99-23038 RESO
RESOLUTION NO.
99-23038
A RESOLUTION OF THE MAYOR AND CITY COMMISSION OF
THE CITY OF MIAMI BEACH, FLORIDA, AUTHORIZING THE
ADMINISTRATION TO ISSUE A REQUEST FOR PROPOSALS
(RFP) FOR THE PROVISION OF GROUP MANAGED MEDICAL
CARE INSURANCE, DENTAL INSURANCE, AND
LIFE/ACCIDENTAL DEATH INSURANCE FOR THE CITY OF
MIAMI BEACH EMPLOYEES' BENEFIT PLAN, FOR A
ONE-YEAR PERIOD, WITH FOUR (4), ONE-YEAR RENEWAL
OPTIONS.
WHEREAS, the City of Miami Beach Employees' Benefit Plan provides for Group Medical
Managed Care Insurance, Dental Insurance, and Life/Accidental Death Insurance for eligible employees
and retirees; and
WHEREAS, the Mayor and City Commission selected Humana to provide the Group Managed
Medical Care Insurance effective October 1, 1996, for the City of Miami Beach Employees' Benefit Plan;
and
WHEREAS, the Mayor and City Commission selected American Dental to provide Dental
Insurance effective July 1, 1997, for the City of Miami Beach Employees' Benefit Plan; and
WHEREAS, the Mayor and City Commission selected Hartford to provide the Life/Accidental
Death Insurance effective October 1, 1994, for the City of Miami Beach Employees' Benefit Plan; and
WHEREAS, the City wishes to assure an optimum balance of coverage and cost; and
WHEREAS, the Administration, with the approval of the Group Insurance Board and the Health
Advisory Committee, has drafted a Request for Proposals (RFP) for providing said services.
NOW, THEREFORE, BE IT DULY RESOLVED BY THE MAYOR AND THE CITY
COMMISSION OF THE CITY OF MIAMI BEACH, FLORIDA, that the Mayor and City
Commission hereby authorize the Administration to issue a Request for Proposals (RFP) for the provision
of Group Managed Medical Care Insurance, Dental Insurance, and Life/Accidental Death Insurance for
the City of Miami Beach Employees' Benefit Plan for a one-year period, with four (4), one-year renewal
options.
ADOPTED this 20th day of
January
,1999.
IpffM
~cr ~~
City Clerk
APPROVED AS TO
FORiv'\ & LANGUAGE
& fOR EXECUTION
Mayor
(jj~
Ciiy Marney
VI ~ It!
r Date
CITY OF MIAMI BEACH
RFP NO. 24-98/99
REQUEST FOR PROPOSALS FOR
GROUP MEDICAL INSURANCE, GROUP DENTAL INSURANCE, AND GROUP
BASIC/SUPPLEMENTAL/LIFE INSURANCE AND ACCIDENTAL DEATH &
DISMEMBERMENT INSURANCE
A PRE-PROPOSAL CONFERENCE IS SCHEDULED FOR 10:00 A.M
ON FEBRUARY 8, 1999, IN THE FIRST FLOOR CONFERENCE ROOM
OF CITY HALL, 1700 CONVENTION CENTER DRIVE, MIAMI BEACH, FLORIDA
PROPOSALS ARE DUE AT THE ADDRESS SHOWN BELOW
NO LATER THAN FEBRUARY 261999 AT 2:00 P. M.
CITY OF MIAMI BEACH
PROCUREMENT DIVISION
1700 CONVENTION CENTER DRIVE, THIRD FLOOR
MIAMI BEACH, FL 33139
PHONE: (305) 673-7490
FAX: (305) 673-7851
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
I
TABLE OF CONTENTS
I. OVERVIEW AND PROPOSAL PROCEDURES
II. SCOPE OF SERVICES
III. PROPOSAL FORMAT
IV. EVALUATION/SELECTION PROCESS; CRITERIA FOR EVALUATION
V. GENERAL PROVISIONS
VI. ATTACHMENTS
VII. PROPOSAL DOCUMENTS TO BE COMPLETED AND RETURNED
TO CITY
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
2
SECTION I - OVERVIEW AND PROPOSAL PROCEDURES:
A. INTRODUCTION/BACKGROUND
The City of Miami Beach (hereinafter referred to as lithe City ") employs approximately 1,700
employees, the majority of which live in Dade County and Broward County. The City has
approximately 1,300 retired employees, of which about half live in the South Florida area and the
majority of the other half live in other areas of Florida. However, there is a small population
of retirees living in other areas of the United States.
The City currently contracts with Humana for the Group Managed Medical Care. The plan is
fully insured and experience rated. The City has contracted with Humana for the Group Managed
Medical Care since November 1, 1987. After the initial contract award on November 1, 1987,
Humana was awarded contracts on October 1, 1989 and October 1, 1992, and October 1, 1996.
The City currently offers Managed Care Medical (PPO), Point of Service (POS), HMO and
Medicare Supplement Plans. The PPO, POS and HMO Plans are available to all full-time
eligible employees; all four plans are available to retirees. There are two exceptions. Effective
October 1, 1986, approximately 200 employees (all members of the fire fighters' bargaining unit,
and some unclassified fire management employees), have had medical insurance coverage
provided by the Florida Fire Fighters Health Insurance Trust Plan. Effective January 1, 1991,
approximately 300 employees (all members of the police officers' bargaining unit, and some
unclassified police management employees), have had medical insurance coverage provided by
the Miami Beach Fraternal Order of Police Health Trust. Presently, the City has 193 in the Fire
Fighters Health Insurance Trust plan and 275 members in the Miami Beach Fraternal Order of
Police Health Trust plan.
The City currently contracts with American Dental for the Group Managed Dental Insurance
Plans. The current managed care/indemnity dental insurance plan is an experience rated, fully
insured plan. The current contract with American Dental was awarded on October 1, 1996. The
contract was originally awarded to Prudential Insurance Company of America effective October
1, 1986, and was subsequently awarded four additional times, effective October 1, 1987, October
1, 1990, October 1, 1992 and October 1, 1995.
The City's Managed Care/Indemnity Dental Insurance Plan is available to all full-time eligible
employees and retirees, with one exception. Since October 1, 1986, approximately 200
employees (all members of the fire fighters' bargaining unit, and some unclassified fire
management employees), have had dental insurance coverage provided by the Florida Fire
Fighters Health Insurance Trust Plan.
The City currently contracts with ITT Hartford to provide Basic Life Insurance and Accidental
Death and Dismemberment Insurance. The current Basic Life. Supplemental Life and
Accidental Death & Dismemberment Insurance Plan is a prospectively rated, non-participating
contract. The current contract was awarded to ITT Hartford on October 1, 1994.
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
3
The City's Basic Life Insurance and Accidental Death & Dismemberment Plans cover all eligible
employees and retirees, with one exception. Since January 1, 1991, approximately 275 employees
(all members of the police officers' bargaining unit, and some unclassified police management
employees), have had Basic Life Insurance and Accidental Death & Dismemberment coverage
provided by the Miami Beach Fraternal Order of Police Health Trust. The City I s Supplemental
Life Insurance Plan is available to all eligible employees, including the employees covered by the
police officers' bargaining unit.
The effective date of October 1st coincides with the City's fiscal year. The fiscal year budget
process requires insurance rates for the next plan year be received no later than March 1999.
The contract term will be from October 1. 1999 to September 30, 2000 (12 months) with four
one-year options to renew.
GROUP MEDICAL
Participant Eligibility
Classified
This category includes all civil service employees, who are all bargaining unit
(union) employees and some non-bargaining unit ("Others") employees. An
employee must be full-time (work 30 or more hours per week) and be Original
Probationary or Regular Status.
Eligible for coverage after 90 consecutive days of employment. For classified
employees rehired with civil service rights (within one year of previous resignation
or layoft), eligible for coverage on date of hire.
Those classified employees whose positions are bargained by the International
Association of Fire Fighters (IAFF) and the Fraternal Order of Police (FOP) are
not eligible for Group Managed Care Medical Plan, Point of Service Plan, HMO
Plan coverage sponsored by the City.
Unclassified This category includes all non-civil service employees, including professional and
management. The mayor and conunissioners are also included. An employee must
be full-time (work 30 or more hours per week) and be Unclassified Status.
Eligible for coverage upon date of hire.
Those non-bargaining unit management employees who elected medical coverage
with the Florida Fire Fighters Health Insurance Trust Plan and the Fraternal Order
of Police (FOP) are not eligible for Group Managed Care Medical (PPO) Plan,
Point of Service (POS) Plan, or HMO coverage sponsored by the City.
Retirees
This category includes all retirees currently receiving a pension benefit from one
of the City's defined benefit or defined contribution pension plans, except those
who retired from positions bargained for by the IAFF, the FOP and who were
covered by the Florida Fire Fighters Health Insurance Trust Plan or the Miami
Beach Fraternal Order of Police Health Trust as employees.
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
4
The surviving dependent(s) of a deceased covered retiree or employee is eligible
if: (1) will be receiving a pension benefit, and (2) was covered as a dependent by
the retiree or employee.
Retirees may elect coverage for themselves and their dependent(s) on or after the
effective date of pension benefit commencement. Retirees are required to enroll
in Medicare Part B (major medical) and, if eligible, Part A. There are some
retirees and widows of retirees who are of Medicare eligibility age, but do not
participate in Medicare Part A (hospitalization). They are not eligible for Part A
because they have never participated in the Social Security system. There are less
than 20 retirees who are in this situation.
Pens. Board
Employees
The City also has two Pension Boards and offers medical coverage to their office
employees upon date of hire with the City and employee sharing the cost
50%/50%, for both employee only coverage and for family [employees and eligible
dependent(s)] .
Th~ir claims experience is pooled together with the employees' and retirees' claim
experience. Their premium costs and benefits shall be the same as the employees
and retirees.
However, we need a separate group number to be issued for the Pension Board
office employees.
Presently, there are 6 employees working for the Pension Boards.
Plan Contributions
Medical coverage is optional for all eligible retirees and eligible survlvmg
dependents of deceased employees and retirees, except those covered by the Florida
Fire Fighters Health Insurance Trust Fund or the Miami Beach Fraternal Order of
Police Health Trust.
The City and the employee/retiree share the cost 50%/50%, for both
employee/retiree only coverage and for family (employee/retiree and eligible
dependent[s]) coverage. "Dependent" includes spouse, and child(ren) from birth
to 19th birthday (or to 25th birthday if a full-time student in college or trade
school). However, under the PPO and POS plan a dependent child can continue
coverage to the end of the calendar year in which the child reaches age 25.
Premium costs are the same for employees and non-Medicare eligible retirees.
Deductions are withheld from 24 of the 26 paychecks per year for the employees.
Effective October 1, 1988, employees can elect Section 125 Cafeteria Plan to
pretax employee payroll deductions.
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
5
Deductions are withheld from the participating retirees' and survivors' pension
benefit checks each month. The City provides the Medicare covered retirees credit
each month for one-half of the Medicare Part B premium for the retiree and, if
applicable, the covered spouse.
Employees' and retirees' claims experience is pooled together for the Group
Managed Care Medical Plan (PPO) and Point of Service (POS), per Florida state
statute. Employees' and pre-Medicare retirees' claims experience is pooled
together for the HMO Plan, per Florida state statute. Medicare retirees in the
HMO Plan are covered by the Humana Gold Plus Plan, Humana's Medicare risk
contract.
DENTAL
Participation
Classified
This category includes all civil service employees, who are all bargaining unit
(union) employees and some non-bargaining unit ("Others ") employees. An
employee must be full-time (work 30 or more hours per week) and be Original
Probationary or Regular Status.
Eligible for coverage after 90 consecutive days of employment. For classified
employees rehired with civil service rights (within one year of previous resignation
or layoff), eligible for coverage on date of hire.
