Download Appendix F: Questionnaire

APPENDIX F: Questionnaire
1. Financial Measures – Capability of vendors to provide competitive financial terms and
sustainability for all group benefits
Describe your renewal methodology for each insured benefit.
Outline your marketing discounts, if any, applied to any of the quoted rates/fees. If applicable
how long will it be in effect and what is the process to eliminate the discount?
Please outline circumstances whereby you reserve the right to modify rates/fees.
If awarded the business, will a transition allowance be provided to IESO? If a transition
allowance is provided, please state: i) whether the transition allowance will be in the form of
cash, or credit for services provided or to be provided, or both; and ii) for what specific
purposes the transition allowance may be used by the IESO ($ value not to be disclosed)
Charges for implementation. If appropriate, please show costs separately for web, call centre
and administration and other services.
2. Health Care Savings Account – Ability to provide, administer and service health care savings
account
Do you administer Health Care Savings Account (HCSA) plans?
Can you administer carry forward of unpaid expenses?
Can HCSA claims be submitted on the same claim form as health?
Are HCSA claims paid as submitted (i.e. no adjudication)?
Do you have a minimum amount for paying a HCSA claim?
Can you produce forfeiture reporting?
3. Drug plan – Ability to administer and provide expertise with regard to drug benefits and
management
Are you able to offer "mandatory" generic / lowest cost alternate substitution? If so, is this
included as a standard offering?
Are you able to offer Prior Authorization / Step Therapy for certain drug categories? If so, is this
included as a standard offering?
Ability to match IESO drug / natural product formulary?
Do you have a Preferred Provider Network?
Is a Mail-Order solution available? What is your standard?
Do you offer any specialized case management for high cost drug therapies?
Indicate the standard mark-up allowed on ingredient cost. Do you balance bill on difference?
Provide your dispensing fee Reasonable & Customary limit. Do you balance bill on difference?
Do you have any pricing deals for high cost drug therapies (i.e. Remicade)?
Do you have the ability to offer pay-direct drug card?
Do you have the ability to monitor or track over-the-counter drugs (e.g., non-prescription
vitamins)?
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4. Flex Plan – Ability to provide, administer and service flexible benefits plan
Confirm your ability to administer the flexible benefits program and other programs as described.
Describe your systems for flexible benefits administration, including software, hardware,
network/communications, disaster recovery, security.
Describe your capability and experience in transmitting and receiving data files electronically from
the plan sponsor and/or its payroll provider for flexible benefits administration. Do files need to be
in your standard format or can you accept any format? Please provide a copy of the file
specifications. Please also confirm any additional fees associated with transmitting and receiving
data files.
Outline your charges for ongoing flex administration. If appropriate, please show costs separately for
web, call centre and administration and other services.
What is the minimum number of lives required for flex plan?
Can the user interface or tool functionality be customized (client branded) or additional wording,
forms or pop-ups be added?
Can non-standard benefits (e.g. vacation purchase) be included?
5. Administration – Ability of vendor to administer health benefits plan (not including health
care savings account and flexible benefits plan which have separate questionnaire sections)
Confirm your ability to administer the current benefits program as outlined. Any concerns,
deviations or factors?
Confirm your ability to cover only specific dental fee codes as provided by IESO.
Describe your full range of administrative capabilities, including technology used. Please comment
specifically on the availability of technology, automation and systems available to the plan
administrator and/or plan members.
Describe your systems for benefits administration, including software, hardware,
network/communications, disaster recovery, security.
Describe your capability and experience in transmitting and receiving data files electronically from
the plan sponsor and/or its payroll provider for benefits administration. Do files need to be in your
standard format or can you accept any format? Please provide a copy of the file specifications.
Please also confirm any additional fees associated with transmitting and receiving data files.
IESO is not open to splitting benefits among carriers. Please confirm acceptance with this approach.
Describe your experiences and abilities to accommodate plans with Unions, particularly in regard to
supporting IESO and responding to potential items tabled during Union negotiations.
Please outline and provide a brief description of your retiree healthcare plan offering that can
be made available to IESO plan members when they retire (or terminate).
6. Service – Ability to provide outstanding performance and customer service on behalf of IESO
and to convey necessary and timely information to plan members
Explain how your customer service delivery model would reduce the burden on IESO’s Human
Resources team, as well as drive positive member experience?
Do you have the ability to enter into a Performance Standards agreement with penalties attached
for non-compliance? Please indicate the penalty in the event of failure to meet the service
standards.
Outline your claims turnaround times and reporting methodology (i.e., are claims turnaround
times calculated based on business or calendar days?). Please confirm turnaround times based on
paper and electronic submission separately.
Provide monthly service performance statistics for your contracts and administration, call centre
and claims teams for 2013, 2014 and 2015.
Outline your communication plan and the level of involvement from your team in providing
communication materials in the event of a provider change.
Confirm that the following reports and management information can be provided (see A-2).
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Outline your online service capabilities.
Do you offer high cost claimant management? Please provide details of the program and
implications cost.
