100.0%"}},{"$f":"1-C47","v":{"v":1,"d":"100.0%"}},{"$f":"1-D47","v":{"v":1,"d":"100.0%"}},{"$f":"1-E47","v":{"v":1,"d":"100.0%"}}]
["Employees NOT Meeting Access Standard",{"$f":"B48*B46","v":474},{"$f":"C48*C46","v":474},{"$f":"D48*D46","v":474},{"$f":"E48*E46","v":474}]
["Average distance to 2 Providers - Employees without Access"]
["Average distance to 1 Providers - Employees without Access"]
[null,"Vendor Network Name","Vendor Network Name","Vendor Network Name","Vendor Network Name"]
["Hospitals  "]
["Access Standard","1 provider within 10 miles","1 provider within 10 miles","1 provider within 10 miles","1 provider within 10 miles"]
["Total number of Providers in network"]
["Total number of employees reported",{"$f":"B16","v":474},{"$f":"B56","v":474},{"$f":"B56","v":474},{"$f":"C56","v":474}]
["Percentage Meeting Access Standard"]
["Percentage NOT Meeting Access Standard",{"$f":"1-B57","v":{"v":1,"d":"100.0%"}},{"$f":"1-C57","v":{"v":1,"d":"100.0%"}},{"$f":"1-D57","v":{"v":1,"d":"100.0%"}},{"$f":"1-E57","v":{"v":1,"d":"100.0%"}}]
["Employees NOT Meeting Access Standard",{"$f":"B58*B56","v":474},{"$f":"C58*C56","v":474},{"$f":"D58*D56","v":474},{"$f":"E58*E56","v":474}]
["Average distance to 1 Providers - Employees without Access"]
[]
[null," "]

{"sheet":"Top Physicians-Provider Disrupt","index":8,"n_rows":108,"n_cols":12,"rows_kept":108,"merged":[[2,10,4,11],[5,10,5,11],[6,1,6,2],[6,10,6,11]]}
[null,{"$f":"'Health Questionnaire'!C2","v":"Request for Health Insurance (ITN) for the St. Johns River Water Management District (the \"District\")"}]
[null,"Access to Top Physicians (Utilization by Member)"]
[null,"Vendor please complete yellow highlighted cells in columns k-l",{"$nulls":8},"Vendor Please Indicate \nParticipation Status"]
[null,"Indicate Current Network Participation and whether the provider is accepting new patients. "]
[null,"Data based on claims paid January 1, 2018 - December 31, 2018"]
[{"$nulls":10},"Provider In Network"]
[null,"Utilization by Member",{"$nulls":8},"Proposed PPO Network"]
[null,"TAX ID","FB PROVIDER NUMBER","PROVIDER NAME","ADDRESS LINE 1","ADDRESS LINE 2","CITY","STATE","ZIP","PROVIDER TYPE DESC","\nPPO\n(Y/N)","Accepting New Patients? (Y/N)"]
[{"v":1,"d":"1."},"382084239","L8020","QUEST DIAGNOSTICS INC","100 NW 170TH ST","STE 204","NORTH MIAMI BEACH","FL","33169","CLINICAL LABORATORY"]
[{"v":2,"d":"2."},"593618240","V3095","PUTNAM RADIOLOGY GROUP","6121 SAINT JOHNS AVE",null,"PALATKA","FL","32177","INDEPENDENT DIAGNOSTIC TESTING"]
[{"v":3,"d":"3."},"461533074","07875","MILANICK, JOHN C","6500 CRILL AVE",null,"PALATKA","FL","32177","PHYSICIAN - M.D."]
[{"v":4,"d":"4."},"590747311","120  ","BAPTIST MEDICAL CENTER","800 PRUDENTIAL DRIVE",null,"JACKSONVILLE","FL","32207","ACUTE CARE HOSPITAL"]
[{"v":5,"d":"5."},"591943502","125  ","SHANDS AND UNIVERSITY OF FLORIDA HEALTH CARE NTWK","1600 SW ARCHER RD",null,"GAINESVILLE","FL","32610","ACUTE CARE HOSPITAL"]
[{"v":6,"d":"6."},"472762362","425  ","PUTNAM COMMUNITY MEDICAL CENTER","611 ZEAGLER DR",null,"PALATKA","FL","32177","ACUTE CARE HOSPITAL"]
[{"v":7,"d":"7."},"650641688","L9320","DERMPATH DIAGNOSTICS CENTRAL FLORIDA","745 ORIENTA AVE","STE 1201","ALTAMONTE SPRINGS","FL","32701","CLINICAL LABORATORY"]
[{"v":8,"d":"8."},"590675143","104  ","FLAGLER HOSPITAL","400 HEALTH PARK BOULEVARD",null,"SAINT AUGUSTINE","FL","32086","ACUTE CARE HOSPITAL"]
[{"v":9,"d":"9."},"592933271","02559","BENSON, NEIL F","108 N PALM AVE",null,"PALATKA","FL","32177","PHYSICIAN - M.D."]
