Download Request for Proposal - City of Hallandale Beach

Hallandale Beach RFP #FY 2012-2013-012
Attachment N
Questionnaire
(Complete and Submit with your proposal)
1. List at least five (5) references with a minimum of 400 employees for whom you provide the
applicable lines of coverage you are proposing. Include group name, contact name, title and
telephone number of reference.
1)
2)
3)
4)
5)
2. Renewal notification is required 180 days prior to the renewal date for all lines of coverage
being proposed. Can you comply with this requirement? If “No”, outline your proposed
alternative by line of coverage.
Yes
No
3. What is the length of the rate guarantee proposed for each line of coverage proposed?
Medical:
Dental:
Vision:
Group Basic Life:
Group Supplemental Life:
Long-term Disability:
Employee Assistance Program:
4. Confirm that the rates provided are “Net of Commission” for all lines of coverage being
proposed.
Yes
No
5. Has Proposer included copies of all network directories applicable to the medical, dental and
vision plans proposed for the City?
Yes _____
No _____
6. Provide a listing of all counties that would be included in the “service area” of the provider
networks available under the programs proposed.
7. Confirm that sample copies of the Insurance Certificates of Coverage for the plans proposed
are included in your submission.
Yes: __________ No: __________
8. Confirm that Benefit Summaries for all plans proposed are included in your submission.
Yes: __________ No: __________
9. Proposer agrees allow Retirees to continue coverage under the same plan at the same rate as
active employees, should they choose to do so.
Yes: __________ No: __________
10. Proposer confirms it has provided coverage options for Retirees, on a comparable level as
active employees, who reside outside of the immediate South Florida area.
Yes: __________ No: __________
11. Confirm that all employees enrolled in the group’s medical, dental, life and long-term
disability plans, who are currently not “actively at work” due to disability, FMLA, or any other
reasons, will continue to be covered under the plans implemented for the effective date
stated in this RFP. If proposing multiple lines of coverage, be specific by line of coverage.
Yes: __________ No: __________
12. Confirm that all policies, identification cards, and any other correspondence will be mailed
directly to the employee.
Yes: __________ No: __________
13. Confirm the proposer has included Geographical Access reports using the criteria stated within
the RFP for all lines of coverage being proposed.
Medical:
Yes: __________ No: __________ Not Applicable:
Dental:
Yes: __________ No: __________ Not Applicable:
Vision:
Yes: __________ No: __________ Not Applicable:
14. Describe any performance guarantee programs your company proposes. Please indicate the
group name, address, contact person and telephone number of up to three firms in Florida to
whom your company has forfeited money because of service problems in the last three years.
15. Please describe your out-of-area coverage for retirees, dependent students or other
dependents not residing with the employee (as a result of divorce or other reasons) but
covered under their medical, dental or vision plans.
16. Is COBRA administration included in your proposal? (Provide details if yes)
Yes: __________ No: __________
17. What is the name, title and office address of the individual who would have direct daily
account responsibility for the program?
Name:
Title:
Address:
Telephone:
Fax:
Email: