Item C12BOARD OF COUNTY COMMSSIONERS
AGENDA ITEM SUMMARY
Meeting Date: May 21, 2014 Division: Employee Services
Bulk Item: Yes X No Department: Employee Benefits
AGENDA ITEM WORDING: Approval to advertise a solicitation for Proposals for a Fully Insured
Dental Policy.
ITEM BACKGROUND:
employees, dependents, retirees, surviving spouses, domestic partners, and COBRA participants.
Coverage is provided to employees of the Board of County Commissioners, the Clerk of the Circuit
Court Tax Collector, Pro�vZL�-
,�.&W,raiser, Supervisor of Elections..-S1LwAs2k&*,T
Court Administration.
Premiums are paid for entirely by active employees through payroll deductions and enrollment is on a
voluntary basis. Premiums for active employees may be paid on a pretax basis through the County's
Section 125 Plan. Premiums for Retirees and Surviving Spouses are collected and forwarded to the
carrier by Monroe County.
IE!REVIOUS REVELANT BOCC ACTION: RFP was done early 2011 and United Concordia
r,-f,surance Company was selected and is the current provider. The last renewal of the policy was
Rpproved by the BOCC on October 16, 2013.
CONTRACT/AGREEMENT CHANGES: N/A. The current policy expires on January 1, 2015.
Advert
TOTAL COST: $800 INDIRECT COST: BUDGETED: Yes X No
DIFFERENTIAL OF LOCAL PREFERENCE:
Advert
COST TO COUNTY: $800 SOURCE OF FUNDS: Internal Service Fund
Primarily Ad Valorem
REVENUE PRODUCING: Yes No X AMOUNT PER MONTH— Year
APPROVED BY: County AttA/ OMEB/Purchasing Risk Management
DOCUMENTATION: Included Not Required
DISPOSITION: AGENDA ITEM
MONROE COUNTY
REQUEST FOR PROPOSALS
FOR
Fully Insured
Dental Benefits
BOARD OF COUNTY COMMISSIONERS
Mayor, Sylvia J. Murphy, District 5
Mayor Pro Tem, Danny L. Kolhage, District 1
George Neugent, District 2
Heather Carruthers, District 3
David Rice, District 4
COUNTY ADMINISTRATOR
Roman Gastesi
CLERK OF THE CIRCUIT COURT EMPLOYEE SERVICES DIVISION
Amy Heavilin Teresa E. Aguiar, Director
May, 2014
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TABLE OF CONTENTS
SECTION ONE - INSTRUCTION TO PROPOSERS
SECTION TWO -
EXHIBIT A - SCOPE OF SERVICES
EXHIBIT B - DENTAL QUESTIONNAIRE
SECTION THREE- COUNTY FORMS
ATTACHMENTS:
A. Dental Benefits SPD
B. Dental Claims History
C. Eligibility Census & Enrollment
D. Current Dental Rates
Note: Attachments and dates will be added after BOCC approval and before advertising.
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SECTION ONE: INSTRUCTIONS TO PROPOSERS
1. Objective of the Request for Proposals (RFP)
The County is seeking an insurance vendor to provide the County with dental benefits to
County Employees/Retirees and their dependents in accordance with the specifications
outlined in this Request for Proposals.
The County anticipates that this contract will be awarded for an effective date of
January 1, 2015. The initial policy term will be for a minimum of two years and the
County may elect to renew for up to three (3) additional consecutive one (1) year
terms. As an alternate, with a 36 month rate guarantee from the selected vendor,
the county may elect to choose an initial term of three (3) years, with up to two (2)
additional one year terms, dependent upon acceptability of cost, coverage, service,
and provider stability.
2. Background Information
Monroe County is a non -charter county and a political subdivision of the State of
Florida. The County population is approximately 73,000 as of the last census. The
Board of County Commissioners, constituted as the governing body, has all the powers
of a body corporate, including the powers to contract; to sue and be sued; to acquire,
purchase, hold, lease and convey real estate and personal property; to borrow money
and to generally exercise the powers of a public authority organized and existing for the
purpose of providing community services to citizens within its territorial boundaries. In
order to carry out this function, the County is empowered to levy taxes to pay the cost of
operations.
Approximately one-third of the population is situated in the City of Key West, which is
the county seat; however, the County offers services throughout the Keys, and has
government buildings throughout the Lower Keys (primarily Big Pine Key), Middle Keys
(primarily Marathon), and Upper Keys (primarily Plantation Key and Key Largo) in
addition to Key West, with employees stationed in all locations.
3. Present Information
Monroe County currently provides fully insured dental which provides the services listed
in the present plan below. Premiums are paid for entirely by active employees through
payroll deductions and enrollment is on a voluntary basis. Premiums for active
employees may be paid on a pretax basis through the County's Section 125 Plan.
Premiums for Retirees and Surviving Spouses are collected and forwarded to the carrier
by Monroe County.
The Proposers should bid benefits that are comparable to our current PPO dental plan.
The County also wishes to evaluate a passive PPO plan design benefit for both in and
out of network benefits. Finally, the County wishes to receive bids for a fully insured
non -network dental plan, with reimbursement levels at the 80t" percentile of usual and
customary charges. Please indicate whether you will offer the PPO and indemnity
plan as a dual choice program.
