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[]
["Monthly Rate Exhibit - Current Plan Designs"]
[]
[null,"DPPO High"]
[]
[null,"Coverage Tier","Lives","Current"]
[null,"Employee",null,41.8]
[null,"Employee/Spouse",null,85.3]
[null,"Employee/Child(ren)",null,85.51]
[null,"Employee/Family",null,135.16999999999999]
[null,"Annual Total",null,{"$f":"SUMPRODUCT($C$9:$C$12,D9:D12)*12","v":0}]
[null,"$ Change",null,"n/a"]
[null,"% Change",null,"n/a"]
[]
[null,"DPPO Low"]
[]
[null,"Coverage Tier","Lives","Current"]
[null,"Employee",null,29.07]
[null,"Employee/Spouse",null,59.41]
[null,"Employee/Child(ren)",null,59.73]
[null,"Employee/Family",null,94.85]
[null,"Annual Total",null,{"$f":"SUMPRODUCT($C$9:$C$12,D20:D23)*12","v":0}]
[null,"$ Change",null,"n/a"]
[null,"% Change",null,"n/a"]
[]
[null,"DHMO"]
[]
[null,"Coverage Tier","Lives","Current"]
[null,"Employee",null,13.4]
[null,"Employee/Spouse",null,26.8]
[null,"Employee/Child(ren)",null,30]
[null,"Employee/Family",null,48.4]
[null,"Annual Total",null,{"$f":"SUMPRODUCT($C$9:$C$12,D31:D34)*12","v":0}]
[null,"$ Change",null,"n/a"]
[null,"% Change",null,"n/a"]

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[]
[null,null,"Request for Dental Proposal (RFP) for Escambia County School District (ECSD)"]
[null,null,"Introduction"]
[null,null,"Escambia County School District hereinafter referred to as \"ECSD\""]
[]
[null,null,"Current Plan Information"]
[null,null,"A description of the ECSD’s current plan design can be found on the \"Plan Design & Rates\" worksheet. Please quote on the proposed plan designs illustrated in the worksheets and utilizing the plan documents provided. \n"]
[null,null,"Scope of RFP"]
[null,null,"OPTION 1:  ECSD currently has a self-funded Direct Reimbursement Dental Plan and is marketing for a TPA/ASO Administrator.  There are currently 2 plan levels ($800 & $1,200 maximum allowance plans).  The TPA/ASO Administrator must be able to:  Make reimbursements to a member via direct deposit; handle two-party checks;  provide assignments;  and accept promissory notes from member to provider.  The Administrator must have a robust portal that is user friendly and members can find the following information:  EOBs, balance of plan allowance, file claims, review benefit plan information, etc.\n\nOPTION 2:  Option 2 should include all of the same requirements as Option 1 only with alternate plan designs detailed on the Plan Designs & Rates tab of this RFP.\n\nOPTION 3: ECSD is also interested in utilizing a wrap around PPO network."]
[]
[null,null,"Proposal Format"]
[null,null,"Your firm's completed proposal questionnaire will consist of two parts, all of which must be received in a single submission by the deadline to be considered for this marketing. Submissions must be provided on a thumb drive as detailed out in the Purchasing RFP & Proposal Acknowledgment document. Below is an overview of what each of part is intended to address."]
[]
[null,null,"Part 1: Proposal Questionnaire File:  A Questionnaire, sheet to provide Explanations, and a Financial Quote Worksheets is contained in this Excel file.  Your firm is expected to respond to the Questionnaire and the various worksheets by entering responses in this file in its entirety.  The majority of the questions on the Questionnaire tab have been structured to elicit declarative responses through the use of drop down boxes.  The entire workbook should be submitted in the original Excel format; with the exception of the \"Officer\" worksheet.  The \"Officer\" worksheet can be returned as a Portable Document Format (PDF) file."]
[]
[null,null,"To record your response:"]
[null,null,"*  Click on the response cell in the Response column;"]
[null,null,"*  Click on the down arrow which appears directly to the right of the cell;"]
[null,null,"*  Click on the response that best describes your answer."]
[]
[null,null,"To enter your responses where a numeric, percent or ratio value is indicated as the answer format, simply enter the value in the corresponding response cell."]
[]
[null,null,"Next to each response cell, additional space is available for a brief text explanation.  However, if the length of the explanation is greater than 400 characters, you must go to the \"Explanation\" worksheet to provide your detailed explanation.  All explanations must be numbered to correspond to the questions to which they pertain and should be brief.  "]
[null,null,"Electronic File Attachments:  Any attachments that you are being asked to provide about your firm must be submitted on the thumb drive requested. An explanation of each attachment that you are required to provide appears in the Questionnaire; please be sure to follow the naming conventions that are provided for each attachment."]
[null,null,"In order to help you organize your proposal and ensure that it is complete, please review the following list to ensure that you have provided each required item for your proposal. "]
[]
[null,null,"Tab #","Worksheet Description",null,"Name of Worksheet Tab"]
[null,null,1,"Introduction",null,"Introduction"]
[null,null,2,"Minimum Requirements",null,"Min. Requirements"]
[null,null,3,"Plan Administration and Service Capabilities",null,"Plan Administration and Service Capabilities"]
[null,null,4,"Net Cost Consideration",null,"Net Cost Consideration"]
[null,null,5,"Fees Tab",null,"Fees"]
[null,null,6,"Plan Design Questionnaire",null,"Plan Design"]
[null,null,7,"Plan Design and Rates Tab",null,"Quoted Plan Designs and Rates"]
[null,null,8,"Option #1 Current Plans",null,"Option #1"]
[null,null,9,"Option #2 Alternative Plan",null,"Option #2"]
[null,null,10,"Option #3 - Network Access and Disruption",null,"Option #3 Questions"]
[null,null,11,"GEO Access",null,"GEO Access"]
[null,null,12,"Related Experience and References",null,"Related Experience and Regerences"]
[null,null,13,"Optional Considerations ",null,"Optional Considerations "]
[null,null,14,"Reporting Tab",null,"Reporting"]
[null,null,15,"Performance Guarantees",null,"Performance Guarantees"]
[null,null,16,"Explanation",null,"Explanation"]
[null,null,17,"Officer Statement",null,"Officer"]
[]
[null,null,"Part 2: Attachments: Please be sure to follow the naming conventions that are provided in the questionnaires, for each attachment.  In order to help you organize your proposal and ensure you have provided each required item, please review the following list to ensure that you have provided each required item. "]
[]
[null,null,"Attachments - Dental",null,null,"Name the File"]
[null,null,"Dental Employer Contract",null,null,"[Your Organization's Name]_Sample Dental Employer Contract"]
[null,null,"Implementation Schedule",null,null,"[Your Organization's Name]_Dental Implementation Schedule"]
[null,null,"Marketing Materials",null,null,"[Your Organization's Name]_Dental Marketing Materials"]
[null,null,"Enrollment Materials",null,null,"[Your Organization's Name]_Dental Enrollment Materials"]
[null,null,"Explanation of Benefits",null,null,"[Your Organization's Name]_Sample EOB"]
[null,null,"Experience Reports",null,null,"[Your Organization's Name]_Dental Sample Experience Reports"]
[null,null,"Underwriting Worksheet",null,null,"[Your Organization's Name]_Underwriting Worksheet"]
[null,null,"Reasonable and Customary Charge Levels",null,null,"[Your Organization's Name]_Dental Charge Level Chart"]
[null,null,"Mobile App",null,null,"[Your Organization's Name]_Mobile App"]
[null,null,"GEO Access",null,null,"[Your Organization's Name]_GEO Access Report"]
[]
[null,null,"Cost of Submitting Proposal"]
[null,null,"All costs associated with your proposal, including preparation and presentation, will be borne by your firm and not ECSD."]