Those classified employees whose positions are bargained by the International
Association of Fire Fighters (IAFF) are not eligible for Managed Care/Indemnity
Dental Insurance Plan coverage sponsored by the City.
Unclassified This category includes all non-civil service employees, including professional and
management. The mayor and commissioners are also included. An employee must
be full-time (work 30 or more hours per week) and be Unclassified Status.
Eligible for coverage upon date of hire.
Those non-bargaining unit management employees who elected coverage with the
Florida Fire Fighters Health Insurance Trust Plan for their medical benefits are not
eligible for Managed Carel Indemnity Dental Insurance Plan coverage sponsored
by the City.
Retirees
This category includes all retirees currently receiving a pension benefit from one
of the City's defined benefit or defined contribution pension plans, except those
who retired after 10/1/86 from positions bargained for by the IAFF or who were
covered by the Florida Fire Fighters Health Insurance Trust Plan as employees.
Retirees can elect coverage within 31 days of the effective date of pension benefit
commencement.
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
6
Pens. Board The City also has two Pension Boards and offers dental coverage to Offices'
Employees their office employees upon date of hire with the City and employee
sharing the cost 50 % /50 %, for both employee only coverage and for family
[employees and eligible dependent(s)].
Their claims experience is pooled together with the employees' and retirees' claim
experience. Their premium costs and benefits shall be the same as the employees
and retirees.
However, we need a separate group number to be issued for the Pension Board
office employees.
Presently, there are 6 employees working for the Pension Boards.
Plan Contributions
The dental plan is optional coverage for all eligible employees, excluding the
members of the Florida Fire Fighters Health Insurance Trust Fund or positions
ba~gainedfor by the IAFF.
The dental plan requires mandatory coverage of at least the employee for all
eligible employees who enroll in a City-sponsored medical plan. Mandatory
coverage of at least the employee is also required for all eligible employees who
enroll in the Miami Beach Fraternal Order of Police Health Trust.
Retirees can elect coverage upon commencement of their pension benefit
payments, except those covered by the Florida Fire Fighters Health Insurance Trust
Fund. Mandatory coverage of at least the retiree is required for all retirees who
enroll in a City-sponsored medical plan. Mandatory coverage of at least the retiree
is required for all eligible retirees who enroll in the Miami Beach Fraternal Order
of Police Health Trust.
The City and the employee/retiree share the cost 50%/50%, for both
employee/retiree only coverage and for family (employee/retiree and eligible
dependent(s). "Dependent" includes spouse, and child(ren) from birth to 19th
birthday (or until the end of the calendar year in which the dependent child attains
age 25 if he/she is a full-time student in college or trade school).
Deductions are withheld from 24 of the 26 paychecks per year for the employees.
Effective October 1, 1988, employees can elect Section 125 Cafeteria Plan to
pretax employee payroll deductions. Deductions are withheld from the
participating retirees' pension benefit checks each month.
Employees' and retirees' claims experience is pooled together. Premium costs are
the same for employees and retirees.
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
7
BASIC LIFE/SUPPLEMENTAL
Participation
Classified
This category includes all civil service employees, who are all bargaining unit
(union) employees and some non-bargaining unit ("Others") employees. An
employee must be full-time (work 30 or more hours per week) and be Original
Probationary or Regular Status.
Eligible for coverage after 90 consecutive days of employment. For classified
employees rehired with civil service rights (within one year of previous resignation
or layoff), eligible for coverage on date of hire.
Those classified employees covered by the Miami Beach Fraternal Order of Police
Health Trust are not eligible for Basic Life Insurance and Accidental Death &
Dismemberment coverage. They are eligible for Supplement Life Insurance
coverage.
Unclassified This category includes all non-civil service employees, including professional and
management. The mayor and commissioners are also included. An employee must
be full-time (work 30 or more hours per week) and be Unclassified Status.
Eligible for coverage upon date of hire.
Those non-bargaining unit management employees who elected coverage with the
Miami Beach Fraternal Order of Police Health Trust for their medical benefits are
not eligible for Basic Life Insurance and Accidental Death & Dismemberment
coverage with the City plans. They are eligible for Supplement Life Insurance
coverage.
Retirees
This category includes all retirees currently receiving a pension benefit from one
of the City's defined benefit or defined contribution pension plans, except those
who retired while covered by the Miami Beach Fraternal Order of Police Health
Trust.
Can elect coverage within 31 days of the effective date of pension benefit
commencement.
Plan Contributions
Basic Life
Insurance
Mandatory coverage for all eligible employees. Retirees can elect coverage upon
commencement of monthly pension benefit payments.
The City and the employee/retiree share the cost 50%/50%. Deductions are
withheld from 24 of the 26 paychecks per year for the employees, and each month
for the retirees.
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
8
Employees' and retirees' experience is pooled together. Premium cost per $1,000
volume is the same for employee and retiree coverage.
Supplemental
Life
Insurance
Optional coverage for all eligible employees, including the members of the Miami
Beach Fraternal Order of Police Health Trust.
The employee pays 100% of the cost. Deductions are withheld from 24 of the 26
paychecks per year.
Pooled Life
Insurance
Pooled life is at $50,000 of Basic Life volume or a combination of Basic &
Supplemental Life volumes. The City pays 100% of the Pooled Life rate.
Accidental
Death &
Dismemberment
Insurance The City pays 100% of the cost.
PLAN SUMMARIES
*Please refer to attached plan summaries for Group Medical, Dental, and Life.
B. RFP TIMETABLE
The anticipated schedule for this RFP and contract approval is as follows:
RFP issued
January 21,1999
Deadline for receipt of questions
February 1,1999
Pre-Proposal Conference
February 8,1999,10:00 A.M.
Deadline for receipt of proposals
February 26,1999,2:00 P. M.
Evaluation committee meeting
March 22 - 31,1999
Commission approval and authorization
of negotiations
April 21, 1999
Contract negotiations
May 5,1999
Projected award date
May 19,1999
Projected contract start date
June 1,1999
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
9
C. PROPOSAL SUBMISSION
An original and ten (10) copies of complete proposal must be received by February 26, 1999
at 2:00 PM and will be opened on that day at that time. The orjginal and all copies must be
submitted to the Procurement Division in a sealed envelope or container stating on the
outside the proposer's name, address, telephone number, RFP number and title, and proposal
due date.
The responsibility for submitting a response to this RFP to the Procurement Division on or
before the stated time and date will be solely and strictly that of the proposer. The City will
in no way be responsible for delays caused by the u.s. Post Office or caused by any other
entity or by any occurrence. Proposals received after the proposal due date and time will not
be accepted and will not be considered.
D. PRE-PROPOSAL CONFERENCE
A pre-proposal conference will be held on February 8, 1999 at 10:00 a. m. in the First
Floor Conference Room of City Hall, 1700 Convention Center Drive, Miami Beach,
Florida.
E. CONTACT PERSON/ADDITIONAL INFORMATION/ADDENDA
The contact person for this RFP is the Procurement Director at (305) 673-7490. Proposers
are advised that from the date of release of this RFP until award of the contract, no contact
with City personnel related to this RFP is permitted, except as authorized by the contact
person. Any such unauthorized contact may result in the disqualification of the proposer's
submittal.
Requests for additional information or clarifications must be made in writing to the
Procurement Director no later than the date specified in the RFP timetable. Facsimiles will
be accepted at (305) 673-7851.
The City will issue replies to inquiries and any other corrections or amendments it deems
necessary in written addenda issued prior to the deadline for responding to the RFP.
Proposers should not rely on representations, statements, or explanations other than those
made in this RFP or in any addendum to this RFP. Proposers are required to acknowledge
the number of addenda received as part of their proposals. The proposer should verify with
the Procurement Division prior to submitting a proposal that all addenda have been
received.
F. PROPOSAL GUARANTY
Not required.
RFP NO.: 24-98/99
DATE: l/2l/99
CITY OF MIAMI BEACH
10
G. MODIFICATIONIWITHDRA W ALS OF PROPOSALS
A proposer may submit a modified proposal to replace all or any portion of a previously
submitted proposal up until the proposal due date and time. M9difications received after the
proposal due date and time will not be considered.
Proposals shall be irrevocable until contract award unless withdrawn in writing prior to the
proposal due date or after expiration of one-hundred-twenty (120) calendar days from the
opening of proposals without a contract award. Letters of withdrawal received after the
proposal due date and before said expiration date and letters of withdrawal received after
contract award will not be considered.
H. RFP POSTPONEMENT/CANCELLA TION/REJECTION
The City may, at its sole and absolute discretion, reject any and all, or parts of any and all,
proposals; re-advertise this RFP; postpone or cancel, at any time, this RFP process; or waive
any irregularities in this RFP or in any proposals received as a result of this RFP.
I. COST INCURRED BY PROPOSERS
All expenses involved with the preparation and submission of proposals to the City, or any
work performed in connection therewith, shall be the sole responsibility of the proposer(s)
and not be reimbursed by the City.
J. VENDOR APPLICATION
Prospective proposers should register with the City of Miami Beach Procurement Division;
this will facilitate their receipt of future notices of solicitations when they are issued. All
proposer(s) must register prior to award; failure to register will result in the rejection of the
proposal. Potential proposers may contact the Procurement Division at (305) 673-7490 to
request an application.
Registration requires that a business entity complete a vendor application and submit an
annual administrative fee of $20.00. The following documents are required:
1. Vendor registration form
2. Commodity code listing
3. Articles of Incorporation - Copy of Certification page
4. Copy of Business or Occupational License
It is the responsibility of the proposer to inform the City concerning any changes, including
new address, telephone number, services, or commodities.
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
11
K. EXCEPTIONS TO RFP
Proposers must clearly indicate any exceptions they wish to take to any of the terms in this
RFP, and outline what alternative is being offered. The City, ?fter completing evaluations,
may accept or reject the exceptions. In cases in which exceptions are rejected, the City may
require the proposer to furnish the services or goods originally described, or negotiate an
alternative acceptable to the City.
L. SUNSHINE LAW
Proposers are hereby notified that all information submitted as part of a response to this RFP
will be available for public inspection after opening of proposals, in compliance with Chapter
286, Florida Statutes, known as the "Government in the Sunshine Law".
M. NEGOTIATIONS
The City rilaY award a contract on the basis of initial offers received, without discussion, or
may require proposers to give oral presentations based on their proposals. The City reserves
the right to enter into negotiations with the selected proposer, and if the City and the selected
proposer cannot negotiate a mutually acceptable contract, the City may terminate the
negotiations and begin negotiations with the next selected proposer. This process may
continue until a contract has been executed or all proposals have been rejected. No proposer
shall have any rights in the subject project or property or against the City arising from such
negotiations.
N. PROTEST PROCEDURE
Proposers that are not selected may protest any recommendations for contract award by
sending a formal protest letter to the Procurement Director, which letter must be received no
later than 5 calendar days after award by the City Commission. The Procurement Director
will notify the protester of the cost and time necessary for a written reply, and all costs
accruing to an award challenge shall be assumed by the protester. Any protests received after
5 calendar days from contract award by the City Commission will not be considered, and the
basis or bases for said protest shall be deemed to have been waived by the protester.
O. RULES; REGULATIONS; LICENSING REQUIREMENTS
Proposers are expected to be familiar with and comply with all Federal, State and local laws,
ordinances, codes, and regulations that may in any way affect the services offered, including
the Americans with Disabilities Act, Title VII of the Civil Rights Act, the EEOC Uniform
Guidelines, and all EEO regulations and guidelines. Ignorance on the part of the proposer
will in no way relieve it from responsibility for compliance.
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
12
P. DEFAULT
Failure or refusal of a proposer to execute a contract upon award by the City Commission,
or untimely withdrawal of a proposal before such award is m~de and approved, may result
in forfeiture of that portion of any proposal surety required as liquidated damages to the City;
where surety is not required, such failure may result in a claim for damages by the City and
may be grounds for removing the proposer from the City's vendor list.