The Proposer must be willing to guarantee that their price will remain valid until January
1, 2015. -
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The Present Plan
• Active employees, dependents, and retirees along with Surviving Spouses are
covered. COBRA participants are also eligible for participation in the plan. The
current dental plan is administered by United Concordia.
• Coverage is currently provided for the employees of the Board of County
Commissioners, the Clerk of the Circuit Court, Tax Collector, Property Appraiser,
Supervisor of Elections, Sheriff's Office, Land Authority and Court Administration.
• Domestic Partners are included as dependents subject to the criteria in Monroe
County's Resolution.
• Active participant (along with their dependents') premiums are deducted bi-
weekly and retiree/surviving spouses and COBRA premiums are paid on a
monthly basis.
• Rates are included in Attachment D and do not include commissions.
Compensation: Proposer shall be in compliance with Section 624.428, Florida
Statutes. If any commissions and/or service fees are included in your rate quotation,
you shall specify the amount of the commissions and/or service fees, to whom they may
be paid and your reason(s) for including them.
• Gallagher Benefit Services, Inc. (the Consultant) is acting in a consulting capacity
for the Monroe County Board of County Commissioners under the terms of an
Agreement between the County and Gallagher Benefit Services, Inc. Gallagher
Benefit Services, Inc. will be analyzing proposals and providing its analysis to the
Selection Committee with regard to this RFP, and will be assisting with ongoing
servicing of the policy. In exchange for these services Gallagher Benefit
Services, Inc. is collecting a consulting fee from the County.
4. Evaluation Criteria
A Selection Committee will be convened to review the Proposals and recommend which
individual or firm should be selected for the project. The successful Proposer will be selected
based on the following criteria.
Cost of services
30 points
Experience and qualifications
30 points
Ability to provide all required services
30 points
Location of firm (local preference if
applicable: up to 10 additional points)
10 points
Total points earned are on a scale of 1 — 100 points
1 = lowest 100 = highest
A Selection Committee will be analyzing Proposals and providing recommendations to the
County Administrator who will ultimately make a recommendation to the Board of County
Commissioners regarding which Proposer should be hired.
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5. Requests for Additional Information or Clarification
Requests for additional information or clarification relating to the specifications of this
Request for Proposals shall be submitted in writing directly to:
Maria Fernandez -Gonzalez, Sr. Benefits Administrator
1100 Simonton Street, Suite 2-268
Key West, Florida 33040
Facsimile (305) 292-4452
All requests for additional information must be received no later than 3:00 PM, ---
---- 2014. Any requests received after that date and time will not be answered. All
questions received prior to the deadline will be answered to the best of the County's
ability and will be distributed to all interested Proposers in the form of an Addendum to
the RFP by no later than , 2014. All questions must be submitted in
writing. Oral requests will not be answered.
All addenda are a part of the contract documents and each Proposer will be bound by
such addenda, whether or not received by him/her. It is the responsibility of each
Proposer to verify that he/she has received all addenda issued before responses are
opened.
6. Content of Submission
The Proposal submitted in response to this Request for Proposals (RFP) shall be
printed on 8-1/2" x 11" white paper and bound; shall be clear and concise, tabbed, and
provide the information requested herein. Statements submitted without the required
information will not be considered. Responses shall be organized as indicated below.
The Proposer should not withhold any information from the written response in
anticipation of presenting the information orally or in a demonstration, since oral
presentations or demonstrations may not be solicited. Each Proposer must submit
adequate documentation to certify the Proposer's compliance with the County's
requirements. Proposer should focus specifically on the information requested.
7. Format.
The proposal, at a minimum, shall include the following:
A. Cover Page,
A cover page that states: "Requests for Proposals for Fully Insured Dental Benefits".
The cover page should contain Proposer's name, address, telephone number, and the
name of the Proposer's contact person(s).
B. Table of Contents:
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Include a clear identification of the material by section and by page number.
C. Letter of Transmittal:
Give the names of the persons who will be authorized to make representations for the
Proposer, their titles, addresses and telephone numbers.
D. Tabbed Sections
Tab 1. General Information
(a) Description of the history of the firm, its corporate structure, and years in
business.
(b) List of governmental agencies serviced in the state of Florida which are similarly
sized.
(c) Insurer's contact Representative's information
(d) Copies of all required licenses/certifications and/or authorizations to conduct
business in the state of Florida.
Tab 2. Experience and Qualifications
• The Proposer shall be licensed in the State of Florida to provide the requested
insurance.
• The Proposer must provide evidence of financial ratings and should have a
minimum size category of VI and a financial rating of A- from A.M. Best, other
financial rating scores must be submitted, such as Moody's Standard and Poor's,
and Fitch.
• If the Proposer is not rated by at least one of the above rating agencies, the
Proposer must provide at least the most recent 3 years of audited financials.
• Proposer must be in compliance with the Florida Office of Insurance Regulation
profitability and reserve requirements.
• Experience with Government entities will be a major factor in the evaluation of
the proposals. All Proposers should furnish a summary of all such experience.
References, including client name, contact person and telephone number should
also be included.
• The Proposer must certify at least annually that all staff members, independent
contractors, subcontracted work, if any, all service providers it uses, engages or
manages, comply with Health Insurance Portability and Accountability Act
(HIPAA) privacy and security rules.
• The County has employees in the Upper, Middle and Lower Keys. Proposer
must have access to networks in Monroe County, Florida providing coverage in
all of these areas.
