Robert A. Ficano County Executive WAYNE COUNTY PURCHASING DIVISION REQUEST FOR PROPOSALS FOR EMPLOYEE / RETIREE VISION BENEFITS

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1 Robert A. Ficano County Executive WAYNE COUNTY PURCHASING DIVISION REQUEST FOR PROPOSALS FOR EMPLOYEE / RETIREE VISION BENEFITS CONTROL # ADDENDUM NO. 2 ADDENDUM ISSUE DATE: MONDAY, JUNE 24, 2013 This Addendum is being issued prior to the acceptance of Proposals / Responses / Bids to allow for the following changes, additions, clarifications, and/or answers to questions: MODIFICATIONS: CHANGE: Minimum Qualification Section (3)(c) regarding GEO Access points to: c. Ability to exhibit adequate access to vision care providers for current vision enrollees. Geo Access reports (or comparable report) must be provided based on the attached census. The Geo Access report should be run based on employee home address and meet the below minimum standard. i. One vision facility that provides frame / lens / contact services within 15 miles of each employee s home address ii. If providing a proposal that includes vision exams, one vision facility that provides eye exam services within 15 miles of each employee s home address QUESTIONS AND ANSWERS: 1. Please clarify the access standards for the requested GeoAccess request. Section 2.3.c. Minimum Qualifications requests a GeoAccess report based on the following standard: 1 vision dispensing facility within 20 miles 1 vision full service facility within 15 miles Section 3.3.c. Evaluation Criteria/Network requests: 1 vision dispensing facility within 10 miles 1 vision full service facility within 10 miles Page 1 of 6

2 ANSWER: please see the Modification above. below: Both Sections should have read the same as 1 vision dispensing facility within 15 miles 1 vision full service facility within 15 miles 2. Section 3.3 Evaluation Criteria/Submittal Requirements Specific to Evaluation Criteria: Section c.6. Network requests provider counts for other SE Michigan counties. Please provide the names of the counties requested. ANSWER: You may treat this as having read Michigan counties other than Wayne, Oakland and Macomb located in southeast Michigan. 3. Please confirm the effective date. Answer: The contract is expected to be effective on October 1, 2013 or upon Wayne County Commission approval, whichever is later. 4. Section Scope of Services/Optical Reimbursement Program: What is the maximum dollar amount to be reimbursed? ANSWER: The maximum dollar amount varies between actives ($150 or $175) and retirees ($75, $100 or $175). The amount for each employee or retiree is indicated in the census information provided under the column header labeled PLAN. The following plan codes and corresponding reimbursement amounts (paid once during two-year policy period which begins on October 1st of each odd year and ends on September 30th of the next odd year) are indicated below. OPT075 = $75 OPT100 = $100 OPT150 = $150 OPT175 = $ In the claims data provided, please clarify the member population represented in the BCBSM Vision Exam Claims Utilization vs. the Vision Plan Utilization Data. ANSWER: The BCBSM claim file includes the vision exam claims for individuals who are enrolled in BCBSM medical with materials-only coverage through the Heritage Vision Plan. The same experience for HAP members who are enrolled in the Heritage Vision Plan is not available. The Excel file labeled with Vision Plan Utilization Data includes two worksheets: one has the claims experience data for the materials-only Heritage Vision Plan and the other for reimbursements submitted and paid under the County s Optical Reimbursement Program. 6. Could you please provide detailed claims information (i.e., service counts, by service, etc.)? ANSWER: Service counts are included in the BCBSM Vision Exam Claims Utilization data file and the Vision Plan Utilization Data file. Further detail is not available. 7. For fully-insured plans: a. How are all plans funded? Page 2 of 6

