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RFP UK-2063-20

Written Questions and Answers – of 21

Written Questions and Answers University of Kentucky Student Health Program

RFP UK-2063-20 Closing Date: 05/27/2020 Today’s Date: 05/11/2020

No Question Answer

1

Since we currently administer the plan using the Anthem network and our proposal is a continuation of the same arrangement is it necessary to provide responses to the following spreadsheets:

• Hospital Access • Physician Access • Hospital Savings • PPO Provider

Reimbursement Types

A Geo Access summary is not required. The proposal shall be a joint proposal between network/TPA and enrollment waiver vendor. UK will be comparing to other vendors to determine finalists. If there is no answer the committee will not make assumptions on what the answer might be.

2

The Health Plan response requires network reporting such as GeoAccess information. Since we currently administer the plan using the Anthem network and our proposal is a continuation of the same arrangement is it necessary to provide responses? The responses we would provide would be the same as the data that UK has in its possession regarding network performance for the UK SHP.

Please refer to answer to Question 1.

RFP UK-2063-20


3

The Health Plan response requests the following attachments:

• Implementation Schedule

• ASO Billing Process Description

• Implementation Work Plan

• Audit Reports • Standard

Management Reports

• Suggested Employer Contract

• ID Card • Member

Enrollment Materials

Since we currently administer the plan, do not propose any changes and these items are currently in place and use with the UK SHP is it necessary for us to provide these attachments either entirely or certain attachments? Please indicate which attachments are required based on our current role as the UK SHP health plan administrator.


4

The Hospital Access spreadsheet requests data for eight separate Geographic/Metropolitan areas but none are listed; will those be provided or are we to provide data for eight areas in Kentucky and contiguous states?

A Geo Access report is not required.

RFP UK-2063-20


5

The Physician Access spreadsheet requests data for eight separate Geographic/Metropolitan areas but none are listed; will those be provided or are we to provide data for eight areas in Kentucky and contiguous states?


6

The Hospital Savings spreadsheet requests data for 2019 for providers that are not named and for eight separate Geographic/Metropolitan areas, but none are listed; will the provider names be provided?


7

The Pay Method spreadsheet requests data for 2019 for providers that are not named and for eight separate Geographic/Metropolitan areas, but none are listed; will the provider names be provided?


8

The Stop Loss spreadsheet requests quotations for stop loss coverage, but the desired Specific Deductible amount has not been provided; should our underwriters determine this level, or will further guidance be provided?

The stop loss contract specifics are included with the answers to these questions.

9

What is the current stop loss Specific Deductible, the contract type and what benefits are

$250,000 ISL; 12/18+gap

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covered by the policy (medical, pharmacy)?

10

Can a copy of the current stop loss contract be provided with premium levels redacted?

A copy of the stop loss contract is attached.

11

Do we have to submit a proposal that includes an Eligibility and Waiver administrator, or can we indicate our willingness to work with any vendor chosen for these services by UK?

If you are partnering with an Eligibility and Waiver vendor UK would like one proposal that is coordinated between the vendors.

12

Are we required to provide our pricing and responses to an Eligibility and Waiver administrator for their response to the RFP to be considered complete?


13

Would UK prefer that we submit individual proposals that contemplate using different Eligibility and Waiver administrators?


14

If we have been contacted by an Eligibility and Waiver administrator(s) and combined proposals are not preferred, should we identify those either in our official response or the accompanying submission letter?


15

Please provide the definition for the term “subcontractor” as contemplated in the RFP.

Vendor partner

RFP UK-2063-20


16

The 1094/1095 spreadsheet requests information regarding production of 1094 and 1095 forms and appears limited to responses pertaining to the Eligibility and Waiver administration. Please confirm this understanding is correct.

The 1094 and 1095 does not have to be limited to the eligibility and waiver vendor but is a required service as a part of this engagement.

17

The Technology spreadsheet requests information regarding online access for UK administrators and students and appears limited to responses pertaining to the Eligibility and Waiver administration. Please confirm this understanding is correct.

If multiple vendors are used to provide services UK would prefer access to as much information as possible. Pertaining to eligibility and waiver, students will need access to enrollment, document uploading and tracking, etc. UK admin will need access to eligibility and waiver records, billing and invoice payment, approvals, etc. UK will need access to claim information and systems that would normally be provided to a self-funded plan.

18

The Service spreadsheet requests information regarding administrative services and appears limited to responses pertaining to the Eligibility and Waiver administration. Please confirm this understanding is correct.