Tab 3. Scope of Services
(a) Proposer shall address each item under the requested Scope of Services and
indicate whether the Proposer can comply completely, comply with deviations,
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or cannot comply.
(b) Deviations: Proposer shall outline all deviations to any provision within the RFP
that exists in the proposal.
(c) Proposer shall provide its standard performance guarantees and the amount it is
willing to put at risk.
Tab 4. Other Information
The Proposer shall provide copies of all materials that the County will be
required to sign in order to implement the Dental Insurance Policy,
including but not limited to: a sample policy for the State of Florida,
application for Dental Insurance, Claim Forms, etc.
Proposer shall provide any additional project experience not already
described in other tabs that will give an indication of the Proposer's overall
abilities.
If the Proposer cannot fully comply with any of the terms contained in this
RFP, all deviations to the terms must be spelled out in this section, i.e.
Tab 4. If the Proposer cannot fully provide any of the elements in Scope
of Services, Exhibit A, these also should be spelled out in Tab 4.
Tab 5. Litigation
In accordance with Section 2-347(h) of the Monroe County Code, the Proposer must
provide the following information:
(1) A list of the person's or entity's shareholders with five (5) percent or more of the
stock or, if a general partnership, a list of the general partners; or, if a limited
liability company, a list of its members; or, if a solely owned proprietorship,
names(s) of owner(s);
(2) A list of the officers and directors of the entity;
(3) The number of years the person or entity has been operating and, if different, the
number of years it has been providing the services, goods, or construction
services called for in the bid specifications (include a list of similar projects);
(4) The number of years the person or entity has operated under its present name
and any prior names;
(5) Answers to the following questions regarding claims and suits:
a. Has the person, principals, entity, or any entity previously owned,
operated or directed by any of its officers, major shareholders or directors,
ever failed to complete work or provide the goods for which it has
contracted? If yes, provide details;
b. Are there any judgments, claims, arbitration proceeding or suits pending
or outstanding against the person, principal of the entity, or entity, or any
entity previously owned, operated or directed by any of its officers,
directors, or general partners? If yes, provide details;
c. Has the person, principal of the entity, entity, or any entity previously
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owned, operated or directed by any of its officers, major shareholders or
directors, within the last five (5) years, been a party to any lawsuit,
arbitration, or mediation with regard to a contract for services, goods or
construction services similar to those requested in the specifications with
private or public entities? If yes, provide details;
d. Has the person, principal of the entity, or any entity previously owned,
operated or directed by any of its officers, owners, partners, major
shareholders or directors, ever initiated litigation against the county or
been sued by the county in connection with a contract to provide services,
goods or construction services? If yes, provide details;
e. Whether, within the last five (5) years, the owner, an officer, general
partner, principal, controlling shareholder or major creditor of the person or
entity was an officer, director, general partner, principal, controlling
shareholder or major creditor of any other entity that failed to perform
services or furnish goods similar to those sought in the request for
competitive solicitation.
Tab 6. County Forms
Proposer shall complete, execute, and attach the forms specified below which are
located in Section Three in this RFP, as well as a copy of a business tax receipt
from the Tax Collector's Office and shall include it in this section, i.e. Tab 6:
Forms:
• Submission Response Form
• Lobbying and Conflict of Interest Ethics Clause
• Non -Collusion Affidavit
• Drug Free Workplace Form
• Public Entity Crime Statement
• Any proposer claiming a local preference as defined in Monroe County
Ordinance 023-2009 must complete the Local Preference Form and attach to the
Proposal.
8. COPIES OF RFP DOCUMENTS
A. Only complete sets of RFP Documents will be issued and shall be used in
preparing responses. The County does not assume any responsibility for
errors or misinterpretations resulting from the use of incomplete sets.
B. Complete sets of RFP Documents may be obtained in the manner and at
the locations stated in the Notice of Request for Proposals.
9. STATEMENT OF PROPOSAL REQUIREMENTS
See also Notice of Request for Competitive Solicitation.
Interested firms or individuals are requested to indicate their interest by submitting the
following numbers of complete set of responses:
- One response in an electronic format compatible with Microsoft Excel or Word as
appropriate (PDF responses will not be deemed responsive), plus
- three (3) signed originals, plus
- three (3) complete copies
The electronic format response and the seven (7) complete hard copy packages must
be delivered in a sealed envelope clearly marked on the outside, with the Proposer's
name and "PROPOSAL FOR FULLY INSURED DENTAL INSURANCE" marked on the
outside. The Proposals must be addressed to Monroe County Purchasing Department,
1100 Simonton Street, Room 2-213, Key West, FL 33040, and must be received on or
before 3:00 P.M. local time on 2014. Hand delivered Proposals may request a
receipt. No Proposals will be accepted after 3:00 P.M. Faxed or e-mailed proposals
shall be automatically rejected. It is the sole responsibility of each Proposer to ensure
its proposal is received in a timely fashion.
Both the hard copy and electronic Proposal originals will constitute the original
governing documents. In the case of any discrepancy between the original Proposal
and the copies, the original will be the governing document. In the case of any omission
from one of the original documents, we will consider the information included in the
other original document.