3 ANSWER: For active employees, employer pays the full premium cost per employee enrolled in the plan. For retirees, employer collects full premium cost per retiree via pension payroll deduction or via check if no pension check is issued and remits same to vendor. b. Is the fully-insured plan voluntary or employer-sponsored? If employer-sponsored, by what percent does the employer contribute? ANSWER: For active employees, the fully-insured plan is employer sponsored and employer pays the full premium cost per employee enrolled in the plan. For retirees, the plan is voluntary / supplemental and employer collects full premium cost per retiree via pension payroll deduction or via check if no pension check is issued and remits same to vendor. c. Please provide the rates for the fully-insured plan. ANSWER: Rate information will not be provided. Vendors responding to this bid should propose their best rate based on the bid specifications. d. Do we need to include commissions in our rates and if so, what percent. ANSWER: The County is not contemplating assigning an agent to this account at this time, but reserves the right to do so a later date. All costs associated with the bid are to be disclosed and clearly identified. e. Please identify the owner of the network being used for the fully-insured plan? Please provide the name for that network. ANSWER: The network being used for the fully-insured materials-only vision plan is Heritage Vision Plans. Eye exams are covered under the employee s medical plan with a $10 copay: either through HAP, as a fully-insured HMO up to once a year per member or under BCBSM, as a self-insured plan up to once every two years per member, both based on a rolling 12 / 24-month period. f. Can you provide the most recent 24 months of monthly claims and enrollment for the fullyinsured plan? ANSWER: This information is not currently available. g. What is the requirement or condition for new hires to move from the reimbursement plan to the fully-insured plan? ANSWER: Employee must have been in the plan for a full two years before they can switch at the next open enrollment period. 8. For optical reimbursement plans: a. How are all plans funded? ANSWER: Employer pays 100% of the reimbursement up to the maximum amount allowed. b. Are the Optical Reimbursement Plans voluntary or employer-sponsored? If employersponsored, by what percent does the employer contribute? ANSWER: The Optical Reimbursement Program is employer-sponsored and the employer pays 100% of the reimbursement up to the maximum amount allowed. Page 3 of 6

4 c. Please provide the rates for the reimbursement insured plans. ANSWER: This is currently a self-funded, self-administered plan. Vendors responding to this bid should propose their best rate based on the bid specifications. d. Are you paying an administrative fee for the reimbursement plans and if so please provide the fee? ANSWER: The Optical Reimbursement Program is an employer /self-administered plan. Vendors responding to this bid should propose their best rate based on the bid specifications. e. Do we need to include commissions in our rates and/or fees and if so, what amount should be included (percentage or flat fee)? ANSWER: The County is not contemplating assigning an agent to this account at this time, but reserves the right to do so a later date. All costs associated with the bid are to be disclosed and clearly identified. f. What or whose network is being used by the optical reimbursement plan? Please provide the name for the network. ANSWER: The Optical Reimbursement Program is an employer /self-administered reimbursement plan. Employees are free to use any vision provider and submit for reimbursement under the plan. g. Can you provide monthly claims and enrollment by plan for the most recent 24 months? ANSWER: Reimbursement claim data for the Optical Reimbursement Program has already been posted on MITN. The census information provided includes information as to current enrollment as well as information as to which programs each employee is eligible to elect. h. What is the requirement or condition for new hires to move from the reimbursement plan to the fully insured plan? ANSWER: For those eligible to move into the Optical Reimbursement Program, employee must have been in the plan for a full two years before they can switch at the next open enrollment period. i. Are the employees free to select the plan or is eligibility linked to the length of service for new hires and retirees. ANSWER: Eligibility for enrollment in the Optical Reimbursement Program is dictated by the terms of the employee s collective bargaining agreement or benefit plan. j. What are the claim frequencies for the reimbursement plans, 12 months or 24 months? Please provide a summary of benefits available for the reimbursement plans? ANSWER: Employees / retirees may be reimbursed at any time during the two-year policy period which begins on October 1st of each odd year and ends on September 30th of the next odd year for any and all eligible optical expenses incurred during that period up to the maximum amount of the benefit. Eligible expenses include those incurred for prescription lenses (eyeglass or contact), prescription frames and vision examinations rendered by a licenses optometrist, optician or ophthalmologist. Tinting, scratch coatings, upgraded lens options are also reimbursable when included as part of the purchase price of prescription eyewear. The optical reimbursement benefit may also be used to reimburse lasik eye surgery Page 4 of 6