If multiple vendors are used to provide services, please outline the service capabilities of each vendor, for each component offered, to include plan administration, eligibility and waiver, etc.

19

The Implementation spreadsheet requests information regarding implementation of services and appears limited to responses pertaining to the Eligibility and Waiver administration. Please confirm this understanding is correct.

If multiple vendors are used to provide services, please outline the implementation schedule / timeline of each vendor, for each component offered, to include plan administration, eligibility and waiver, etc. We expect a coordinated implementation plan, if you are proposing using multiple vendors.

20 Please provide a list of all other vendor

Submitted questions are included in this document.

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questions submitted and University of Kentucky’s corresponding responses.

21

Due to COVID-19 and social distancing measures, can the proposal be submitted electronically? Or will there be someone on campus to receive the hard copies requested and they must be submitted?

The response CANNOT be submitted electronically. Please submit your response as outlined in the RFP Section 3.6 under the “Instructions to Bidders” tab.

22

Please provide the file referenced in this statement: “A file has been provided for re-pricing of medical claims. Please review files and reprice the claims using your network discounts.”

This file has been provided by UK Purchasing via email on 5/1/2020. The information for the request is in Section III, Financial Funding, Question 2 on the “Health Plan – 4.5” tab.

23

Please provide paid claims by month for the 2016-17, 2017-18, 2018-19, and 2019-20 policy years separated by medical and prescription drugs.

This information has been provided in a zip file for dates January 2018 – February 2020. We do not have access to 2016 and 2017 claims detail.

24

Will you be sharing all questions and UKY responses from vendors with the invited entities?

Yes.

25 What is the anticipated RFP award date?

The first week of June, subject to change.

26

Is it your preference that we respond to the questions in the Excel spreadsheet boxes presented or may we transfer the questions to a document where more

It is preferred to respond to all questions in the Excel document. Where more room is needed, please use the “Explanation” tab included in the worksheet, referencing the Tab and Question to which each answer pertains.

RFP UK-2063-20


room could be provided for longer responses?

27

Is UKY anticipating holding fall 2020 classes on campus in light of the current COVID-19 pandemic?

To be determined.

28

Has the University developed any projections regarding potential reductions in student enrollment and consequently in SHIP due to COVID-19?

To be determined.

29

Is the purpose for this RFP based upon procurement rules (e.g. UKY must release a solicitation for this program every 2 years) or is there something specific you are hoping to improve upon possibly in terms of fee structure, service, benefit enhancements, etc.? Please outline response to this question for both the Health Plan and the Eligibility/Waiver Administrator.

UK is always looking for best in class vendors to provide services.

30

Please outline in as much detail as possible the current process for the eligibility/waiver administration.

The Waiver Process is included with the RFP as Attachment A.

31

Would UKY provide one point of contact (or multiple) for coordination of day to day activities, IT integration and communications relating to all aspects of the eligibility / waiver process?

Upon award the point of contact(s) will be shared with the successful offeror.

RFP UK-2063-20


32

We will be partnering with vendors for the health plan segment of this RFP and they will submit their specific questions under separate cover.

OK.

33

Would it be UKY’s preference that we submit our proposal for waiver administration alongside our partner TPA/PPO network vendor(s) or may we submit independently and outline in the cover letter the vendors with whom we have an existing relationship and could partner?

UK would prefer one proposal to include all services proposed. All vendors should be outlined accordingly.

34

Please provide a detailed outline of the waiver criteria to be used in the 20/21 plan year. Include criteria for both domestic and international if they are different.

We do not have a hard waiver system for our domestic students, only international. I have attached the criteria for the international waiver. (We have the waiver process for international students and it was distributed with the RFP).

35

Please provide a sample template of the eligibility data file that would be transacted from UKY to the waiver vendor.

a. Is UKY able to send an eligibility file containing all students in both the required and voluntary status daily?

b. Can UKY provide a full file (not a change only file)?

c. Can UKY receive a full file daily from the waiver vendor with

- We use the 834-file layout.

- UKY is able to send a waiver eligibility file for international students as often as needed.

- A full file can be provided

- UKY can receive a daily full file.

RFP UK-2063-20


indicators of students who have waived, taken no action or opted in?

36

Understanding that the plan effective date is 8/1, what date would UKY propose to open the waiver/enrollment system for the 20/21 plan year?