10. DISQUALIFICATION OF PROPOSER
A. NON -COLLUSION AFFIDAVIT: Any person submitting a proposal in
response to this invitation must execute the enclosed NON -COLLUSION
AFFIDAVIT. If it is discovered that collusion exists among the Proposers,
the proposals of all participants in such collusion shall be rejected, and no
participants in such collusion will be considered in future proposals for the
same work.
B. PUBLIC ENTITY CRIME: A person or affiliate who has been placed on the
convicted vendor list following a conviction for a public entity crime may
not submit a proposal on a contract to provide any goods or services to a
public entity, may not submit a proposal on a contract with a public entity
for the construction or repair of a public building or public work, may not
submit Proposals on leases or perform work as a contractor, supplier,
subcontractor, or contractor under a contract with any public entity, and
may not transact business with any public entity in excess of the threshold
amount provided in Section 287.017, Florida Statutes, for CATEGORY
TWO for a period of 36 months from the date of being placed on the
convicted vendor list. Category Two: $25,000.00
C. DRUG -FREE WORKPLACE FORM: Any person submitting a bid or
proposal in response to this invitation must execute the enclosed DRUG -
FREE WORKPLACE FORM and submit it with his/her proposal. Failure to
complete this form in every detail and submit it with the bid or proposal
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may result in immediate disqualification of the bid or proposal.
D. LOBBYING AND CONFLICT OF INTEREST ETHICS CLAUSE: Any
person submitting a bid or proposal in response to this invitation must
execute the enclosed LOBBYING AND CONFLICT OF INTEREST
CLAUSE and submit it with his/her bid or proposal. Failure to complete
this form in every detail and submit it with the bid or proposal may result
in immediate disqualification of the bid or proposal.
11. EXAMINATION OF RFP DOCUMENTS
A. Each Proposer shall carefully examine the RFP and other contract
documents, and inform himself/herself thoroughly regarding any and all
conditions and requirements that may in any manner affect cost,
progress, or performance of the work to be performed under the contract.
Ignorance on the part of the Proposer shall in no way relieve him/her of the
obligations and responsibilities assumed under the contract.
B. Should a Proposer find discrepancies or ambiguities in, or omissions
from, the specifications, or should he be in doubt as to their meaning, he
shall at once notify the County.
12. GOVERNING LAWS AND REGULATIONS
The Proposer is required to be familiar with and shall be responsible for complying with
all federal, state, and local laws, ordinances, rules, professional license requirements
and regulations that in any manner affect the work. Knowledge of business tax
requirements for Monroe County and municipalities within Monroe County are the
responsibility of the Proposer.
13. PREPARATION OF RESPONSES
Signature of the Proposer: The Proposer must sign the response forms in the
space provided for the signature. If the Proposer is an individual, the words "doing
business as or "Sole Owner" must appear beneath such signature. In the
case of a partnership, the signature of at least one of the partners must follow the firm
name and the words "Member of the Firm" should be written beneath such signature. If
the Proposer is a corporation, the title of the officer signing the Response on behalf of
the corporation must be stated along with the Corporation Seal Stamp.
14. MODIFICATION OF RESPONSES
Written modifications will be accepted from Proposers if addressed to the entity
and address indicated in the Notice of Request for Competitive Solicitation and received
prior to Proposal due date and time. Modifications must be submitted in a sealed
envelope clearly marked on the outside, with the Proposer's name and "Requests for
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Proposals for Fully Insured Dental Benefits". If sent by mail or by courier, the above -
mentioned envelope shall be enclosed in another envelope addressed to the entity and
address stated in the Notice of Request for Proposals. Faxed or e-mailed modifications
shall be automatically rejected.
15. RESPONSIBILITY FOR RESPONSE
The Proposer is solely responsible for all costs of preparing and submitting the
response, regardless of whether a contract award is made by the County.
16. RECEIPT AND OPENING OF RESPONSES
Responses will be received until date/time and will be publicly opened.
Proposers' names shall be read aloud at the appointed time and place stated in the
Notice of Request for Competitive Solicitation. Monroe County's representative
authorized to open the responses will decide when the specified time has arrived and
no responses received thereafter will be considered. No responsibility will be attached
to anyone for the premature opening of a response not properly addressed and
identified. Proposers or their authorized agents are invited to be present.
The County reserves the right to reject any and all responses and to waive
technical error and irregularities as may be deemed best for the interests of the County.
Responses that contain modifications that are incomplete, unbalanced, conditional,
obscure, or that contain additions not requested or irregularities of any kind, or that do
not comply in every respect with the Instruction to Proposer, may be rejected at the
option of the County.
17. AWARD
A. The County reserves the right or to re -advertise for all or part of the work
contemplated.
B. The recommendation of staff shall be presented to the Board of County
Commissioners of Monroe County, Florida, for final selection and award.
18. PAYMENT TERMS
Payment will be made according to the Florida Local Government Prompt
Payment Act, Section 218.70, Florida Statutes. The Provider shall submit to the
County an invoice with supporting documentation in a form acceptable to the
Clerk. Acceptability to the Clerk is based on generally accepted accounting
principles and such laws, rules and regulations as may govern the Clerk's
disbursal of funds. The Director of Employee Services will review the request,
note his/her approval on the request and forward it to the Clerk for payment.
Any extension of this Agreement beyond the term noted in Section One is
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contingent upon annual appropriation by Monroe County.
