2020-0269-HR/BT RFP for Employee Benefit Programs (NM Commodity Code(s): 94982, 95352,95380,91840) Addendum No. 1

Agency: Santa Fe County
State: New Mexico
Level of Government: State & Local
Category:
  • G - Social Services
  • R - Professional, Administrative and Management Support Services
Opps ID: NBD14263590556885275
Posted Date: Jul 22, 2020
Due Date: Aug 7, 2020
Solicitation No: 2020-0269-HR/BT
Source: Members Only

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Henry P. Roybal
Commissioner, District 1
Anna Hansen
Commissioner, District 2
Rudy N. Garcia
Commissioner, District 3
Anna T. Hamilton
Commissioner, District 4
Ed Moreno
Commissioner, District 5
Katherine Miller
County Manager
July 22, 2020
SANTA FE COUNTY
RFP NO. 2020-0269-HR/BT
EMPLOYEE INSURANCE BENEFITS
ADDENDUM NO. 1
Dear Offerors,
This addendum is issued to reflect the following immediately. It shall be the responsibility of
interested Offerors to adhere to any changes or revisions to the RFP as identified in this
Addendum No. 1. This documentation shall become permanent and made part of the
departmental files.
The following questions have been received from prospective Offerors to the RFP. Responses
to the questions have been provided as follows:
Question No. 1:
Answer No. 1:
Question No. 2:
Answer No. 2:
Question No. 3:
Answer No. 3:
Please confirm if a hard copy is required?
Hard copies are not required. Offeror may submit electronically to Drop box
link.
To confirm when submitting the proposal electronically through Dropbox we
are also supposed to email to Gallagher contacts listed in the Advertisement
section of the RFP.
Correct.
Can we please receive current fees/rates?
Current fee and rates are not being released under this RFP.
102 Grant Avenue · P.O. Box 276 · Santa Fe, New Mexico 87504-0276 · 505-986-6200 · FAX:
505-995-2740 www.santafecountynm.gov
Question No. 4:
Please confirm if there have been any plan changes in the past 12 months on
any of the inforce products we are quoting on and if so please provide those
changes.
Answer No. 4: No plan changes.
Question No. 5: Please confirm if the Client is asking for a bundled or unbundled approach
for Rx and for Stop Loss or do they want both?
Answer No. 5:
Both, Offerors proposing medical claims administration services must
propose on a bundled basis for stop loss and must respond to the separate
PBM RFP 2020-0009-HR/BT.
Question No. 6: When will the PBM RFP be issued, will it be a different due date?
Answer No. 6: July 20, 2020, with same submittal date of August 7, 2020.
Question No. 7:
Please provide a 12-month pharmacy claims utilization report that includes
NDC-11, drug name/strength, metric quantity, and days’ supply, date of
service/fill date, mail/retail indicator, generic/brand indicator, and NABP/NPI
of dispensing pharmacy.
Answer No. 7:
Questions related to the PBM RFP must be addressed under that RFP. Claim
data will be released to respondents submitting Appendix A and Exhibit 1 per
the requirements of the PBM RFP.
Question No. 8: Can we please get the current ER contribution by employee and employee +
dependent?
Answer No. 8:
Current funding rates and employer contributions are not being released
under this RFP.
Question No. 9: Is the provider reimbursement for in-patient, out-patient and professional
services on the HMO plan completely on a capitated basis?
Answer No. 9: No.
Question No. 10: Are claims on the HMO plan reimbursed under the ISL and ASL?
Answer No. 10: Yes.
Question No. 11: Outside of what was listed in the RFP, are there specific concerns or issues
Santa Fe County is trying to solve for by going to market?
Answer No. 11: There are no concerns or issues that require resolution. This is strictly a
government procurement requirement.
102 Grant Avenue · P.O. Box 276 · Santa Fe, New Mexico 87504-0276 · 505-986-6200 · FAX:
505-995-2740 www.santafecountynm.gov
Question No. 12: What onsite wellness resources and programs do employees currently have
access to?
Answer No. 12:
Santa Fe County offers an Employee Assistance Program, which is a free,
professional and confidential counseling program designed to assist
employees and their families with any issues they perceive to be a problem.
