{"text_format":"3","workbook":"xlsx","n_sheets":15,"sheets":["Introduction","Scoring Details","Information","Proposer Info","1 - Experience & Reference","2 - Service Capabilities","2 - Plan Admin","Sheet1","3 - Plan Design Medical","3 - Plan Design Pharmacy","3 - Value Add","4 - Medical Network","5 - Questionnaire Pharmacy","5 - Cost Pharmacy","5 - Cost Medical"],"not_rendered":{"external_links":1,"defined_names":11},"read":"whole","date_system":"1900"}

{"sheet":"Introduction","index":0,"n_rows":67,"n_cols":2,"rows_kept":67,"merged":[[7,1,7,2],[8,1,8,2],[9,1,9,2],[10,1,10,2],[11,1,11,2],[12,1,12,2],[13,1,13,2],[14,1,14,2],[15,1,15,2],[15,3,15,4],[17,1,17,2],[17,3,21,3],[18,1,18,2],[19,1,19,2],[20,1,20,2],[21,1,21,2],[26,1,26,2],[28,1,28,2],[30,1,30,2],[32,1,32,2],[33,1,33,2],[34,1,34,2],[35,1,35,2],[36,1,36,2],[37,1,37,2],[38,1,38,2],[39,1,39,2],[40,1,40,2],[41,1,41,2],[42,1,42,2],[43,1,43,2],[44,1,44,2],[45,1,45,2],[46,1,46,2],[49,1,49,2],[51,1,51,2],[52,1,52,2],[53,1,53,2],[56,1,56,2],[57,1,57,2],[58,1,58,2],[59,1,59,2],[60,1,60,2],[63,1,63,2],[64,1,64,2],[65,1,65,2],[66,1,66,2]]}
[]
[null,"Request for Proposal (RFP) for Employee Benefits Plan Medical ASO and Pharmacy"]
[null,"for Hamilton County Schools (HCS)"]
[null,"RFP 23-39"]
[null,"Request for Proposal - Introduction"]
[null,"Effective 1/1/2024"]
[]
[null,"If you have any questions, please contact Hamilton County School's Procurement Department:"]
[null,"Debbie Jackson"]
[null,"Purchasing Specialist"]
[null,"Hamilton County Schools"]
[null,"Procurement Management Division"]
[null,"3074 Hickory Valley Road"]
[null,"Chattanooga, TN 37421"]
[null,"Email: DOE_Purchasing@HCDE.ORG"]
[null,"Direct Line: (423) 498-7036"]
[]
[null,"RFP Instructions:"]
[null,"Refer to Hamilton County Schools (HCS) Procurement RFP Posting for complete RFP Submission Details.\n\nInformational Tabs included in this \"Attachment A\" Document:\n   Introduction\n   Scoring Details\n   Information\n   Proposer Info"]
[null,"Tabs to be completed by proposer in this \"Attachment A\" Document are organized by scoring section and are as follows:\n   1 - Experience & References                                                     \n   2 - Service Capabilities\n   2 - Plan Admin\n   3 - Plan Design - Medical\n   3 - Plan Design - Pharmacy\n   3 - Value Add\n   4 - Network\n   4 - Provider Disruption\n   5 - Cost - Medical\n   5 - Cost - Pharmacy"]
[null,"Attachments to be provided by proposer as indicated in this Attachment A:\n   Tab 1 - III.4. \"[Proposer] Service Team\"\n   Tab 2 - I.15 \"[Proposer] Subcontractors\"\n   Tab 2 - III.1. \"[Proposer] Performance Guarantees\"\n   Tab 3 - I.2. \"[Proposer] Website\"\n   Tab 3 - I.2. \"[Proposer] Mobile App\"\n   Tab 3 - I.3. \"[Proposer] Communication Samples\"\n  "]
[null,"\nAny modifications to this RFP will be published in the form of an addendum posted solely by Hamilton County Department of Education on the HCS procurement website, DOE_Purchasing@HCDE.Org, under this solicitation number."]
[]
[null,"I.                     OVERVIEW OF THE RFP AND THE OPPORTUNITY"]
[]
[null,"A.      Statement of Intent"]
[null,"Hamilton County Schools hereinafter referred to as “HCS” is soliciting sealed proposals from health plan administrators and pharmacy benefit managers to administer the health and pharmacy plans.  HCS would prefer to keep the health and pharmacy plans combined but will take proposals from stand-alone pharmacy benefit managers that meet the general requirements in this RFP as well as requirements pertaining to pharmacy benefits.  Throughout this document the terms Proposer, Contractor, Company, Vendor, Firm or Bidder are used interchangeably and refer to any organization submitting a response to this RFP.  The purpose of this request for proposal (RFP) is to define the HCS minimum requirements and to gain adequate information from which HCS can evaluate your company and your response to HCS requirements."]
[]
[null,"Responses are required for each item in this section in the same order that the questions are asked.  Please describe your proposed solution for each requirement.  If no specific information is to be provided, a response of “understand and comply” should be utilized for each.  If you cannot meet or comply with any item, please include an explanation as to your exception or alternative.  Any proposal not complying with this requirement may be considered to be non-responsive and disqualified at the sole discretion of HCS."]
[]
[null,"Include an appropriate level of detail in your response as to give HCS sufficient information to understand your experience in management of a project/service of this type and your proposed approach to this RFP.  Additional information to the end of our required sections/questions as appropriate to fully convey your value proposition."]
[]
[null,"Within your proposal, HCS at a minimum, is looking for the following services:"]
[null,"1.       Claims Administration Services"]
[null,"2.       Customer Service"]
[null,"3.       National network of providers as well as local high-performance networks"]
[null,"4.       Utilization Review"]
[null,"5.       Case Management"]
[null,"6.       Clinical oversight of the full health plan"]
[null,"7.       Pharmacy Benefit Administration"]
[null,"8.       Eligibility Management"]
[null,"9.       Claims and Membership Reporting"]
[null,"10.   Integration of Onsite Pharmacy and Clinic Data"]
[null,"11.   Account Management Team to support the HCS Team"]
[null,"12.   Integrating Third-party Pharmacy Benefit Management Data, should pharmacy be carved out"]
[null,"13.   Fees on a per employee per month basis with no additional charges"]
[null,"14.   If shared savings is used with any part of the administration process, these fees must be clearly identified"]
[]
[null,"B.      Background"]
[null,"HCS currently provides self-insured health plan(s) to approximately 4,913 employees covered under the plan with 6,142 total eligible.  The plan start date will be January 1, 2024.  The PPO health plan has been administered by BCBST in excess of 10 years, and the HMO and HDHP plan(s) have been administered by Cigna in excess of 10 years.  Under the Affordable Care Act (ACA), HCS has “Non-Grandfathered” status.  Employees can access the plan(s) on the First Day of Employment.  Retirees are also covered to age 65.  COBRA benefits are offered to qualified employees and dependents that lose coverage through the HCS plan and it is administered by P&A, their COBRA vendor."]
[null,"C.       Description of Service Requested"]
[null,"·         Be aware that HCS is working exclusively with our employee benefits advisor, Russ Blakely and Associates, on this RFP.  Proposals will ONLY be accepted directly from third party administrators and pharmacy benefits administrators.  Proposals will not be accepted from brokers or enrollment firms."]
[null,"·         HCS currently offers three health plans:  a PPO with BCBST (P Network) and an HMO (local TN Network) and HDHP (OAP Network) with Cigna to active employees and retirees.  A copy of current Benefit Summaries are found in the \"Information\" Tab.  Clinics are offered to all employees through One to One Health with full-service pharmacy at three locations within Hamilton County.  One to One Health clinic services and pharmacy are provided to employees at a reduced copay(s)."]
[null,"·         The Reinsurance is provided by HMIG.  HCS is not requesting Reinsurance proposals at this time."]
[]
[null,"D.      Vendor Qualifications"]
[null,"HCS is contacting prospective vendors who have an interest in or are known to be business relevant to this Request for Proposal meeting the following requirements:"]
[null,"·         Must have experience with large public sector clients"]
[null,"·         Must have all relevant licenses and certifications (Federal, State, or local as applicable) required"]
[null,"·         Must have sufficient, competent, and skilled staff, with experience in performing/providing the requested services"]
[null,"·         Meet Mandatory Requirements as outlined in herein."]
[]
[null,"E.       Contract Terms"]
[null,"The successful proposer(s) will be required to enter into a contract with HCS to satisfy the requirements of this RFP.  HCS reserves the right to award this contract to a single proposer or to award multiple, separate contracts in the best interest of HCS.  It is HCS’ desire to have the same health plan administrator and pharmacy benefit manager.  We will accept bids from stand alone pharmacy benefit managers as well."]
[null,"It is HCS’ intent to enter in a one-year (1) contract with the successful proposers.  Thereafter, HCS may at its option, extend the term of the contract for five (5) additional one (1) year terms under the same terms and conditions."]
[null,"In the event that HCS exercises such renewal rights, all terms, conditions and provisions of the original contract shall remain the same and apply during the renewal period with the possible exception of rate adjustments and minor scope additions and/or deletions which may be agreed upon in accordance with provisions set forth in Sections III – VI and any other applicable parts of this document."]
[null,"Note that these are not automatic renewals.  It will be the responsibility of both parties to notify the other party in writing no less than ninety (90) days before the expiration of the contract period if the contract is not to be extended for each additional term."]