5 expenses. Non-prescription eyewear, warranties and purchase program fees are not reimbursable. A summary of the Optical Reimbursement Program is posted on MITN in conjunction with the Optical Reimbursement Form. k. Can we get a detailed plan description of all the Optical Reimbursement Plans? ANSWER: See response to question 8 (j) above and Optical Reimbursement Form and Program Information posted on MITN. l. The form provided indicates reimbursements will be made as a non-taxable earning in your bi-weekly payroll check/monthly pension check unless you are not currently receiving a regular payroll/. Do the reimbursement checks go back to Wayne County so it can handle the non-taxable earning aspect? We would like to have more details on the claims processing for this program and how the County would like for it to be handled. ANSWER: The current program is a self-administered, self-funded program. All claims for reimbursement are submitted directly to the Wayne County Benefits Administration Division using a reimbursement form, a copy of which has been posted on MITN. Once a claim for reimbursement has been deemed eligible for reimbursement, the reimbursement is paid as a separate earning on the employee s payroll / retiree s pension check. This earning is not subject to tax. If no check is printed by Wayne County (i.e., in the case of an employee on leave without pay, a claim submitted after leaving County employment, or a retiree that has no pension check but is eligible for health care benefits), a separate check is cut in the amount of the reimbursement. Vendor s providing proposals for taking over administration of the Optical Reimbursement Program can propose solutions that would include paying the reimbursement directly to the employee / retiree without further County involvement (i.e., vendor cuts the check) and/or providing claim administration services with claim payment determinations being sent to the County electronically so that the County can make the reimbursement to the employee / retiree (i.e., County cuts the check). If proposing more than one solution, please make sure to clearly state the cost differences between them. m. Please provide a list or summary of the services performed by your TPA that s administering the reimbursement plan. If done in house, please provide any additional information on how the program works today. ANSWER: There is currently no TPA administering the Optical Reimbursement Program it is a self-funded, self-administered program. See response to question 8(n) above for additional information. n. Are non-prescription optical expenses (sunglasses, cleaning solution, warranties etc) reimbursable? ANSWER: No. o. Will lasik surgery expenses be reimbursable? ANSWER: Yes, up to the maximum amount of benefit or remaining balance of the benefit, whichever is less. p. Is the program set up on a declining balance? For example: If a member was on the $175 reimbursement plan and submitted $80 for an exam, could they submit a $95 claim later in the month/year for their glasses. Page 5 of 6

6 ANSWER: Yes. 9. The RFP indicates that we need to match benefits. However, we don t have plan designs that are a 100% match. Can we provide a proposal as long as our plan(s) do not decrease any of the benefit provision? ANSWER: Yes. 10. Please confirm the number of eligible employees. The census only appears to have 3937 listed. The RFP states that there are 4000 full time and 5500 retirees. Please confirm and provide an updated census in excel if possible. ANSWER: The 4,000 active employee and 5,500 retiree figures were overall estimates. Use the census information provided on MITN in making your proposal determinations as it provides the most current data. 11. For Option 2 under scope of services, how would you like the Exam to be covered? 100%, or with a copay? ANSWER: Eye exams (without diagnosis) should be covered with a $10 copay. 12. HAP members get an exam every 12 months and BCBSM has one every 24 months. Can we get them identified on the census or a breakdown of how many are each plan? ANSWER: Of the approximately 2,247 active employees enrolled in the fully-insured vision plan, 804 employees are enrolled in the HAP HMO plan with vision exams covered once every 12 months and 1,443 employees are enrolled in a BCBSM plan with vision exams covered once every 24 months. 13. Is the experience available for HAP exam claims? ANSWER: This information is not currently available. Page 6 of 6