19. TERMINATION/NON-RENEWAL NOTICE
Either party may terminate this Agreement because of the failure of the other party to
perform its obligations under the Agreement. The CONTRACTOR may terminate this
Agreement with ninety (90) days' notice to the COUNTY. The COUNTY may terminate
this Agreement with or without cause upon thirty (30) days' notice to the
CONTRACTOR. COUNTY shall pay CONTRACTOR for work performed through the
date of termination.
20. INDEMNIFICATION
The Proposer to whom a contract is awarded shall defend, indemnify and hold
harmless the County as outlined below.
The Proposer covenants and agrees to indemnify, hold harmless and defend
Monroe County, its commissioners, officers, employees, agents and servants from any
and all claims for bodily injury, including death, personal injury, and property damage,
including damage to property owned by Monroe County, and any other losses,
damages, and expenses of any kind, including attorney's fees, court costs and
expenses, which arise out of, in connection with, or by reason of services provided by
the Proposer or any of its Subcontractor(s), occasioned by the negligence, errors, or
other wrongful act or omission of the Proposer, its Subcontractor(s), their officers,
employees, servants or agents.
In the event that the service is delayed or suspended as a result of the
Proposer/Vendor's failure to purchase or maintain the required insurance, the Vendor
shall indemnify the County from any and all increased expenses resulting from such
delay.
The first ten dollars ($10.00) of remuneration paid to the Proposer is
consideration for the indemnification provided for above. The extent of liability is in no
way limited to, reduced, or lessened by the insurance requirements contained
elsewhere within this agreement.
21. EXECUTION
The County intends to make an award to the Proposer that has complied with the terms,
conditions and requirements of the RFP. Any agreement resulting from this RFP must
be approved by the Monroe County Attorney, must be governed by the laws of the State
of Florida, and must have venue established in the State of Florida. The agreement
approved by the Monroe County Attorney will be submitted to the Monroe County Board
of County Commissioners for final approval.
If the Proposer cannot fully comply with any of the terms contained in this RFP, all
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deviations to the terms must be spelled out in Tab 4
22. RECORDS
CONTRACTOR shall maintain all books, records, and documents directly pertinent to
performance under this Agreement in accordance with generally accepted accounting
principles consistently applied. Each party to this Agreement or their authorized
representatives shall have reasonable and timely access to such records of each other
party to this Agreement for public records purposes during the term of the agreement
and for five (5) years following the termination of this Agreement. If an auditor
employed by the COUNTY or Clerk determines that monies paid to CONTRACTOR
pursuant to this Agreement were spent for purposes not authorized by this Agreement,
the CONTRACTOR shall repay the monies together with interest calculated pursuant to
Section 55.03 of the Florida Statutes, running from the date the monies were paid to
CONTRACTOR.
Pursuant to Florida Statute §119.0701, Contractor and its subcontractors shall comply
with all public records laws of the State of Florida, specifically to:
(a) Keep and maintain public records that ordinarily and necessarily would be
required by Monroe County in the performance of this Agreement.
(b) Provide the public with access to public records on the same terms and
conditions that Monroe County would provide the records and at a cost that does not
exceed the cost provided in Florida Statutes, Chapter 119 or as otherwise provided by
law.
(c) Ensure that public records that are exempt or confidential and exempt from
public records disclosure requirements are not disclosed except as authorized by law.
(d) Meet all requirements for retaining public records and transfer, at no cost, to
Monroe County all public records in possession of the contractor upon termination of
this Agreement and destroy any duplicate public records that are exempt or confidential
and exempt from public records disclosure requirements. All records stored
electronically must be provided to Monroe County in a format that is compatible with the
information technology systems of Monroe County.
23. PUBLIC ACCESS
The COUNTY and CONTRACTOR shall allow and permit reasonable access to, and
inspection of, all documents, papers, letters or other materials in its possession or under
its control subject to the provisions of Chapter 119, Florida Statutes, and made or
received by the COUNTY and CONTRACTOR in conjunction with this Agreement; and
the COUNTY shall have the right to unilaterally cancel this Agreement upon violation of
this provision by CONTRACTOR.
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SECTION TWO
SCOPE OF SERVICES
EXHIBIT A
Organization Name:
Primary Contact/Representative:
Title:
Address:
City, State, Zip Code:
Telephone Number:
Fax Number:
E-mail Address:
Yes, Can Comply but
Yes
No
with Specified
Service
Can
Cannot
Deviations (please
Comply
Comply
detail deviations
below)
Provide a toll free number
and sufficient staffing to
handle inquiries directly from
staff and plan members.
The County shall review and
approve all communication
materials prior to the
Proposer mailing directly to
the employee's home.
Postage costs are paid by
the Proposer.
Member information is to be
mailed, in a timely manner,
to the employer/employee.
Postage costs are paid by
the Proposer.
Actively -at -work provisions
shall be waived for all
participants.
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A no-loss/no-gain provision
shall apply to all current plan
participants.
Variations in actual
enrollment shall have no
effect on the rate proposal.
The proposal shall be valid
regardless of the final
enrollment mix, number of
Proposers, number of plan
designs or outcome.
There shall be no exclusion
provisions for preexisting
conditions except for late
entrants.
The Proposer must provide
full HIPAA administration
services.
The Proposer must provide
tracking, maintenance, and
distribution of all HIPAA
related certificates and
certifications listed in Tab 2.