What recent initiatives have you undertaken to ensure a best in class employee experience and
improve customer/employee satisfaction levels?
Do you offer on-line claim submission? If so, please outline the claims that can be processed online. Do you have on-line Employee access for review of claim status?
What is the average wait time for Health/Dental Customer Service phone calls? How do you
handle peak months? Do you measure 1st call resolution, and if so please provide statistics.
Please confirm you are able to administer co-ordination of benefits.
Provide a short description of any new initiatives your organization will be focusing on in the next
12 months.
Do you offer a 1-800 call center specific to plan administrators? Plan members? If so, please
provide times of operation.
Please provide the location of Head Office and Service Office(s) including street address, phone
number and email address.
7. Long Term Disability – Capability of vendors to assess, manage and administer an effective
disability benefits plan
Describe your overall Disability Management philosophy including Long Term Disability claims
adjudication, case management and rehabilitation intervention processes. Describe your
unique strategies in helping a plan sponsor reduce claim costs.
Describe your Structure of Rehabilitation Services (in-house or outsourced, team structure,) and
its philosophy regarding rehabilitation interventions.
Describe all resources your company utilizes to effectively assess and manage complex LTD
claims.
Provide a step-by-step description of your process and timelines to follow up for information
that has been requested from stakeholders in the claims process.
Describe your firm’s process in working with another party with respect to Short Term Disability
(Salary Continuance) claims adjudication.
Describe how the plan sponsor will be kept informed of the ongoing status of the claim
including the frequency for providing updates.
8. Plan Governance – Ensuring that vendors have the necessary framework to govern IESO’s
data and plan proposal
Detail / list and explain all deviations in your proposal to this RFP. Reference to your standard
contract language wording is not acceptable.
Confirm you are prepared to grandfather all present amounts of insurance, if required.
Outline your internal audit procedures to ensure that claims are assessed in accordance with
contractual provisions.
Outline how provider audits are undertaken.
Do you have a Code of Ethics to Safeguards regarding the confidentiality of personal
information?
What security systems are in place to ensure confidentiality of the employee data being
transferred to your company during an enrolment process?
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9. Reporting – Ability to provide regular and adhoc reporting in accordance.
Confirm that the following reports and information can be provided. Reports should be
available for each entity where applicable. Indicate if reports are available electronically
via the Internet and in a format that can be manipulated by IESO (i.e., Excel format).
Confirm any costs for the reports, if applicable.
Available
Report
Paper
(Y/N)
Internet
(Y/N)
A. Distribution (cost and utilization) of Extended Health Care and Dental claims by
procedure
B. Distribution (cost and utilization) of Extended Health Care and Dental claims by
provider
C. Prescription Drugs-Top 100 by Drug Identification Number
D. Prescription Drugs-Claims by Therapeutic class
E. Rejected Claims Summary
F. Monthly – Medical Underwriting Decisions
G. Quarterly - Health and Dental claims by division (SOC, PWU, MGT) by month
H. Quarterly - Travel claims by plan by month
I.
month
J.
Quarterly - Drug Transaction Count – transactions by submission type by
Quarterly – Health and Dental Claim Turnaround Times
K. Quarterly - Health and Dental Claim Accuracy (financial and non-financial)
L. Quarterly – Customer Service Centre (percentage of call answers within
specified time)
M. Annual renewal Reports showing:
i. Life and LTD demographics (5 year age banded)
ii. Renewal rating by benefit (including manual rates)
iii. DLR by claimant (LTD)
iv. Waiver of Premium reserve by claimant (Life)
v. Extended Health Care/Dental claims in excess of specified claims dollars
submitted and paid
vi. Extended Health Care/Dental claims by type of expense
N. Drug Utilization Reports
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9. Reporting continued.
Confirm that you are able to provide the following Disability Management reports
electronically via the Internet, in a format that can be manipulated (i.e., Excel format),
and in hard copy at no cost at least once per quarter:
Available
Report Type
Paper
(Y/N)
Internet
(Y/N)
A. Detailed claim listing by individual denoting status (pending, active,
permanent, rehabilitation, appeal, statement of claim), disability dates, benefit amount,
offset amount, reserve amount
B. Number of active LTD claims
C. Number of new claims received within the reporting period
D. Number of claims approved
E. Number of claims declined
F. Number of claims pended
G. Number of claims resolved
H. Number of claims withdrawn
I.
Claim termination activity by reason
J.
Active claims by Diagnosis, Age, Gender
K. Claim distribution by Division
L. Claim trend by diagnosis and with comparison to "like industry" as well the
insurer's block of business
M. Average claim duration compared to "like industry" and block business
N. Claim incidence compared to "like industry" and block business
O. Claim submission "lag time" compared to "like industry" and block business
P. Number of claims in the own occupation and any occupation stages
Q. Details of Return to Work and Rehabilitation initiatives undertaken from open
LTD claims, including the number of files actively engaged in rehabilitation services, and
this number expressed as a percentage of IESO's active claims
R. Monthly claims status reports that provide summarized case management
plans, current case status and future actions to be taken.
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