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[null,null,null,null,null,"Your firm can offer a pre-enrollment website and 800 number"]
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[null,null,null,null,null,"A designated account representative must be assigned to the M-DCPS. This account representative will have the responsibility and authority to manage the entire range of services discussed in this RFP and must be able to respond immediately to changes in plan design, changes in claims processing procedures, or general administrative problems identified by the M-DCPS."]
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[null,null,null,null,null,"Confirm that your firm will provide 1 onsite Customer/Claims Advocate for escalated claims and network issues.  This person will sit with M-DCPS Benefits team in their downtown Miami offices"]
[null,null,null,null,null,"Confirm on-site representative will be available to M-DCPS 90 days prior to 1/1/2020 to allow for training and participation in open enrollment."]
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[null,null,null,null,null,"Does your firm offer any special programs which serve to promote dental health and encourage preventive care, specifically for pregnant members or those with certain chronic conditions that may warrant additional / different services such as more covered cleanings in a given year?"]
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[null,null,null,25,null,"If your firm offers other product lines solicited in this RFP, please provide pricing breaks if your firm is to be awarded other lines of coverage. "]
[null,null,null,26]
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[]
[null,null,null,27]
[null,null,null,27]
[null,null,null,27]
[null,null,null,27]
[null,null,null,27]
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[null,null,null,32]
[null,null,null,33]
[null,null,null,33]
[null,null,null,33]
[null,null,null,33]
[null,null,null,33]
[null,null,null,33]
[null,null,null,33]
[null,null,null,33]
[null,null,null,33]
[null,null,null,33]

{"sheet":" Dental Questionnaire","index":2,"n_rows":374,"n_cols":7,"rows_kept":374,"cut":false,"hidden":false,"merged":[[5,4,5,6],[6,4,6,6]]}
[]
[]
[null,null,null,null,"Request for Proposal (RFP) for Escambia County School District (ECSD)"]
[null,null,null,null,"Dental Questionnaire "]
[]
[null,null,null,null,"Introduction"]
[null,null,null,null,"Escambia County School District, is soliciting bids to process employee dental claims in accordance with the employee Dental Benefit plan approved by the School Board. The District is interested in a renewable annual agreement with the initial term effective January 1, 2020.  "]
[]
[null,null,null,null,"MINIMUM REQUIREMENTS","Response","Explanation"]
[null,null,null,null,"The effective date of coverage is acknowledged and accepted."]
[null,null,null,null,"You must be licensed in Florida."]
[null,null,null,null,"Administrative fees must be guaranteed for a minimum of three (3) years from the effective date, with rate increase caps for years 4 and 5."]
[null,null,null,null,"Renewal rates must be submitted 120 days prior to the renewal date."]
[null,null,null,null,"You have reviewed and accept the notice of termination requirements."]
[null,null,null,null,"You have reviewed and accept the requirements relative to attendance at client and open enrollment meetings."]
[null,null,null,null,"Coverage must be provided on a no-loss / no-gain basis so the current group does not suffer a loss of benefit solely due to the transfer of coverages to your firm."]
[null,null,null,null,"Your systems must be compliant with the HIPAA Electronic Data Interface (EDI) requirements."]
[null,null,null,null,"You have reviewed and accept the requirements for eligibility administration."]
[null,null,null,null,"You have reviewed and accept the payment terms and conditions as set forth."]
[null,null,null,null,"The quoted rates / fees are NET of commissions."]
[null,null,null,null,"You have reviewed and accept the electronic reporting requirements."]
[null,null,null,null,"You have reviewed and accept the Proposed Performance Guarantees."]
[null,null,null,null,"You  have  reviewed and accept the data warehouse requirements."]
[null,null,null,null,"You have reviewed and accept the member communication requirements."]
[null,null,null,null,"You have reviewed and accept the Florida-based client management team requirement."]
[null,null,null,null,"You have reviewed and accept the transition management requirements."]
[]
[null,null,null,null,"PLAN ADMINISTRATION AND SERVICE CAPABILITIES","Response","Explanation"]
[null,null,null,null,"Dental General Information"]
[null,null,null,null,"Dental Organization / ASO Name"]
[null,null,null,null,"Date formed "]
[null,null,null,null,"Company Ratings: A.M Best, Moody's, Standard & Poor's"]
[null,null,null,null,"Number of  Employees"]
[null,null,null,null,"Number of groups over 5,000 employees in force"]
[null,null,null,null,"Number of public sector and/or school district clients"]
[null,null,null,null,"Number of covered/serviced employees"]
[null,null,null,null,"Have you recently been acquired or been involved with any merger/acquisition? If yes describe"]
[null,null,null,null,"What customer service office will be responsible for this account? "]
[null,null,null,null,"NAIC for Liable Underwriting Source"]
[null,null,null,null,"Street Address"]
[null,null,null,null,"City"]
[null,null,null,null,"State"]
[null,null,null,null,"Zip"]
[null,null,null,null,"Web Address"]
[null,null,null,null,"Dental Contacts"]
[null,null,null,null,"Please indicate the contact who can answer questions related to this dental RFP."]
[null,null,null,null,"Primary Contact"]
[null,null,null,null,"Name"]
[null,null,null,null,"Title"]
[null,null,null,null,"Address"]
[null,null,null,null,"City"]
[null,null,null,null,"State"]
[null,null,null,null,"Zip"]
[null,null,null,null,"Phone Number"]
[null,null,null,null,"Fax Number"]
[null,null,null,null,"E-mail Address"]
[null,null,null,null,"Secondary Contact"]
[null,null,null,null,"Name"]
[null,null,null,null,"Title"]
[null,null,null,null,"Address"]
[null,null,null,null,"City"]
[null,null,null,null,"State"]
[null,null,null,null,"Zip"]
[null,null,null,null,"Phone Number"]
[null,null,null,null,"Fax Number"]
[null,null,null,null,"E-mail Address"]
[null,null,null,null,"Dental Contract Information"]
[null,null,null,null,"January 1, 2020 is the contract effective date"]
[null,null,null,null,"The contract is to be issued in Florida unless you obtain permission from ECSD to use an alternative situs."]
[null,null,null,null,"Please include a copy of a sample employer contract that includes all exclusions and limitations that the vendor expects will apply to ECSD.  Attach and name the file:  \"[Your Organization's Name]_Sample Dental Employer Contract\"."]
[null,null,null,null,"Please attach a dental implementation schedule Including action items and due dates. In the attached, confirm the Company will prepare and distribute to District employees 30 days prior to effective date, a notice announcing the new address for filing a claim, point of contact, phone number, and step-by-step procedure to be followed in filing a claim, follow-up on a claim, and appealing a disputed claim. Attach and name the file:  \"[Your Organization's Name]_Dental Implementation Schedule\".",null,"`"]
[null,null,null,null,"Dental Eligibility "]
[null,null,null,null,"Employee: All full-time employees as defined as working more than 20 hours per week. "]
[null,null,null,null,"Spouse: Legal spouse"]
[null,null,null,null,"Children: Unmarried children under age 19, 25 if full-time student. \n    Includes:\n    - Natural children\n    - Children places for adoption and legally adopted children\n    - Stepchildren \n    - Eligible dependent for whom have court-approved legal guardianship\n    "]
[null,null,null,null,"Retiree - if: Eligible for benefits under the Florida Retirement System"]
[null,null,null,null,"Effective Date of Coverage "]
[null,null,null,null,"If hired the 1st through the 15th of the month, effective date will be the first of the month following date of hire\nIf hired the 16th through the end of the month, effective date will be the first of the second month following date of hire"]
[null,null,null,null,"Claims Administration"]
[null,null,null,null,"The Company will accept fiduciary responsibility for all payments made in error for any reason. The financial error rate will be less than 2%"]
[null,null,null,null,"Describe the edits used to ensure the integrity of the data and to guard against duplicate payments."]
[null,null,null,null,"Will the claims system automatically audit for duplicate payments?"]
[null,null,null,null,"Describe your systems, including back-up accommodations."]
[null,null,null,null,"Your system requires no manual operations at any point during the claims process."]
[null,null,null,null,"All dental procedures are coded using the ADA 4-digit code for in-network claims, out-of-network and out-of-area claims."]
[null,null,null,null,"The claims system maintains on-line eligibility files that are updated at least monthly."]
[null,null,null,null,"The claims system maintains dependent eligibility files."]
[null,null,null,null,"Claims system can meet COB requirements."]
[null,null,null,null,"COB data is updated at least annually."]
[null,null,null,null,"Your company can administer eligibility requirements and update systems at least monthly. The claims system will maintain eligibility of dependents. Electronic transmission to receive and update files will be acceptable."]
[null,null,null,null,"The claims system automatically screens for duplicate bills."]
[null,null,null,null,"Please note the source of your R&C information (HIAA, MDR, internally developed, other)"]
[null,null,null,null,"The security of the system, includes safeguards against employee embezzlement and theft."]
[null,null,null,null,"Plan summaries are stored in the computer memory for screening purposes."]
[null,null,null,null,"You maintain geographically specific reasonable and customary (R&C) charge screens for dental procedures."]
[null,null,null,null,"Your company can provide claims adjudication at varying R&C percentiles beginning with the 50th percentile."]
[null,null,null,null,"In the event of contract termination, how will you process the following?"]
[null,null,null,null,"Claims in house, but not processed"]
[null,null,null,null,"Claims mailed prior to termination but not received by your organization until after the termination?"]
[null,null,null,null,"Claims mailed after the termination?"]
[null,null,null,null,"Please answer the question by selecting 1 of the 4 options available and fill in the blanks in the explanation column if applicable.\nIn the event of contract termination, how will you process the \"run-out\" claims? 1) Service not available, 2) A predetermined fee per capita. $___ per capita for ____ months? 3) A predetermined fee for claim processed. $_____ per claim? 4) A predetermined percentage of paid claims. %___ of paid claim?"]
[null,null,null,null,"What are your current claims/customer service standards? What were your actual results for 2017 and 2018?"]
[null,null,null,null,"Describe insurance coverage limits for Errors and Omissions"]
[null,null,null,null,"Describe insurance coverage limits for Employee bonding"]
[null,null,null,null,"Dental Specifications"]
[null,null,null,null,"Audit Rights: It will be the right of ECSD or its representative(s) to audit claims at any time. Will you agree to an independent audit?"]
[null,null,null,null,"ECSD Logo: ECSD may wish to have its logo appear on various printed materials. The designated vendor must agree to this at no additional cost and must ensure that logo placement and color requirements are met."]
[null,null,null,null,"The vendor agrees not to appoint any agent, general agent, or broker, nor authorize payment of any kind to a party not approved in writing by ECSD."]
[null,null,null,null,"We understand that terminology and contract provisions may vary among the involved vendors. We will permit such alternative language provided benefit payment levels are not adversely impacted."]
[null,null,null,null,"Vendor agrees to accept this contract without preliminary funding prior to binding coverage January 1, 2020."]
[null,null,null,null,"Describe your process for Coordination of benefits. Has the process been contemplated in your quote? Is it negotiable? If so, what is the associated cost?"]
[null,null,null,null,"Please include copies of current marketing materials that you feel would be of assistance in evaluating your program.  Attach and name the file:  \"[Your Organization's Name]_Dental Marketing Materials\"."]
[null,null,null,null,"Please include copies of current member enrollment materials that you feel would be of assistance in evaluating your program.  Attach and name the file:  \"[Your Organization's Name]_Dental Enrollment Materials\"."]
[null,null,null,null,"Supply a sample EOB with EOB messages. The EOB shall include as a minimum, the name of the Insured, the patient covered, the Dentist providing the Services, the date services were provided, the ADA 4-digit procedural code number and description of services provided, and all itemized charges, deductibles applied, net reimbursement made, and balance due to the Dentist by the employee.  If a claim is not payable, an explanation for its rejection shall be stated.  Attach and name the file: \"[Your Organization's Name]_Sample EOB\"."]
[null,null,null,null,"What method does your firm utilize to determine Usual and Customary: HIAA, company profile, network contracted rates, RVS, etc.? "]
[null,null,null,null,"If HIAA (or related database, identify the percentage used."]
[null,null,null,null,"Can the client select a different level?"]
[null,null,null,null,"If a schedule, provide the name and conversation factors."]
[null,null,null,null,"How often are allowances revised? (Quarterly, monthly, semi-monthly, other)"]
[null,null,null,null,"For services not covered or not eligible for reimbursement, describe any discounts that members are eligible to receive. Also indicate any specific steps necessary on behalf of members to secure those discounts. "]
[null,null,null,null,"Administrative Capabilities"]
[null,null,null,null,"Confirm your organization will accept a self reported (self-bill) eligibility invoice and payment from ECSD on a monthly basis without reconciliation requirements."]
[null,null,null,null,"Confirm the District will wire transfer funds on a weekly basis to an account of the Company's choice within three workdays after receipt of documentation with details of checks issued for claims paid.  Documentation may be paper or electronic form.   No funds will be transferred without supporting documentation."]
[null,null,null,null,"Confirm acceptance of ECSD's eligibility file layout and payment process. Include details of any standard limitations to file receipt, banking, or wire transfers."]
[null,null,null,null,"Confirm that the Company will receive, process and issue a check to the employee in ten (10) workdays or less from receipt of claim request.  All disputes shall be reported to the Director of Risk Management for resolution. Reports shall track the average time required to process claims and indicate all exceptions."]
[null,null,null,null,"Confirm that you will accept electronic file transfers for eligibility in HIPAA 834 / 5010 format"]
[null,null,null,null,"Confirm that you will provide a complete, final Summary Plan Description / Benefit Certificate within 30 days of the effective date of the plan (1/1/2020)."]
[null,null,null,null,"Does your organization provide online access to  ECSD Risk Management staff to view and download claim and network utilization reports?"]
[null,null,null,null,"Please confirm that current retirees and future retirees may enroll in the proposed plans, as defined and administered by ECSD."]
[null,null,null,null,"Please see \"Reporting\" Tab within this RFP. Please confirm you can meet the requested frequency and reports availability. "]
[null,null,null,null,"Please attach a copy of a standard plan experience report provided on a monthly basis that ECSD can review regularly to evaluate your program. The frequency that the reports are available will be indicated. Reports will track and group charges by the ADA 4-digit procedure code.  Attach and name the file:  \"[Your Organization's Name]_Dental Sample Experience Reports\"."]
[null,null,null,null,"Online Capabilities"]
[null,null,null,null,"Please confirm which of the following tasks can members and sponsor representatives perform ONLINE?"]
[null,null,null,null,"Enrollment (New Hires and Open Enrollment)"]
[null,null,null,null,"Change in Status"]
[null,null,null,null,"Billing (Plan Administrators only)"]
[null,null,null,null,"Claim Inquiry (Direct Deposit Capabilities)"]
[null,null,null,null,"Provider Search"]
[null,null,null,null,"ID Card Request (only if applicable)"]
[null,null,null,null,"Electronic EOB"]
[null,null,null,null,"Terminations"]
[null,null,null,null,"Is there additional cost for ONLINE services?"]
[null,null,null,null,"If yes, describe."]