{"sheet":"Scoring Details","index":1,"n_rows":16,"n_cols":4,"rows_kept":16,"merged":[[7,1,7,3],[14,1,14,2],[15,1,15,3]]}
[]
[null,{"$f":"Introduction!B2","v":"Request for Proposal (RFP) for Employee Benefits Plan Medical ASO and Pharmacy"}]
[null,"for Hamilton County Schools (HCS)"]
[null,{"$f":"Introduction!B4","v":"RFP 23-39"}]
[null,"Request for Proposal - Scoring"]
[null,{"$f":"Introduction!B6","v":"Effective 1/1/2024"}]
[]
[null,"Scoring Details"]
[null,"Criteria","Criteria Description","Maximum Points Available"]
[null,1,"Carrier Relevant Experience and Reference",25]
[null,2,"Carrier Service Capabilities & Plan Administration",15]
[null,3,"Plan of Approach – Plan Design",30]
[null,4,"Personnel & Network",15]
[null,5,"Price Scoring",15]
[null,"Total Points",null,100]
[null,"*Additional details and documents found within submittal package, although not located within tabs as listed above, may be reviewed and considered by evaluation committee when scoring Proposers.   "]

{"sheet":"Information","index":2,"n_rows":81,"n_cols":3,"rows_kept":81,"merged":[[7,1,7,2],[17,1,17,2],[36,1,36,2],[61,1,62,1],[61,2,62,2]]}
[]
[null,{"$f":"Introduction!B2","v":"Request for Proposal (RFP) for Employee Benefits Plan Medical ASO and Pharmacy"}]
[null,"for Hamilton County Schools (HCS)"]
[null,{"$f":"Introduction!B4","v":"RFP 23-39"}]
[null,"Request for Proposal - Information"]
[null,{"$f":"Introduction!B6","v":"Effective 1/1/2024"}]
[]
[null,"Commissions Details:"]
[null,"Frequency","Monthly"]
[null,"Commission Type","Percentage"]
[null,"Type of Fee / Commission","Brokerage"]
[null,"Initial Commission","0.00%"]
[null,"Commission Expectation",0]
[null,"Ongoing Commission","0.00%"]
[null,"Paid To","N/A"]
[]
[]
[null,"Enrollment as of 02/01/2022\n     For detailed enrollment, please refer to additional data provided with the solicitation"]
[null,"Benefit Eligible",6142]
[null,"PPO - Plan 1"]
[null,"Employee Only",1083]
[null,"Employee + Spouse",168]
[null,"Employee + Child(ren)",404]
[null,"Employee + Family",233]
[null,"HMO - Plan 2"]
[null,"Employee Only",1326]
[null,"Employee + Spouse",179]
[null,"Employee + Child(ren)",928]
[null,"Employee + Family",480]
[null,"HDHP - Plan 3"]
[null,"Employee Only",55]
[null,"Employee + Spouse",19]
[null,"Employee + Child(ren)",16]
[null,"Employee + Family",22]
[]
[]
[null,"ASO Fees and Network Cost\n     \n    \n     1/1/2023 - 12/31/2023"]
[null,"PPO - Plan 1"]
[null,"Administration Fee",{"v":34.46,"d":"$34.46"}]
[null,"Advanced Radiological Imaging",{"v":0.48,"d":"$0.48"}]
[null,"Network Access Fee","Incl."]
[null,"Stop Loss Interface Fee",{"v":1.2,"d":"$1.20"}]
[null,"HMO - Plan 2"]
[null,"Administration Fee",{"v":17.77,"d":"$17.77"}]
[null,"Advanced Radiological Imaging","Incl."]
[null,"Network Access Fee",{"v":15.83,"d":"$15.83"}]
[null,"Stop Loss Interface Fee",{"v":3,"d":"$3.00"}]
[null,"HDHP - Plan 3"]
[null,"Administration Fee",{"v":17.77,"d":"$17.77"}]
[null,"Advanced Radiological Imaging","Incl."]
[null,"Network Access Fee",{"v":15.83,"d":"$15.83"}]
[null,"Stop Loss Interface Fee",{"v":3,"d":"$3.00"}]
[]
[null,"Data\n     Included with this solicitation are the following reports:","File Name"]
[null,"Census","Medical Census de-identified - Final.xlsx"]
[]
[null,"SBC - PPO Plan 1","SBC PPO Plan 1"]
[null,"SBC - HMO Plan 2","SBC HMO Plan 2"]
[null,"SBC - HDHP Plan 3","SBC HDHP Plan 3"]
[]
[null,"ASO Contract - PPO Plan 1","2023 ASO Contract - PPO Plan 1"]
[null,"ASO Contract - HMO Plan 2 and HDHP Plan 3","2023 ASA Amendment HMO Plan 2 and HDHP Plan 3\n2023 ASA AC Rider HMO Plan 2 and HDHP Plan 3\n2023 ASA ET Rider HMO Plan 2 and HDHP Plan 3\n2023 ASA Rider HDHP Plan 3\n2023 ASA Rider HMO Plan 2"]
[]
[]
[null,"Medical Repricing File - PPO Plan 1","WR645_G81009_BROKER_Med File"]
[null,"Medical Repricing File - HMO Plan 2 and HDHP Plan 3","HAMILTON COUNTY DEPARTMENT OF EDUCATION ClaimExtract-OA"]
[]
[null,"Rx Repricing File - PPO Plan 1","WR001_RXReprice_81009_2.1.22_1.31.23"]
[null,"Rx Repricing File - HMO Plan 2 and HDHP Plan 3","HAMIL2_Rx_Utilization_Rpt_v20230306"]
[]
[null,"Paid Claims 7/1/2020 - 6/30/2021 - PPO Plan 1","PPO Plan 1 Claims 7/1/2020 - 6/30/2021 "]
[null,"Paid Claims 7/1/2021 - 6/30/2022 - PPO Plan 1","PPO Plan 1 Claims 7/1/2021 - 6/30/2022 "]
[null,"Paid Claims 7/1/2022 - 2/28/2023 - PPO Plan 1","PPO Plan 1 Claims 7/1/2022 - 2/28/2023 "]
[]
[null,"Enrollment 7/1/2020 - 6/30/2021 - PPO Plan 1","PPO Plan 1 Enrollments by Tier 7/1/2020 - 6/30/2021 "]
[null,"Enrollment 7/1/2021 - 6/30/2022 - PPO Plan 1","PPO Plan 1 Enrollments by Tier 7/1/2021 - 6/30/2022 "]
[null,"Enrollment 7/1/2022 - 2/28/2023 - PPO Plan 1","PPO Plan 1 Enrollments by Tier 7/1/2022 - 2/28/2023 "]
[]
[null,"Paid Claims and Enrollment 7/1/2020 - 6/30/2021 - HMO Plan 2 and HDHP Plan 3"]
[null,"Paid Claims and Enrollment 7/1/2021 - 6/30/2022 - HMO Plan 2 and HDHP Plan 3"]
[null,"Paid Claims and Enrollment 7/1/2022 - 2/28/2023 - HMO Plan 2 and HDHP Plan 3"]