[{"v":10,"d":"10."},"593337028","90840","SCHAEF JOHNS, GRETCHEN","4500 SAN PABLO RD S",null,"JACKSONVILLE","FL","32224","PHYSICIAN - M.D."]
[{"v":11,"d":"11."},"810559052","23350","BOHN, DEREK S","6101 CRILL AVE",null,"PALATKA","FL","32177","PHYSICIAN - M.D."]
[{"v":12,"d":"12."},"200702282","V2739","ST AUGUSTINE IMAGING CENTER","190 SOUTHPARK BLVD","STE 101","SAINT AUGUSTINE","FL","32086","INDEPENDENT DIAGNOSTIC TESTING"]
[{"v":13,"d":"13."},"591680273","L8486","FLORIDA CLINICAL PRACTICE ASSOCIATION INC","1600 SW ARCHER RD",null,"GAINESVILLE","FL","32610","CLINICAL LABORATORY"]
[{"v":14,"d":"14."},"592947745","682  ","ST AUGUSTINE ENDOSCOPY CENTER","212 SOUTHPARK CIR E",null,"SAINT AUGUSTINE","FL","32086","AMBULATORY SURGICAL CENTER"]
[{"v":15,"d":"15."},"590675143","V00F9","FLAGLER IMAGING CENTER","101 HEALTH PARK BLVD",null,"SAINT AUGUSTINE","FL","32086","INDEPENDENT DIAGNOSTIC TESTING"]
[{"v":16,"d":"16."},"593112273","49888","HARRIS, PATRICK J","200 MISSION RD",null,"PALATKA","FL","32177","PHYSCIAN - OSTEOPATH"]
[{"v":17,"d":"17."},"593618240","V2766","DOCTORS IMAGING GROUP LLC","6716 NW 11TH PL","STE 200","GAINESVILLE","FL","32605","INDEPENDENT DIAGNOSTIC TESTING"]
[{"v":18,"d":"18."},"593407776","58914","TOWNE, LAURA E","1750 TREE BLVD","STE 1","SAINT AUGUSTINE","FL","32084","PHYSICIAN - M.D."]
[{"v":19,"d":"19."},"461533074","Y09U7","SCHIFFBAUER, GEORGE","6500 CRILL AVE",null,"PALATKA","FL","32177","PHYSICIAN ASSISTANT"]
[{"v":20,"d":"20."},"203512969","65EUH","SMITH, RICHARD","11375 CORTEZ BOULEVARD",null,"BROOKSVILLE","FL","34613","PHYSICIAN - M.D."]
[{"v":21,"d":"21."},"650641688","L8328","DERMPATH DIAGNOSTICS SOUTH FLORIDA","895 SW 30TH AVE","STE 101","POMPANO BEACH","FL","33069","CLINICAL LABORATORY"]
[{"v":22,"d":"22."},"611269294","132  ","NORTH FLORIDA REGIONAL MEDICAL CENTER","6500 W NEWBERRY ROAD",null,"GAINESVILLE","FL","32614","ACUTE CARE HOSPITAL"]
[{"v":23,"d":"23."},"810559052","14942","JACOBSON, JERRY R","2651 20TH ST",null,"VERO BEACH","FL","32960","PHYSICIAN - M.D."]
[{"v":24,"d":"24."},"202013359","B917V","CARESPOT EXPRESS HEALTHCARE","2095 US HIGHWAY 1 S",null,"ST AUGUSTINE","FL","32086","URGENT CARE CENTER"]
[{"v":25,"d":"25."},"593337028","145SA","FARFORD, BRYAN A","4500 SAN PABLO RD S",null,"JACKSONVILLE","FL","32224","PHYSCIAN - OSTEOPATH"]
[{"v":26,"d":"26."},"590724459","302  ","ADVENTHEALTH ORLANDO","601 E ROLLINS ST",null,"ORLANDO","FL","32803","ACUTE CARE HOSPITAL"]
[{"v":27,"d":"27."},"800564919","31785","HAMPTON, TROY","14000 FIVAY ROAD",null,"HUDSON","FL","34667","PHYSICIAN - M.D."]
[{"v":28,"d":"28."},"593544464","08900","MAS, MIGUEL A","1301 PLANTATION ISLAND DR S","STE 404","SAINT AUGUSTINE","FL","32080","PHYSICIAN - M.D."]