The County also offers on-site workout facilities in some County offices, as
well as providing employees and dependents who enroll in medical coverage
with gym memberships paid through Prime.
Question No. 13: Does Presbyterian currently utilize a wellness fund? If so, is it offered on an
annual basis from Presbyterian?
Answer No. 13: Yes/Yes.
Question No. 14:
Can you also send the following details - Census (including coverage
elections and number of children). Large claim data- include identifiers, paid
med and rx claims and diagnosis information for 2020, 2019 and 2018.
Aggregate claim data- monthly enrollment and paid med and rx claims for
2020, 2019 and 2018?
Answer No. 14:
Census data provided lists employee/subscriber detail only. Overall average
members per subscriber is 2.0. Large claim data to be provided under
separate Addendum.
Question No. 15: What network should we use? What TPA should we assume since this hasn’t
been decided and we are a standalone stop loss carrier?
Answer No. 15:
Per RFP, for specialty stop loss carriers, base initial proposed rates/terms
assuming continuation of Presbyterian for medical and prescription drug
claims administration and management. Once responses are received from
Offerors, alternative rates/terms may be requested assuming transition to one
of those Offerors. Assume Presbyterian’s broadest network.
Question No. 16: Is Santa Fe County following Mental Health Parity or did they opt out as a
self-funded non-Federal governmental plan?
Answer No. 16: Santa Fe County intends to follow MHP.
Question No. 17: What is the benefit for physician charges for outpatient surgeries performed
at an outpatient facility?
Answer No. 17: Per SBCs, member share for outpatient physician charges are 20% on both
plans.
Question No. 18: Can the County’s current admin fee and stop loss rates be provided?
Answer No. 18: Current fees/rates are not being released under this RFP.
102 Grant Avenue · P.O. Box 276 · Santa Fe, New Mexico 87504-0276 · 505-986-6200 · FAX:
505-995-2740 www.santafecountynm.gov
Question No. 19: Would you be able to supply a detailed pharmacy claims file?
Answer No. 19: Questions related to the PBM RFP must be addressed under that RFP.
Question No. 20: Does the group have a formulary with exclusions?
Answer No. 20: Questions related to the PBM RFP must be addressed under that RFP.
Question No. 21: Please confirm if a broad network or narrow network is currently in place
Answer No. 21: Questions related to the PBM RFP must be addressed under that RFP.
Current medical network is Presbyterian’s broadest network.
Question No. 22: Please confirm if the County receives Rx rebates or ASO fee credit
Answer No. 22: The County receives Rx rebates.
Question No. 23: Please confirm stop loss request should be bundled or stand alone
Answer No. 23:
Stop loss must be offered on a bundled basis if medical claims administration
is being proposed by your firm. If your stop loss proposal can be offered on a
standalone basis over another claims administrator, please indicate within
your proposal.
Question No. 24: Please confirm production requirements. If dropbox Is utilized, does Santa Fe
County still require any hard copies?
Answer No. 24: No. Offeror may submit electronically to Drop box link.
Question No. 25: Please confirm if any credits or funds are requested, inclusive of wellness. (ie.
Auditing, transition, tech)
Answer No. 25: Yes. Offerors are encouraged to include credits.
Question No. 26: Is there a way to get CM, or claim detail information on the large claimants?
Answer No. 26: Large claim data to be provided under separate Addendum.
Please add this Addendum No. 1 to the original bid documents and refer to bid documents, hereto as
such. This and all subsequent addenda will become part of any resulting contract documents and
have effects as if original issued. All other unaffected sections will have their original interpretation
and remain in full force and effect. Responders are reminded that any questions or need for
clarification must be addressed to Bill Taylor, Procurement Manager at
wtaylor@santafecountynm.gov. or Michael Rohr, Client Consultant and Mary Kay Oakes Client
Manager, Gallagher Benefit Services at mike_rohr@ajg.com and marykay_oakes@ajg.com
respectively.
102 Grant Avenue · P.O. Box 276 · Santa Fe, New Mexico 87504-0276 · 505-986-6200 · FAX:
505-995-2740 www.santafecountynm.gov
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