Q. CONFLICT OF INTEREST
All proposers must disclose with their proposal the name(s) of any officer, director, agent,
or immediate family member (spouse, parent, sibling, child) who is also an employee of the
City of Miami Beach. Further, all proposers must disclose the name of any City employee
who owns, either directly or indirectly, an interest of ten (10%) percent or more in the
proposer or any of its affiliates.
R. PROPOSER'S RESPONSIBILITY
Before submitting proposal, each proposer shall make all investigations and examinations
necessary to ascertain all conditions and requirements affecting the full performance of the
contract. Ignorance of such conditions and requirements resulting from failure to make such
investigations and examinations will not relieve the successful proposer from any obligation
to comply with every detail and with all provisions and requirements of the contract
documents, or will be accepted as a basis for any claim whatsoever for any monetary
consideration on the part of the proposer.
S. RELATION OF CITY
It is the intent of the parties hereto that the successful proposer be legally considered to be
an independent contractor and that neither the proposer nor the proposer's employees and
agents shall, under any circumstances, be considered employees or agents of the City.
T. PUBLIC ENTITY CRIME (PEe)
A person or affiliate who has been placed on the convicted vendor list following a conviction
for public entity crimes may not submit a bid on a contract to provide any goods or services
to a public entity, may not submit a bid on a contract with a public entity for the construction
or repair of a public building or public work, may not submit bids on leases of real property
to public entity, may not be awarded or perform work as a contractor, supplier, sub-
contractor, or consultant under a contract with a public entity, and may not transact business
with any public entity in excess of the threshold amount provided in Sec. 287.017, for
CA TEGOR Y TWO for a period of 36 months from the date of being placed on the convicted
vendor list.
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
13
SECTION II - SCOPE OF SERVICES
A. MEDICAL, DENTAL, AND LIFE
All Plans
The City desires to maintain the current benefits level for Medical and Life Insurance and
desires to increase the benefit level for Dental. The City requests that for Dental
Insurance, that a response be submitted for a Prepaid Plan and a PPO/Indemnity Plan.
All bids must be for fully insured, two tiers (single and family) plans. Alternative plans
providing increased benefits levels and multiple tiers for all plans may be submitted.
Bids will be accepted on all three plans (Group Medical, Dental, and Life) separately or
combined. Favorable consideration will be given to those bids which include two or more
plans (Group Medical, Dental and Life).
Each bidder is required to provide monthly paid claim and utilization reports to the City
for all plans. The reports will show premiums (or equivalent premiums) and paid claims
to the City separately for the following groups, with a summary for the entire group:
Employees
* AFSCME bargaining unit civil service employees
* CW A bargaining unit civil service employees
* "Others" non-bargaining unit civil service employees
* Unclassified non-civil service employees
Retirees
* Pre-Medicare retirees/dependents in service area
* Pre-Medicare retirees/dependents out of service area
* Medicare retirees &/ or dependents in service area
* Medicare retirees &/ or dependents out of service area
With the renewal proposal, the successful bidder is required to provide a paid claims
report through November 30th and an up-to-date pending claims report to the City. The
reports should differentiate between employee subgroups and pre-Medicare and Medicare
retiree claims.
The City occasionally hires employees on a provisional status. Provisional employees
are hired for civil service positions pending the development of an eligibility list and
selection for permanent hire from the list. If the provisional employee is not selected from
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
14
the list, employment is terminated. Currently, provisional employees are not eligible for
any benefits other than Federal holidays, but consideration maybe being given to offering
medical coverage to them (after 90 days of employment) with the employee paying 100%
of the premium.
Also, the City hires some employees on a permanent, part-time (less than 30 hours per
week) basis. Permanent part-time employees are currently not eligible for any group
insurance benefits, but consideration maybe being given to offering medical coverage to
them (after 90 days of employment) with the employee paying 100% of the premium.
Your proposal should state if you are willing to provide coverage on this basis.
The City currently offers a Premium Payment Cafeteria Plan to its employees.
Consideration is being given to expanding this Plan to include the Medical Reimbursement
Salary Reduction (aka "Health FSA") and, perhaps, the Dependent Care Assistance Salary
Reduction (aka "DCAP") features permitted under IRS Section 125. The City will
entertain any suggestions, cost projections and requisite services your Company can put
forward. -
No change is anticipated in current plan contribution structure.
The plans should not have a lapse in coverage and take over all currently enrolled
members.
The plans are to be effective October 1, 1999. A twelve month premium rate guarantee
is required from all bidders with an option to renew for four additional years. If you are
capable of guaranteeing your rates for a greater period, favorable consideration will be
given to this type of quotation and the added exposure to the bidder will be considered in
the evaluation process.
Group Medical-Funding
The City prefers to have a managed care/indemnity benefit plan, point of service plan and
HMO plan. Bids are also requested for an annual choice among the PPO/indemnity plan,
POS or a HMO plan. Rates for a managed care/indemnity, point of service, and HMO
plans are to be provided separately for employees and pre-Medicare retirees as a group and
Medicare retirees as another group. Rates for an annual choice plan are to be provided
separately for the PPO/indemnity plan choice, POS and the HMO plan choice. The
separate rates are to motivate employees and retirees to enroll in the HMO plan, but be
partially blended to account for the fact that many of the retirees without Medicare
coverage do not live in an HMO service area, and therefore will have to select the PPO
option. There are approximately 44 pre-Medicare retirees with retiree only coverage and
45 who have family coverage, in this situation. Fully blended annual choice
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
15
(PPO/indemnity, POS or HMO) rates are also requested, to be selected at the City's
option.
The City also offers Medicare retirees the choice of an inde!TInity Medicare Supplement
plan. Fully insured Medicare Supplement indemnity plan (no PPO) rates are to be
provided for retirees with full Medicare coverage and separately for retirees with partial
Medicare coverage. The partial Medicare rates account for the fact that a small number
of retirees do not participate in Medicare Part A (hospitalization). Retirees are required
to enroll in Medicare Part B (major medical) and, if eligible, Part A. Certain retirees and
their spouses are not eligible for Part A by virtue of the fact that some City employees
have never participated in the Social Security system. There are less than 20 retirees who
are in this situation. Rates are to be presented which account for this lack of Medicare
Part B coverage. For your information, effective April 1, 1986, all newly hired
employees contribute to the Medicare portion of FICA.
For the PPO, POS and Medicare Supplement plan bids, you must indicate which method
of benefit. payment is being utilized and provide several sample illustrations of actual
payments under the proposed method.
Group Medical-Administration
The City wishes to utilize a system of roster billing for all persons eligible for medical
coverage on a monthly basis.
Also, City group insurance staff may occasionally request telephone verification while
assisting a plan member. Please state in writing if you are unable to comply with this
request.
Medical claims are to be submitted directly to the insurance carrier by the plan members
or, if assigned to the providers.
The City requires that separate booklet-certificates be issued for the managed care medical
(PPO), Point of Service (POS), HMO and Medicare Supplement plans. Charges for
printing & mailing by your firm are to be incorporated into the proposed rates. Booklet-
certificates are to be provided within three months of plan implementation. If the current
carrier continues, new booklet-certificates are not required.
The City would like that an account service representative be placed in the City of Miami
Beach Employee Benefit Section on a full-time basis. This individual will assist
employees and retirees with questions and concerns regarding their plan benefits. It would
be necessary to have a on-line computer to assess pertinent information on claim history
and eligibility status. The account service representative will also need a 1-800 telephone
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
16
number so retirees residing outside of South Florida may contact the representative.
Dental-Funding
.
The City requests a fully-insured (experience rated) traditional/managed care insurance
plan. All rates are to illustrate 100% premium rates; annual or terminal retrospective
premium agreements are not desired. All bids must offer both PPO/Indemnity and Prepaid
dental insurance coverage(s); no partial bids will be considered.
Dental-Administration
The City wishes to utilize a system of roster billing. Each bargaining unit and non-
bargaining unit will have its own branch number under the City of Miami Beach's group
number.
The City requests that telephone verification of coverage and benefits be provided by the
carrier. Also, the City's group insurance staff may occasionally request telephone
verification while assisting a plan member.
The City requires that a separate booklet-certificate be issued for the managed carel
indemnity dental insurance plan. Charges for printing and mailing by your firm are to be
incorporated into the proposed rates. Booklet-certificates are to be mailed to
employees/retirees within three months of plan implementation. If the current carrier
continues, new booklet-certificates are not required. Any riders or addendum shall be
mailed by the carrier. Charges for printing and mailing by your firm are to be
incorporated into the proposed rates.
Plan members and providers will be mailing claims directly to the carrier. The City
requires that payment be mailed directly to the member or, if assigned, the provider.
Life-Funding
Bids are requested for prospectively rated, non-participating contract for Basic Life,
Supplemental Life and fully pooled Accidental Death & Dismemberment insurance. All
rates are to illustrate 100% premium rates; annual or terminal retrospective premium
agreements are not desired. All bids must offer coverage for both life and accidental death
& dismemberment; no partial bids will be considered. Any pooling levels appropriate
to the size of the group should be set by the carriers.
Life- Administration
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
17
The City wishes to utilize a system of self-billing. Each bidder is expected to propose a
self-billing arrangement. The City requests that the current life insurance enrollment cards
and beneficiary designation forms be maintained as the source documents for life insurance
amounts and designation of beneficiaries.
*BIDS WHICH CANNOT COMPLY WITH THESE REOUIREMENTS MAYBE
REJECTED.
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
18
SECTION III - PROPOSAL FORMAT
Proposals must contain the following documents, each fully completed and signed as required.
Proposals which do not include all required documentation or are not submitted in the required
format, or which do not have the appropriate signatures on each document, may be deemed to be
non-responsive. Non-responsive proposals will receive no further consideration.
A. CONTENTS OF PROPOSAL
1. Table of Contents
Outline in sequential order the major areas of the proposal, including enclosures. All
pages must be consecutively numbered and correspond to the table of contents.
2. Proposal Points to Address:
Proposer must respond to all minimum requirements listed below, and provide
documentation which demonstrates ability to satisfy all of the minimum qualification
requirements. Proposals which do not contain such documentation may be deemed
non-responSIve.
3. Price Proposal
Proposer must include price which will be charged to the City.
3. Acknowledgment of Addenda and Proposer Information forms (Section VIII)
4. Any other document required by this RFP. such as a Questionnaire or Proposal
Guaranty.
B. MINIMUM REQUIREMENTS / QUALIFICATIONS:
All Bidders must respond to the following:
1. Price Proposal/Questions
2. Pricing Format
3. Medical, Dental, and Life Questionnaires
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
19
PRICE PROPOSAL/QUESTIONS
Please provide answers to the following questions, noting any differences pertaining to the various
funding arrangements being proposed. Specify the plan design applicable to following questions
regarding rates, retention illustrations, and financial guarantees, if any. Please respond to each
question separately for each plan you are proposing.
1. Please describe in detail the funding arrangement(s) you propose. The City prefers not to
have an annual retrospective premium agreement.
2. Please describe the timing on the funding of all claims, including any capitation or other
provider payment arrangements.
3. Please describe the period-to-period and annual financial accounting procedures, taking
into consideration:
A. Ca.rryover of funding deficits, and refund formulas (if applicable).
4. Please describe how claims and expenses will be accounted for at the close of each plan
year.
5. How are incurred dates established? Date of service or date of payment?
6. What is your conversion charge? Describe your conversion process and types of medical
conversion contracts available.
7. Please describe your procedures and timing relating to the disposition of the reserve ronout
liability in the event of contract cancellation. If a terminal retrospective premium
arrangement is offered, please describe its application to any liability in effect at time of
termination.
8. The City is interested in stabilizing its health care costs. Are you willing to offer any
mechanism which would limit future increases over the next two to three years. If yes,
please describe in detail how this financial guarantee or risk sharing arrangement would
operate. Please specify all circumstances under which it would not apply. In addition,
please provide any cost increase factors by plan and contract year which may be a part of
this arrangement.
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
20
PRICING FORMAT
Please complete the fully insured rate summaries provided following .this section. The summaries
consider a two tier plan (Single=Retiree, Family = Dependent). We have included presumed
enrollment figures for illustration and comparison purposes.
If you desire to submit an optional multiple tier plan, please provide as an attachment to your
response.
*Premium rates should not include any commissions.
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
21
A. MEDICAL PREMIUM RATE SUMMARY
FULL Y INSURED (EXPERIENCE RATED) BIDS
1. ANNUAL CHOICE - MANAGED CARE MEDICAL p'LAN (PPO)
Monthly Total
Premium Monthly
Coverage Exposures Rate Premium
Emp loyee/Pre- Medicare
Retiree Only 237 $ $
Family (Emp/Pre-Medicare
Retiree & Dep(s) 209 $ $
Pre-Medicare Retiree
& Medicare Spouse 7 $ $
Medicare Retiree Only 138 $ $
Medicare Retiree &
Pre-Medicare Dep(s) 40 $ $
Medicare Retiree
& Medicare Spouse 77 $ $
TOTAL MONTHLY PREMIUM $
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
22
2. ANNUAL CHOICE - POINT OF SERVICE (POS)
Monthly Total
Premium Monthly
Coverage Exposures Rate Premium
Emp loyee/Pre- Medicare
Retiree Only 4 $ $
Family (Emp/Pre-Medicare
Retiree & Dep(s) 8 $ $
Pre-Medicare Retiree
& Medicare Spouse 1 $ $
Medicare Retiree Only 0 $ $
Medicare Retiree &
Pre-Medicare Dep(s) 0 $ $
Medicare Retiree
& Medicare Spouse 0 $ $
TOTAL MONTHLY PREMIUM $
3. ANNUAL CHOICE - HMO PLAN
Monthly Total
Premium Monthly
Coverage Exposures ~ Premium
Employee/Pre-Medicare
Retiree Only 350 $ $
Family (Emp/Pre-Medicare
Retiree & Dep(s) 331 $ $
Pre-Medicare Retiree
& Medicare Spouse 0 $ $
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
23
Medicare Retiree Only 56 $ $
(Gold Plus Plan)
Medicare Retiree &
Pre-Medicare Spouse 11 $ $
Medicare Retiree
& Medicare Spouse 26 $ $
(Gold Plus Plan)
TOTAL MONTHLY PREMIUM $
4. ANNUAL CHOICE - MEDICARE SUPPLEMENT PLAN
Monthly Total
Premium Monthly
Covera~e Exposures ~ Premium
Pre-Medicare Retiree
& Medicare Spouse nla $ $
Medicare Retiree Only 73 $ $
Medicare Retiree &
Pre-Medicare Spouse nla $ $
Medicare Retiree
& Medicare Spouse 36 $ $
TOTAL MONTHLY PREMIUM $
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
24
CERTIFICATION OF QUOTATION BY UNDERWRITER:
SIGNED:
TITLE:
COMPANY:
DATE:
This bid is valid until
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
25
DENTAL
PPO/INDEMNITY INSURANCE PLAN BID SUMMARY
Please complete the following form and include this page in your bid response.
A. PREMIUM RATE SUMMARY/TRADITIONAL
Total
Covered Premium Monthly
Emps & Rets Rate Premium
Employee/Retiree 1030 $ $
Single Coverage
Family Coverage 1090 $ $
TOT AL MONTHLY PREMIUM $
B. PREMIUM RATE SUMMARY/PREPAID
Total
Covered Premium Monthly
Emps & Rets Rate Premium
Employee/Retiree 1030 $ $
Single Coverage
Family Coverage 1090 $ $
TOTAL MONTHLY PREMIUM $
RFP NO.: 24-98/99
DATE: l/2l/99
CITY OF MIAMI BEACH
26
CERTIFICATION OF QUOTATION BY UNDERWRITER:
SIGNED:
TITLE:
COMPANY:
DATE:
This bid is valid until
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
27
LIFE INSURANCE PLAN BID SUMMARY
Please complete the following form and include this page in your bid response.
1. What is your conversion charge per $1, OOO? Describe your conversion process and types
of life conversion contracts available.
2. PREMIUM RATE SUMMARY
Total
Covered Total Rate per Monthly
Emps & Rets Volume llQQQ Premium
Basic Life 1,847 $34,107,000 $ $
Supplemental
Life 363 $12,913,000 $ $
Pooled Life 325 $ 9,061,000 $ $
Accidental
Death/ 956 $14,866,500 $ $
Dismemberment
TOT AL MONTHLY PREMIUM $
5. Are you willing to provide any guarantees of rates? If yes, please describe your offer (specifying
which coverage(s) and length of time.)
CERTIFICATION OF QUOTATION BY UNDERWRITER:
SIGNED:
TITLE:
COMPANY:
This bid valid until
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
28
GROUP MEDICAL QUESTIONNAIRE
The information in this questionnaire is important and will be used in evaluating your proposal. Please
be certain that all questions are answered completely and accurately. Your responses to these questions
must be based on your current capabilities. You may, in addition, describe your future capabilities, but
only as a supplement to your "current capabilities" response. Please include the questions in your
response. All responses should be clear and as complete as possible. Do not provide responses which
direct the reader to an attached exhibit. Where appropriate, please indicate which plan your response
applies to, if the response does not apply to all plans.
A. GENERAL INFORMATION
1. Provide the name, title, address, and a brief description of their qualifications and experience for
the individual with the following responsibilities:
(a) The individual (in your home, regional, or local office) who will have overall
responsibility for planning, supervising and delivering service, and resolving problems.
(b) The individual representing your company during the bidding process.
(c) The individual who will be assigned the overall ongoing service responsibility.
(d) The individual responsible for day-to-day service.
(e) The individual responsible for the supervision of the claims administration.
(f) The individual who will be assigned ongoing underwriting responsibility.
(g) The Medical Director of the South Florida area network.
(h) The individual responsible for the Utilization Management/Health Services of the local
network.
(i) The individual responsible for day-to-day membership service.
(j) The individual representing your company during the renewal process and Group
Insurance Board Meetings.
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
29
2. Please provide a copy of your most recent audited financial statement or annual report, and the
Best's rating of your company and/or that of your insurer. For your proposed network, please
provide the most recent audited financial statement and an Qverview of its finances for the past
three years.
3. Please provide a list of three current and three former clients of similar size and coverage as the
city's. Former clients are those which have terminated coverage within the last three years. All
references should include:
- Name of Company
- Name of contact
- Title of contact
- Address of contact
- Telephone number of contact
- Service~ provided to company (Plan Type)
- Approximate number of employees to whom services are/were provided
If possible, the references should be from those serviced by the same account
representative designated for the City.
B. ADMINISTRATION
4. Give the location of the administrative office which will be utilized. Give each location if more
than one office will be used.
5. Describe the coordination between the administration of the following:
A. Eligibility file maintenance
B. Claims processing
C. Financial accounting
D. Utilization reporting
E. Premium billing
6. Please describe your eligibility information management procedures, including your capabilities
for handling on-line (uploaded from PC), and paper updates, and your turnaround time for having
updated data on file. Note any differences between the indemnity plan and the managed care
network.
7. Please describe the level of assistance you are willing to provide the City in the initial enrollment,
installation, and established of administrative procedures for this case.
8. Describe your role and capabilities in communicating the proposed plan changes to City
RFP NO.: 24-98/99
DATE: 1121199
CITY OF MIAMI BEACH
30
employees. Provide samples of the standard communication material included in your fee. Note
separately the additional cost (if any) to provide service representatives for on-site educational
sessions three or four times a year for employees. Describe any additional services you could
provide and their costs.
9. If warranted, would you provide a service representative to meet with employees and retirees (one
round of jobsite and City Hall presentations would be about 15 meetings)?
10. Please provide a specimen contract and a specimen booklet-certificate. Also, please provide
specimen new enrollment packets and educational information.
11. What are the billing arrangements for each proposed coverage? Attach samples of your billing
forms.
12. Describe your COBRA administrative capabilities? What are your fees?
13. Will you meet the City I S renewal rate presentation deadline of March 1 st each year for an October
1st effective date?
14. Please explain what happens in the event of contract termination, including the transition process
and the claims detail history you will provide.
C. UNDERWRITING
15. Please note all underwriting requirements, maximum amounts of coverage, requirements for no
medical evidence of insurability, requirements for late enrollments or Open Enrollment additions,
minimum participation requirements, and all restrictions and limitations for each proposed plan.
16. Please outline the procedures required to implement this plan. How do you propose to credit
existing deductibles and benefit maximums already met for calendar year 1998?
17. Discuss your options in your proposed plan design. How much flexibility does the City have in
changing the plan design you have proposed? What design features can not be modified.
Specifically, what changes are from the current or requested plan design described in Section Four
are you suggesting?
18. Please list all exclusions and limitations contained in each option of your plan.
19. What level of trend are you currently using for your indemnity medical? Managed care medical?
20. Are you willing to provide any guarantees of rates and/or retention? If yes, please describe your
offer.
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
31
21. What are your procedures for renewal underwriting? Do you require any specific information
from the City?
22. Explain the distribution and timing of excess premium or reserves in the event of contract
cancellation' on any date. What percent of interest is credited on positive cash flow?
D. NETWORK ASSESSMENT
23. Briefly describe your network, including when it was started, whether it is a PPO, POS, HMO
or other form, whether it is physician or hospital based, etc. Please prepare a one page overview
including information you feel would better acquaint the City with the network history and
operation.
24. Providey<?ur most recent provider directory. Please note your physician and hospital provider
locations by 3 digit zip code. Please include listings for providers of: diagnostic radiology,
laboratory, durable medical equipment, physical therapy, lithotripsy, outpatient surgical centers,
extended care facilities, home health care agencies, and ambulance services. Describe any
coverage deficiencies which exist by geographic area for any physician (primary or specialist) or
hospital.
25. Provide maps indicating as clearly as possible the location of hospitals, other institutional
providers and any large multi-specialty groups that are operational within your network.
26. Please describe how the psychiatric/ psychological! mental health providers in your network are
selected, monitored and reimbursed. If subcontracted, please discuss contract provisions.
27. Are you willing to provide additional information concerning the background of each physician
within the network for members use in the selection of a physician? If not full credentials, at least
information regarding sub-specialities, other areas of expertise, experience in certain procedures,
etc?
28. Under what circumstances would you be willing to expand your existing networks to include
physicians who currently treat City employees/retirees and their dependents, if not already in your
network?
RFP NO.: 24-98/99
DATE: l/2l/99
CITY OF MIAMI BEACH
32
29. Please complete the following network profile. Please provide the number of facilities/physicians
servicing each of the following categories.
--3 Digit Zip Codes --
330 331 332
TOTAL
Number of physicians
General practice/Family practice
Internal medicine
OB/GYN
Cardiology
Radiology
Pediatrics
Psychiatry
--3 Digit Zip Codes --
330 331 332 TOTAL
Number of Physicians
Board certified
Board eligible
Neither Board certified nor eligible
Number of JCAH approved Hospitals,
& Beds by Specialty
(Example: Obstetrics 'J.!1.2 )
(For obstetrics, in the 330 zip code, 3 hospitals have 75 OB beds total)
Acute psychiatric
Intensive care
Rehabili~ation - skilled nursing
General medical
General surgical
Coronary intensive care
Emergency trauma center
Burn
Hospice
Neonatal intensive care
RFP NO.: 24-98/99
DATE: l/2l/99
CITY OF MIAMI BEACH
33
Total number of members, including employees, retirees and dependents, as follows:
South Florida service area
as of 12/1/98
as of 12/1/97
Other service areas
as of 12/1/98
as of 12/1 /97
30. Are primary providers capitated? If not, please describe the reimbursement mechanism. Is there
provider risk-sharing? If yes, please describe.
31. Please describe the reimbursement mechanism used for network specialists.
32. For the managed care medical option, please indicate locations and size of networks if you have
service areas outside of South Florida.
E. PROVIDER REIMBURSEMENT MECHANISMS AND CONTROLS
33. Referring to your South Florida area network, please provide the following statistics:
.l22Q
.l.221
l228.
Hospital Admissions/! ,000
Hospital Inpatient Days/1 ,000
Hospital Outpatient Visits/1, 000
Primary Care Encounters/1, 000
Specialty Referrals/1, 000
A verage Hospital Length of Stay
-- Medical/Surgical
-- Mental & Substance Abuse
Hospital Outpatient Surgeries/1, 000
Hospital Emergency Room Visits/1 ,000
Monthly Claims/Claimant
Total Charges/ Hospital Admissions
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
34
Rate of C-Section to Live
Birth
-- With Complications
-- Without Complications
34. Please indicate the correct response with an "X" in the corresponding space.
Physician Reimbursement
Primary Care
Capitation
Discounted Fee-for Service
Discounted Fee-for Service with a Withhold
Fee Schedule
Other (Please explain)
Specialty Care
Capitation
Discounted Fee-for Service
Discounted Fee-for Service with a Withhold
Fee Schedule
Other (Please explain)
Hospital Reimbursement
Capitation
Discounted Fee-for Service
Discounted Fee-for Service with a Withhold
Fee Schedule
Other (Please explain)
Average Percent Physician Discount (331zip)
Average Monthly Physician Capitation (where
appropriate) (331zip)
Average Percent Hospital Discount (331zip)
35. Are primary providers capitated? If not, please describe the reimbursement mechanism. Is there
provider risk-sharing? If yes, please describe.
36. Please describe the reimbursement mechanism used for network specialists.
37. If withholds are applied, please explain their reconciliation.
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
35
38. Are you willing to share specific information about provider reimbursement (e.g., fee schedules)
if selected as a finalist?
39. For the managed care medical option, please indicate locatiuns and size of networks if you have
service areas outside of South Florida.
40. Based on the zip code listing of the retirees who do not reside in Dade & Broward County, please
indicate how many may be serviced by your network in other locations. Please detail which
metropolitan areas may be serviced.
F. PROVIDER CONTRACTING
41. Please provide copies of model contracts between your networks and all relevant provider types
(i.e., selection and participation requirements.)
42. What crit~ria are use to select provider members (e.g., physicians, hospitals, other facilities)?
43. How are individual providers monitored?
44. Describe peer review and the role of medical directors within your network.
45. Please provide copies of your Quality Assurance planes).
46. Please describe your system for evaluating the quality of care delivered within your network.
47. Do you have a process for excluding or penalizing providers who do not meet performance
standards?
Please address the following:
(a) Performance standards or criteria for exclusion or penalties.
(b) Due process protocol.
(c) Linkage to data system.
(d) Any pending or settled suits related to this activity.
48. What is the termination notice required between providers and the network? What IS the
procedure when a physician wants to opt out of the network?
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
36
G. MANAGED CARE UTILIZATION BY PATIENT
49. If you offering a daily choice type of plan, how do you prevent plan members from "maximizing"
their benefit coverage by choosing the other choice when benefits are exhausted with the first
choice?
50. How often can a member change into or out of the managed care option?
51. Are participants required to select a primary care physician? If so, how do participants change
their primary care physician? How often can this be done?
52. What is your target travel time to secure network care from a primary care physician, a specialist
and a hospital?
53. What is your target for a wait time to obtain a visit with a network physician?
54. If a City employee cannot secure an appointment within a reasonable wait-time period what
provisions are made to meet employee needs, both immediate and long term.
55. Please describe your system for evaluation of the accessibility to and quality of care delivered
within your network by both primary and specialty providers.
56. What happens if a participant seeks care through their primary care physician, but that physician
refers the patient to a non-network providers? Explain how the City and the employee will be
protected from incremental costs.
57. How do you handle payment situation when patients using a network primary care physician
receive treatment by non-network specialists (usually in emergency situations) through no action
of their own? Are these charges paid at network, or non-network levels?
58. Do you have a membership service staff to accept telephone calls from members and City group
insurance staff on claims and benefits inquiries?
59. Describe, in detail, your proposed mechanism for servicing the telephone-prompted needs of City
of Miami Beach plan participants as it relates to your network. Give examples of the kinds of
inquires you anticipate and how they will be responded to.
60. Describe the specific grievance system that would be implemented to hear and resolve plan
participants' problems regarding the network and its operation. Include the procedure for
requesting a review of denied services.
61. Have you conducted member satisfaction surveys? If yes, please include the most recent results
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
37
available for the South Florida service area.
H. CLAIMS PAYMENT
62. Give the location of each claim/office which will be utilized for each benefit where different
benefits are paid from different offices.
63. Do you employ a II dedicated claim unit II which only processes medical claims? Does the same
claim unit review all types (hospital, physician, other major medical providers) of indemnity and
managed care medical claims?
64. Describe the claim paying team who will be responsible for the City's account. Please identify
by function the number of individuals to be assigned to this case and their average length of
service with the proposed plan.
65. Is your claim system fully automated for both in-network and out-of-network processing? If not,
indicate the steps performed to coordinate those who use both network and non-network
providers.
66. Please describe the claim payment procedures that employees will be expected to follow when
using network and non-network providers. Your description should include all situations where
the employee must complete a claim form, and conversely, all situations where no claim form is
required (i.e., paperless claims system).
67. Please indicate the medical claims turnaround time in the proposed City claim office(s):
14 Calendar Days
Tar~et % Actual %
30 Calendar Days
Tar~et % Actual %
3rd Qtr. 1998
2nd Qtr. 1998
68. What is the maximum period of time which can elapse between a service being incurred and
notification of the claim provided? (15 months, 24 months, etc.)
69. Please indicate below the claim processing accuracy rates for medical claims in the office(s) that
will pay City claims:
4th Quarter 1998
Target % Actual %
2nd Quarter 1998
Target % Actual %
RFP NO.: 24-98/99
DATE: l/2l/99
CITY OF MIAMI BEACH
38
Payment Accuracy
Dollar Accuracy
Other (Describe)
How is an error defined under your standards?
70. What guidelines do you use for determining reasonable and customary charges? What charges
are subject to R & C review? How frequently are these figures updated? What is your source
of R & C data? If you do not use R & C schedules, provide detailed information on your payment
procedures.
71. Provide your R & C allowance levels for the following procedures performed in South Florida:
CPT4 Miami Miami Miami Ft. Lauderdale
Procedure ~ (330XX) (331XX) (332XX) (333XX)
Tenotomy, Foot 28230
Laryngoscopy 31515
Triple Coronary
Artery Bypass 33512
Cholecystectomy 47600
Hysterectomy 58150
Normal Deliver 59400
Chest X-Ray,
Two View 71020
Individual
Psychotherapy 90844
Intermediate
Hospital Care 90260
Office Visit -
Intermediate 90050
Office Visit -
Consultation 90605
CBC With
Differential 85022
Chemistry Profile 80018
72. Describe the claim cost control program. How do you detect overcharges, unnecessary or
extensive hospital and handle confinements, unnecessary medical treatment (both inpatient and
outpatient), or provider abuses?
RFP NO.: 24-98/99
DATE: l/2l/99
CITY OF MIAMI BEACH
39
73. What type of audit programs are use to evaluate performance? How frequently are they
conducted? What percent of each processor's production is audited? How are audit results used
by the administrator? What production standards are claim processors expected to maintain?
74. Will you agreed to provide on a quarterly basis the results of your internal audit of the accuracy,
consistency and timeliness of benefit payments on behalf of the City? Please provide a sample of
this report.
75. Describe the procedures you would use to effectively administer non-duplicating coordination of
benefits (COB) for both network and non-network providers. You should include (but not limit)
your discussion to:
(a) Recommendations of gathering information.
(b) Unique claim forms or claim payment procedures.
(c) Reporting and monitoring devices.
(d) Procedures when third-party subrogation is involved.
76. Please describe your proposed method of integrating benefits with Medicare. Discuss your claim
adjudication process with examples of inpatient and outpatient claims.
77. Do you provide the following services for network, out-of-network and out-of-area participation?
- Hospital preadmission review
- Concurrent stay review
- Discharge planning
- Procedure-specific second opinion
Yes
Yes
Yes
Yes
No
No
No
No
- Retrospective review for medical
necessity prior to payment (with
employer and employee held harmless
- Large case management for inpatient
and outpatient claims
Yes
No
Yes
No
- Psychiatric and substance abuse
case management
- Ambulatory services review
- Hospital bill audit program
- Other services (please specify)
Yes
Yes
Yes
Yes
No
No
No
No
RFP NO.: 24-98/99
DATE: l/2l/99
CITY OF MIAMI BEACH
40
Are your utilization review services different in any way for in-network versus out-of-network
versus out -of-area participants?
78. Describe the utilization management procedures from request for hospitalization to date of
discharge.
79. Describe the process of obtaining approval for extended stay.
80. What is your criteria for on-site review?
81. Describe your procedures and staff for handling hospital admissions for mental health and
chemical dependency. Note the process of authorization of the requested treatment plan and those
guidelines used for determining the appropriate length of stay. (Please answer separately for
psychiatric and chemical dependency, where appropriate).
82. Describe your procedures for managing outpatient care for mental health/substance abuse.
83. What are the selection criteria for individual case management, and how are they administered?
84. Describe your procedures for outpatient case management other than those described above.
Provide a list of procedures or criteria for case management/UR. How were these criteria
developed?
85. Please describe specifically your strategy for managing large case medical claims (i.e., medical
case management programs).
86. Please describe your proposed staff composition to be dedicated to utilization review for the City.
(Note: network.a.ru1 out-of-network).
Full-time
Equivalent
Nurses: RN
Psychiatric
LPN RN
Others
(please
specify) _
Physicians:
On Staff
Consultants
Consultant/advisory capacity:
Psychiatrists: On Staff
Psychologists: On Staff
Clerical and Support:
Consultants
Consultants
RFP NO.: 24-98/99
DATE: 1/2l/99
CITY OF MIAMI BEACH
41
Please describe their qualifications, procedures reviewed and give the ratio of review staff to
members.
87. Please describe your quality control and internal audit pr9cedures with regard to utilization
management.
88. For both the managed care and indemnity options, describe your predetermination and alternate
course of treatment procedures. Provide samples of forms used. What is the turnaround time in
calendar days for medical predeterminations? Provide specimen of notification forms used.
89. What penalty do you apply or recommend to apply to benefit payment when a plan members fails
to pre-certify or obtain prior authorization?
90. With regard to the coordination of the claim payment system with the utilization review system:
(a) Please describe your procedures and facilities for communicating utilization review decisions
to the claims payment system.
(b) What is the frequency and mode of communications?
(c) Is the interface between the two systems manual or automated?
(d) Specifically, what data are passed to the claim system?
91. Claim Reporting:
(a) Identify your standard package of utilization and financial reports, their frequency, and
costs. Please provide sample reports. The City requires monthly claim details and annual
utilization data for all medical options. Will you provide these reports at a minimum?
Please detail additional reports you will provide.
(b) Identify optional utilization, financial reports, their frequency, and costs. Please provide
sample reports.
(c) Describe the support given by your information systems to the utilization management
function. Provide same reports.
(d) Please provide a list of claims data elements which can be assessed if the City requests ad
hoc reports.
92. Describe your data analysis capabilities and provide samples of the types of analysis reports you
can produce for both network and non-network services, including prescription drug services.