[{"v":29,"d":"29."},"260609255","146T1","NEEDHAM, LAILA B","201 HEALTH PARK BLVD","STE 211","ST AUGUSTINE","FL","32086","PHYSICIAN - M.D."]
[{"v":30,"d":"30."},"593544464","56035","CLINE, SHELBY H","1301 PLANTATION ISLAND DR S","STE 404","SAINT AUGUSTINE","FL","32080","PHYSICIAN - M.D."]
[{"v":31,"d":"31."},"454717431","16726","KANTOR, JONATHAN","105 SOUTHPARK BLVD","STE A103","SAINT AUGUSTINE","FL","32086","PHYSICIAN - M.D."]
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[{"v":34,"d":"34."},"800564919","14457","OLAUGHLIN, SABINE R","800 PRUDENTIAL DRIVE",null,"JACKSONVILLE","FL","32207","PHYSICIAN - M.D."]
[{"v":35,"d":"35."},"475298764","E0375","SOLERA HEALTH INC","1018 W ROOSEVELT ST",null,"PHOENIX","AZ","85007","INSTITUTION AND ASSOCIATION"]
[{"v":36,"d":"36."},"455269184","14MM9","PULIDO, ALEX M","700 ZEAGLER DR","STE 1","PALATKA","FL","32177","PHYSICIAN - M.D."]
[{"v":37,"d":"37."},"593407776","14PR3","BRENNAN, CHRISTINA","1750 TREE BLVD","STE 1","SAINT AUGUSTINE","FL","32084","PHYSICIAN - M.D."]
[{"v":38,"d":"38."},"593452442","54062","DAVIS, GEORGE A","1400 US HIGHWAY 1 S",null,"SAINT AUGUSTINE","FL","32084","PHYSICIAN - M.D."]
[{"v":39,"d":"39."},"590714831","107  ","MAYO CLINIC FLORIDA HOSPITAL","4500 SAN PABLO RD S",null,"JACKSONVILLE","FL","32224","ACUTE CARE HOSPITAL"]
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[{"v":41,"d":"41."},"593502843","L8298","BUREAU OF LABORATORIES","1217 N PEARL ST",null,"JACKSONVILLE","FL","32202","CLINICAL LABORATORY"]
[{"v":42,"d":"42."},"590624449","108  ","ST VINCENTS MEDICAL CENTER RIVERSIDE","1 SHIRCLIFF WAY",null,"JACKSONVILLE","FL","32204","ACUTE CARE HOSPITAL"]
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[{"v":46,"d":"46."},"593751155","44688","LIMERES, MIGUEL M","530 ZEAGLER DR","STE 102","PALATKA","FL","32177","PHYSICIAN - M.D."]
[{"v":47,"d":"47."},"593582647","78802","WHITMER, KEITH B","114 NW 76TH DR",null,"GAINESVILLE","FL","32607","PHYSICIAN - M.D."]
[{"v":48,"d":"48."},"593377108","26966","GRIMES, JAMES M","1 ORTHOPAEDIC PL",null,"SAINT AUGUSTINE","FL","32086","PHYSICIAN - M.D."]
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[{"v":53,"d":"53."},"590624371","301  ","HOLMES REGIONAL MEDICAL CENTER","1350 HICKORY STREET",null,"MELBOURNE","FL","32901","ACUTE CARE HOSPITAL"]
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[{"v":55,"d":"55."},"592831153","04357","MATHENY, JACK M","205 ZEAGLER DR","STE 101","PALATKA","FL","32177","PHYSICIAN - M.D."]
[{"v":56,"d":"56."},"593675191","65513","MILES, DAWN S","1851 OLD MOUTRIE RD",null,"SAINT AUGUSTINE BEACH","FL","32084","PODIATRIST"]
[{"v":57,"d":"57."},"205147377","V3178","PRECISION IMAGING CENTERS","7860 GATE PKWY","STE 123","JACKSONVILLE","FL","32256","INDEPENDENT DIAGNOSTIC TESTING"]
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[{"v":59,"d":"59."},"592630204","19870","MILES, DAVID E","1403 DUNN AVE","STE 15","JACKSONVILLE","FL","32218","OPTOMETRIST"]
[{"v":60,"d":"60."},"590624371","170  ","PALM BAY HOSPITAL","1425 MALABAR ROAD NE",null,"PALM BAY","FL","32907","ACUTE CARE HOSPITAL"]
[{"v":61,"d":"61."},"260609255","25577","YARIAN, SUSAN E","300 HEALTH PARK BLVD","STE 3002","SAINT AUGUSTINE","FL","32086","PHYSICIAN - M.D."]
