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Benefits Consultant SOWBackground & General Information Background The City of Denton (the City) is requesting your proposal to provide Benefit Consultant Services for the City’s total employee and retiree benefits program (excluding TMRS and ICMA). The effective date will be January 1, 2020. The City currently provides or offers employees the following insurance coverage: a self-insured dual option EPO medical plan, a dual option PPO dental plan, a PPO vision plan, group Life/AD&D insurance, supplemental life/AD&D insurance, and short-term and long-term disability. The City currently pays the cost of coverage on all eligible employees for basic Life/AD&D and long-term disability. The City also offers health, dental, and vision benefits to all retirees who retire from the City after 20 years of service, or five (5) years of service, past age 60. The City offers the dual option EPO medical plan to under 65 retirees and dependents, and a Medicare Supplement plan to over 65 retirees (and over 65 spouses). The City of Denton has approximately 133,808 (based on 2016 estimate) residents and was incorporated in 1866. Denton is located approximately 40 miles north of Dallas and Fort Worth. It sits at the apex of a triangle that encompasses the Dallas-Fort Worth metropolitan area. Although it benefits from the forward thrust and continuous expansion of the largest Consolidated Metropolitan Statistical Area in the state, Denton and its economy stand proudly independent. The City of Denton has a work force of approximately 1,500 employees. The City has had an effective safety and risk management program since 1970, an active Wellness Program since 1990, an insured employee assistance program (EAP) since 1998, and a self-funded health program since 2008. The City also has an Employee Insurance Committee (EIC) representing all departments, providing education and feedback as well as recommendations to City Management and City Council. Additionally, the City has an employee wellness incentives program and opened its own employee health center (clinic) in 2011. In general, Denton is a full-service city that provides law enforcement, fire safety, paramedics/rescue, refuse collection, sanitary landfill, electric distribution and transmission, water, wastewater, storm sewer, animal control, parks/recreation, library and airport services. The City has two full-service, private hospitals and several private rest homes. Two major universities—University of North Texas and Texas Woman’s University—along with a fully accredited public school system, allow local citizens every educational advantage possible and a rich blend of cultures. The City runs its employee benefits program on a January 1 plan year. Proposal Evaluation Criteria will be grouped into percentage factors as follows: 20% - Compliance with specifications, quality, reliability, characteristics to meet stated or implied needs 30% - Indicators of probable performance under contract 50% - Cost of Services Scope of Services - Insurance Consultant Outline of Expected Services Evaluate the current programs and provide written analysis within 30 days of receipt of necessary data. Assist the City in creating and maintaining a competitive (cost & plan design) benefit program, and in doing so, provide benchmark data from like entities Review of Benefit Design Review of Benefit Utilization Claims analysis including review of historical, monthly, and large claims, as well as plan utilization to track trends and target potential plan design modifications and educational opportunities.  Review of benefits cost for employees, retirees and the City Provide funding analysis, financial underwriting, including renewal analysis and negotiation, budget projections, and quarterly reporting of plan’s financial performance Evaluate plan design annually, or as required, in light of labor market conditions, cost trends, delivery systems and legal requirements Annually analyze, compare and review fully insured vs. self-insured plans/options Review of current carriers’ performance Assist in developing long-term strategies and future or proposed benefit plans Assist in developing long-term strategies and future for City’s Retiree benefits Obtain necessary monthly, quarterly and annual reports and data from carriers in a timely manner Assist in the monitoring of Vendors’ quality of service and institute quality standards with penalties for poor performance Provide information/education/training to City staff related to benefit implementation and administration when requested Develop Renewal Strategy Conduct annual strategic planning meetings to establish goals, priorities, and identify areas of concern. Provide plan design recommendation, with estimated cost implications, for benefit modifications Projected Funding requirements and funding level analysis/development Provide recommended COBRA rates and Employer/Employee contributions Negotiate with carriers to obtain favorable renewals Coordinate Proposal Process Collect and organize the information required to obtain competitive bids Respond to questions, clarification and requests for additional information of the bid specifications Review, evaluate and summarize