[]
[null,null,null,null,"NET COST CONSIDERATION","Response","Explanation"]
[null,null,null,null,"Dental Rate Development and Financial Information"]
[null,null,null,null,"A description of the current Administrative Fees and Current Rates are located in the \"Fees\" and \"Plan Design and Rates\" tab of the Questionnaire"]
[null,null,null,null,"Confirm your organization is providing a rate guarantee for Administrative Fees for a minimum of three (3) years with rate increase caps for years 4 and 5, as stated in the Minimum Requirements Section of this RFP. "]
[null,null,null,null,"Confirm you have uploaded an underwriting worksheet to support proposed rates  Attach and name the file:  \"[Your Organization's Name]_Underwriting Worksheet\"."]
[null,null,null,null," Please  provide  a  copy  of  your  most  recent  annual  financial  statement,  or  other documentation reflecting financial performance."]
[null,null,null,null,"Vendor's credibility factors used to generate quote"]
[null,null,null,null,"Trend"]
[null,null,null,null,"Vendor's expected or targeted loss ratios"]
[null,null,null,null,"Please confirm that any additional charges identified are completely cross-referenced in your response to the cost forms."]
[null,null,null,null,"Please specify the portion of the ACA Health Insurer Fee that is included in the proposed rates."]
[null,null,null,null,"Please attach a chart of your Reasonable and Customary Charge Levels.  Attach and name the file:  \"[Your Organization's Name]_Dental Charge Level Chart\"."]
[null,null,null,null,"Please see \"Performance Guarantee\" tab of this Questionnaire and confirm you agree with the requested PGs. "]
[null,null,null,null,"This RFP has described the communications efforts and requirements associated with the award of this contract. Do you have suggestions for less costly, more effective ways for communicating, in lieu of meetings? What would be the impact on cost?"]
[]
[null,null,null,null,"PLAN DESIGN","Response","Explanation"]
[null,null,null,null,"Dental Plan Design"]
[null,null,null,null,"A description of ECSD's current plan designs can be found in the \"Plan Design and Rates\" tab."]
[null,null,null,null,"Indicate all age and frequency limits within the proposed plans for the follow services:"]
[null,null,null,null,"Routine Adult Cleanings"]
[null,null,null,null,"Routine Child Cleanings"]
[null,null,null,null,"Topical Fluoride Treatments"]
[null,null,null,null,"Sealants"]
[null,null,null,null,"Space Maintainers"]
[null,null,null,null,"X-Rays / Bitewings"]
[null,null,null,null,"Panoramic X-rays"]
[null,null,null,null,"Appliances"]
[null,null,null,null,"Orthodontia"]
[null,null,null,null,"Specify restrictions, limitations, or exclusions related to composite fillings."]
[null,null,null,null,"Specify restrictions, limitations, or exclusions related to porcelain and high noble metal crowns. "]
[null,null,null,null,"Confirm Annual Deductible is waived for Preventive Care and Diagnostic services."]
[null,null,null,null,"Please describe the \"Missing Tooth\" clause included in your policy."]
[null,null,null,null,"Please confirm how local anesthesia is a covered service under the dental plans."]
[null,null,null,null,"Is General Anesthesia covered?"]
[null,null,null,null,"If yes, please provide details, limitations, and exclusions"]
[null,null,null,null,"Preventive and Diagnostic care is excluded from annual maximum accumulators"]
[null,null,null,null,"Cover sealants up to age 19"]
[null,null,null,null,"Annual Maximum benefit carryover/extension feature"]
[null,null,null,null,"Benefits in excess of the Annual Maximum"]
[null,null,null,null,"Added coverage for additional cleanings for specific medical conditions (e.g. maternity, diabetes) aimed to improve health and promote wellness"]
[null,null,null,null,"Discounts for additional services"]
[null,null,null,null,"Added benefits for non-network providers"]
[null,null,null,null,"Wellness benefits that integrate with the health plan or wellness program"]
[null,null,null,null,"Other (please describe)"]
[null,null,null,null,"Confirm you can administer taking over the Orthodontic Benefit if the patient was already fully banded prior to the effective date of the contract."]
[null,null,null,null,"What happens to work in progress when coverage is terminated?"]
[null,null,null,null,"Does your policy differ for orthodontia treatment? If so, please explain."]
[null,null,null,null,"Do you require pre authorization (submission of a treatment proposal for predetermination of costs) prior to service for any dental procedures or for treatment exceeding a specified dollar amount? "]
[null,null,null,null,"Describe your process for handling appeals."]
[null,null,null,null,"What is the pre-determination of benefits threshold amount in your proposed plans?"]
[null,null,null,null,"Describe Late Entrant definition and any rules that apply."]
[null,null,null,null,"Will Late Entrant rules be waived for all employees joining the plan 1/1/2020, regardless of prior coverage?"]
[null,null,null,null,"Do you have an extension of benefits when an employee initiates treatment while covered and completes it after termination of coverage? "]
[null,null,null,null,"If member cost is greater than $250, are Dentists required to follow the Least Expensive Alternative Treatment plan?"]
[null,null,null,null,"How and when do you assume responsibility for orthodontic treatment that is in process on the effective date?"]
[null,null,null,null,"How are out-of-area dental emergencies handled?"]
[]
[null,null,null,null,"OPTION #3 ONLY - NETWORK ACCESS AND DISRUPTION","Response","Explanation"]
[null,null,null,null,"Dental General Information"]
[null,null,null,null,"We will be conducting a GEO Access and Provider Disruption Analysis. Please see GEO Access Standards and Provider Disruption tabs and confirm you have responded accordingly. "]
[null,null,null,null,"Network ownership/controlling interest"]
[null,null,null,null,"Network Name"]
[null,null,null,null,"Please provide the total number of providers in Escambia County for each of the following:"]
[null,null,null,null,"Total network PPO membership as of 1/1/2018"]
[null,null,null,null,"Total network PPO membership as of 1/1/2017"]
[null,null,null,null,"Dental Provider Management Capabilities"]
[null,null,null,null,"During the dentist selection/credentialing process, indicate if primary verification is used to check the following items."]
[null,null,null,null,"Graduation from an accredited US college of dentistry"]
[null,null,null,null,"Valid state license (for state of practice)"]
[null,null,null,null,"Board certification/eligibility appropriate to practice area"]
[null,null,null,null,"Federal and state DEA controlled substance registration and unrestricted prescribing privileges"]
[null,null,null,null,"Malpractice coverage"]
[null,null,null,null,"Detailed malpractice history"]
[null,null,null,null,"Detailed history of disciplinary action or litigation"]
[null,null,null,null,"Membership in professional organization"]
[null,null,null,null,"Detailed history of general health"]
[null,null,null,null,"Detailed history of chemical dependency"]
[null,null,null,null,"Detailed history of mental health"]
[null,null,null,null,"Detailed history of conviction for fraud or felony"]
[null,null,null,null,"Dental PPO Network Information"]
[null,null,null,null,"Has the dental Geo-Access reporting been completed using the requested PPO Network parameters?"]
[null,null,null,null,"Confirm that if a provider has multiple locations, the provider is only counted once"]
[null,null,null,null,"Please note the dental geo-mapping method used:"]
[null,null,null,null,"Number of general/family (GFDs) accepting new patients."]
[null,null,null,null,"Number of members per general/family dentist."]
[null,null,null,null,"Length of GFD contract"]
[null,null,null,null,"How many providers were added to your network last year?"]
[null,null,null,null,"Number of GFDs who left the network last year (due to both voluntary and involuntary reasons)."]
[null,null,null,null,"Reimbursement - Percent of GFDs' services paid by:"]
[null,null,null,null,"Capitation"]
[null,null,null,null,"Fee Schedule"]
[null,null,null,null,"Discounted fees"]
[null,null,null,null,"Incentive programs (bonus, withholds)"]
[null,null,null,null,"GFDs' average percent discount."]