[{"v":62,"d":"62."},"593337028","42465","MCBRAYER, RUEBEN H","4500 SAN PABLO RD S",null,"JACKSONVILLE","FL","32224","PHYSICIAN - M.D."]
[{"v":63,"d":"63."},"592282957","06596","BARLOW, WILLIAM J","1601 SW ARCHER RD",null,"GAINESVILLE","FL","32608","PHYSICIAN - M.D."]
[{"v":64,"d":"64."},"592995257","71514","SKELLY, CYNTHIA D","6910 OLD WOLF BAY RD",null,"PALATKA","FL","32177","PHYSICIAN - M.D."]
[{"v":65,"d":"65."},"593647972","148SR","DEBOER, MATTHEW R","120 GATEWAY CIR","UNIT 1","JACKSONVILLE","FL","32259","PHYSCIAN - OSTEOPATH"]
[{"v":66,"d":"66."},"260689148","CETYB","BEDENBAUGH, JEFFREY AUSTEN","3715 CRILL AVE",null,"PALATKA","FL","32177","REGISTERED PHYSICAL THERAPIST"]
[{"v":67,"d":"67."},"593582647","03376","CANOVA, ERICA P","114 NW 76TH DR",null,"GAINESVILLE","FL","32607","PHYSICIAN - M.D."]
[{"v":68,"d":"68."},"200484743","47024","HUANG, QIXIA","1301 PLANTATION ISLAND DR S","STE 102A","SAINT AUGUSTINE","FL","32080","PHYSICIAN - M.D."]
[{"v":69,"d":"69."},"593549147","14E3D","GENEBRIERA DE LAMO, JOSEP","1541 RIVERSIDE AVE",null,"JACKSONVILLE","FL","32204","PHYSICIAN - M.D."]
[{"v":70,"d":"70."},"591726273","345  ","ORLANDO REGIONAL MEDICAL CENTER","1414 KUHL AVENUE",null,"ORLANDO","FL","32806","ACUTE CARE HOSPITAL"]
[{"v":71,"d":"71."},"113667807","899  ","IMPLANTABLE PROVIDER GROUP INC","3616 HARDEN BLVD","STE 187","LAKELAND","FL","33803","MEDICAL SUPPLY COMPANY WITH ORTHOTIST AND PROSTHETIST"]
[{"v":72,"d":"72."},"020769966","000ZT","VAXCARE CORPORATION","3113 LAWTON RD","STE 250","ORLANDO","FL","32803","CONVENIENT CARE CENTER"]
[{"v":73,"d":"73."},"593337028","32178","GRIMARD, BRIAN H","4500 SAN PABLO RD S",null,"JACKSONVILLE","FL","32224","PHYSICIAN - M.D."]
[{"v":74,"d":"74."},"113454103","R9753","APRIA HEALTHCARE INC","9143 PHILLIPS HWY","STE 280","JACKSONVILLE","FL","32256","DURABLE MEDICAL EQUIPMENT"]
[{"v":75,"d":"75."},"592282957","28137","VILLANUEVA, STEVEN Y","1601 SW ARCHER RD",null,"GAINESVILLE","FL","32608","PHYSICIAN - M.D."]
[{"v":76,"d":"76."},"454758296","46974","ALLEN, JAMES K","11912 SHELDON RD",null,"TAMPA","FL","33626","PHYSICIAN - M.D."]
[{"v":77,"d":"77."},"593377108","14AM4","MCCLONE, CASEY","1 ORTHOPAEDIC PL",null,"SAINT AUGUSTINE","FL","32086","PHYSICIAN - M.D."]
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[{"v":79,"d":"79."},"593026704","10910","SILVERA, ROBERT R","800 ZEAGLER DR","STE 610","PALATKA","FL","32177","PHYSICIAN - M.D."]
[{"v":80,"d":"80."},"593549147","14QK2","BETHEA, WILLIAM A","1720 DUNLAWTON AVE","STE 2","PORT ORANGE","FL","32127","PHYSCIAN - OSTEOPATH"]
[{"v":81,"d":"81."},"593407776","53013","MILLER, ROBERT S","3 SAN BARTOLA DR",null,"SAINT AUGUSTINE","FL","32086","PHYSICIAN - M.D."]
[{"v":82,"d":"82."},"593239895","07701","SINGH, KAUSHALENDRA K","320 ZEAGLER DRIVE",null,"PALATKA","FL","32177","PHYSICIAN - M.D."]