The Proposer is required to
maintain compliance with
Federal guidelines for ADEA,
HIPAA, PPACA, Medicare
and COBRA, as well as all
Florida mandated benefits.
The Proposer must provide
and agree to performance
standards with the County.
Financial penalties for failure
to perform within the
negotiated guidelines will be
included. Such standards
shall apply, but not be limited
to..
• Claim issuance
time
• Claim payment
accuracy
• Telephone
response time
The Proposer must provide
cost and utilization reports in
a format agreed to and on a
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schedule agreed to by the
County. The cost of the
reports must be included in
the rate quote. Such reports
shall include at least the
following and reports must
be provided no less
frequently than quarterly:
• Premiums paid by
month
• Amounts
submitted for
reimbursement by
month
• Amounts paid by
month
• Account
enrollment by
month
• Complaints
received by cause
category, by
quarter
The successful Proposer
must provide an account
executive from within its
sales/marketing
department for the
County. The account
executive must have
sufficient time in his/her
day to pay particular
attention to the County.
The successful Proposer
must provide a senior level
employee to participate in
the installation of the County
plan.
The successful Proposer
must participate in open
enrollment meetings on an
annual basis.
The successful Proposer
must provide a rate quote for
the cost of one directory per
eligible employee per year
plus 15% for turnover.
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Directories are distributed at
open enrollment period and
to new employees.
The successful Proposer
must produce and distribute
all applicable materials
including but not limited to:
Enrollment materials, Plan
booklets & Schedule of
Benefits, Explanation of
Benefits, Provider
Directories, etc.
The successful Proposer
must provide and maintain
access to provider networks
in Monroe County.
The successful Proposer
must agree to payment terms
that comply with the Florida
Local Government Prompt
Payment Act, Section
218.70, Florida Statutes.
The payment terms must be
stated in the final agreement.
The CONTRACTOR will
indemnify and hold harmless
the BOCC as provided in
Paragraphs 20 of the RFP.
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DENTAL QUESTIONNAIRE
EXHIBIT B
Organization Name:
Primary Contact/Representative:
Title:
Address:
City, State, Zip Code:
Telephone Number:
Fax Number:
E-mail Address:
1. Please provide references for your 3 largest clients (Governmental clients are preferred),
by enrollment, for South Florida (Monroe, Miami -Dade, Broward) using the following
format:
Employer
Name
Total
Number of
Employees
in South
11 Florida
Number of
Employees
Enrolled in
Your PPO
plan(s)
Date
Services
Commenced
Contact
Person
Address
Phone
Number
1. Is your organization currently in compliance with Florida Department of Insurance
Statutes and requirements? Yes No . If no, describe why not.
2. Please provide a copy of your Florida Office of Insurance Regulation licensure as a
Florida health insurance company.
3. Provide your organization's most recent financial ratings (e.g., Moody's, S&P, AM Best).
If not currently rated by any independent organizations, please explain why.
4. Provide the location of the office that will manage the County account and provide the
names of the individuals who will be responsible for all aspects of the County account
service.
5. Where are the dental claims processed? What are the office objectives for claim
turnaround and accuracy?
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6. Are you willing to provide rate guarantees for 24 and 36 months? Will you guarantee the
existing benefit allowance schedule for at least twelve full months?
7. Will at least a 120 days notice be provided on any renewal rate increase or other
modification of the policy?
8. Does proposal conform to Take-over requirements?
9. How are usual and customary charges determined by your company? What sources do
you use for updating the usual and customary profile and how frequently is the profile
updated? Your proposal should assume payment at the 80th percentile. Can you pay
claims at a different percentile if requested?
10. Will the County be notified of any changes to the usual and customary profile prior to
implementation of such changes?
11. How are renewal rates and fees determined? Please provide sample methodology
including experience credibility factors for renewal purposes (e.g., number of years'
experience, number of insured lives, etc.).
12. Please provide specimen dental contracts.
13. Complete the following exhibit for Monroe County
County
Total Number
of Dentists
Total Number of
Specialists
Percentage of Dentists
accepting new patients
Percentage of Specialty Dentists
accepting new patients
Monroe
Number of
Number of
Number of
Number of
Number of
General
Endodontists
Periodontists
Orthodontists
Pedodontists
County
Dentists
Monroe
14. Provide a current 2014 directory in a usable Excel format (NOT PDF) of your network
providers, by location, including TIN, Name, address and zip code, for your proposed
network(s). Please use only one row per provider.
15. Complete the following GeoAccess summary for Monroe County employees. The census
is included in Exhibit C. Your study should include a summary report for each of the
items listed below. Each summary should indicate the total number and percentage of
employees with access by City. Include GeoAccess Reports.
a) Number and percentage of employees with two General Dentists within 5 miles and 10
miles of the employee's zip code.
b) Number and percentage of employees without the desired access to General Dentists by
City.
c) Number and percentage of employees with two Specialists within 5 miles and10 miles of
the employee's zip code.
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d) The number and percentage of employees without the desired access to Specialists by
City.
Number of
General Dentists - %
General Dentists - %
Specialists - %
Specialists - %
Eligible
EEs w/ 2 General
EEs w/ 2 General
EEs w/ 2 Specialists
EEs w/ 2
Employees
Dentists
Dentists
Specialists
Dental
within 5 miles
within 10 miles
within 5 miles
within 10 miles
Network
PPO
16. What percentage of dentists participating in your network is closed to new patients?
17. Provide samples of utilization/management reports that are available to the County.
18. Describe your quality improvement and utilization review procedures in terms of provider
networks. Specifically, who is responsible for quality improvements?