[null,null,null,null,"Percent of dental specialists who are board certified in network by type:"]
[null,null,null,null,"Endodontists"]
[null,null,null,null,"Oral Surgeons"]
[null,null,null,null,"Periodontists"]
[null,null,null,null,"Prosthodontists"]
[null,null,null,null,"Orthodontists"]
[null,null,null,null,"Length of dental specialist contract"]
[null,null,null,null,"Reimbursement - Percent of specialists' services paid by:"]
[null,null,null,null,"Capitation"]
[null,null,null,null,"Fee Schedule"]
[null,null,null,null,"Discounted fees"]
[null,null,null,null,"Incentive programs (bonus, withholds)"]
[null,null,null,null,"Dental specialists' average percent discount."]
[null,null,null,null,"Does your company lease networks?"]
[null,null,null,null,"Are the savings reported net of those leasing costs?"]
[null,null,null,null,"How are preferred dentists paid? Discounted fee for service? Fee schedule? Other?"]
[null,null,null,null,"Do you have differing network provider arrangements (preferred vs. participating?)"]
[null,null,null,null,"If you answered yes to the above question, please answer yes or no to the following: "]
[null,null,null,null,"Preferred providers: Are network discounts available with plan design differentials? "]
[null,null,null,null,"Preferred providers: Are network discounts available with no plan design differentials?"]
[null,null,null,null,"Participating providers: Are network discounts available with plan design differentials?"]
[null,null,null,null,"Participating providers: Are network discounts available with no plan design differentials?"]
[null,null,null,null,"Does your organization provide online access to ECSD Risk Management staff to view and modify eligibility and claims data?"]
[null,null,null,null,"How are participating dentists paid? Discounted fee for service? Fee Schedule?"]
[null,null,null,null,"Please be sure to include a Florida provider directory."]
[null,null,null,null,"If a participating dentist refers a patient outside the network, are benefits paid at the PPO level?"]
[null,null,null,null,"Describe your benefits for emergency care in the service area."]
[null,null,null,null,"Describe your benefits for emergency care outside the service area. "]
[null,null,null,null,"Is the PPO Network proposed a National network or available only in Florida?"]
[null,null,null,null,"How do you accommodate dependents who attend college away from home?"]
[null,null,null,null,"Network dentists routinely submit claims to the network and the claims administrator (For example, is it a paperless process from the employee's point of view)."]
[null,null,null,null,"Network members enrolled in the PPO never have to submit claim forms for in-network services. The Company will supply all standard claim forms if required."]
[null,null,null,null,"Each of your networks serving ECSD members is supported by a computerized, on-line direct access claims processing system containing plan/claim information storage and retrieval."]
[null,null,null,null,"With regard to network directories, please respond to the following:"]
[null,null,null,null,"a. How frequently are directories distributed?"]
[null,null,null,null,"b. How are members, plan sponsors and providers notified of changes?"]
[null,null,null,null,"c. Is your directory available on the Internet or WEB? If so, please explain."]
[]
[null,null,null,null,"RELATED EXPERIENCE AND REFERENCES","Response","Explanation"]
[null,null,null,null,"Qualifications of Staff - Account Management  "]
[null,null,null,null,"Confirm at least the following dentist-specific database information is available to members by calling the member services department or viewing online: name, specialties, age, sex, years in practice, board certification, education, fluent languages, hours of operation, accepting new patients, and number of complaints."]
[null,null,null,null,"Can dental network members access emergency care 24 hours a day, 7 days a week via a national toll-free number?"]
[null,null,null,null,"Identify key personnel that will directly support this contract, and whose performance appraisal is impacted by their performance on this contract.  Do not include first-line supervisor personnel at this point.  Be sure to include, at least, the below functions.  Also, please indicate the expected percentage of time that each manager will devote to this contract and the number of years of experience in handling contracts similar in scope to ECSD."]
[null,null,null,null,"Senior Corporate Officer with ultimate decision-making authority for this contract"]
[null,null,null,null,"Account Manager"]
[null,null,null,null,"Network Building/Provider Relations Manager(s)"]
[null,null,null,null,"Account Manager"]
[null,null,null,null,"Customer Service Manager"]
[null,null,null,null,"Dental Director"]
[null,null,null,null,"Utilization Review Director"]
[null,null,null,null,"Senior Underwriter"]
[null,null,null,null,"Describe how your company will support ECSD."]
[null,null,null,null,"Qualifications of Staff - Claims Adjudicators"]
[null,null,null,null,"Number of full-time equivalent (FTEs) claims adjudicators that will be assigned to ECSD's contract."]
[null,null,null,null,"Will these claims adjudicators be dedicated solely to ECSD's contract? "]
[null,null,null,null,"What are the qualifications of the claims adjudicators to be assigned to the contract?"]
[null,null,null,null,"Educational Degree"]
[null,null,null,null,"Years of Experience"]
[null,null,null,null,"Number of Clients served"]
[null,null,null,null,"What type of formal training is done for your claims adjudicators?"]
[null,null,null,null,"Describe your process for solving escalated complaints of claims adjudication."]
[null,null,null,null,"Qualifications of Staff - Customer Service/Call Center Representative"]
[null,null,null,null,"Number of full-time equivalent (FTEs) customer service/call center representatives will be assigned to the contract"]
[null,null,null,null,"Will these customer service/call center representatives be dedicated solely to ECSD's contract?  "]
[null,null,null,null,"What are the qualifications of the customer service/call center representatives to be assigned to the contract?  "]
[null,null,null,null,"Educational Degree"]
[null,null,null,null,"Years of Experience"]
[null,null,null,null,"Number of Clients served"]
[null,null,null,null,"Bilingual staff"]
[null,null,null,null,"Confirm extension of customer services hours during open enrollment (nightly and weekends). "]
[null,null,null,null,"Describe your process for solving escalated complaints of call center service."]
[null,null,null,null,"Member Satisfaction and Quality of Services"]
[null,null,null,null,"Describe your processes and controls in providing member services (by phone, letter in person and/or on-line)"]
[null,null,null,null,"Confirm whether ID cards are provided to members (if applicable)."]
[null,null,null,null,"Confirm there is a single toll-free, customer service telephone number for addressing claims payment, member services and any appeals."]
[null,null,null,null,"Confirm that a dedicated individual or the Company will refer all disputes concerning payments to the District's Director of Risk Management"]
[null,null,null,null,"Indicate any minimum requirement for employee/retiree and dependent participation. Please be specific as to specific funding and/or plan design alternatives."]
[null,null,null,null,"Confirm each dependent member can choose dentists independently."]
[null,null,null,null,"Confirm any age requirement for pediatrics."]
[null,null,null,null,"Does your organization have a mobile app?  If so, please attach details on services available through the app. Name the document: \"[Your Organization's Name]_Mobile App\"."]
[null,null,null,null,"Does your organization have a secure website for employees to log in and view claims experience?"]
[null,null,null,null,"Can members see pre-treatment estimates online?  "]
[null,null,null,null,"What decision making tools are available to members?"]
[null,null,null,null,"Can members file claims online for out of network services online?"]
[null,null,null,null,"LEGAL/CONTRACTUAL & COMPLIANCE","Response","Explanation"]
[null,null,null,null,"Compliance, Privacy, and Confidentiality"]
[null,null,null,null,"Indicate status as a small or minority business enterprise, or provide a plan to incorporate small or minority business in your proposal. "]
[null,null,null,null,"The vendor adopts and implements written confidentiality policies and procedures in accordance with applicable law to ensure the confidentiality of member information used for any purpose."]
[null,null,null,null,"How are Business Associate Agreements to be addressed?"]
[null,null,null,null,"The vendor 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."]
[null,null,null,null,"The vendor agrees to use appropriate safeguards to prevent the unauthorized use or disclosure of the PHI.  Vendor agrees to report to the plan sponsor any unauthorized use or disclosure of the PHI."]
[null,null,null,null,"The 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."]