RFP NO.: 24-98/99
DATE: 1/2l/99
CITY OF MIAMI BEACH
42
93. What specific programs in your data analysis system are designed to monitor provider
performance with respect to quality of care and accessibility of services in the managed medical
care network?
I. OTHER INFORMATION
94. Will your company be willing to offer medical coverage to the City of Miami Beach Pension
Board office employees? (They will need to have a separate group number).
95. If the City decides, at a future date, to offer medical coverage to part-timers and provisional
employees will your company be agreeable to provide the coverage? The premium will be paid
with 100 % employee contribution.
96. Will retirees residing outside of the So. Florida area be covered under your proposed planes)?
If so, what type of plan will they be utilizing to obtain medical coverage? (Includes other areas
of Florida -and the United States). Please specify which planes) would cover those retirees residing
out of the area.
97. Did your company, its subsidiary, parent, parent's subsidiary cancelled or failed to renew any
personal or commercial lines property insurance policy in the City of Miami Beach based on the
risk of hurricane claims and/or claims arising as a consequence of Hurricane Andrew?
(Resolution No. 93-20877)
98. Is your planes) accredited by the National Committee for Quality Assurance (NCQA)? Specify
the status description and length of time your accreditation is valid until. Provide the expiration
date.
99. Describe your prescription planes) (i.e. mail-in program, prescription card, indemnity plan.) Do
members have a choice as to what program(s) they wish to utilize? Specify how often members
can change their selections. What process should be followed to obtain prescription benefits.
100. Will you company be willing to provide an account service representative on a full-time basis at
the City Hall location. Please specify if the representative will have a toll-free number and access
to an on-line computer for claims and eligibility information.
101. If desired, please make additional comments which may more fully explain your capabilities.
102. Please complete the following chart for each proposed planes): DO NOT REFER READER TO
ANOTHER EXHIBIT IN YOUR PROPOSAL.
RFP NO.: 24-98/99
DATE: l/2l/99
CITY OF MIAMI BEACH
43
Physician Services Benefit/Copayment:
Primary Care
Specialist Care
Diagnostic Tests & X-rays
Allergy Injections
Emerge. Physician Visit
Lifetime Ma.ximum
Calendar Year Deductible:
Individual
Family
Coinsurance Percentage:
Out-of-Pocket Limit:
Major Medical
Hospitaliz~tion
Hospital Services Benefit/Copayment:
Inpatient Care
Outpatient Surgery
N on-Surgical Care
Emergency Care
Mandatory Precertification
Benefit Level Penalty
Prior Authorization
Benefit Level Penalty
Second Surgical Opinion
Benefit Level Penalty
Other Medical Services:
Ambulance
Home Health Care
Radiology /Pathology /Lab
Preventative Care
RFP NO.: 24-98/99
DATE: 1/2l/99
(Plan Name)
(Plan Name)
(Plan Name)
(Plan Name)
YES/NO
YES/NO
CITY OF MIAMI BEACH
44
Well Child Visits
Immunizations
Mammogram
Annual Pap Smear
Maternity Care
Vision Care
Hearing Care
Elective Sterilization
Sub luxation/Manipulation
Therapy
Durable Medical Equip.
Hospice Care
Home Health Visits
Physical Therapy
Speech/Vision Therapy
Prescription Drugs:
Type of Program
Deductible
Copayment
(Plan Name)
(Plan Name)
Psychological/Psychiatric Services Benefit/Copayment:
Outpatient (_ Visit Limit)
Inpatient (_ Visit Limit)
Alcoholism & Drug Dependency Cov Benefit/Copayment:
Inpatient (_ Visit Limit)
Outpatient (_ Visit Limit)
Detoxification:
Inpatient
Outpatient
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
45
MANAGED CAREl INDEMNITY DENTAL INSURANCE PLAN QUESTIONNAIRE
The information in this questionnaire is important and will be used in evaluating your proposal. Please
be certain that all questions are answered completely and accurately. Your responses to these questions
must be based on your current capabilities. You may, in addition, describe your future capabilities, but
only as a supplement to your "current capabilities II response. All responses should be clear and as
complete as possible. A separate section of your proposal should be exclusively devoted to this
questionnaire. In addition, please follow the numerical order presented and restate the question prior to
your response.
DO NOT PROVIDE RESPONSES WHICH DIRECT THE READER TO AN A TT ACHED
EXHIBIT.
A. GENERAL INFORMATION
1. Provide the name, title, address, telephone number, and a brief description of their qualifications
and experience for the individual with the following responsibilities:
(a). The individual (in your home, regional, or local office) who will have overall responsibility
for planning, supervising and delivering service, and resolving problems.
(b). The individual representing your company during the bidding process.
(c). The individual who will be assigned the overall ongoing service responsibility.
(d). The individual responsible for day-to-day service.
(e). The individual responsible for the supervision of the claims administration.
(t). The individual who will be assigned ongoing underwriting responsibility.
(g). The Dental Director of the South Florida area network.
(h). The individual responsible for day-to-day membership service.
(i). The individual representing your company during the renewal process and Group Insurance
Board meetings.
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
46
2. Please provide a list of three current and three former clients of similar size and coverage as the
City's. Former clients are those which have terminated coverage within the last three years. All
references should include:
- Name of company
- Name of contact
- Title of contact
- Address of contact
- Telephone number of contact
- Services provided to company (Plan Type)
- Approximate number of employees to whom services arelwere provided
If possible, the references should be from those serviced by the same account representative
designated for the City.
3. Which claim office would service City of Miami Beach?
4. How many plans are you proposing? List the names of each and type of planes) (i.e. managed
care or indemnity, etc.)
5. Please note all underwriting requirements, maximum amounts of coverage, requirements for late
enrollments or open enroll additions, minimum participation requirements, all restrictions and
limitations for each proposed plan.
6. Please list here all exclusions and limitations contained in each option of your plan.
7. Discuss what procedures need be followed to obtain dental care under your proposed planes).
How much flexibility does the City have in changing the plan design you have proposed? What
proceduresldesign features can not be modified.
8. If you are offering a choice between two options or two plans, how do you prevent plan members
from "maximizing" their benefit coverage by switching options or plans?
9. Does your bid comply with all of the specifications provided? Unless exceptions are clearly
stated, the City will assume full compliance.
10. Will your company waive the "missing tooth" exclusion and "work in progress" exclusion if the
patient was covered by the City's dental plan when the condition occurred.
11. Are members allowed to switch from one plan to another? If so, how often are they allowed to
switch.
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
47
12. Complete the rate response sheets located prior to the questionnaire on page 18 & 19. Please note
the different proposed model types on page 15 in order to quote each of the respective benefit plan
designs.
B. ADMINISTRATION
13. Please provide a specimen contract and a specimen booklet-certificate. Also, please provide
specimen new enrollment packets and educational information.
14. Please outline the procedures required to implement this plan. How long will these process take?
Please state any requirements that need to be satisfied prior to the plan commencement.
15. How do you propose to credit existing deductibles and benefit maximums already met for calendar
year 1999?
16. What are the billing arrangements for each proposed plan? How are they coordinated? Attach
samples of your billing forms.
17. Will your company be willing to have a roster billing?
18. Give the location of the claim/administrative office which will be utilized. Give each location if
more than one office will be used.
19. Describe the coordination between the administration of the indemnity and the managed care
options for eligibility file maintenance.
20. Do you have a membership service staff to accept telephone calls from members and City group
insurance staff on claims and benefits inquiries?
21. Do you employ a "dedicated claim unit" which only processes dental claims? Does the same
claim unit review indemnity and managed care dental claims?
22. Would you provide a service representative to meet with employees and retirees (one round of job
site and City Hall presentations would be about 15 meetings) for the purpose of assisting with
enrollment?
23. Will your company provide the City with monthly claim experiences for all of the planes)? If not,
specify which plan will not apply. Please note that failure to submit timely claim experience
reports will result in monetary penalties.
RFP NO.: 24-98/99
DATE: l/2l/99
CITY OF MIAMI BEACH
48
24. What are your minimum acceptable performance standards for claim processing, including
accuracy goals regarding dollar amounts paid and the number of financial and procedural errors?
What is your definition of a claim for purposes of production measurement? What is your
guaranteed minimum COB savings and claim turnaround time? What action would you take if
the City of Miami Beach claims unit failed to meet these standards?
25. Describe the procedure you propose for responding to claim inquiries make by telephone.
26. Describe how you verify eligibility.
27. Describe the in-house training program used for new dental claim examiners. How long does the
training program last?
C. MANAGED CARE OPTION
28. For the managed care dental option, describe your criteria for the selection of network providers,
both primary care and specialty care.
29. For managed care dental option, please complete the chart below for the South Florida service
area:
First day of network operation
Number of Primary Dentists (specify by County)
Number of Specialists (specify by County)
Periodontist
Orthodontists
Other
Total number of members, including employees, retirees and dependents, as follows:
South Florida service area
as of 1/1/98
as of 1/1/97
Other service areas
as of 1/1/98
as of 1/1/97
For the South Florida service area: (specify by County)
Providers terminated in 1997 Providers were added in 1998
Provider-initiated Primary dentists
Network-initiated Specialists
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
49
Providers currently with closed practices
due to level of capacity, etc.)
A verage number of calendar days between scheduling
and having non-urgent exam and cleaning?
A verage number of calendar days between
scheduling and having urgent exam and treatment?
30. For the managed care dental option, please indicate locations and size of networks if you have
service areas outside of South Florida.
31. Describe the specific measures used by your organization to monitor provider access. Provide
the most recent corresponding statistics available. (Examples: provider to member ratios, average
wait time required for an appointment, etc.)
32. How does a member select a primary dentist? How can a member change dentists, and how often
can this be done?
33. Are members required to choose a provider? If "yes, "
a. Does the whole family have to pick the same dental provider?
b. Is there a limit on the number of changes allowed per year?
c. How long after notification to the plan does the change become effective?
34. How quickly are members informed when their provider leaves? Check the appropriate response
below:
Before the provider leaves
Within 2 weeks after leaving
More than 2 weeks
35. Would member be allowed to change dentists if the need arises (i.e. move to a new address, or
prefer to use another dentist.) What are the exceptions to changing primary dentists?
36. How often can a member change in or out of the managed care option?
37. Please describe your system for evaluation of the accessibility to and quality of care delivered
within your network by both primary and specialty providers.
38. Have you conducted member satisfactions surveys? If yes, please include the most recent results
available for the South Florida service area and users of the same plan being offered to the City.
How often are these surveys conducted amongst plan members?
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
50
39. Are primary providers capitate? If not, please describe the reimbursement mechanism. Is there
provider risk-sharing? If yes, please describe.
40. Please describe the reimbursement mechanism used for network specialists.
41. In addition to routine reimbursement and any withhold provisions, can your providers increase
the total reimbursement received from your plan (for example, provider incentive programs)? If
"yes," please explain.
42. What provisions are contained in provider contracts regarding increases in payment levels in
future years?
43. Do you use specific centers (owned and/or contracted) for procedures in treatment of certain
diagnoses?
D. QUALITY ASSURANCE
44. Please indicate whether or not your organization's application and credentialing process for
participating dentists requires the following:
a. Written verification of education and experience
b. Verification of current license
c. Investigation for adverse action on license
d. Verification of letters of recommendation
e. On-site inspection of provider's offices
f. Personal interviews
g. Investigation of malpractice history
45. Do you require any per occurrence or per professional liability insurance?
46. Do you require periodic recertification of your participating dentists? Explain in detail:
a) Recertification process
b) How often providers are certified
47. Is the credentialing function delegated? If so, what is delegated and to whom?
48. Please describe your quality review program. What types of audits are performed in-house and
by home office? How often? How are claims selected? Who selects the claims?