The actual plan effective date is 08/15. For the 20/21 plan year we would expect to open the enrollment system on 7/6 and the waiver system on 8/3 for the Fall semester. For the Spring we would expect the enrollment system to open on 12/7 and the waiver system to open on 1/4.

37

Is it anticipated that the eligibility administrator will communicate via e-mail the waiver requirement and process to UKY students or does UKY handle that process themselves and direct the student to a link provided by the vendor to capture the waiver application?

d. If the eligibility vendor communicates with the students, what is the desired frequency of follow ups for students who have not taken any action (opt-in or waive)?

e. Does UKY have the ability to provide the official University e-mail address of student’s subject to the process and can the University whitelist the ISP of the waiver vendor?

It is anticipated that both the eligibility administrator and UKY will communicate waiver requirements and processes to UKY students. d. The eligibility vendor would communicate with students no more than 3 times during the semester (on dates to be determined at a later time) to remind students of waiver deadlines. e. Yes, UKY has the ability to provide email addresses. We will work through the process to whitelist the ISP of the waiver vendor.

38 Mention was made of a third party submitting a

UK will use the waiver process to confirm student’s coverage.

RFP UK-2063-20


waiver on behalf of a student. Is this question in relation to a parent completing a waiver application for their student or is it asking about a UKY administrative staff person completing the application on behalf of a student?

39

Does UKY involve campus resources like Parent and Family programs, Facebook posts and campus newspaper to ensure students are made aware of the waiver process and requirements. Please outline what the University does to support student understanding of the waiver requirement and process.

Currently, the only process is that UKY sends an initial email to students who are eligible to apply for a waiver to alert them that the portal is open and ready to accept their waiver application, to alert them of the minimum requirements needed to be approved for a waiver, the waiver deadline and a link to the waiver portal. After that, an email is sent weekly from UKY to remind students of the waiver deadline. Similar emails are also sent to students from the waiver vendor and from the International Student Center.

40

Presuming the implementation period would be very short by the time this RFP is awarded and the time the waiver portal is expected to open, is UKY able to provide dedicated data management resource personnel to assist in establishment and testing of the necessary data transaction files between UKY and the waiver administrator. We understand that many campuses have staff working from home and may not have access to the necessary systems because of COVID-19.

Due to the current environment, this is to be determined. However, UK will make all necessary adjustments and provide ample resources to ensure a successful enrollment.

RFP UK-2063-20


41

What student classifications will need to be tracked for waiver or eligibility processing and or reporting? e.g. Grad/Undergrad, Domestic/International, Program Type, Early start.

Only the international student group would need to be tracked.

42

Does UKY enroll all students in the required categories on SHIP up front and then remove their enrollment after they provide an approved waiver application or is the SHIP charge loaded on the student account but no enrollment in SHIP becomes active until the student positively enrolls (opts-in)?

All students in the required categories are enrolled up front and then removed upon approved waiver application.

43

How are Social Security numbers captured in the present process for 1095 reporting?

a. Which entity handles reporting of 1095 information under your current system to the IRS?

b. Would UKY be able to remit a separate SSN file under separate secure cover directly to the claim administrator or carrier network instead of having that information captured through the eligibility system?

Currently, the same vendor that handles the enrollment processes for UKY also handles the transmission of information needed for 1095 processing, to a third-party administrator. UKY has the ability to provide the SSN file, however this process will provide discussion and an approval process – to be determined upon implementation.

RFP UK-2063-20


44

Voluntary enrollment of dependents is noted in the RFP. Please outline the current process of enrollment for this class and how dependents are validated by UKY as being eligible to enroll.

Dependents are currently enrolled by students visiting the website of the current enrollment administrator and adding their dependent(s) to their plan. Payment is made at the time of enrollment with a debit or credit. Documentation that proves the relationship of the dependent to the member is uploaded to the enrollment administrator’s website at the time of enrollment. The document is reviewed by the enrollment administrator.

45

What is UKY’s expectation in terms of premium collection for voluntary / dependent students? Would the eligibility administrator be required to accept credit card payments, or can the charge be posted to the eligible student account on behalf of the dependent?

It is expected and preferred that the eligibility administrator collect the payments for dependents. Payments will be made by debit or credit card only.

46

We are not seeing a separate page or segment in the fees structure provided to outline waiver/eligibility processing fees. Please advise where you would like us to present our fee structure.

In tab 4.7 – Financial, put quote under “other” in the grid “Proposed Program Costs.” Provide as much detail as necessary for each component.