{"sheet":"Proposer Info","index":3,"n_rows":68,"n_cols":4,"rows_kept":68,"merged":[[6,3,8,5],[7,1,7,2],[11,1,11,3],[12,1,12,3],[14,1,14,3],[22,1,22,3],[45,1,45,3]]}
[]
[null,{"$f":"Introduction!B2","v":"Request for Proposal (RFP) for Employee Benefits Plan Medical ASO and Pharmacy"}]
[null,"for Hamilton County Schools (HCS)"]
[null,{"$f":"Introduction!B4","v":"RFP 23-39"}]
[null,"Request for Proposal - Tab 1: Proposer Info"]
[null,{"$f":"Introduction!B6","v":"Effective 1/1/2024"}]
[]
[null,"To Proposer: Please enter Carrier name in the space provided below."]
[null,"Name of Proposer:"]
[]
[]
[null,"Provide a Description (If proposing both Medical and Pharmacy provide a response to both): \n\nCarrier Experience \nCarrier Services (abilities, capacity, skill, strengths)\nCustomer Service Team"]
[null,"[Enter Company's Response Here]"]
[]
[null,"Provide the contact name and email address of the individual that can answer questions on your proposal."]
[null,"Question","Medical Response","Pharmacy Response"]
[null,"Name:","[Enter Company's Response Here]","[Enter Company's Response Here]"]
[null,"Title:","[Enter Company's Response Here]","[Enter Company's Response Here]"]
[null,"Phone:","[Enter Company's Response Here]","[Enter Company's Response Here]"]
[null,"Email:","[Enter Company's Response Here]","[Enter Company's Response Here]"]
[null,"Additional Notes:","[Enter Company's Response Here]","[Enter Company's Response Here]"]
[]
["I.","General Proposer Information"]
[null,"Question","Medical Response","Pharmacy Response"]
[1,"Brand Name of Proposer:"]
[2,"Parent Co. Legal Entity Name:"]
[3,"d/b/a (Name in Marketplace):"]
[4,"Year Established/Incorporated:"]
[5,"NAIC Code"]
[6,"Industry Classification:"]
[7,"FEIN (Federal Employer Identification Number):"]
[8,"Tax Status (for-profit; not-for-profit)"]
[9,"Public or Privately Held?"]
[10,"Ownership/Controlling Interest Structure"]
[11,"Home Office Location"]
[null,"Address Line #1"]
[null,"Address Line #2"]
[null,"City"]
[null,"State"]
[null,"Zip"]
[null,"Web Address"]
[12,"Location(s) where employees will be assigned to provide services described in this RFP. "]
[13,"Are you authorized to do business in the State of Tennessee?"]
[14,"Will subcontractors be used to provide administrative services should your organization be awarded this business?"]
[]
["II.","Proposer Financial Rating\nFor the entity that will be providing medical claims administration services, provide your  most recent financial ratings or filings and effective dates of the ratings from each of the following agencies:"]
[null,"Question","Medical Response","Pharmacy Response"]
[1,"A.M. Best: Financial Rating Status"]
[null,"Financial Rating (do not report credit rating)"]
[null,"Financial Rating Modifiers (if applicable)"]
[null,"Date Rating Effective (if rated; if not financially rated, leave response cell blank)"]
[2,"Standard & Poor's: Financial Rating Status"]
[null,"Financial Rating (do not report credit rating)"]
[null,"Financial Rating Modifiers (if applicable)"]
[null,"Date Rating Effective (if rated; if not financially rated, leave response cell blank)"]
[3,"Moody's: Financial Rating Status"]
[null,"Financial Rating (do not report credit rating)"]
[null,"Financial Rating Modifiers (if applicable)"]
[null,"Date Rating Effective (if rated; if not financially rated, leave response cell blank)"]
[4,"Fitch: Financial Rating Status"]
[null,"Financial Rating (do not report credit rating)"]
[null,"Financial Rating Modifiers (if applicable)"]
[null,"Date Rating Effective (if rated; if not financially rated, leave response cell blank)"]
[5,"Proposer's financial rating change within the past 12 months:"]
[null,"A.M. Best"]
[null,"Standard & Poor's"]
[null,"Moody's"]
[null,"Fitch."]

{"sheet":"1 - Experience & Reference","index":4,"n_rows":23,"n_cols":5,"rows_kept":23,"merged":[[7,2,7,4],[12,2,12,4],[20,2,20,4]]}
[]
[null,null,{"$f":"Introduction!B2","v":"Request for Proposal (RFP) for Employee Benefits Plan Medical ASO and Pharmacy"}]
[null,null,"for Hamilton County Schools (HCS)"]
[null,null,{"$f":"Introduction!B4","v":"RFP 23-39"}]
[null,null,"Request for Proposal - Scoring Section 1: Experience & References"]
[null,null,{"$f":"Introduction!B6","v":"Effective 1/1/2024"}]
[]
[null,null,"To Proposer: Please enter your Carrier name in the space provided below."]
[null,null,"Question","Medical Response","Pharmacy Response"]
[null,null,"Name of Proposer:"]
[]
[]
["I.",null,"Experience"]
[null,null,"Question","Medical Response","Pharmacy Response"]
[1,null,"Please provide your company's experience in working with self-funded clients with over 1500 employees in the past three years."]
[2,null,"List the number and percentage of public sector employers that your organization currently contracts with directly for ASO and/or Pharmacy Services. "]
[3,null,"Provide details as to whether there have been any mergers, acquisitions, and sales within your company within the last five years.  If there has been, provide an explanation of relevant detail."]
[4,null,"How many years has your organization been providing ASO and/or Pharmacy Services?"]
[5,null,"Describe what makes your company uniquely qualified to administer benefits to HCS employees?"]
[]
["II.",null,"References"]
[null,null,"Question","Medical Response","Pharmacy Response"]
[1,null,"Provide a list of three current accounts and two accounts that are no longer clients.  References should preferably be within the public sector and similar in size to HCS.  Contact Information should include company name, contact name, contact title, phone number, and email address."]

{"sheet":"2 - Service Capabilities","index":5,"n_rows":33,"n_cols":5,"rows_kept":33,"merged":[[7,2,7,4],[12,2,12,4],[17,2,17,4],[29,2,29,4]]}
[]
[null,null,{"$f":"Introduction!B2","v":"Request for Proposal (RFP) for Employee Benefits Plan Medical ASO and Pharmacy"}]
[null,null,"for Hamilton County Schools (HCS)"]
[null,null,{"$f":"Introduction!B4","v":"RFP 23-39"}]
[null,null,"Request for Proposal - Scoring Section 2: Service Capabilities"]
[null,null,{"$f":"Introduction!B6","v":"Effective 1/1/2024"}]
[]
[null,null,"To Proposer: Please enter your Carrier name in the space provided below."]
[null,null,"Question","Medical Response","Pharmacy Response"]
[null,null,"Name of Proposer:"]
[]
[]
[null,null,"Medical ASO and Pharmacy RFP\n"]
[null,null,"Question","Medical Response","Pharmacy Response"]
[null,null,"Proposer confirms that all requirements set forth in the RFP will be met, including mandatory minimums within the Specifications Document and attached all items."]
[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 \"[Proposer] Subcontractors\" in your response that includes the following information: in your response that includes the following information:\n  * Year Established/Incorporated\n  * NAIC Code\n  * Specify services to be provided"]
[]
["IV.",null,"Account Service Detail"]
[null,null,"Question","Medical Response","Pharmacy Response"]
[1,"a","Will the account be serviced by a dedicated account manager?"]
[null,"b","Average tenure for team or dedicated account manager?"]
[null,"c","Average Size of Clients for team or dedicated account manager?"]
[null,"d","Number of Current Clients Managed by this team or Account Manager"]
[2,null,"Describe how your company intends to be a strategic partner with the ability and insight to anticipate and communicate new regulatory requirements industry best practices and cost savings initiative"]
[3,null,"Name of person responsible for overall client satisfaction?"]
[4,null,"Name of person responsible for day to day direct contact with HCS?"]
[5,null,"Please include team biographies and organizational chart in an additional attachment. Label the attachment \"[Proposer] Service Team\""]
[]
[]
["III.",null,"Implementation Support"]
[null,null,"Question","Medical Response","Pharmacy Response"]
[1,null,"Do you provide implementation support?"]
[2,null,"Is there a dedicated implementation manager?"]