various benefit options of the competitive proposals Provide the City with an in-depth analysis of proposals and alternatives to assist with the vendor selection process. Review the policies to make sure they are consistent with the bid response Meet with proposed carriers regarding contract negotiations, implementation, and other bid requirements Assist in the implementation of the Benefit Program Develop transition plan when necessary Assist in establishing administrative procedures Prepare communication plan and City Benefit Booklet Work with carrier/administrators coordinating the enrollment process of all related plans Advise and make recommendations regarding on-line open enrollment and electronic communication capabilities Administration of Employee Benefits Program Keep City advised on new developments involving employee benefit plans Act as liaison between City and carriers Assist in the timely resolution of claims problems Assist in the timely resolution of billing issues Assist City Staff in development of multi-media educational programs and presentations, as well as provide support in the preparation of reports and presentations to City Management and Council Meet monthly with City Employee Insurance Committee (EIC) regarding current issues Appear at City Council Meetings and other necessary meetings as required As needed, and no less than annually, provide written reports regarding the overall plan performance, including comparison with historic data, trend identification, cost projections, etc. Assist the City with compliance in the areas of COBRA/HIPAA and other benefits related legislation and legal requirements, as well as act as a technical resource to include timely periodic updates on legislative developments, emerging trends, and insurers’ status Assist the City with compliance with the Affordable Care Act Vendor should include an example of the HIPAA Business Associate Agreement that will need to be executed Monitor the prospective markets and changes, which may affect the City’s benefit plans Provide research materials on various topics, as requested Provide periodic educational information and seminars regarding current benefit trends, regulatory compliance, legislative changes, etc., at no cost to the City Monitor and assist with reconciliation of stop loss recoveries Review stop loss expenditures and provide alternatives for cost savings, including self-funding, captives and other risk management approaches. Evaluate if any voluntary benefit offerings are desired from an employer or employee perspective. Provide annual incurred but not reported (IBNR) analysis NOTE: By responding to this RFP, the Proposer agrees to comply with the above Scope of Services. If you are unable to provide/perform any service, please list that service and provide and explanation. The information submitted shall be divided into tabbed, marked sections and shall include, but not limited to, information for each of the following: FIRM OVERVIEW: Proposer is requested to define the overall structure of the Firm to include the following: A descriptive background of Proposer’s history State its principal business location and any other service locations, including the primary office servicing the City State its primary line of business State how long it has been providing services as described herein State how many states other than Texas, where services are in use Describe your firm’s marketplace strength and your ability to negotiate with insurance companies. PROPOSED PROJECT TEAM, STAFF QUALIFICATIONS, EXPERIENCE, AND CREDENTIALS: Proposer is requested to address services offered by their company to include, but not necessarily limited to, those required services as stated above. Proposer is requested to state the organization’s experience, experience of the staff, and technical experience in providing these types of services State level of organizational responsibility of key project staff members Proposer is requested to include certifications held by Proposer’s personnel As the City assigns individual projects, successful Proposer shall identify personnel assigned to each specific project requirement Please describe what sets your company apart from other consulting firms Identify which Account Managers from United HealthCare would most likely be assigned to work with the City and your firm. Describe your firms compliance resources and team SCOPE OF SERVICES: As indicated above, please include a detailed explanation of services offered, as they relate to the City’s “Outline of Expected Services” provided herein, and your recommended approach to addressing the City’s needs. Please provide reasonable estimates of the cost to the City on a monthly and/or annual basis. Please include any services offered that may be above and beyond the Outline of Expected Services indicated by the City. REFERENCES: Proposer is requested to provide with the Request for Proposals a list of at least five (5) references where like services or their firm has performed similar projects. Include name of the client, address, telephone number and name of representative. In addition, please include all municipalities or other public entities (and number of employees) served by your firm. FEE SCHEDULE: Proposer