[{"v":83,"d":"83."},"260689148","Y115R","FRISVOLD, JOHN M","1601 SW ARCHER RD",null,"GAINESVILLE","FL","32608","REGISTERED PHYSICAL THERAPIST"]
[{"v":84,"d":"84."},"141973790","B908T","MEDFAST URGENT CARE CENTERS LLC","7925 N WICKHAM RD","STE A","MELBOURNE","FL","32940","URGENT CARE CENTER"]
[{"v":85,"d":"85."},"593614870","58033","FRANSON, CHARLES J","100 S LAWRENCE BLVD",null,"KEYSTONE HEIGHTS","FL","32656","PHYSCIAN - OSTEOPATH"]
[{"v":86,"d":"86."},"274980266","49324","MALYKH, LARISA","6100 SAINT JOHNS AVE","STE 4D","PALATKA","FL","32177","PHYSICIAN - M.D."]
[{"v":87,"d":"87."},"592951990","323  ","ADVENTHEALTH PALM COAST","60 MEMORIAL MEDICAL PARKWAY",null,"PALM COAST","FL","32164","ACUTE CARE HOSPITAL"]
[{"v":88,"d":"88."},"611269295","134  ","ORANGE PARK MEDICAL CENTER","2001 KINGSLEY AVE",null,"ORANGE PARK","FL","32073","ACUTE CARE HOSPITAL"]
[{"v":89,"d":"89."},"202047704","6M9  ","OUTPATIENT SURGERY CENTER OF ST AUGUSTINE LLC","1 ORTHOPAEDIC PL","STE 200","SAINT AUGUSTINE","FL","32086","AMBULATORY SURGICAL CENTER"]
[{"v":90,"d":"90."},"621727350","67U  ","NORTH FLORIDA ENDOSCOPY CTR","6400 W NEWBERRY RD","STE 201","GAINESVILLE","FL","32605","AMBULATORY SURGICAL CENTER"]
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[{"v":92,"d":"92."},"593647972","10968","GEHRET, RICHARD G","2140 SMITH ST",null,"ORANGE PARK","FL","32073","PHYSICIAN - M.D."]
[{"v":93,"d":"93."},"592282957","78966","AHMADI, ANIS A","1601 SW ARCHER RD",null,"GAINESVILLE","FL","32608","PHYSICIAN - M.D."]
[{"v":94,"d":"94."},"593377108","56562","STARK, JOHN B","1 ORTHOPAEDIC PL",null,"SAINT AUGUSTINE","FL","32086","PHYSICIAN - M.D."]
[{"v":95,"d":"95."},"454758296","49878","AUSTRIA, MARTIN R","11375 CORTEZ BOULEVARD",null,"BROOKSVILLE","FL","34613","PHYSICIAN - M.D."]
[{"v":96,"d":"96."},"593605170","32333","ZABAD, HUSSEIN A","800 ZEAGLER DR","STE 430","PALATKA","FL","32177","PHYSICIAN - M.D."]
[{"v":97,"d":"97."},"260609255","01257","SEKINE, KENNETH M","11945 SAN JOSE BLVD","STE 400","JACKSONVILLE","FL","32223","PHYSICIAN - M.D."]
[{"v":98,"d":"98."},"593155402","Y05LJ","GONZALEZ, HECTOR","103 SOLANA RD","STE B","PONTE VEDRA BEACH","FL","32082","PHYSICIAN ASSISTANT"]
[{"v":99,"d":"99."},"202013359","B90NC","CARESPOT EXPRESS HEALTHCARE","1708 BLANDING BLVD",null,"MIDDLEBURG","FL","32068","URGENT CARE CENTER"]
[{"v":100,"d":"100."},"742963965","A0000","METROPLEX PATHOLOGY ASSOCIATES","P O BOX 840294","","DALLAS","TX","75284"," "]

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[]
["Instructions to Client Team: Add rows for additional provisions.  PLEASE NOTE:  Common provisions listed below are populated with sample answers.  You will need to fill in the correct In Force plan design provisions."]
[]
["Client Name:   ",{"$f":"ClientName","v":{"$error":"#REF!"}}]
["Plan Provisions for Medical Plan:"]
[]
[null,"Inforce Plan",null,"Vendor Response"]
["Plan Benefits","IN","OON","IN","OON"]
["Annual Deductible - Individual"]
["Annual Deductible - Family"]
["Out-of-Pocket Limit - Individual"]
["Out-of-Pocket Limit - Family"]
["Deductible Applies to OOP?"]
["Coinsurance"]
["Physician Care Office Visits"]
["PCP"]
["Specialist"]
["Hospital Services"]
["Inpatient Hospital"]
["Outpatient Hospital"]
["Diagnostic X-ray/Lab Services"]
["Physician Office"]
["Outpatient Facility"]
["Major Diagnostics (CT, PET, MRI, MRA)"]
["Emergency Services"]
["Emergency Room"]
["Urgent Care"]
["Rx"]
["Is there an Rx deductible?"]