19. How will you implement corrective actions for identified service problems with
providers?
20. How will providers who fail to perform at an acceptable level be removed from the
network?
21. Identify the grievance/dispute resolution system that would be implemented to respond to
network disputes for both plan participants and providers of care (i.e., participant disputes,
referral or lack of referral, etc.).
22. Please indicate for both facilities and dentists the re-election (i.e., renewal) process for
provider contracts. Outline any criteria used in this evaluation.
23. Describe your program for conducting provider and employee satisfaction surveys. What
efforts are made to evaluate and remedy any problems?
24. List all pre-existing conditions and limitations for each plan you are offering.
25. Will you administer the proposed plan design exactly as described? If not, what changes
are suggested or required?
26. In general, how are treatments initiated prior to the effective date continued under the
managed network? Be specific with regards to orthodontia.
27. Will you have personnel available to assist in enrollment or informational meetings?
28. Is the network owned by your organization or subcontracted through a third party? If so,
please identify the company and outline the business relationship.
29. How quickly are members informed when their provider leaves the network?
30. What is the annual rate of network dentist turnover?
31. Are you willing to add dentists to your network at the County's request?
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32. What are your organization's target waiting times for appointments? Do you have
statistics on actual waiting times? What information is included in provider directories?
How often are they updated? How often are they distributed to participants? Are your
provider directories available on-line? Provide Directories in Excel for your networks
including South Florida (Monroe, Miami -Dade and Broward County).
33. What is your average discount off usual and customary fees (please estimate if non -
discount reimbursement methods are used)?
34. Please describe your standard orthodontia benefit rider. Be specific with regards to age
limitations of participants, benefit maximums, and other limitations.
35. What protections do you provide to members against balance billing by providers?
36. Will you mail to each member a copy of the certificate of coverage and benefit plan
description detailing the terms and conditions of receiving benefits and documentation of
the complaint and appeals process?
37. What is your standard process for loading initial enrollment? How long do you need to
ensure that your system is set up and that all eligibility is entered accurately?
38. Are ID cards issued for the Dental coverage? Yes No If yes, are these issued
annually or only once? Is there a charge for additional ID cards? Yes No If yes,
what is the charge?
39. Report the schedule/time frame for ID card distribution. Include an explanation of how providers
are instructed to handle members who have not yet been issued member ID cards.
40. Will you accept self -reporting and payment in lieu of list bills? What eligibility audit
process would you require internally (i.e. quarterly audits, semiannual)?
41. Can the County Benefits Staff enter eligibility information directly into your eligibility
system? Is the entry in real time? If not, how long does it take for eligibility information
to be updated?
42. Can your plan track and report member enrollment information? Will you provide reports
to the County upon request to confirm accuracy of the data?
43. Can your plan track and report on customer service activity?
44. Is this an authorized offer?
45. Has your proposal been signed by an authorized person?
46. Please state any exceptions to specifications.
47. Please provide your proposed rates in the table format below. All costs for the services
requested are to be included in the proposed rates.
a. DENTAL Coverage Tiers:
PPO Per payday (26 pay periods) Per month
Employee only
Employee & Spouse
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Employee & Child(ren)
Full Family
Passive PPO
Per payday (26 pay periods)
Per month
Employee only
Employee & Spouse
Employee & Child(ren)
Full Family
Indemnity
Per payday (26 pay periods)
Per month
Employee only
Employee & Spouse
Employee & Child(ren)
Full Family
48. Please outline each charge that has been added into your rates over and above the standard
rates (for each quoted plan) on a PEPM basis with a description of the expense.
The Representative stated below is the authorized agent of the Proposer and is authorized to bind
the company upon acceptance by the County. Deviations from the requested program have been
stated. Coverage(s) or services will be issued as proposed.
Authorized Representative Print Name Firm Telephone Date
Authorized Representative Signature
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SECTION THREE: COUNTY FORMS AND INSURANCE FORMS
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RESPONSE FORM
RESPOND TO: MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
Purchasing Department
GATO BUILDING, ROOM 2-213
1100 SIMONTON STREET
KEY WEST, FLORIDA 33040
El acknowledge receipt of Addenda No.(s)
I have included:
• Response Form ❑
• Lobbying and Conflict of Interest Clause ❑
• Non -Collusion Affidavit ❑
• Drug Free Workplace Form ❑
• Public Entity Crime Statement ❑
• Copy of business tax receipt from the ❑
Tax Collector's office
• Local Preference Form (if applicable) ❑
❑ I have included a current copy of the following professional licenses and business tax receipts:
If the applicant is not an individual (sole proprietor), please supply the following information:
APPLICANT ORGANIZATION:
(Registered business name must appear exactly as it appears on www.sunbiz.org).
Any applicant other than an individual (sole proprietor) must submit a printout of the "Detail by
Entity Name" screen from Sunbiz, and a copy of the most recent annual report filed with the
Florida Department of State, Division of Corporations.
Mailing Address
Signed
(Print Name)
(Title)
STATE OF:
COUNTY OF:
Telephone: _
Fax: Date
Witness:
Subscribed and sworn to (or affirmed) before me on
(date) by
to me or has produced
identification.