is requested to provide (1) the cost of services, (2) explain the basis for the above fee and any subsequent annual fees, and (3) identify ad hoc services your company provides and the cost for these services. The City will not recognize or name an Agent of Record. No commissions or other forms of compensation of any type may be included in your pricing. Pricing must be on a flat fee basis, with full disclosure of all fees, including any which may deviate from the flat fee schedule. SUPPORTING MATERIALS: Various questions included in this Request for Proposals will be used in making a selection and should be addressed by section and number. Proposer is requested to submit information requested, one (1) original and two (2) copies of descriptive literature sufficient in detail to enable an intelligent comparison of services. FINANCIAL STATEMENTS: Proposer is requested to submit recent financial statements with this Request for Proposal. Audited financial statements are not mandatory. Unaudited financial statements will be accepted. If Proposer’s firm does, however, have audited financial statements, please include a copy with the response to the RFP. Financial statements must show the name and address of the firm preparing the financial statements and the date thereof. Supplemental Questionnaire Describe how your firm establishes and monitors performance criteria for all vendors, carriers and contracts. Describe your firm’s marketplace leverage in negotiating with carriers in regard to rates, policy terms and plan design. Provide information on litigation pertaining to your role as a benefit consultant over the last three (3) years. Provide information on client turnover for your firm’s benefit consulting division over the past three (3) years. Provide information on any National, State or local associations to which your company belongs, and your involvement with each. Discuss your technological abilities to provide communication in various forms (i.e., websites, printed materials, enrollment, etc.). Are there any restrictions or pending reviews by Federal or State authorities for non-compliance with Federal or State regulations? If yes, please explain. Has any party brought legal action against the organization during the past three (3) years? If yes, please explain. Have you made any claims against the City in the past three (3) years? If yes, what was the outcome/status? Describe the compliance resources the City will have access to. Provide a sample of any newsletters, updates, and seminars you provide to your clients. Respond to questions, clarification and requests for additional information of the bid specifications Review, evaluate and summarize various benefit options of the competitive proposals Provide the City with an in-depth analysis of proposals and alternatives to assist with the vendor selection process. Review the policies to make sure they are consistent with the bid response Meet with proposed carriers regarding contract negotiations, implementation, and other bid requirements Assist in the implementation of the Benefit Program Develop transition plan when necessary Assist in establishing administrative procedures Prepare communication plan and City Benefit Booklet Work with carrier/administrators coordinating the enrollment process of all related plans Advise and make recommendations regarding on-line open enrollment and electronic communication capabilities Administration of Employee Benefits Program Keep City advised on new developments involving employee benefit plans Act as liaison between City and carriers Assist in the timely resolution of claims problems Assist in the timely resolution of billing issues Assist City Staff in development of multi-media educational programs and presentations, as well as provide support in the preparation of reports and presentations to City Management and Council Meet monthly with City Employee Insurance Committee (EIC) regarding current issues Appear at City Council Meetings and other necessary meetings as required As needed, and no less than annually, provide written reports regarding the overall plan performance, including comparison with historic data, trend identification, cost projections, etc. Assist the City with compliance in the areas of COBRA/HIPAA and other benefits related legislation and legal requirements, as well as act as a technical resource to include timely periodic updates on legislative developments, emerging trends, and insurers’ status Assist the City with compliance with the Affordable Care Act Vendor should include an example of the HIPAA Business Associate Agreement that will need to be executed Monitor the prospective markets and changes, which may affect the City’s benefit plans Provide research materials on various topics, as requested Provide periodic educational information and seminars regarding current benefit trends, regulatory compliance, legislative changes, etc., at no cost to the City Monitor and assist with reconciliation of stop loss recoveries Review stop loss expenditures and provide alternatives for cost savings, including self-funding, captives and other risk management approaches. Evaluate if any voluntary benefit offerings are desired from an employer or employee