["Rx Applies to Medical OOP?"]
["Rx Out-of-Pocket Limit - Individual"]
["Rx Out-of-Pocket Limit - Family"]
["Retail (30 day supply)"]
["Generic"]
["Formulary"]
["Non-Formulary"]
["Specialty"]
["Mail Order (90 day supply)"]
["Generic"]
["Formulary"]
["Non-Formulary"]
["Specialty"]
["Eligibility Rules"]
[]
["  Employee Type: ","All eligible employees "]
["  Rule: ","Full-time"]
["  Period to Wait: ",30]
["  Unit of Time: ","days"]
["Coverage Start Date:","Date of Eligibility"]
["  Coverage End Date: ","Date of Termination"]
[null,"If you chose \"Other\" Coverage End Date, please explain"]
["  "]

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[]
["Instructions to client team:  Enrollment and rate fields are populated with sample entries, please fill in the appropriate numbers or delete contents of enrollment and rates if you do not want the vendor to see them."]
[]
["Client Name:  ",{"$f":"ClientName","v":{"$error":"#REF!"}}]
["Medical Plan:"]
[]
[null,"Inforce Plan",null,"Vendor Response"]
["Class: All Employees","Lives","Rates","Rates",{"$f":"\"Proposed \" & B5 & \" Alternate Rates\"","v":"Proposed  Alternate Rates"}]
["Employee"]
["Employee + Spouse"]
["Employee + Child(ren)"]
["Employee + Family"]
["Annual Total",{"$f":"SUM(B9:B12)","v":0},{"$f":"SUMPRODUCT($B$9:$B$12,C9:C12)*12","v":{"v":0,"d":"$0"}},{"$f":"SUMPRODUCT($B$9:$B$12,D9:D12)*12","v":{"v":0,"d":"$0"}}]
["Medical Monthly Cost",{"$f":"SUM(B13:B13)","v":0},{"$f":"SUMPRODUCT(B13:B13,C13:C13)","v":{"v":0,"d":"$0"}},{"$f":"SUMPRODUCT(B13:B13*D13:D13)","v":{"v":0,"d":"$0"}},{"$f":"SUMPRODUCT(C13:C13*E13:E13)","v":{"v":0,"d":"$0"}}]
["Annual Cost",null,{"$f":"C14*12","v":{"v":0,"d":"$0"}},{"$f":"D14*12","v":{"v":0,"d":"$0"}},{"$f":"E14*12","v":{"v":0,"d":"$0"}}]
[]
["Amount changed from Current",null,null,{"$f":"D15-C15","v":{"v":0,"d":"$0"}},{"$f":"E15-D15","v":{"v":0,"d":"$0"}}]
["% Change from Current",null,null,{"$f":"D15/C15-1","v":{"$error":"#DIV/0!"}},{"$f":"E15/D15-1","v":{"$error":"#DIV/0!"}}]
[]
["Medical > Rate Information"]
["Rate Guarantee End Date "]
["Rates conform to all applicable state mandates."]
[]
["Describe underlying rate assumptions:"]
["a) Minimum enrollment assumptions"]
["b) Minimum employer contribution levels"]
["c) Enrollment deviations +/- 15%:"]
["d) Multi-line Discount"]
[]
["Rate Caveats"]
["Confirm Rates Include Requested Commission",null,{"$f":"#REF!","v":{"$error":"#REF!"}}]
[]
["Health Savings Account Fee "]
["Account Set-Up Fee (per account)"]
["Monthly Service Charge"]
["Debit Card (per card)"]
[]
["Health Reimbursement Account Fee "]
["Account Set-Up Fee (per account)"]
["Monthly Service Charge"]
["Debit Card (per card)"]

{"sheet":"Rx - Top 50 Spend","index":11,"n_rows":57,"n_cols":8,"rows_kept":57}
[null,{"$f":"'Health Questionnaire'!C2","v":"Request for Health Insurance (ITN) for the St. Johns River Water Management District (the \"District\")"}]
[null,"Formulary Match - Top 50 Drugs by Spend"]
[]
[null,"Provide data as of December  31, 2018"]
[]
[{"$nulls":7},"VENDOR RESPONSE"]
[null,"DRUG NAME","GENERIC","NUMBER OF MEMBERS","CLAIM COUNT","TOTAL PLAN PAID","CURRENT FORMULARY","Vendor Formulary (Y/N)"]