47

Instruction to Bidders Tab: 2.1 Intent and Scope section states “it is recommended that vendors offering only a portion of the services required in this RFP partner with another vendor that offer the remaining services and or products.” Are you looking for a complete proposal for all service or can we just respond to specific services being requested without partnering with another vendor to provide the remaining services? For


RFP UK-2063-20


example, could we just respond to the services related only to the Eligibility and Enrollment Administration (Criteria 2 only)? If so, which sections would we need to respond to? How would we communicate our fees?

48

Instruction to Bidders Tab: 3.6 Proposal Submission and Deadline section states that “proposals received via fax or email are not acceptable”. Considering the impact of COVID-19 and our remote work situations would you be agreeable to accepting proposals via email rather having to physically print and ship materials during this time?


49

Instruction to Bidders Tab: 5.0 Evaluation Criteria Process section states “Proposals must contain responses to each of the criteria listed in Section 4 even if the offeror’s response cannot satisfy the criteria” If we are only responding to Eligibility, Enrollment and Waiver Administration (section 4.6), must sections 4.5, 4.7 and 4.8 be completed?


50

Why is the university going to bid for these services?

UK is always looking for best in class providers.

51 When will University of Kentucky provide a

N/A

RFP UK-2063-20


response to written questions submitted?

52

When does University of Kentucky plan to award this bid?

The first week of June, subject to change.

53

Can you confirm the Tax ID’s for the UK Preferred Providers to be included in tier 1 of the network build? Are they University of Kentucky, College of Medicine (Kentucky Medical Services Foundation) Tax ID# 61-0945743, 61-6001218 and 77-0651881 (Practices/Clinics)

Confirmed.

54

When do you expect to send the census data, along with the claims information?

Vendors were to request this file, upon submitting the intent to bid to the University. Instructions for this process are included on the “Instructions to Bidders” tab, Section 3.2 in the RFP.

55

Can you please share the desired stop loss deductible and contract type (whether paid or incurred)?

Current stop loss deductible is $250,000, and contract type is 12/18+gap.

56 Can you request a large claims file from 1-1-2019 thru 7-31-2019


57

Do you have the current administration fee and the current stop loss premium?

Current fee and premium will not be shared.

58

On the file “UK STUDENTS_Monthly Paid Claims_2019_02-29-2020.pdf”, is the University Health column the claims for the non-processed UHS claims? I’m asking because I didn’t think those claims were

We agree with your assessment.

RFP UK-2063-20


process, rather, I thought they were suppressed?

59

Please clarify whether all vendor questions and answers will be distributed to all bidders when the University provides responses.

Confirmed.

60

Please provide additional details on the current stop loss rates and commission level, carrier and current coverage (specific deductible, aggregate corridor, incurred/paid period, etc.).

Current rates, commission levels will not be shared. Note: Stop loss rates will be net of commission going forward.

61

When will you require firm stop loss quotes? Can we finalize based on reporting through May 2020?

Please provide best quote, with any limitations noted using current data. Provide requirements for change in rate and parameters you will use.

62

Please provide aggregate claims reporting by month separated by plan year for 2016-17, 2017-18, 2018-19 and 2019-20. Please provide medical, Rx and total.

This information has been provided in a zip file for dates January 2018 – February 2020. We do not have access to 2016 and 2017 claims detail.

63

Please provide large claim reporting separated by plan year for 2016-17, 2017-18, 2018-19 and 2019-20. Please provide medical, Rx and total.

We have large claim detail from 8/2019 – current, but nothing before that.

64

Please provide updated reports through April 2020.

We only have reporting current through February at this time. March reports are in process.

RFP UK-2063-20


65

Please provide full details on the claimant on the large claim report with Rx paid $24,959.70 YTD, including diagnosis/prognosis, clinical case notes, drugs prescribed, etc.

Please provide best quote, with any limitations noted using the current data provided. Provide requirements for change in rate and parameters you will use. If you are deemed a finalist, we will provide additional information that would be required to provide a firm quote or remove a quoted laser.

66

Please provide case management reporting for the 2019-20 plan year and 2018-19 plan year.


67

In the "Instructions to Bidders" section, Intent and Scope, paragraph 1, the RFP States "…services shall combine medical and Rx coverages for the purpose of stop loss, enrolling students and or determining eligibility for coverage" If Rx is to be included in the Stop Loss, we will require a minimum of 2 years of Rx claims data.