perspective. Provide annual incurred but not reported (IBNR) analysis NOTE: By responding to this RFP, the Proposer agrees to comply with the above Scope of Services. If you are unable to provide/perform any service, please list that service and provide and explanation. The information submitted shall be divided into tabbed, marked sections and shall include, but not limited to, information for each of the following: FIRM OVERVIEW: Proposer is requested to define the overall structure of the Firm to include the following: A descriptive background of Proposer’s history State its principal business location and any other service locations, including the primary office servicing the City State its primary line of business State how long it has been providing services as described herein State how many states other than Texas, where services are in use Describe your firm’s marketplace strength and your ability to negotiate with insurance companies. PROPOSED PROJECT TEAM, STAFF QUALIFICATIONS, EXPERIENCE, AND CREDENTIALS: Proposer is requested to address services offered by their company to include, but not necessarily limited to, those required services as stated above. Proposer is requested to state the organization’s experience, experience of the staff, and technical experience in providing these types of services State level of organizational responsibility of key project staff members Proposer is requested to include certifications held by Proposer’s personnel As the City assigns individual projects, successful Proposer shall identify personnel assigned to each specific project requirement Please describe what sets your company apart from other consulting firms Identify which Account Managers from United HealthCare would most likely be assigned to work with the City and your firm. Describe your firms compliance resources and team SCOPE OF SERVICES: As indicated above, please include a detailed explanation of services offered, as they relate to the City’s “Outline of Expected Services” provided herein, and your recommended approach to addressing the City’s needs. Please provide reasonable estimates of the cost to the City on a monthly and/or annual basis. Please include any services offered that may be above and beyond the Outline of Expected Services indicated by the City. REFERENCES: Proposer is requested to provide with the Request for Proposals a list of at least five (5) references where like services or their firm has performed similar projects. Include name of the client, address, telephone number and name of representative. In addition, please include all municipalities or other public entities (and number of employees) served by your firm. FEE SCHEDULE: Proposer is requested to provide (1) the cost of services, (2) explain the basis for the above fee and any subsequent annual fees, and (3) identify ad hoc services your company provides and the cost for these services. The City will not recognize or name an Agent of Record. No commissions or other forms of compensation of any type may be included in your pricing. Pricing must be on a flat fee basis, with full disclosure of all fees, including any which may deviate from the flat fee schedule. SUPPORTING MATERIALS: Various questions included in this Request for Proposals will be used in making a selection and should be addressed by section and number. Proposer is requested to submit information requested, one (1) original and two (2) copies of descriptive literature sufficient in detail to enable an intelligent comparison of services. FINANCIAL STATEMENTS: Proposer is requested to submit recent financial statements with this Request for Proposal. Audited financial statements are not mandatory. Unaudited financial statements will be accepted. If Proposer’s firm does, however, have audited financial statements, please include a copy with the response to the RFP. Financial statements must show the name and address of the firm preparing the financial statements and the date thereof. Supplemental Questionnaire Describe how your firm establishes and monitors performance criteria for all vendors, carriers and contracts. Describe your firm’s marketplace leverage in negotiating with carriers in regard to rates, policy terms and plan design. Provide information on litigation pertaining to your role as a benefit consultant over the last three (3) years. Provide information on client turnover for your firm’s benefit consulting division over the past three (3) years. Provide information on any National, State or local associations to which your company belongs, and your involvement with each. Discuss your technological abilities to provide communication in various forms (i.e., websites, printed materials, enrollment, etc.). Are there any restrictions or pending reviews by Federal or State authorities for non-compliance with Federal or State regulations? If yes, please explain. Has any party brought legal action against the organization during the past three (3) years? If yes, please explain. Have you made any claims against the City in the past three (3) years? If yes, what was the outcome/status? Describe the compliance resources the City will have access to. Provide a sample of any newsletters, updates, and seminars you provide to your clients.