[{"v":1,"d":"1."},"ELOCTATE","N",1,23,{"v":528434.11,"d":"$528,434.11"},"N"]
[{"v":2,"d":"2."},"REVLIMID","N",1,13,{"v":180158.5,"d":"$180,158.50"},"N"]
[{"v":3,"d":"3."},"HUMIRA","N",1,13,{"v":119194.9,"d":"$119,194.90"},"N"]
[{"v":4,"d":"4."},"BETASERON","N",1,9,{"v":60484.63,"d":"$60,484.63"},"N"]
[{"v":5,"d":"5."},"NOVOLOG","N",4,16,{"v":31538.71,"d":"$31,538.71"},"N"]
[{"v":6,"d":"6."},"TRESIBA FLEXTOUCH","N",4,24,{"v":28771.32,"d":"$28,771.32"},"N"]
[{"v":7,"d":"7."},"LAMOTRIGINE ER","Y",2,13,{"v":21808.49,"d":"$21,808.49"},"Y"]
[{"v":8,"d":"8."},"CROMOLYN SODIUM","Y",2,12,{"v":20567.55,"d":"$20,567.55"},"Y"]
[{"v":9,"d":"9."},"JARDIANCE","N",5,25,{"v":19491.2,"d":"$19,491.20"},"N"]
[{"v":10,"d":"10."},"XIFAXAN","N",2,10,{"v":17798.67,"d":"$17,798.67"},"N"]
[{"v":11,"d":"11."},"THALOMID","N",1,2,{"v":15426.08,"d":"$15,426.08"},"N"]
[{"v":12,"d":"12."},"FARYDAK","N",1,2,{"v":13224.11,"d":"$13,224.11"},"N"]
[{"v":13,"d":"13."},"COPAXONE","N",1,3,{"v":12549.04,"d":"$12,549.04"},"N"]
[{"v":14,"d":"14."},"JANUVIA","N",4,17,{"v":11900.24,"d":"$11,900.24"},"N"]
[{"v":15,"d":"15."},"ADVAIR DISKUS","N",6,20,{"v":11289.87,"d":"$11,289.87"},"N"]
[{"v":16,"d":"16."},"LYRICA","N",4,20,{"v":11280.97,"d":"$11,280.97"},"N"]
[{"v":17,"d":"17."},"BREO ELLIPTA","N",6,26,{"v":10563.95,"d":"$10,563.95"},"N"]
[{"v":18,"d":"18."},"XARELTO","N",3,19,{"v":10556.71,"d":"$10,556.71"},"N"]
[{"v":19,"d":"19."},"VICTOZA","N",2,12,{"v":8858.06,"d":"$8,858.06"},"N"]
[{"v":20,"d":"20."},"ALBENZA","N",1,1,{"v":8526.92,"d":"$8,526.92"},"N"]
[{"v":21,"d":"21."},"TRUVADA","N",1,4,{"v":8221.07,"d":"$8,221.07"},"N"]
[{"v":22,"d":"22."},"XTAMPZA ER","N",2,12,{"v":8131.58,"d":"$8,131.58"},"N"]
[{"v":23,"d":"23."},"TROKENDI XR","N",1,2,{"v":6935.42,"d":"$6,935.42"},"N"]
[{"v":24,"d":"24."},"NOVOLOG FLEXPEN","N",4,12,{"v":6444.22,"d":"$6,444.22"},"N"]
[{"v":25,"d":"25."},"LINZESS","N",4,12,{"v":6360.23,"d":"$6,360.23"},"N"]
[{"v":26,"d":"26."},"FARXIGA","N",2,12,{"v":6213.63,"d":"$6,213.63"},"N"]
[{"v":27,"d":"27."},"NEUPRO","N",1,8,{"v":6054.02,"d":"$6,054.02"},"N"]
[{"v":28,"d":"28."},"AFLURIA QUADRIVALENT 2018-2019","N",167,167,{"v":5663.89,"d":"$5,663.89"},"Y"]
[{"v":29,"d":"29."},"ELIQUIS","N",4,14,{"v":5660.51,"d":"$5,660.51"},"N"]
[{"v":30,"d":"30."},"MESALAMINE DR","Y",2,5,{"v":5578.54,"d":"$5,578.54"},"N"]
[{"v":31,"d":"31."},"TRINTELLIX","N",4,12,{"v":5381.69,"d":"$5,381.69"},"N"]
[{"v":32,"d":"32."},"LEVEMIR FLEXTOUCH","N",2,12,{"v":5379.21,"d":"$5,379.21"},"N"]
[{"v":33,"d":"33."},"JANUMET XR","N",1,4,{"v":4710.84,"d":"$4,710.84"},"N"]
[{"v":34,"d":"34."},"TEMOZOLOMIDE","Y",2,4,{"v":4642.54,"d":"$4,642.54"},"Y"]
[{"v":35,"d":"35."},"VYVANSE","N",4,26,{"v":4324.42,"d":"$4,324.42"},"N"]
[{"v":36,"d":"36."},"XIIDRA","N",3,10,{"v":4302.3,"d":"$4,302.30"},"N"]
[{"v":37,"d":"37."},"VESICARE","N",2,4,{"v":4182.04,"d":"$4,182.04"},"N"]
[{"v":38,"d":"38."},"NUVARING","N",4,19,{"v":4152.92,"d":"$4,152.92"},"N"]
[{"v":39,"d":"39."},"DICLOFENAC SODIUM","Y",23,44,{"v":4102.5,"d":"$4,102.50"},"Y"]
[{"v":40,"d":"40."},"TRULICITY","N",1,2,{"v":4100.48,"d":"$4,100.48"},"N"]
