6198-1 Health Clinic Pricing Sheet- EX1 8-18-16Exhibit 1
RFP 6198 Pricing Sheet for Employee Health Clinic Operations & Management Services
The respondent shall complete the following section, which directly corresponds to the specifications. The contractor shall not make changes to this format.
Quantity amounts are estimates only to be used for comparison purposes.
Services Proposal Pricing
ITEM
Implementation (One Time Costs)
1
2
3
Monthly Cost
4
5
6
7
8
Total Annual Cost
Staffing Hourly Rates
ITEM
9
10
11
12
13
Services Proposal Pricing: Services (If not included within PEPM pricing)
ITEM
14
15
16
17
18
19
20
21
22
23
24
25
Services Proposal Pricing: Optional Services
ITEM
26
27
28
29
Cost of Additional Services identified by Respondent:
ITEM
30
31
32
33
34
TOTAL
Quantity
1
1
1
1500
1500
1500
900
1
Time Period
1
1
1
12
12
12
12
12
UOM
EA
EA
EA
PEPM
PEPM
PEPM
EA
MO
UOM
HR
HR
HR
HR
UOM
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
UOM
EA
EA
EA
EA
DESCRIPTION
This below listed equipment, software, license, and services are representative of the City's of Denton requirements
for the identified project. The request pricing shall be utilized in determination of the "cost of service", of the various phases of the project,
and any additional needs that may become known to the City during the contract period.
*NOTE: PLEASE EMAIL THIS EXHIBIT 1 AS AN EXCEL FILE TO EBIDS@CITYOFDENTON.COM
Respondent's Business Name
Principal Place of Business (City and State)
Type of Service Requested
Implementation Fees
Transition Costs/Fees
Data Transfer Costs/Fees
Overall Per Employee Per Month (PEPM) Clinic Administrative Cost/Fees
Disease Management Administration Costs (if not included in above PEPM fee)
Wellness Program (if not included in above PEPM fee)
Supplement #1 - HRA Biometric Costs (if not included in above PEPM fee)
Malpractice Insurance
Type of Service Requested
Medical Doctor
Nurse Practioner
Nurse (LVN)
Nurse (RN)
Office Admin
Type of Service Requested
Cholesterol Test (Lipid Panel--HDL/LDL, Total Cholesterol, Trigylcerides)
Blood Sugar Test (Fasting and Non-Fasting)
A1C Test
Strep Test (Rapid and Regular)
Flu Test
Flu Shot
Tetanus Shot
Hepatitis Vaccinations
Pregnancy Test (Blood)
Lab Draw Fees
Lab Processing Fees
EKG
Type of Service Requested
Post offer Physicals
Annual Physicals
Drug Test Collection
Onsite X-Ray Machine
Cost of Service
Cost of Service
Cost of Service
Cost of Service
TOTAL
0
Total Cost of Service
0
0
0
0
0
0
0
0
0