{"sheet":"2 - Plan Admin","index":6,"n_rows":46,"n_cols":5,"rows_kept":46,"merged":[[7,2,7,4],[12,2,12,4],[30,2,30,4],[39,2,39,4]]}
[]
[null,null,{"$f":"Introduction!B2","v":"Request for Proposal (RFP) for Employee Benefits Plan Medical ASO and Pharmacy"}]
[null,null,"for Hamilton County Schools (HCS)"]
[null,null,{"$f":"Introduction!B4","v":"RFP 23-39"}]
[null,null,"Request for Proposal - Scoring Section 2: Plan Administration"]
[null,null,{"$f":"Introduction!B6","v":"Effective 1/1/2024"}]
[]
[null,null,"To Proposer: Please enter your Carrier name in the space provided below."]
[null,null,"Question","Medical Response","Pharmacy Response"]
[null,null,"Name of Proposer:"]
[]
[]
["I.",null,"Plan Admin"]
[null,null,"Question","Medical Response","Pharmacy Response"]
[1,null,"Where will the HCS health plan/pharmacy claims be processed?  Confirm all claims will be handled onshore."]
[2,null,"Average Speed to Live Voice:  Indicate your administrative standard for the time it should take for a member to reach a member services representative.","Number of Seconds:","Number of Seconds:"]
[3,null,"Describe any quality assurance and continuous quality improvement programs in place."]
[4,null,"Please provide the hours of availability for you customer service team."]
[5,null,"Describe the structure, roles, and responsibilities of your account management team that will be assigned to the client."]
[6,null,"Percentage of calls resolved with one call."]
[7,null,"Abandonment Rate:  Indicated the percentage of callers who hang up after being placed on hold by member services."]
[8,null,"Please confirm you have provided your standard performance guarantee.   Name the file:  \"[Proposer] Performance Guarantees\"."]
[9,null,"What is your average in-network utilization (%) for your Medical/Pharmacy (2022 book-of-business)?"]
[10,null,"Please confirm that The vendor adopts and implements written HIPAA confidentiality policies and procedures in accordance with applicable law to ensure the confidentiality of member information used for any purpose."]
[11,null,"Describe the services available to assist claimants in filing a claim and to maximize benefits."]
[12,null,"Describe the reports available to HCS on a monthly, quarterly and annual basis."]
[13,null,"Confirm Carrier is able to provide reports on an ad hoc basis."]
[14,null,"Are there any plan systems enhancements or migrations over the next four years?"]
[15,null,"What percentage of claims are auto-adjucated?"]
[]
["II.",null,"Compliance, Privacy and Confidentiality"]
[null,null,"Question","Response","Response"]
[1,null,"The Carrier will not use or further disclose protected health information (PHI) other than as permitted or required by the Business Associate Agreement or as required by law."]
[2,null,"The Carrier agrees to use appropriate safeguards to prevent the unauthorized use or disclosure of the PHI.  Carrier agrees to report to the plan sponsor any unauthorized use or disclosure of the PHI."]
[3,null,"The Carrier agrees to mitigate, to the extent practicable, any harmful effect that is known to Carrier of a use or disclosure of PHI by Carrier in violation of the requirements of the federal privacy rule."]
[4,null,"The Carrier agrees to ensure that any agent, including a subcontractor, to whom it provides PHI received from, or created or received by the Carrier agrees to the same restrictions and conditions that apply to vendor with respect to such information."]
[5,null,"The Carrier 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 the vendor agrees to implement reasonable and appropriate safeguards to protect such PHI."]
[6,null,"The Carrier agrees to make internal practices, books, and records relating to the use and disclosure of PHI received from, or created or received by the organization  available to the Secretary of the Department of Health and Human Services for purposes of the Secretary of the Department of Health and Human Services determining organization’s compliance with the privacy rules."]
[]
["III.",null,"Plan Implementation"]
[null,null,"Question","Response","Response"]
[1,null,"Please confirm a Medical/Pharmacy plan implementation schedule has been included with your proposal. Name the file: \"[Proposer] Implementation Schedule\""]
[2,null,"What information would be required from HCDE for implementation?"]
[3,null,"Please confirm your capabilities for:"]
[null,"a.","Working with HCS for annual enrollment and new hire enrollment."]
[null,"b.","Accepting enrollment information electronically"]

{"sheet":"Sheet1","index":7,"n_rows":61,"n_cols":1,"rows_kept":61,"hidden":true}
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[48]
[49]
[50]
[51]
[52]
[53]
[54]
[55]
[56]
[57]
[58]
[59]
[60]

{"sheet":"3 - Plan Design Medical","index":8,"n_rows":74,"n_cols":4,"rows_kept":74,"merged":[[2,4,8,6],[7,2,7,3],[11,2,11,3],[39,2,39,3],[51,2,51,3],[63,2,63,3]]}
[]
[null,null,{"$f":"Introduction!B2","v":"Request for Proposal (RFP) for Employee Benefits Plan Medical ASO and Pharmacy"}]
[null,null,"for Hamilton County Schools (HCS)"]
[null,null,{"$f":"Introduction!B4","v":"RFP 23-39"}]
[null,null,"Request for Proposal - Scoring Section 3: Plan Design"]
[null,null,{"$f":"Introduction!B6","v":"Effective 1/1/2024"}]
[]
[null,null,"To Proposer: Please enter your Carrier name in the space provided below."]
[null,null,"Name of Proposer:"]
[]
[]
["I.",null,"Medical Plan Design Questionnaire"]
[null,null,"Question","Response"]
[1,null,"What are your Medical exclusions?"]
[2,null,"Carrier agrees to duplicate/enhance all current benefits/provisions as described in this RFP and accompanying documentation.  If Carrier does not intend to duplicate the current plans exactly, all deviations must be specifically identified in your response to this RFP in the plan design sections below. "]
[3,null,"Describe your \"value added\" services."]
[4,null,"Plan design deviations are noted on the plan design worksheet within this RFP."]
[5,null,"Will you provide an Engagement Consultant at not cost to HCS?"]
[6,null,"Do you provide patient-level reporting on prior authorization and other clinical programs?"]
[7,null,"Provide performace guarantees for claim payment, customer service, implementation, account management, and achieved discounts. "]
[8,null,"Please provide a draft copy of your Administrative Services Agreement/contract for both the medical plan and pharmacy benefit administration."]
[9,null,"Will a complete summary plan description be provided as well as the SBCs for each benefit plan offered?"]
[10,null,"What percentage of claims are auto-adjucated?"]
[11,null,"Confirm your ability to administer the current benefit plans?"]
[12,null,"Can you administer $0 claims from the Onsite Clinic?  If so, is there an additional service charge?"]
[13,null,"Please list the clinical services provided within your proposal."]
[]
["II.",null,"Subrogation:\nTo be in compliance with Tenn. Code Ann. ₴.8-27-901, HCS wants to understand your cababilities regarding subrgation, settlement negotiations and litigation.","Response"]
[1,null,"Has a request for subrogation or reimbursement interest (RSRI) been added to your SPD?"]
[2,null,"Can HCS include their own RSRI in the SPD?"]
[3,null,"Do you have the ability to notify HCS of any potential subrogation claims before any settlement or negotiations are started?  Please define the process."]
[4,null,"Outline your process of collecting the RSRI and notifying HCS of receipt."]
[5,null,"Will you provide a response to the individual or attorney who has submitted the RSRI and what documentation will be provided to HCS to insure the response has been sent?"]
[6,null,"Confirm no settlement discussions will take place without prior notification and discussion with HCS' legal team."]
[7,null,"Confirm you will not keep any portion of the recovery for subrogation claim and settlement."]
[8,null,"Explain, in specific detail, the processes you will undertake to insure HCS' attorney's office participates as your co-counsel in all subrogation/settlement processes or litgation."]
[9,null,"Are you able to modify or cease your subrogation/settlement processes or litigation in the event HCS determines that it should be lead or even exclusive counsel in a particular case?"]
[10,null,"In the event HCS, your co-counsel for all subrogation/settlement and litigation is dissatisified with your management of a particular case, what is your process to resolve this?"]
[]
["III.",null,"PPO Deviations\nUse the columns to the right to notate any deviations to current plan designs. A blank cell is a response that the plan will be administered as noted in the existing plan design."]
[1,null,"Deviation","Current Plan Design"]
[null,"a"]
[null,"b"]
[null,"c"]
[null,"d"]
[2,null,"Deviation","Current Plan Design"]
[null,"a"]
[null,"b"]
[null,"c"]
[null,"d"]
[]
["IV.",null,"HMO Deviations"]
[1,null,"Deviation","Current Plan Design"]
[null,"a"]
[null,"b"]
[null,"c"]
[null,"d"]
[2,null,"Deviation","Current Plan Design"]
[null,"a"]
[null,"b"]
[null,"c"]
[null,"d"]
[]
["V.",null,"HDHP Deviations"]
[1,null,"Deviation","Current Plan Design"]
[null,"a"]
[null,"b"]
[null,"c"]
[null,"d"]
[2,null,"Deviation","Current Plan Design"]
[null,"a"]
[null,"b"]
[null,"c"]
[null,"d"]