[null,null,null,null,"The vendor agrees to ensure that any agent, including a subcontractor, to whom it provides PHI received from, or created or received by the vendor agrees to the same restrictions and conditions that apply to vendor with respect to such information."]
[null,null,null,null,"The 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 the vendor agrees to implement reasonable and appropriate safeguards to protect such PHI."]
[null,null,null,null,"Dental Legal/Contractual/Compliance"]
[null,null,null,null,"Vendor has complied with all state insurance department filing requirements for all plans/products being offered in this quote in each state in which ECSD has employees.  "]
[null,null,null,null,"If the answer to the preceding question is \"no\",  for all plans/products quoted in this RFP for which the required state insurance department filing requirements have not been met, please specify the applicable plan/product and corresponding state."]
[null,null,null,null,"Vendor is bonded"]
[null,null,null,null,"Vendor maintains a fidelity bond."]
[null,null,null,null,"Vendor maintains professional liability insurance that exceeds $5 million per claim and $20 million aggregate. "]
[null,null,null,null,"If not please explain amount of coverage."]
[null,null,null,null,"Liability insurance covers:"]
[null,null,null,null,"Dental review decisions"]
[null,null,null,null,"Dentist contracting"]
[null,null,null,null,"Please describe any judgment or settlement during the past three years or pending litigation that could result in judgments or settlements in excess of $100,000."]
[null,null,null,null,"The vendor maintains executed contracts with all providers participating in the network."]
[null,null,null,null,"The vendor agrees to comply with all provisions set forth within all federal and state legislation requirements, including but not limited to HIPAA and ACA."]
[null,null,null,null,"Your organization is not a creditor of any provider in the network."]
[null,null,null,null,"Vendor agrees to indemnify and hold ECSD harmless for Vendor’s negligence or for Vendor’s failure to perform under the Agreement.  ECSD shall not provide any indemnity in favor of the Vendor.  Vendor agrees to language contained in worksheet \"Hold Harmless\"."]
[null,null,null,null,"The vendor 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."]
[null,null,null,null,"References"]
[null,null,null,null,"List three current clients as references that are using the same or similar services as requested in this RFP. "]
[null,null,null,null,"Company Name"]
[null,null,null,null,"Address"]
[null,null,null,null,"Contact Name"]
[null,null,null,null,"Contact Phone Number"]
[null,null,null,null,"Years as Client"]
[null,null,null,null,"Number of Claims Processed Annually"]
[null,null,null,null,"Company Name"]
[null,null,null,null,"Address"]
[null,null,null,null,"Contact Name"]
[null,null,null,null,"Contact Phone Number"]
[null,null,null,null,"Years as Client"]
[null,null,null,null,"Number of Claims Processed Annually"]
[null,null,null,null,"Company Name"]
[null,null,null,null,"Address"]
[null,null,null,null,"Contact Name"]
[null,null,null,null,"Contact Phone Number"]
[null,null,null,null,"Years as Client"]
[null,null,null,null,"Number of Claims Processed Annually"]
[]
[null,null,null,null,"OPTIONAL CONSIDERATIONS","Response","Explanation"]
[]
[null,null,null,null,"Please confirm your company will agree to provide a pre-implementation audit credit of $25,000 to be used prior to, or within the first 6 months of the effective date. "]
[null,null,null,null,"Please confirm your company agrees to provide a claims audit credit of $35,000 to be used within the initial contract period. "]
[null,null,null,null,"Confirm proposal includes a one-time $10,000 allowance for implementation communication and support."]

{"sheet":"Fees","index":3,"n_rows":34,"n_cols":5,"rows_kept":34,"cut":false,"hidden":false,"merged":[[4,4,5,4],[25,1,25,2],[24,1,24,2],[21,1,21,2],[22,1,22,2],[23,1,23,2],[10,1,10,2],[9,1,9,2],[14,1,14,2],[15,1,15,2],[12,1,12,2],[11,1,11,2],[4,1,5,2],[6,1,6,3],[7,1,7,3],[8,1,8,3],[4,3,5,3],[20,1,20,2],[19,1,19,2],[18,1,18,2],[17,1,17,2],[13,1,13,2],[31,1,31,2],[32,1,32,2],[33,1,33,2],[26,1,26,2],[27,1,27,2],[28,1,28,2],[29,1,29,2],[30,1,30,2]]}
[]
[null,{"$f":"' Dental Questionnaire'!E3","v":"Request for Proposal (RFP) for Escambia County School District (ECSD)"}]
[null,"Dental Administration Fees"]
[]
[null,"Important! Please Read: ",null,"Current","Vendor Response"]
[]
[null,"Self-funded/ASO quotes: The administrative services fees should be quoted in full detail. Fees must be valid for a minimum of three years. Maximum rate increase caps must be provided for years 4 and 5. The District is currently administering a self-funded Dental Plan. The contractor will assume the responsibility of processing dental claims using a Direct Reimbursement process for district employees, retirees, and covered dependents. "]
[null,"Capabilities: The company will attest to possess the necessary capacities, resources, and knowledge to implement the Dental Benefit plan as presented in the Plan Designs & Rates tab and in accordance to the terms, conditions, and specifications herein. "]
[null,"Runout Provision: Upon completion of the contract term, cancellation or termination, the Vendor will administer all runout claims incurred prior to the date of cancellation, termination or completion for a period not to exceed 90 days. "]
[null,"Dental Administration Fees",null,"Current","Vendor Response"]
[null,"Base administration fee",null,1.43]
[null,"Benefit Certification",null,"Included"]
[null,"Preparation of claims for processing",null,"Included"]
[null,"Computation of benefits",null,"Included"]
[null,"Issuance of checks with EOB's (Explanation of Benefits) or Direct Deposit (ACH) with an electronic EOB's through the vendor portal",null,"Included"]
[null,"Claims control activities",null,"Included"]
[null,"Coordination of benefits",null,"Incuded"]
[null,"Auditing services",null,"Included"]
[null,"Filing applicable 1099's to providers at year end",null,"Included"]
[null,"Direct deposit of Claim payments into Employee bank accounts. Relevant bank account infomration to be supplied to vendor by Employer",null,"Included"]
[null,"On-line employee access to vendor portal to access claims submitted and paid. The on-line portal will replace the mailing of EOB's when claim payment are disbursed by ACH payment. Notification to the employee email address of the EOB processing to be sent if available.",null,"Included"]
[null,"Reporting"]
[null,"Claims paid",null,"Included"]
[null,"Claim checks issues",null,"Included"]
[null,"Current Census",null,"Included"]
[null,"Claims Paid - Monthly by Patient/Employee",null,"Included"]
[null,"Quarterly Year to Date report of payments by Provider",null,"Included"]
[null,"Quarterly Year to Date report of payments by Patient/Employee",null,"Included"]
[null,"Quarterly Year to Date report of payments by ADA code",null,"Included"]
[null,"Vendor shall prepare and print the following: ",null,"Included"]
[null,"Enrollment forms",null,"Included"]
[null,"Claim checks issues",null,"Included"]
[null,"Plan documents, if necessary",null,"Included"]
[null,"I.D. Cards, if necessary",null,"Included"]

{"sheet":"Plan Designs & Rates","index":4,"n_rows":40,"n_cols":10,"rows_kept":40,"cut":false,"hidden":false,"merged":[[24,5,24,9],[25,5,25,9],[4,1,4,9],[22,1,22,9]]}
[]
[null,{"$f":"' Dental Questionnaire'!E3","v":"Request for Proposal (RFP) for Escambia County School District (ECSD)"}]
[null,"Dental Plan Designs and Rates"]
[]
[null,"Option 1 - Current"]
[]
[null,null,"Current ","Deviations"]
[null,"Plan Benefits","Base Plan",null,null,"Basic","Enrolled","Rates","ER\nSubsidy ","EE\nContrib."]