[{"v":41,"d":"41."},"PRADAXA","N",1,4,{"v":4053.6,"d":"$4,053.60"},"N"]
[{"v":42,"d":"42."},"SOLIQUA 100/33","N",1,7,{"v":4017.08,"d":"$4,017.08"},"N"]
[{"v":43,"d":"43."},"EPIDUO FORTE","N",10,12,{"v":3944.24,"d":"$3,944.24"},"N"]
[{"v":44,"d":"44."},"BRILINTA","N",2,11,{"v":3890.76,"d":"$3,890.76"},"N"]
[{"v":45,"d":"45."},"ANDROGEL PUMP","N",1,3,{"v":3776.91,"d":"$3,776.91"},"N"]
[{"v":46,"d":"46."},"CIALIS","N",2,10,{"v":3648.46,"d":"$3,648.46"},"Y"]
[{"v":47,"d":"47."},"BYDUREON","N",1,2,{"v":3610.03,"d":"$3,610.03"},"N"]
[{"v":48,"d":"48."},"BUPRENORPHINE","N",1,8,{"v":3521.85,"d":"$3,521.85"},"N"]
[{"v":49,"d":"49."},"LANTUS SOLOSTAR","N",4,10,{"v":3483.48,"d":"$3,483.48"},"N"]
[{"v":50,"d":"50."},"METHYLPHENIDATE HYDROCHLORIDE ER","Y",6,21,{"v":3338.22,"d":"$3,338.22"},"Y"]

{"sheet":"Officer","index":12,"n_rows":29,"n_cols":2,"rows_kept":29,"merged":[[0,0,0,1],[6,0,6,1],[21,0,21,1]]}
[{"$f":"'Health Questionnaire'!C2","v":"Request for Health Insurance (ITN) for the St. Johns River Water Management District (the \"District\")"}]
["Officer Certification"]
[]
["Please have an Officer review and sign this worksheet to confirm the information is valid."]
["Please include the completed form with your proposal."]
[]
["OFFICER'S STATEMENT"]
["Vendor Legal Name"]
["Vendor Marketing Name"]
["Street Address"]
["City"]
["State"]
["Zip"]
["Phone Number"]
["Fax Number"]
["Web Address"]
["Name of Officer completing statement"]
["Title of Officer completing statement"]
["Phone Number of Officer completing statement"]
["Email Address of Officer completing statement"]
[]
["I certify that our response to the St Johns River Water Management District's (the \"District\") ITN (Invitation to Negotiate) is complete and accurate to the best of my knowledge and contains no material omissions or misstatements. I acknowledge that the District will rely upon the information included in our response to make decisions concerning their benefits that are offered to their employees."]
[]
[]
[null,"(Entering name to the left is binding)"]
["Officer's Signature"]
[]
[]
["Date Signed"]

{"sheet":"Explanation","index":13,"n_rows":1141,"n_cols":11,"rows_kept":1141}
[null,{"$f":"+#REF!","v":{"$error":"#REF!"}},{"$f":"'Health Questionnaire'!C2","v":"Request for Health Insurance (ITN) for the St. Johns River Water Management District (the \"District\")"}]
[null,null,"Explanation"]
[]
[null,null,"This worksheet should be used to provide additional explanations for any questions for which a \"See Explanation\" response "]
[null,null,"was given.  Explanations must be numbered to correspond to the question to which they pertain and they must be brief."]
[]
[null,null,"State the section and number of each question you addressed with further explanation below:"]
[]
[null,null,"Section/ Question #","Explanation"]
{"$rows_empty":1130}
[{"$nulls":8},60,null,"What tools and methods are used to prevent hospital emergency room usage and hospital readmissions"]
[{"$nulls":10},"What tools and methods are used to prevent hospital emergency room usage and hospital readmissions"]