{"sheet":"3 - Plan Design Pharmacy","index":9,"n_rows":26,"n_cols":4,"rows_kept":26,"merged":[[2,4,8,5],[7,2,7,3],[14,2,14,3]]}
[]
[null,null,{"$f":"Introduction!B2","v":"Request for Proposal (RFP) for Employee Benefits Plan Medical ASO and Pharmacy"}]
[null,null,"for Hamilton County Schools (HCS)"]
[null,null,{"$f":"Introduction!B4","v":"RFP 23-39"}]
[null,null,"Request for Proposal - Scoring Section 3: Plan Design"]
[null,null,{"$f":"Introduction!B6","v":"Effective 1/1/2024"}]
[]
[null,null,"To Proposer: Please enter your Carrier name in the space provided below."]
[null,null,"Name of Proposer:"]
[]
[]
[]
[]
[]
["I.",null,"Pharmacy Deviations\nUse the columns to the right to notate any deviations to current plan designs. A blank cell is a response that the plan will be administered as noted in the existing plan design."]
[{"$nulls":3},"Current Plan Design"]
[1]
[2]
[3]
[4]
[5]
[6]
[7]
[8]
[9]
[10]

{"sheet":"3 - Value Add","index":10,"n_rows":26,"n_cols":5,"rows_kept":26,"merged":[[6,5,9,5],[7,2,7,4],[12,2,12,4],[22,2,22,4]]}
[]
[null,null,{"$f":"Introduction!B2","v":"Request for Proposal (RFP) for Employee Benefits Plan Medical ASO and Pharmacy"}]
[null,null,"for Hamilton County Schools (HCS)"]
[null,null,{"$f":"Introduction!B4","v":"RFP 23-39"}]
[null,null,"Request for Proposal - Scoring Section 3: Value Add"]
[null,null,{"$f":"Introduction!B6","v":"Effective 1/1/2024"}]
[]
[null,null,"To Proposer: Please enter your Carrier name in the space provided below."]
[null,null,"Line Item","Medical Response","Pharmacy Response"]
[null,null,"Name of Proposer:"]
[]
[]
["I.",null,"Employee and Employer Experience"]
[null,null,"Line Item","Medical Response","Pharmacy Response"]
[1,null,"Use this line to indicate what sets your customer service experience apart from your competitors."]
[2,null,"Use this line to indicate what sets your website experience apart from your competitors. Include snapshots of your website with your proposal. Name the additional attachment \"[Proposer] Website\"."]
[3,null,"Use this line to indicate what sets your mobile app experience apart from your competitors. Include snapshots of your mobile app with your proposal. Name the additional attachment \"[Proposer] Mobile App\"."]
[4,null,"Use this line to indicate what sets your network apart from your competitors."]
[5,null,"Use this line to indicate what sets your employer experience apart from your competitors."]
[6,null,"List any additional enhancements to your proposal that have not been captured in this Attachment A."]
[7,null,"What future plan or benefit enhancements do you feel the HCS should know when evaluating this offer?"]
[]
["II.",null,"Audits"]
[null,null,"Line Item","Medical Response","Pharmacy Response"]
[1,null,"Provide details around your audit guidelines"]
[2,null,"Confirm you will allow HCS to do a full audit and the notice required by HCS to initiate the audit."]

{"sheet":"4 - Medical Network","index":11,"n_rows":28,"n_cols":4,"rows_kept":28,"merged":[[7,2,7,3],[11,2,11,3],[23,2,23,3]]}
[]
[null,null,{"$f":"Introduction!B2","v":"Request for Proposal (RFP) for Employee Benefits Plan Medical ASO and Pharmacy"}]
[null,null,"for Hamilton County Department Of Education"]
[null,null,{"$f":"Introduction!B4","v":"RFP 23-39"}]
[null,null,"Request for Proposal - Scoring Section 4: Network"]
[null,null,{"$f":"Introduction!B6","v":"Effective 1/1/2024"}]
[]
[null,null,"To Proposer: Please enter your Company's name in the space provided below."]
[null,null,"Name of Proposer:"]
[]
[]
["I.",null,"Network Access and Disruption"]
[null,null,"Line Item","Carrier Response"]
[1,null,"Network ownership/controlling interest"]
[2,null,"Network Name"]
[3,null,"Please provide the total number of providers in Hamilton County for each of the following:"]
[null,"a","Total network PPO Providers as of 1/1/2023"]
[null,"b","Total network HMO Providers as of 1/1/2023"]
[5,null,"If you have renegotiated any provider contracts in the last 12 to 24 months, what was the financial impact to your organization and your customers?"]
[6,null,"What are your credentialing standards?"]
[7,null,"What is the procedure if a member or HCS requests a provider to be included in your network?"]
[8,null,"What is your average network savings in Hamilton County, TN?"]
[]
["I.",null,"Network Access and Disruption"]
[null,null,"Line Item","Carrier Response"]
[1,null,"Count of all Non-Network Providers"]
[1,null,"Billed Charges of all Non-Network Providers"]
[1,null,"List any provider type not included in your repricing"]