RFP NO.: 24-98/99
DATE: l/21199
CITY OF MIAMI BEACH
51
E. UTILIZATION MANAGEMENT
49. For both the managed care and indemnity options, describe your predetermination and alternate
course of treatment procedures. Provide samples of forms used. What is the turnaround time in
calendar days of dental predeterminations? Provide specimen of notification forms used.
50. For the managed care, what controls are in place to prevent unnecessary referrals?
51. How many full- and part-time dental consultants do you employ? What types of procedures do
they review? What percentage of claims do they review?
52. Provide a detailed description of the utilization management process, accompanied by sample
utilization management reports that are regularly reviewed in this process.
53. If the dental consultant disagrees with what the dentist recommends as a form of treatment,
explain w~at steps should be followed to assist the members.
54. Describe the claims data reporting available for both indemnity and managed care dental claims.
Provide sample claims and utilization reports and a standard production schedule for these reports.
Also, list the claims data elements which can be assessed if ad hoc reports are requested.
55. Please provide a full description of the controls that you currently have in place to detect
fraudulent submissions.
56. How would you develop and maintain information on reasonable and customary charges for the
City? How often is this information updated? How is it applied to submissions? Is this the same
system as your usual book of business?
57. Do you conduct on-site audits or providers in your network? If yes, please describe and indicate
frequency.
58. What is the maximum period of time which can elapse between a service being incurred and
notification of the claim provided? (15 months, 24 months, etc.)
59. Please explain what happens in the event of contract termination, including the transition process
and the claims detail history you will provide.
F. FINANCIAL
60. Please provide a copy of your most recent audited financial statement or annual report, and the
1998 Best's rating of your company.
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
52
61. Are you willing to provide any guarantees of rates andlor retention? If yes, please describe your
offer.
62. Please provide a history of the average increases in premium rates or fees, as appropriate, for the
last 3 calendar years (or since inception of your organization, if shorter):
Calendar Year
A verage Rate Increases
63. What level of trend are you currently using for your indemnity dental? Managed care dental?
64. Will you meet the City's renewal rate presentation deadline of March 1st each year for an October
1st effective date?
65. Explain your renewal underwriting methodology? What indicators or areas are used to determine
the renewal rates?
66. Explain your method of deficit carry forward on experience rated contracts, and percent of interest
charged on deficits.
67. Explain the distribution and timing of excess premium or reserves in the event of contract
cancellation on any date. What percent of interest is credited on positive cash flow?
68. What percentage of premium is used for administration?
69. Are there any restrictions or pending reviews by state or federal authorities for noncompliance
with state or federal regulations? If "yes," please provide details for the past 3 years including the
outcome.
70. Has any party brought legal action against your organization during the past 3 years? If "yes,"
what was the outcomelstatus? Describe the organization's and employer's position in the suit.
Has any party brought legal action against any participating dentist during the past 3 years? If
"yes," what was the outcome/status?
G. OTHER INFORMATION
71. If desired, please make additional comments which may more fully explain your capabilities.
72. Did your company, its subsidiary, parent, parent's subsidiary canceled or failed to renew any
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
53
personal or commercial lines property insurance policy in the City of Miami Beach based on the
risk of hurricane claims andlor claims arising as a consequence of Hurricane Andrew? (Reference
to Resolution No: 93-20877)
73. Will your company be willing to otTer dental coverage to the City of Miami Beach Pension Board
office employees? (They will need to have a separate group number).
74. Does your company offer a dental plan for those retirees residing outside of the So. Florida area?
If so, what type of plan will they be utilizing to obtain dental coverage? (includes other areas of
Florida and the United States). Explain how benefits and services will be rendered.
75. If you are submitting a bid for an alternative dental plan design were services are covered based
on what services are rendered. Please complete the following chart for each proposed planes):
Specify the employee's copayment and/or coinsurance only whether your plan offers a flat
amount or percentage based on the U.C. charges. If your plan provides a percentage,
please - specify the flat dollar amount for each charge which is based on the percentage of
the usual and customary charges (Le. $12 = 20% of $60 usual & customary charges). The
flat dollar amount and the usual and customary charges are very important to our
analysis. Do not leave any blanks. Mark "N/ A" if these benefits do not apply to your
proposed plan(s). Do not refer reader to another form or exhibit.
(Plan Name)
(Plan Name)
Annual Deductible
Annual Benefit Maximum
Oral Exam Visit
# of Visits Per Calendar Year
Complete X-ray Series
Periapical X-rays
Prophylaxis
# of Visits Per Calendar Year
Bitewing X-rays
Fluoride - Children only
Sealants (permanent molars only)
Space Maintainers
Amalgam & Composite Fillings
Inlays, Onlays & Crowns
(other than stainless steel crowns)
Stainless Steel Crowns
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
54
Pulp Capping
Pulpotomy
Root Canal Therapy
Anterior or premolar
Molar tooth
Apicoectomy
Gingival Curettage
Osseous Surgery, including flap
entry & closure
Scaling and Root Planing
Full and Partial Dentures
Denture Repair
Tissue Conditioning for Dentures
Bridge Pontics & Abutments
Implants
Extractions (uncomplicated)
Surgical Removal of Erupted Tooth
Removal of:
Soft Tissue Impacted Tooth
Bony Impacted Tooth
Incision & Drainage of Abscess
Frenectomy
Excision of Hyperplastic Tissue
General Anesthesia
Orthodontics Appliances & Treatment
Deductible
Covered Percentage
Employee I s coinsurance
Lifetime maximum
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
55
LIFE INSURANCE PLAN QUESTIONNAIRE
The information in this questionnaire is important and will be used in evaluating your proposal. Please
be certain that all questions are answered completely and accurately. Your responses to these questions
must be based on your current capabilities. You may, in addition, describe your future capabilities, but
only as a supplement to your "current capabilities" response. Please include the questions in your
response. All responses should be clear and as complete as possible. Do not provide responses which
direct the reader to an attached exhibit.
A. GENERAL INFORMATION
1. Provide the name, title, address, and a brief description of their qualifications and experience for
the individual with the following responsibilities:
(a). . ~he individual (in your home, regional, or local office) who will have overall
responsibility for planning, supervising and delivering service, and resolving problems.
(b). The individual representing your company during the bidding process.
(c). The individual who will be assigned the overall ongoing service responsibility.
(d). The individual responsible for day-to-day service.
(e). The individual responsible for the supervision of the claims administration.
(t). The individual who will be assigned ongoing underwriting responsibility.
(g). The individual representing your company during the renewal process and Group
Insurance Board Meetings.
2. Give the location of the claim/administrative office which will be utilized. Give each location if
more than one office will be used.
3. Please provide a list of three current and three former clients of similar size and coverage.
Former clients are those which have terminated coverage within the last three years. Please
provide the name, title, address and telephone number of a contact person at each of the six
references.
If possible, the references should be from those serviced by the same account representative
designated for the City.
RFP NO.: 24-98/99
DATE: 1/2l/99
CITY OF MIAMI BEACH
56
4. Please note all underwriting requirements, maximum amounts of coverage, requirements for non-
medical evidence of insurability, minimum participation requirements, all restrictions and
limitations for each line of coverage.
5. Please provide a copy of your most recent audited financial statement and the Best's rating of your
company.
6. Discuss your proposed plan design. How much t1exibility does the City have in changing the plan
design you have proposed? What design features can not be modified.
7. Explain renewal rating process. Will you meet the City's renewal rate presentation deadline of
March 1 st each year for an October I st effective date?
8. If you are also offering medical andlor dental coverage in a separate bid, does your life bid
require acceptance of your medical and/or dental bid?
-
B. ADMINISTRATION
9. What billing arrangements do you require? Attach a sample of your billing forms.
10. How frequently do you require a covered population census? What data would be required?
Please attach a sample of your census format.
11. Describe the process in paying a life claim.
12. Describe the process in applying for disability life claim (waiver of premium).
13. Please provide a specimen contract and a specimen booklet-certificate.
C. FINANCIAL
14. What is your conversion charge per $1,000'1 Describe your conversion process and types of life
conversion contracts available. Is the conversion charge waived if satisfactory evidence of
insurability is provided?
15. How are waiver of premium claims charged against experience?
16. Are you willing to provide any guarantees of rates andlor retention? If yes, please describe your
offer.
17. Did your company, its subsidiary, parent, parent's subsidiary cancel or fail to renew any personal
or commercial lines property insurance policy in the City of Miami Beach based on the risk of
hurricane claims and/or claims arising as a consequence of Hurricane Andrew? (Reference to
Resolution No. 93-20877) (List criteria to be considered during evaluation)
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
57
SECTION IV - EV ALVA TION/SELECTION PROCESS: CRITERIA FOR EV ALVA TION
The procedure for proposal evaluation and selection is as follows:
I. Request for Proposals issued.
2. Receipt of proposals.
3. Opening and listing of all proposals received.
4. An Evaluation Committee, appointed by the City Manager, shall meet to evaluate each proposal in
accordance with the requirements of this RFP. If further information is desired, proposers may be
requested to make additional written submissions or oral presentations to the Evaluation Committee.
5. The Evaluation Committee shall review their findings with the Health Advisory Committee and,
then, recommend to the City Manager the proposal or proposals acceptance of which the Evaluation
Committee deems to be in the best interest of the City.
The Evaluation Committee shall base its recommendations on the following factors:
1. Size and financial stability of the Insurance Company
2. Size and quality of the Physician/Dentist and Hospital networks in relationship to the
City's employee/retiree demographics
3. Premium costs and guarantees (multi-year guarantees will be favorably considered)
4. Benefits provided by the plans
5. Ability to provide insurance benefits and services to out of area participants
6. Response to Medical, Dental, and Life Questionnaires
7. Overall response to RFP
6. After considering the recommendation(s) of the Evaluation Committee, the City Manager shall
recommend to the City Commission the proposal or proposals acceptance of which the City Manager
deems to be in the best interest of the City.
7. The City Commission shall consider the City Manager's recommendation(s) in light of the
recommendation(s) and evaluation of the Evaluation Committee and, if appropriate, approve the City
Manager's recommendation(s). The City Commission may reject City Manager's
recommendation(s) and select another proposal or proposals. In any case, City Commission shall
select the proposal or proposals acceptance of which the City Commission deems to be in the best
interest of the City. The City Commission may also reject aU proposals.
8. Negotiations between the selected proposer and the City Manager take place to arrive at a contract.
If the City Commission has so directed, the City Manager may proceed to negotiate a contract with
a proposer other than the top-ranked proposer if the negotiations with the top-ranked proposer fail
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
58
to produce a mutually acceptable contract within a reasonable period of time.
9. A proposed contract or contracts are presented to the City Commission for approval, modification
and approval, or rejection.
10. If and when a contract or contracts acceptable to the respective parties is approved by the City
Commission, the Mayor and City Clerk sign the contract(s) after the selected proposer(s) has (or
have) done so.
Important Note:
By submitting a proposal, all proposers shall be deemed to understand and agree that no property
interest or legal right of any kind shall be created at any point during the aforesaid
evaluation/selection process until and unless a contract has been agreed to and signed by both parties.
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
59
SECTION V - GENERAL PROVISIONS
A. ASSIGNMENT
The successful proposer shall not enter into any sub-contract. retain consultants, or assign,
transfer, convey, sublet, or otherwise dispose of this contract. or of any or all of its right, title,
or interest therein, or its power to execute such contract to any person, firm, or corporation
without prior written consent of the City. Any unauthorized assignment shall constitute a default
by the successful proposer.