[null,"Maximum Dental Allowance","$800 per person, per plan year\n(excluding ortho)",null,null,"Employee Only",1777,13.65,12.65,1]
[null,"Dental Coinsurance ","Plan pays 90% of first $125 \n(excluding ortho)",null,null,"Employee+Family",1061,28.1,12.65,15.45]
[null,"Plan Year Deductible","$100 (1 deductible per person, 3 per family, per plan year)",null,null,"Retiree Only & LOA",1203,13.65,0,13.65]
[null,"Remaining Coinsurance","Plan pays 50% after deductible to a max of $800",null,null,"Retiree+Family & LOA",700,28.1,0,28.1]
[null,"Orthodontics ","Plan Pays 50% to a lifetime\nmax of $1,000\n(limited to dep. children to age 19)"]
[null,null,"Enhanced Buy-Up Plan",null,null,"Enhanced","Enrolled","Rates","ER\nSubsidy ","EE\nContrib."]
[null,"Maximum Dental Allowance","$1,200 per person, per plan year\n(excluding ortho)",null,null,"Employee Only",582,22.200000000000003,12.65,9.5500000000000007]
[null,"Dental Coinsurance ","Plan pays 100% of the first $125 \n",null,null,"Employee+Family",377,50.65,12.65,38]
[null,"Plan Year Deductible","$100 (1 deductible per person, 3 per family, per plan year)",null,null,"Retiree Only & LOA",221,22.200000000000003,0,22.200000000000003]
[null,"Remaining Coinsurance","Plan pays 50% after deductible to a max of $1,200",null,null,"Retiree+Family & LOA",92,50.65,0,50.65]
[null,"Orthodontics ","Plan Pays 50% to a lifetime\nmax of $1,000\n(limited to dep. children to age 19)",null,null,"Current Plan Document"]
[]
[]
[]
[null,"Option 2 - Alternative Plan "]
[]
[]
[null,null,"Alternative Plan","Deviations",null,"Please enter your proposed premium equivalent rates:"]
[null,"Plan Benefits","Base Plan",null,null,"Basic","Enrolled","Rates","ER\nSubsidy ","EE\nContrib."]
[null,"Deductible","$50/$100",null,null,"Employee Only",1777]
[null,"Preventative",1,null,null,"Employee+Family",1061]
[null,"Basic",0.8,null,null,"Retiree Only & LOA",1203]
[null,"Major",0.5,null,null,"Retiree+Family & LOA",700]
[null,"Ortho",0.5]
[null,"Annual Max",800]
[null,null,"Enhanced Buy-Up Plan",null,null,"Enhanced","Enrolled","Rates","ER\nSubsidy ","EE\nContrib."]
[null,"Deductible","$50/$100",null,null,"Employee Only",582]
[null,"Preventative",1,null,null,"Employee+Family",377]
[null,"Basic",0.8,null,null,"Retiree Only & LOA",221]
[null,"Major",0.5,null,null,"Retiree+Family & LOA",92]
[null,"Ortho",0.5]
[null,"Annual Max",1200]

{"sheet":"Reporting","index":5,"n_rows":22,"n_cols":4,"rows_kept":22,"cut":false,"hidden":false,"merged":[[5,1,5,3]]}
[]
[null,{"$f":"' Dental Questionnaire'!E3","v":"Request for Proposal (RFP) for Escambia County School District (ECSD)"}]
[null,"Reporting"]
[]
[]
[null,"Electronic Data Collection Reporting Requirements "]
[]
[null,"Reports","Frequency","Report Availability "]
[null,"Premium vs. Claim","Monthly","All Insured Plans"]
[null,"Payments by Month","Monthly","All ASO Plans"]
[null,"Payments by Benefit Type","Monthly","All Plans"]
[null,"Detail Payment","Monthly","All Health"]
[null,"Claim Lag","Annually","All ASO Plans"]
[null,"Executive Summary Report (includes Analysis, Trend Summary, Enrollment Profile, Total Case Analysis, and Network Analysis Report)","Annually","All Plans"]
[null,"Distribution of Discounts","Annually, or more frequently","All PPO Plans"]
[null,"Distribution of Other Savings","Annually, or more frequently","All Plans"]
[null,"Network Utilization","Quarterly","All PPO Plans"]
[null,"Top Dental Providers Ranked by Total Net Paid","Annually, or more frequently","All Plans"]
[null,"Membership by Month","Monthly","All Plans"]
[null,"Membership by Line of Coverage","Monthly","All Health"]
[null,"Comparative Total Cost per Member per Plan","Annually, or more frequently","All Plans"]
[null,"Distribution of Payment Analysis (Cost Sharing, Plan Costs, and Claims deemed not eligible)","Quarterly","All Plans"]

{"sheet":"Geo Access Request Standards","index":6,"n_rows":17,"n_cols":4,"rows_kept":17,"cut":false,"hidden":false,"merged":[]}
[]
[null,{"$f":"' Dental Questionnaire'!E3","v":"Request for Proposal (RFP) for Escambia County School District (ECSD)"}]
[null,"Dental Geographical Access Report"]
[]
[]
[null,"Instructions:"]
[null,"a. Include all member zip codes listed on the census"]
[null,"b. Only list multiple locations if there is a dentist in each location accepting new patients"]
[null,"c. Only report providers in your Florida PPO network; This report of access should reflect the same network reported in the Provider Disruption analysis"]
[null,"d. If proposing more than one provider network for the PPO, please complete at SEPARATE Geo Access report for each network proposed."]
[]
[null,"Type of Provider","Number of Dental Providers","Miles from Residence"]
[null,"General Dentists",2,10]
[null,"Orthodontists",2,10]
[null,"Periodontists",2,10]
[null,"Oral Surgeon",2,10]
[null,"Endodontists",2,10]

{"sheet":"Performance Guarantees","index":7,"n_rows":51,"n_cols":5,"rows_kept":51,"cut":false,"hidden":false,"merged":[[50,1,50,3],[5,1,5,3],[42,4,44,4],[48,4,49,4],[11,1,16,1],[14,3,16,3],[8,3,10,3],[8,1,10,1],[11,3,13,3],[33,3,35,3],[30,1,35,1],[39,3,41,3],[39,1,41,1],[20,4,21,4],[22,4,29,4],[30,4,32,4],[48,1,49,1],[30,3,32,3],[42,3,44,3],[17,3,19,3],[45,3,47,3],[22,3,29,3],[48,3,49,3],[20,3,21,3],[22,1,29,1],[36,1,38,1],[36,3,38,3],[42,1,44,1],[45,1,47,1]]}
[]
[null,{"$f":"' Dental Questionnaire'!E3","v":"Request for Proposal (RFP) for Escambia County School District (ECSD)"}]
[null,"Dental Performance Guarantees"]
[]
[]
[null,"The District requests each Vendor to place a portion of the total annual premium paid at risk, based on the performance measurements outlined below."]
[]
[null,"  Service Category","Expected Standards/Results","% Risk","Vendor Response"]
[null,"Claims Processing Accuracy","Vendor guarantees that 95% of claims will be processed accurately.",0.02]
[null,null,"The percentage of audited client claims processed accurately. Calculated as the total number of audited claims. Definition of “error” includes any type of error that has an affect on the member or provider, e.g. incorrect explanations of benefits or payments. processed without any errors, divided by the total number of audited claims. Each type of error is counted as one full error and no more than one error can be assigned to one claim. "]
[null,null,"Measurement will be Quarterly, with monthly reporting to client. Based on randomly selected statistical audit sample results."]