{"sheet":"5 - Questionnaire Pharmacy","index":12,"n_rows":84,"n_cols":4,"rows_kept":84,"merged":[[2,4,8,6],[7,2,7,3],[11,2,11,3]]}
[]
[null,null,{"$f":"Introduction!B2","v":"Request for Proposal (RFP) for Employee Benefits Plan Medical ASO and Pharmacy"}]
[null,null,{"$f":"Introduction!B3","v":"for Hamilton County Schools (HCS)"}]
[null,null,{"$f":"Introduction!B4","v":"RFP 23-39"}]
[null,null,"Request for Proposal - Scoring Section 5: Cost"]
[null,null,{"$f":"Introduction!B6","v":"Effective 1/1/2024"}]
[]
[null,null,"To Proposer: Please enter your Company's name in the space provided below."]
[null,null,"Name of Proposer:"]
[]
[]
["I.",null,"Pharmacy Questionnaire"]
[null,null,"Question","Response"]
[1,null,"What are your Pharmacy exclusions?"]
[2,null,"Carrier agrees to duplicate/enhance all current benefits/provisions as described in this RFP and accompanying documentation.  If Carrier does not intend to duplicate the current plans exactly, all deviations must be specifically identified in your response to this RFP in the plan design sections below. "]
[3,null,"Describe your \"value added\" services."]
[4,null,"Plan design deviations are noted on the plan design worksheet within this RFP."]
[5,null,"Does your plan utilize a formulary? If so, please provide a copy.","\nAttach Copy:"]
[6,null,"What is the name and address of the Specialty Pharmacy that will be providing Specialty Drug Services?"]
[7,null,"What is the name and address of the Mail Order Pharmacy that will be providing mail pharmacy services?"]
[8,null,"Do you own a Specialty Pharmacy?"]
[9,null,"Do you own a Mail Order Pharmacy?"]
[10,null,"Across your entire book of business, what percent of your revenues are from spread (i.e.  Mark up between what you pay the pharmacy and what you pay the employer)"]
[11,null,"Across your entire book of business, what percent of your overall revenues are from pharmacies that your own?"]
[12,null,"Across your entire book of business, what percent of your revenues are from clients administrative fees paid directly by the client?"]
[13,null,"Do you agree to pass-through 100% of negotiated discounts with network pharmacies at the point of service? (i.e.  PBM shall not charge client a greater amount than the price paid to the dispensing pharmacy for the drug dispensed, including ingredient cost and dispensing fee, as determined without mark up by PBM)"]
[14,null,"Do you agree to pass-through the full value of any funds received or recovered from pharmaceutical manufacturers attributible to the purchase or utilization of covered drugs by eligible persons of the Client's drug plans including but not limited to:  incentive rebates categorized as mail order purchase discounts; credits; rebates regardless of how categorized as formulary, access, or reimbursements; price protection rebates and discounts; market share incentives; promotional allowances; educational grants; drug pull-through programs; implementation allowances; clinical derailing; rebate submission fees; administrative or management fees earned from pharmaceutical manufacturers relating, directly or indirectly, to the Client's covered drug utilization (collectively referred to as \"total manufacturer value\" or \"rebate\")."]
[15,null,"Do you own a separate legal entity that holds the manufacturer rebates, whether as a GPO, rebate aggregator or otherwise?"]
[16,null,"If yes above, do you agree to pass through to the Client the full value of any funds received or recovered by your rebate aggregator or GPO from pharmaceutical manufacturers to the Client?"]
[17,null,"Do you agree that you will not take clawbacks from network pharmacy?"]
[18,null,"Do you agree that 100% of your revenue for this Client will ONLY come from the fees that are paid directly by the client to your organization and that no other revenue will be earned through data, access or programs related to the client or their patients in any subsidiary business?"]
[19,null,"Do you agree that the client will have the right to make changes to prior authorization coverage of specific medications, including eliminating a drug from coverage?"]
[20,null,"Please provide the hours of availability for your specialty pharmacy and the clinical resource team."]
[21,null,"Please provide the hours of availability for your customer service team."]
[22,null,"Confirm that your account team will conduct client quarterly meetings to report on prescription drub performance and develop an action plan."]
[23,null,"Describe the types of communications you provide to members for the formulary transition, pharmacy transition (retail, mail, and specialty), and the prior authorization program."]
[24,null,"Describe how accumulators, including deductibles and out-of-pocket maxes will be managed with the health plans."]
[25,null,"AWP will be based on 11 digit NDC as supplied by a nationally recognized pricing source (i.e. Medispan) on the date of service (for both retail and mail)."]
[26,null,"Members will pay the lowest of:  A) copay  B) UandC  C)  Contracted Rate"]
[27,null,"Minimum Generic Discount Guarantees for both mail and retail will be defined as follows:  Total discounted ingredient cost/total discount AWP:  A)  Total discounted ingredient cost before the application of copayments will be used in this calculation.  B)  Undiscounted AWP will be from a single nationally recognized price source for all claims.  C)  Dispensing Fees will not be included in the guaranteed discounted ingredient cost.  D) The Undiscounted AWP from the date of adjudiction shall be used.  E) Disount guarantees shoudl b measured and reconciled on a channel (retail, mail order, and specialty) basis only. Surpluses in one channel may not be utilized to offset deficits in another channel. F) In no event shall Average AWP be used. G) Claims paid 100% by the member copaymnet shall be included in the calcualtion with the applicable discounted ingredient cost. H) Compounds, defined specialty claims through the vendor's specialty pharmacy, and OTC claims shall be excluded from the calculation.  I)  Claims from LTC, Veterans, Military, and 340B are excluded.  J) Your proposed pricing (retail, mail order, and specialty discounts; any fees) should be guaranteed for the term of the agreement period within 90 days after the end of any contract year, you will provide a report to the client that provides the actual discounts and fees for the year.  Any shortfall with any of the guarantees will be paid to the client with 120 of the end of the plan year.  \n"]
[28,null,"PBM will provide guarantees as set forth in the pricing template.  No shortfall in one (1) guarantee (i.e.  Rebates, discounts, copay assitance, or clinical) shall be offset by favorability in another guarantee.  No shortfall in one (1) guarantee period shall be offset by favorability in another guarantee period.  Each guarantee and each guarantee period shall stand alone."]
[29,null,"On an annual basis, we will provide the client with the greater of:  A)  100% of the total manufacturer value  B) the guaranteed rebates (as provided by our proposal)."]
[30,null,"PBM will provide rebate reconcilation report, within six months of the close of the plan year, so as to reconcile the rebate payments for that year.  The PBM will outline each channels' rebate returns to compare with minimum rebate guarantees."]
[31,null,"PBM will provide a discount reconciliation report by drug category consistant with the pricing template, within three months of the close of the plan year, so as to reconcile the discounts for that year.  The PBM will include a list of claims excluded from the reconciliation totals.  "]
[32,null,"Do you provide drug-level rebate reporting to the client as part of the quarterly reporting?"]
[33,null,"Do you offer integrated pharmacy and medical reporting for specialty drugs as part of the quarterly reporting?"]
[34,null,"Do you provide patient-level reporting on prior authorization and other clinical programs?"]
[35,null,"PBM will not implement or administer any program that results in the therapeutic switching of members from lower net-cost products to higher net-cost products without the prior written consent of the client."]
[36,null,"Which of the following drugs are on the formulary being proposed for this client, either as preferred or non-preferred?  (Vimovo, Duexix, Metformin ER (OSM), Diclegis, Pennsaid 2%, Acthar, Auvi-Q)"]
[37,null,"For any new-to-market specialty drug, PBM will exclude for up to twelve months to insure appropriate financial arrangements and clinical programs are in place."]
[38,null,"Describe your Prior Authorization Process."]
[39,null,"Please state the number of Prior Authorizations that would be in place on this formulary that require submission of objective information beyond physician attestatation.  "]
[40,null,"Describe if ePA is available for providers and members and if so, what percent of PA's are completed through your ePA process."]
[41,null,"What is your approval rate for prior authorizations over all?"]
[42,null,"What is your approval rate for prior authorizations for traditional medications?"]
[43,null,"What is your approval rate for prior authorizations for specialty medication?"]
[44,null,"If a prior authorization is not approved, how are the member and provider notified?  When is outbound calling performed?  When are peer-to-peer consults performed?"]
[45,null,"Does your formulary allow for grandfathering of current specialty drug users?  For what time period?"]
[46,null,"What is the client and member notification process and time period for formulary changes?"]
[47,null,"Do your clinical programs incorporate medical claims data information?  Please attach a description of your medical specialty management program.","Attachment"]
[48,null,"Do you offer a true out-of-pocket tracking program for copay assistance, meaning that ony payment made by the member will be allowed to the deductible and out-of-pocket maximums and that no manufacturer dollars will be applied to any deductibles or out-of-pocket maximums?  While we have the desire to allow members to utilize coupons to lower their out-of-pocket expenses, HCS does not want the coupon value to be applied to the deductible or out-of-pocket maximums or members in order to maintain equitable plan accumulators across all particpants."]
[49,null,"Describe if true out-of-pocket tracking is only available for claims process through certain pharmacies."]
[50,null,"Do your offer a copay maximizer program for specialty drugs?"]
[51,null,"How many drugs are included in your copay maximizer program?"]
[52,null,"Savings from the copay maximizer will be calculated as the amount of funding provided by the pharmaceutical manufacturer.  Savings will not include true out-of-pocket tracking."]
[53,null,"Is there any impact to rebate guarantees if the client implements true out-of-pocking tracking or copay maximizer?  If so, please describe."]
[54,null,"All rebates and discount revenue earned or owed to the client in a given plan year will be paid regardless of its termination status as a client."]
[55,null,"Please confirm you are proposing an initial contract term of 1 year with 5 additional 1 year renewals."]
[56,null,"Please confirm you agree to an initial 1 year rate guarantee."]
[57,null,"Your responses within this document will supercede any conflicting information that may be presented outside of this template (e.g.  Pricing supplements, exhibits, etc.)"]
[58,null,"You agree that all responses within this document are binding."]
[59,null,"The client and appointed consultant will have the right to audit, with full cooperation, the services and pricing (including discounts and rebates) to validate compliance with all programs requirements and contractual guarantees.  There will be no fees assessed by the PBM for the audit including for any necessary data files period."]
[60,null,"The client and appointed consultant will have the right to an annual clinical audit of the prior authorization program."]
[61,null,"All eligibility and claims data belong to the client and shall not be sold to third parties."]
[62,null,"All rebate and discount revenue earned or owed to the client in a given plan year will be paid regardless of its termination status as a client."]
[63,null,"Upon expiration or termination of the Contract, we will, at the Client's request, provide mutually agreed upon post-termination services.  These services include but are not limited to the following:  A)  Processing of mail service prescriptions not requiring clarification and electronically submitted retail claims that are received prior to the termination date.  B)  Processing of paper claims for which we receive completee information and that were incurred prior to the termination date for a period of 90 days following the termination date.  C)  Transimission of eligibility and open refill files (including prior authoriization) to the subsequent vendor.  D)  Provision of claims history in a format as mutually agreed upon by both parties.  Reports, eligibility files, open refill files and claims history files will be provided within 30 days of receipt of written request by the Client unless otherwise agreed upon by both parties. "]
[64,null,"Are there any costs associated with your proposal that is not covered by the rates included below? If yes, please include details on the fees including when they would apply and an estimate of costs for a group of HCS' size."]
[65,null,"Minimum Brand Discount Guarantee for both Mail Order and Retail shall be defined as follows:  1)  Total discounted ingredient cost/total undiscounted AWP.  A) Total Discounted Ingredient Cost before the application of copayments shall be used in this calculation.  B)  Total Undiscounted AWP shall be from a single, nationally recognized price source for all claims."]
[null,null,"Supporting Information","Attachments"]
["A",null,"Attach proposers specialty drug list with associated minimum AWP discounts."]
["B",null,"Attach proposers formulary."]
["C",null,"Attach detailed evidence from your pharmacy and medical claims analysis for any clinical savings that are being claimed."]
["D",null,"Attach the clinical savings methodology."]
["E",null,"Attach services, guarantees and associated financial comittments."]

{"sheet":"5 - Cost Pharmacy","index":13,"n_rows":100,"n_cols":5,"rows_kept":100,"merged":[[2,4,8,6],[7,2,7,3],[11,2,11,3],[57,3,57,4],[58,3,58,4]]}
[]
[null,null,{"$f":"[1]Introduction!B2","v":"Request for Proposal (RFP) for Employee Benefits Plan Medical ASO and Pharmacy"}]
[null,null,{"$f":"[1]Introduction!B3","v":"for Hamilton County Schools (HCS)"}]
[null,null,{"$f":"[1]Introduction!B4","v":"RFP0001"}]
[null,null,"Request for Proposal - Scoring Section 5: Cost"]
[null,null,{"$f":"[1]Introduction!B6","v":"Effective 1/1/2024"}]
[]
[null,null,"To Proposer: Please enter your Company's name in the space provided below."]
[null,null,"Name of Proposer:"]
[]
[]
["I."]
[null,null,"Base Administrative Fee ","Response"]
[1,null,"Fully Transparent 100% Pass Thru Fee","Year 1:_____  Year 2:_____ Year 3:_____  Year 4:_____  Year 5:_____"]
[2,null,"Copay Assistance Program Fee (if offered)","Year 1:_____  Year 2:_____ Year 3:_____  Year 4:_____  Year 5:_____"]
[null,null,"List Any Wellness or Implementation Credits"]
[null,null,"Base Administrative Services:  Indicate whether the following services are including in your Base Administrative Fee.","Response                                                      If \"No\" Explain"]
[1,null,"Point of service claims processing "]
[2,null,"Processing of paper claim form"]
[3,null,"Quarterly experience and utilization reports"]
[4,null,"Ad hoc reports"]
[5,null,"ID Card production and mailing"]
[6,null,"Replacement of ID Cards"]
[7,null,"Communication (Member and Physician)"]
[8,null,"Manual eligibility"]
[9,null,"Eligibility maintenance"]
[10,null,"Coordination with medical plan to coordinate deductibles"]
[11,null,"Prior Authorization"]
[null,null,"List prior Authorization Programs"]
[12,null,"Step Therapy"]
[null,null,"List Step Therapy programs"]
[13,null,"Drug Quantity Management"]
[14,null,"Benefit design / coverage change notification"]
[15,null,"Clinical program update / change notification"]
[16,null,"1st level appeals"]
[17,null,"2nd level appeals"]
[18,null,"External appeals "]
[19,null,"Claims data feeds to third parties (e.g., disease management vendors data analytics vendors)"]
[null,null,"Pharmacy Minimum Rebate Rebate Guarantee","Response"]
[1,null,"Per Traditional Brand (30-day supply)","Year 1:_____  Year 2:_____ Year 3:_____  Year 4:_____  Year 5:_____"]
[2,null,"Total Traditional brand claim count"]
[3,null,"Per Specialty Brand (30-day supply)","Year 1:_____  Year 2:_____ Year 3:_____  Year 4:_____  Year 5:_____"]
[4,null,"Total Specialty Brand cllaim count"]
[5,null,"Other_____________________________","Year 1:_____  Year 2:_____ Year 3:_____  Year 4:_____  Year 5:_____"]
[6,null,"List rebate guarantee exclusions"]
[7,null,"Define Brand for use in Rebates"]
[6,null,"Less:  Other Programs Savings Guarantee"]
[7,null,"Less:  Member Share (if provided for a AWP analysis)"]
[8,null,"Net Ingredients Cost Spend"]
[9]
[]
["II.",null,"Minimum Discount Guarantees\nAssume an open network with no major retail chains excluded.","Minimum Brand Discount Guarantee","Minimum Dispensing Fee Guarantee"]
[]
[1,null,"Retail 30 for Traditional Drugs"]
[2,null,"Retail 90 for Traditional Drugs"]
[3,null,"Mail Order for Traditional Drugs"]
[4,null,"Specialty - Provide overall effective rate based on claims data provided and attached Specialty Drug List with minimum discount guarantee per drug."]
[]
[5,null,"List Discount Guarantee Exclusions"]
[6,null,"Define Brand for Use and Discounts"]
[7,null,"Define Generic for Use and Discounts"]
[8]
[]
["III.",null,"Prescription Drug Spend Under Pharmacy (Repricing Results) - BCBS File\n"]
[{"$nulls":3},"Time Period:  7/1/21 - 6/30/22"]
[null,null,"Total Scripts Should Must Equal",{"v":44499,"d":"44,499"}]
[null,null,"Generic Scripts -Tier 1 "]
[null,null,"Preferred Brand Sripts - Tier 2"]
[null,null,"Non Preferred Brand Scripts - Tier 3"]
[null,null,"Specialty Scripts"]
[null,null,"Not Covered Scripts"]
[null,null,"Not Covered AWP Cost"]
[1,null,"Annual AWP Indgredient Cost Spend (from file provided)"]
[2,null,"Less:  Pharmacy Discounts"]
[3,null,"Less:  Rebates"]
[4,null,"Less:  Copay Maximizer Savings Guarantee"]
[5,null,"Less:  Clinical Management Savings Guarantee"]
[6,null,"Less:  Other Programs Savings Guarantee"]
[7,null,"Less:  Member Share (if provided for a AWP analysis)"]
[8,null,"Net Ingredients Cost Spend"]
[9]
[]
["III.",null,"Prescription Drug Spend Under Pharmacy (Repricing Results) - Cigna File\n"]
[{"$nulls":3},"Time Period:  7/1/21 - 6/30/22"]
[null,null,"Total Scripts Should Must Equal",{"v":74495,"d":"74,495"}]
[null,null,"Generic Scripts -Tier 1 "]
[null,null,"Preferred Brand Sripts - Tier 2"]
[null,null,"Non Preferred Brand Scripts - Tier 3"]
[null,null,"Specialty Scripts"]
[null,null,"Not Covered Scripts"]
[null,null,"Not Covered AWP Cost"]
[1,null,"Annual AWP Indgredient Cost Spend (from file provided)"]
[2,null,"Less:  Pharmacy Discounts"]
[3,null,"Less:  Rebates"]
[4,null,"Less:  Copay Maximizer Savings Guarantee"]
[5,null,"Less:  Clinical Management Savings Guarantee"]
[6,null,"Less:  Other Programs Savings Guarantee"]
[7,null,"Less:  Member Share (if provided for a AWP analysis)"]
[8,null,"Net Ingredients Cost Spend"]
[9]