B. INDEMNIFICATION
The successful proposer shall be required to agree to indemnify and hold harmless the City of
Miami Beach and its officers, employees, and agents, from and against any and all actions,
claims, liabilities, losses and expenses, including but not limited to attorneys' fees, for personal,
economic or bodily injury, wrongful death, loss of or damage to property, in law or in equity,
which - may arise or be alleged to have arisen from the negligent acts or omissions or other
wrongful conduct of the successful proposer, its employees, or agents in connection with the
performance of service pursuant to the resultant Contract; the successful proposer shall pay all
such claims and losses and shall pay all such costs and judgments which may issue from any
lawsuit arising from such claims and losses, and shall pay all costs expended by the City in the
defense of such claims and losses, including appeals.
C. TERMINATION FOR DEFAULT
If through any cause within the reasonable control of the successful proposer, it shall fail to
fulfill in a timely manner, or otherwise violate any of the covenants, agreements, or stipulations
material to the Agreement, the City shall thereupon have the right to terminate the services then
remaining to be performed by giving written notice to the successful proposer of such
termination which shall become effective upon receipt by the successful proposer of the written
termination notice.
In that event, the City shall compensate the successful proposer in accordance with the
Agreement for all services performed by the proposer prior to termination, net of any costs
incurred by the City as a consequence of the default.
Notwithstanding the above, the successful proposer shall not be relieved of liability to the City
for damages sustained by the City by virtue of any breach of the Agreement by the proposer, and
the City may reasonably withhold payments to the successful proposer for the purposes of set
off until such time as the exact amount of damages due the City from the successful proposer is
determined.
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
60
D. TERMINATION FOR CONVENIENCE OF CITY
The City may, for its convenience, terminate the services then remaining to be performed at any
time without cause by giving written notice to successful proposer of such termination, which
shall become effective thirty (30) days following receipt by proposer of such notice. In that
event, all finished or unfinished documents and other materials shall be properly delivered to the
City. If the Agreement is terminated by the City as provided in this section, the City shall
compensate the successful proposer in accordance with the Agreement for all services actually
performed by the successful proposer and reasonable direct costs of successful proposer for
assembling and delivering to City all documents. No compensation shall be due to the
successful proposer for any profits that the successful proposer expected to earn on the balanced
of the Agreement. Such payments shall be the total extent of the City's liability to the successful
proposer upon a termination as provided for in this section.
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
61
SECTION VI - ATTACHMENTS
1. Plan Summaries
2. Employee Census Information
3. Claim Loss Experience
4. Cone of Silence, Ordinance No. 99-3164
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
62
SECTION VII - PROPOSAL DOCUMENTS TO BE COMPLETED
AND RETURNED TO CITY
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
63
PROPOSER INFORMATION
Submitted by:
Proposer (Entity):
Signature:
Name (Typed):
Address:
City/State:
Telephone:
Fax:
It is understood and agreed by proposer that the City reserves the right to reject any and all
proposals, to make awards on all items or any items according to the best interest of the City, and to
waive any irregularities in the RFP or in the proposals received as a result of the RFP. It is also
understood and agreed by the proposer that by submitting a proposal, proposer shall be deemed to
understand and agree than no property interest or legal right of any kind shall be created at any point
during the aforesaid evaluation/selection process until and unless a contract has been agreed to and
signed by both parties.
(Authorized Signature)
(Date)
(Printed Name)
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
64
REQUEST FOR PROPOSALS NO. 24-98/99
ACKNOWLEDGMENT OF ADDENDA
Directions: Complete Part I or Part II, whichever applies.
Part I: Listed below are the dates of issue for each Addendum received in connection with this RFP:
Addendum No. L Dated
Addendum No.2, Dated
Addendum No.3, Dated
Addendull?- No.4, Dated
Addendum No.5, Dated
Part II:
No addendum was received in connection with this RFP.
Verified with Procurement staff
Name of staff
Date
(Proposer - Name)
(Date)
(Signature)
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
65
DECLARA TION
TO: Sergio Rodriguez
City Manager
City of Miami Beach, Florida
Submitted this
day of
, 1999.
The undersigned, as proposer, declares that the only persons interested in this proposal are named herein;
that no other person has any interest in this proposal or in the Contract to which this proposal pertains; that
this proposal is made without connection or arrangement with any other person; and that this proposal is in
every respect fair and made in good faith, without collusion or fraud.
The proposer agrees if this proposal is accepted, to execute an appropriate City of Miami Beach document
for the purpose of ~stablishing a formal contractual relationship between the proposer and the City of Miami
Beach, Florida, for the performance of all requirements to which the proposal pertains.
The proposer states that the proposal is based upon the documents identified by the following number: RFP
No. 24-98/99
SIGNATURE
PRINTED NAME
TITLE (IF CORPORATION)
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
66
Proposer's Name:
Principal Office Address:
Official Representative:
Individual
Partnership (Circle One)
Corporation
If a Corporation. answer this:
When Incorporated:
In what State:
If Foreien Corporation:
Date of Registration with
Florida Secretary of State:
Name of Resident Agent:
Address of Resident Agent:
President's Name:
Vice-President's Name:
Treasurer's Name:
Members of Board of Directors:
RFP NO.: 24-98/99
DATE: 1/21/99
QUESTIONNAIRE
CITY OF MIAMI BEACH
67
Ouestionnaire (continued)
If a Partnership:
Date of organization:
General or Limited Partnership*:
Name and Address of Each Partner:
NAME
ADDRESS
* Designate general partners in a Limited Partnership
I. N umber of years of relevant experience in operating similar business:
2. Have any similar agreements held by proposer for a project similar to the proposed project
ever been canceled?
Yes ( )
No ( )
If yes, give details on a separate sheet.
3. Has the proposer or any principals of the applicant organization failed to qualify as a
responsible bidder, refused to enter into a contract after an award has been made, failed to
complete a contract during the past five (5) years, or been declared to be in default in any
contract in the last 5 years?
If yes, please explain:
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
68
Ouestionnaire (continued)
4. Has the proposer or any of its principals ever been declared bankrupt or reorganized under
Chapter 11 or put into receivership?
If yes, give date, court jurisdiction, action taken, and any other explanation deemed necessary.
5. Person or persons interested in this bid and Qualification Form (have) (have
not) been convicted by a Federal, State, County, or Municipal Court of any violation of law,
other than traffic violations. To include stockholders over ten percent (10%). (Strike out
inappropriate words)
Explain any convictions:
6. Lawsuits ~any) pending or completed involving the corporation, partnership or individuals
with more than ten percent (10%) interest:
A. List all pending lawsuits:
B. List all judgments from lawsuits in the last five (5) years:
C. List any criminal violations and/or convictions ofthe proposer and/or any of its principals:
7. Conflicts of Interest. The following relationships are the only potential, actual, or perceived
conflicts of interest in connection with this proposal:
(If none, so state.)
RFP NO.: 24-98/99
DATE: 1/2l/99
CITY OF MIAMI BEACH
69
8. Public Disclosure. In order to determine whether the members of the Evaluation Committee
for this Request for Proposals have any association or relationships which would constitute
a conflict of interest, either actual or perceived, with any proposer and/or individuals and
entities comprising or representing such proposer, and in an attempt to ensure full and
complete disclosure regarding this contract, all Proposers are required to disclose all persons
and entities who may be involved with this Proposal. This list shall include public relation firms,
lawyers and lobbyists. The Procurement Division shall be notified in writing if any person or
entity is added to this list after receipt of proposals.
RFP NO.: 24-98/99
DATE: 1/21/99
CITY OF MIAMI BEACH
70
The proposer understands that information contained in this Questionnaire will be relied upon by the City in
awarding the proposed Agreement and such information is warranted by the proposer to be true. The
undersigned proposer agrees to furnish such additional information, prior to acceptance of any proposal
relating to the qualifications of the proposer, as may be required by the City Manager.
The proposer further understands that the information contained in this questionnaire may be confirmed
through a background investigation conducted by the Miami Beach Polic~ Department. By submitting this
questionnaire the proposer agrees to cooperate with this investigation, including but not necessarily limited to
fingerprinting and providing information for credit check.
WITNESSES:
IF INDIVIDUAL:
Signature
Signature
Print Name
Print Name
WITNESSES:
IF PARTNERSHIP:
Signature
Print Name of Firm
Print Name
Address
By:
(General Partner)
Signature
(Print Name)
(Print Name)
WITNESSES:
IF CORPORATION:
Signature
Print Name of Corporation
Print Name
Address
By:
President
Attest:
Secretary
(CORPORATE SEAL)
RFP NO.: 24-98/99
DATE: l/21/99
CITY OF MIAMI BEACH
71
~ITY OF MIAMI BEACH
ITY HALL 1700 CONVENTION CENTER DRIVE MIAMI BEACH, FLORIDA 33139
,tp:\\ci. miami-beach. fl. us
COMMISSION MEMORANDUM NO. 55.-g.:L
TO:
Mayor Neisen O. Kasdin and
Members of the City C mission
DATE: .January 20,1999
FROM: Sergio Rodriguez
City Manager
SUB.JECT: A RESOLUl' ON OF THE MAYOR AND CITY COMMISSION OF THE
CITY OF MIAMI BEACH, FLORIDA, AUTHORIZING THE
ADMINISTRA TION TO ISSUE A REQUEST FOR PROPOSALS (RFP) FOR
THE PROVISION OF GROUP MANAGED MEDICAL CARE INSURANCE,
DENTAL INSURANCE, AND LIFE/ACCIDENTAL DEATH INSURANCE
FOR THE CITY OF MIAMI BEACH EMPLOYEES' BENEFIT PLAN, FOR
A ONE-YEAR PERIOD, WITH FOUR, ONE-YEAR RENEWAL OPTIONS.
ADMINISTRATION RECOMMENDATION:
Adopt the Resolution.
BACKGROUND:
The City of Miami Beach Employees' Benefit Plan provides Group Medical, Dental, and Life
insurance benefits to eligible employees and retirees. The insurance for the City of Miami Beach
Employees' Benefits Plan is currently provided by various insurance carriers.
On October 1, 1996, the Mayor and City Commission appointed Humana as provider for the Group
Managed Medical Care Insurance for City of Miami Beach Employees' Benefit Plan. The contract
was for a one-year term with four renewal options. The City is currently in the third contract year.
Humana increased the premium rates by 12.6% for the PPO, and 2.5% for the POS and HMO for
this year.
On October I, 1997, the Mayor and City Commission appointed American Dental for the Dental
Insurance Plan. The contract was for a one-year term with options to renew for three years. The rate
was guaranteed for 20 months. American Dental has been unresponsive to inquiries regarding any
premium guarantee for the future, and we have had several concerns expressed by employees about
the level of benefits provided by this Plan.
continued...
DATE
{2'7D
/-2o-9't
AGENDA ITEM
COMMISSION MEMORANDUM
PAGE 2
On October I, 1994, the Mayor and City Commission appointed Hartford for the Life/Accidental
Death Insurance for the City of Miami Beach Employees' Benefit Plan. The contract was for a
one-year term with options to renew in each of the following four years. Our final option year ends
on September 30, 1999.
The quality of our benefit plans and their cost are paramount concerns to the Administration and our
employeeslretirees. To assure ourselves that we have the optimum mix of quality coverage and
competitive pricing, we believe it is prudent to enter the marketplace at this time. Previously, we
have searched for medical, dental, and life insurance programs separately. This RFP offers
prospective providers the option of responding to one, two, or all three coverage requests. We
believe that this modeling may cause some carriers to offer a more competitive price structure. The
attached RFP has been reviewed and approved by the Group Insurance Board and the Health
Advisory Committee.
The issuance of an RFP will allow the City to move forward with the selection of an insurance
carrieres) that will provide Group Managed Medical Care Insurance, Dental Insurance and
Life/Accidental Death Insurance under the City of Miami Beach Employees' Benefit Plan.
CONCLUSION:
The City Administration recommends that the City Commission authorize the Administration to
issue a Request for Proposals for the provision of group managed medical care insurance, dental
insurance, and life/accidental insurance.
.1
SR:RWB:lsg
Attachments
a: ICom m-mem4. 98\INS URM& D. RFP