Rx data is included in the monthly claims and enrollment files.

68

In the "Instructions to Bidders" section, Proposal Submission and Deadline, paragraph 1 and paragraph 2, the RFP States "… and one (2) printed original copies” Please clarify if we are to submit one or two printed copies.

Two.

RFP UK-2063-20


69

In the "Instructions to Bidders" section, Proposal Submission and Deadline, paragraph 2, the RFP States "The Financial Proposal should include the Commercial Traditional and Commercial Transparent and the Part D EGWP, each separated and marked with the appropriate plan (Traditional, Transparent, and Part D EGWP.)" The services described do not appear to be part of the RFP request, however, if an Rx quote for Medicare and non-Medicare eligible students is requested, please provide supporting data and additional specifications on what coverage would be requested.

Please disregard this instruction. Rx quotes are not being requested.

RFP UK-2063-20


70

Tab "Health Plan - Section 4.5", Section III "Financial", Subsection "Funding", Q2 asks: "A file has been provided for re-pricing of medical claims. Please review files and reprice the claims using your network discounts. Repricing needs to be completed down to the specific provider level. Please disclose provider disruption in your analysis. Confirm this exercise has been completed. Label: "Attachment: Claims Repricing."". We have not received this file of medical claims. Please provide this information for the purposes of re-pricing. Even though we are the incumbent carrier, we have found that the best comparison of re-pricing results is if all bidders (including the incumbent) reprice the claims exhibit utilizing an actuarially sound method.

A claims repricing file has been provided.

71

Tab "Health Plan - Section 4.5", Section IV, Subsection "Student Access for Providers", Q16 refers to GeoAccess reporting: "For valuating the network, complete the GeoAccess reporting using the access criteria requested in the worksheet "Introduction". We are unable to locate the worksheet "Introduction” Please

Please disregard request for GeoAccess.

RFP UK-2063-20


provide the criteria/parameters you would like us to use.

72

Tab - "Hospital Access - Section 4.8" requests a list of Acute Care Hospitals for the metropolitan areas noted, however, there are no metropolitan areas noted in the exhibit. Please clarify what metropolitan areas you would like us to use for this hospital list.


73

Tab "Physician Access - Section 4.8" requests a number of Physicians for the geographic/metropolitan areas noted, however, there are no geographic/metropolitan areas noted in the exhibit. Please clarify what geographic/metropolitan areas you would like us to use for these physician counts.


74

Tab "HospSav(3)" asks for hospital-specific discounts for geographic/metropolitan areas however, there are no geographic/metropolitan areas noted in the exhibit. Please clarify what geographic/metropolitan areas you would like us to use for these hospital-specific discounts.

Disregard request

RFP UK-2063-20


75

"Tab Pay(3)" asks for approximate percentage of medical expenses for the 12-month period noted above associated with each type of payment method for PCP's, specialists, hospitals, diagnostic radiology, mental health/substance abuse and pharmacy for geographic/metropolitan areas however, there are no geographic/metropolitan areas noted in the exhibit. Please clarify what geographic/metropolitan areas you would like us to use for this exhibit.

Disregard.

76

If after reviewing the reporting package there are additional questions, will we have the opportunity to ask further questions as needed?

To be determined. If need is deemed appropriate, questions will be accepted.

77

Is UK interested in PBM quotes as a part of this RFP?

No.

78

Does the University have specific Geographic/Metro locations as referenced in the POS/PPO Acute Care Hospital grids (Hospital and Physician Access – 4.8, Types of Payment)?

Disregard.

79

Please include a detailed medical claim file for network analytics.

A claims repricing file has been provided.

80

Please include the most current 36 months of monthly claims

Vendors were to request this file, upon submitting the intent to bid to the University. Instructions for this process are included on the “Instructions to Bidders” tab, Section 3.2 in the RFP.

RFP UK-2063-20


experience, enrollment and high cost claims.

81

Please supply a current Summary Plan Document and note any plan changes that have been implemented in the past 3 years.

Provided.

82

Request the file that contains all claims, demographic, and other proprietary information (section 3.2)


83

Please provide a working web address for section 6.25

https://apps.legislature.ky.gov/moreinfo/contracts/homepage.html

https://apps.legislature.ky.gov/moreinfo/contracts/PSC%20INVOICE%20FORM.pdf

84

Clarify the financial proposal and the need for EGWP bid (section 3.6)

Please disregard. An Rx quote is not being requested at this time.





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