{"sheet":"5 - Cost Medical","index":14,"n_rows":90,"n_cols":6,"rows_kept":90,"merged":[[2,4,8,6],[7,2,7,3],[11,2,11,3],[44,2,44,3],[52,2,52,3],[59,2,59,3]]}
[]
[null,null,{"$f":"Introduction!B2","v":"Request for Proposal (RFP) for Employee Benefits Plan Medical ASO and Pharmacy"}]
[null,null,{"$f":"Introduction!B3","v":"for Hamilton County Schools (HCS)"}]
[null,null,{"$f":"Introduction!B4","v":"RFP 23-39"}]
[null,null,"Request for Proposal - Scoring Section 5: Cost"]
[null,null,{"$f":"Introduction!B6","v":"Effective 1/1/2024"}]
[]
[null,null,"To Proposer: Please enter your Company's name in the space provided below."]
[null,null,"Name of Proposer:"]
[]
[]
["I.",null,"Cost - Questionnaire"]
[null,null,"Question","Response"]
[1,null,"Please confirm you are proposing an initial contract term of 1 year with 5 additional 1 year renewals.",null,"*"]
[2,null,"Please confirm you agree to an initial 1 year rate guarantee.",null,"*"]
[3,null,"Your responses within this document will supercede any conflicting information that may be presented outside of this template (e.g.  Pricing supplements, exhibits, etc.)",null,"*"]
[4,null,"You agree that all responses within this document are binding.",null,"*"]
[5,null,"The client and appointed consultant will have the right to audit, with full cooperation, the services and pricing (including discounts and rebates) to validate compliance with all programs requirements and contractual guarantees.  There will be no fees assessed by the PBM for the audit including for any necessary data files period.",null,"*"]
[6,null,"The client and appointed consultant will have the right to an annual clinical audit of the prior authorization program.",null,"*"]
[7,null,"All eligibility and claims data belong to the client and shall not be sold to third parties.",null,"*"]
[8,null,"All rebate and discount revenue earned or owed to the client in a given plan year will be paid regardless of its termination status as a client.",null,"*"]
[9,null,"Upon expiration or termination of the Contract, we will, at the Client's request, provide mutually agreed upon post-termination services.  These services include but are not limited to the following:  A)  Processing of mail service prescriptions not requiring clarification and electronically submitted retail claims that are received prior to the termination date.  B)  Processing of paper claims for which we receive completee information and that were incurred prior to the termination date for a period of 90 days following the termination date.  C)  Transimission of eligibility and open refill files (including prior authoriization) to the subsequent vendor.  D)  Provision of claims history in a format as mutually agreed upon by both parties.  Reports, eligibility files, open refill files and claims history files will be provided within 30 days of receipt of written request by the Client unless otherwise agreed upon by both parties. ",null,"*"]
[10,null,"Are there any costs associated with your proposal that is not covered by the rates included below? If yes, please include details on the fees including when they would apply and an estimate of costs for a group of HCS' size.",null,"*"]
[]
[null,null,"Base Administrative Services:  Indicate whether the following services are including in your Base Administrative Fee.","Response"]
[1,null,"Point of service claims processing ",null,"*"]
[2,null,"Processing of paper claim form",null,"*"]
[3,null,"Quarterly experience and utilization reports",null,"*"]
[4,null,"Ad hoc reports",null,"*"]
[5,null,"ID Card production and mailing",null,"*"]
[6,null,"Replacement of ID Cards",null,"*"]
[7,null,"Communication (Member and Physician)",null,"*"]
[8,null,"Manual eligibility",null,"*"]
[9,null,"Eligibility maintenance",null,"*"]
[10,null,"Coordination with medical plan to coordinate deductibles",null,"*"]
[11,null,"Clinical Utilization Management Programs",null,"*"]
[null,null,"List all Clinical programs included"]
[14,null,"Benefit design / coverage change notification\\",null,"*"]
[15,null,"Clinical program update / change notification",null,"*"]
[16,null,"1st level appeals",null,"*"]
[17,null,"2nd level appeals",null,"*"]
[18,null,"External appeals ",null,"*"]
[19,null,"Claims data feeds to third parties (e.g., disease management vendors data analytics vendors)",null,"*"]
[]
["III."]
[null,null,"PPO ","Proposed Monthly Rates"]
[1,null,"Base Administration Fee PEPM","Year 1:_____  Year 2:_____ Year 3:_____  Year 4:_____  Year 5:_____"]
[null,null,"Network Access/Clinical Programs PEPM","Year 1:_____  Year 2:_____ Year 3:_____  Year 4:_____  Year 5:_____"]
[4,null,"Stop Loss Interface Fee"]
[2,null,"Any additional Fees Must be disclosed and listed"]
[null,null,"List any Implementation/Wellness Credits"]
[]
["IV.",null,"HMO"]
[null,null,"Enrollment Tier (current enrollment count)","Proposed Monthly Rates"]
[1,null,"Base Administration Fee PEPM","Year 1:_____  Year 2:_____ Year 3:_____  Year 4:_____  Year 5:_____"]
[null,null,"Network Access/Clinical Programs PEPM","Year 1:_____  Year 2:_____ Year 3:_____  Year 4:_____  Year 5:_____"]
[4,null,"Stop Loss Interface Fee"]
[2,null,"Any additional Fees Must be disclosed and listed"]
[null,null,"List any Implementation/Wellness Credits"]
["V."]
[null,null,"HDHP","Proposed Monthly Rates"]
[1,null,"Base Administration Fee PEPM","Year 1:_____  Year 2:_____ Year 3:_____  Year 4:_____  Year 5:_____"]
[null,null,"Network Access/Clinical Programs PEPM","Year 1:_____  Year 2:_____ Year 3:_____  Year 4:_____  Year 5:_____"]
[4,null,"Stop Loss Interface Fee"]
[2,null,"Any additional Fees Must be disclosed and listed"]
[null,null,"List any Implementation/Wellness Credits"]
[]
["IV.",null,"Medical Repricing Results - Cigna File\n","Charged Amount",null,"Allowed Amount"]
[{"$nulls":3},"Time Period:  7/1/21 - 6/30/22",null,"Time Period:  7/1/21 - 6/30/22"]
[null,null,"Confirm Results Below Represent a Provider Specific Repricing"]
[null,null,"Total of next 6 rows must equal this charged amount",{"$f":"56598643.2+989364.62","v":{"v":57588007.82,"d":"$57,588,007.82"}}]
[null,null,"Primary Care Providers"]
[null,null,"Specialty Providers"]
[null,null,"Outpatient Providers"]
[null,null,"Inpatient Providers"]
[null,null,"Other Services"]
[null,null,"Out-of-Network Providers"]
[null,null,"Excluded from Repricing"]
[]
["IV.",null,"Medical Repricing Results - BCBS File\n","Charged Amount",null,"Allowed Amount"]
[{"$nulls":3},"Time Period:  7/1/21 - 6/30/22",null,"Time Period:  7/1/21 - 6/30/22"]
[null,null,"Confirm Results Below Represent a Provider Specific Repricing"]
[null,null,"Total of next 6 rows must equal this charged amount",{"v":45668786.49,"d":"$45,668,786.49"}]
[null,null,"Primary Care Providers"]
[null,null,"Specialty Providers"]
[null,null,"Outpatient Providers"]
[null,null,"Inpatient Providers"]
[null,null,"Other Services"]
[null,null,"Out-of-Network Providers"]
[null,null,"Excluded from Repricing"]