[null,"Claim Turnaround Time","Vendor guarantees that 95% of clean claims (claims that do not require audit or PROVIDER consultation adjudication) will be processed within fourteen (14) calendar days or 10 business days. ",5.0000000000000001E-3]
[null,null,"Claims turnaround time includes all working days from the initial receipt of the payment claim with complete information to the date the claim is processed. The day the claim is received will not be included in this calculation."]
[null,null,"Measurement will be on a client-specific basis, reviewed monthly, reported quarterly and paid annually. Based on randomly selected statistical audit sample results."]
[null,null,"Vendor guarantees that 98% of clean claims (claims that do not require audit or PROVIDER consultation adjudication) will be processed within fourteen (14) calendar days or tne (10) business days. ",1.4999999999999999E-2]
[null,null,"Claims turnaround time includes all working days from the initial receipt of the payment claim with complete information to the date the claim is processed. The day the claim is received will not be included in this calculation."]
[null,null,"Measurement will be on a client-specific basis, reviewed monthly, reported quarterly and paid annually. Based on randomly selected statistical audit sample results."]
[null," Financial Accuracy","Vendor offers that the percentage of dollars paid accurately will not be less than 99%.",0.02]
[null,null,"Financial (dollar) accuracy is defined as the percentages of dollars paid correctly over the total dollar that should have been paid in the sample."]
[null,null,"Measurement will be on a client-specific basis, reviewed monthly, reported quarterly and paid annually.  Based on randomly selected statistical audit sample results."]
[null,"Registration and Activity on Website/Portal","Website availability:  Vendor guarantees that their website for ECSD employees has 99.8% availability, twenty-four (24) hours a day, seven (7) days a week except for planned maintenance.",0.01]
[null,null,"Measurement will be on a client-specific basis, reviewed and reported semi-annually and paid annually."]
[null,"Customer Service","Vendor’s average speed to answer will be thirty (30) seconds or less for 90% of calls.",0.02]
[null,null,"The Amount of time that elapses between the time a call is received into the phone system to the time answered by a representative (live voice answer)."]
[null,null,"Measurement will be on a client-specific basis, reviewed monthly, reported quarterly and paid annually.  Based on randomly selected statistical audit sample results."]
[null,null,"Vendor will provide a written response within five (5) business days to 90% of enrollees filing a grievance and 98% within(15) days of receipt."]
[null,null,"Vendor will resolve all Appeals &  Grievances within thirty (30) days. 98% of all Appeals & Grievances will be resolved within sixty (60) days."]
[null,null,"Percent of telephone inquiries completely resolved at the time of initial contact will be no less than 95% within one (1) business day."]
[null,null,"First call resolution rate is the number of telephone inquiries completely resolved within one (1) business day in which the call was opened divided by the total number of calls received by that service team."]
[null,null,"Measurement will be on a global basis, reviewed monthly, reported quarterly and paid annually."]
[null,"Patient Satisfaction Survey","Vendor will ensure initial survey, follow up survey and annual employee satisfaction surveys be provided.",0.02]
[null,null,"Results are to be determined by dividing the number of “satisfied” and “very satisfied” and “neutral”  responses by the total number of “satisfied”, “very satisfied”, ”neutral”  dissatisfied” and “very dissatisfied” responses."]
[null,null,"Measurement will be yearly. EX: Initial survey Feb. 2020 annual: Each Feb after 2021"]
[null,null,"Vendor will ensure that 90% of provider satisfaction survey participants will be satisfied or very satisfied.",0]
[null,null,"Mutually agreed upon survey tool.\nStatistically valid sample to determine initial satisfaction benchmark.\nFollow-up survey with results compared to initial benchmark to demonstrate improvement or lack thereof.\nAnnual survey to continue to monitor Contractor’s services."]
[null,null,"Measurement will be yearly. EX: Initial survey Feb. 2020 annual: Each Feb after 2021"]
[null,"Provider Service","Vendor will ensure that 90% of providers will accept new patients.",0.02]
[null,null,"Review panel and determine cumulative open panel access"]
[null,null,"Measurement will be quarterly reported forty-five (45) days following the end of quarter"]
[null,"ID Cards","Vendor will ensure ID cards will be provided within ten (10) working days from receipt of eligibility information.",0.02]
[null,null,"The amount of time elapsed from the date of receipt of eligibility information to the date ID cards are mailed to members.\nID cards for “future” enrollees (reported thirty (30) days prior) will be mailed fourteen (14) business days prior to the effective date."]
[null,null,"Measurement will be quarterly."]
[null,"Account Management","Vendor’s account management will exceed or meet ECSD's expectations.  Vendor will receive a satisfactory score of three (3) or higher.","$1000 for score below 3 per agency, up to $2,000 max per year. Corrective action plan required to address needed improvement if score is at an unacceptable level."]
[null,null,"Client will evaluate each member of Administrator’s designated Account Management team. Scale is as follows:\nScore Description\n    4           Exceeds Expectations\n    3           Meets Expectations\n    2           Needs Improvement\n    1           Unacceptable"]
[null,null,"Measurement will be Semi-annually by joint meeting with each Agency and Contractor no later than sixty (60) days following end of the measuring period."]
[null,"Timeliness of Financial Accounting and Renewal Proposals","Vendor will provide Monthly, quarter-to-date, year-to-date paid claims and lag reports within twenty-five (25) days following end of reporting period.","$200 per late report delivered to each agency after the report submission date"]
[null,null,"Client Receipt of Financial reports"]
[null,null,"Measurement will be on a client-specific basis. Monthly within twenty-five (25) days following the end of the month. Quarterly reports within forty-five (45) days following the end of the quarter."]
[null,"Plan Booklet Accuracy and Timeliness","Vendor will deliver an electronic copy of the Plan Booklet no later than the first day of the plan year as per the Contract. Vendor will take sole responsibility for the accuracy of the Plan Booklet as per the Contract.",0.01]
[null,null,"Measurement will be on a client-specific basis, reported annually and paid annually."]
[null,"TOTAL ANNUAL PREMIUM AT RISK"]

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[]
[null,{"$f":"' Dental Questionnaire'!E3","v":"Request for Proposal (RFP) for Escambia County School District (ECSD)"}]
[null,"Dental Questionnaire"]
[null,"Explanations"]
[]
[null,"This worksheet should be used to provide additional explanations for any questions for which a \"See Explanation\" response "]
[null,"was given.  Explanations must be numbered to correspond to the question to which they pertain and they must be brief."]
[]
[null,"State the number of questions you addressed with further explanation: "]
[]
[null,"Section & Question #","Explanation:"]

{"sheet":"Officer Statement","index":9,"n_rows":31,"n_cols":2,"rows_kept":31,"cut":false,"hidden":false,"merged":[[7,1,7,2],[23,1,23,2]]}
[]
[null,"Request for Dental Proposal (RFP) for Escambia County School District (ECSD)"]
[null,"Officer Certification"]
[]
[null,"Please have an Officer review and sign this worksheet to confirm the information is valid."]
[null,"Please include the completed form with your proposal."]
[]
[null,"OFFICER'S STATEMENT"]
[null,"Dental Proposer Legal Name"]
[null,"Dental Proposer Marketing Name"]
[null,"Street Address"]
[null,"City"]
[null,"State"]
[null,"Zip"]
[null,"Phone Number"]
[null,"Fax Number"]
[null,"Web Address"]
[null,"Name of Officer completing statement"]
[null,"Title of Officer completing statement"]
[null,"Phone Number of Officer completing statement"]
[null,"Email Address of Officer completing statement"]
[]
[]
[null,"I certify that our response to ECSD's RFP (Request for Proposal) is complete and accurate to the best of my knowledge and contains no material omissions or misstatements. I acknowledge that ECSD will rely upon the information included in our response to make decisions concerning the dental benefits that are offered to its employees."]
[]
[]
[]
[null,"Officer's Signature"]
[]
[]
[null,"Date Signed"]