(name of affiant). He/She is personally known
(type of identification) as
NOTARY PUBLIC
My Commission Expires:
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LOBBYING AND CONFLICT OF INTEREST CLAUSE
SWORN STATEMENT UNDER ORDINANCE NO. 010-1990
MONROE COUNTY, FLORIDA
ETHICS CLAUSE
it
(Company)
11
"...warrants that he/it has not employed, retained or otherwise had act on his/her behalf
any former County officer or employee in violation of Section 2 of Ordinance No. 010-
1990 or any County officer or employee in violation of Section 3 of Ordinance No. 010-
1990. For breach or violation of this provision the County may, in its discretion,
terminate this Agreement without liability and may also, in its discretion, deduct from the
Agreement or purchase price, or otherwise recover, the full amount of any fee,
commission, percentage, gift, or consideration paid to the former County officer or
employee."
(Signature)
Date:
STATE OF:
COUNTY OF:
Subscribed and sworn to (or affirmed) before me on
(date) by
personally known to me or has produced
(type of identification) as identification
(name of affiant). He/She is
NOTARY PUBLIC
My Commission Expires:
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NON -COLLUSION AFFIDAVIT
I, of the city of
law on my oath, and under penalty of perjury,
depose and say that
according to
I am of the firm
of the bidder
making the Proposal for the project described in the Request for Proposals
for and that I executed
the said proposal with full authority to do so;
2. The prices in this bid have been arrived at independently without collusion,
consultation, communication or agreement for the purpose of restricting
competition, as to any matter relating to such prices with any other bidder or
with any competitor;
3. Unless otherwise required by law, the prices which have been quoted in this
bid have not been knowingly disclosed by the bidder and will not knowingly
be disclosed by the bidder prior to bid opening, directly or indirectly, to any
other bidder or to any competitor; and
4. No attempt has been made or will be made by the bidder to induce any
other person, partnership or corporation to submit, or not to submit, a bid for
the purpose of restricting competition;
5. The statements contained in this affidavit are true and correct, and made
with full knowledge that Monroe County relies upon the truth of the
statements contained in this affidavit in awarding contracts for said project.
(Signature)
Date:
STATE OF:
COUNTY OF:
Subscribed and sworn to (or affirmed) before me on
(date) by
known to me or has produced
as identification.
(name of affiant). He/She is personally
(type of identification)
NOTARY PUBLIC
My Commission Expires:
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DRUG -FREE WORKPLACE FORM
The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies
that:
(Name of Business)
1. Publishes a statement notifying employees that the unlawful manufacture,
distribution, dispensing, possession, or use of a controlled substance is
prohibited in the workplace and specifying the actions that will be taken against
employees for violations of such prohibition.
2. Informs employees about the dangers of drug abuse in the workplace, the
business' policy of maintaining a drug -free workplace, any available drug
counseling, rehabilitation, and employee assistance programs, and the penalties
that may be imposed upon employees for drug abuse violations.
3. Gives each employee engaged in providing the commodities or contractual
services that are under bid a copy of the statement specified in subsection (1).
4. In the statement specified in subsection (1), notifies the employees that, as a
condition of working on the commodities or contractual services that are under
bid, the employee will abide by the terms of the statement and will notify the
employer of any conviction of, or plea of guilty or nolo contendere to, any
violation of Chapter 893 (Florida Statutes) or of any controlled substance law of
the United States or any state, for a violation occurring in the workplace no later
than five (5) days after such conviction.
5. Imposes a sanction on, or require the satisfactory participation in a drug abuse
assistance or rehabilitation program if such is available in the employee's
community, or any employee who is so convicted.
6. Makes a good faith effort to continue to maintain a drug -free workplace through
implementation of this section.
As the person authorized to sign the statement, I certify that this firm complies fully with
the above requirements.
STATE OF:
COUNTY OF:
Subscribed and sworn to (or affirmed) before me on
produced
(Signature)
Date:
(date) by
(name of affiant). He/She is personally known to me or has
(type of identification) as identification.
NOTARY PUBLIC
My Commission Expires:
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PUBLIC ENTITY CRIME STATEMENT
"A person or affiliate who has been placed on the convicted vendor list following a
conviction for public entity crime 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, subcontractor, or CONTRACTOR under a contract with any
public entity, and may not transact business with any public entity in excess of the
threshold amount provided in Section 287.017, Florida Statutes, for CATEGORY TWO
for a period of 36 months from the date of being placed on the convicted vendor list."
I have read the above and state that neither (Proposer's
name) nor any Affiliate has been placed on the convicted vendor list within the last 36
months.
(Signature)
Date:
STATE OF:
COUNTY OF:
Subscribed and sworn to (or affirmed) before me on
(date) by
known to me or has produced
(type of identification) as identification.
(name of affiant). He/She is personally
NOTARY PUBLIC
My Commission Expires:
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LOCAL PREFERENCE FORM
A. Vendors claiming a local preference according to Monroe County Ordinance 023-2009 must complete this form.
Name of Bidder/Responder
Date:
1. Does the vendor have a valid receipt for the business tax paid to the Monroe County Tax Collector dated at least
one year prior to the notice or request for bid or proposal? (Please furnish copy.)
2. Does the vendor have a physical business address located within Monroe County from which the vendor operates
or performs business on a day to day basis that is a substantial component of the goods or services being offered to
Monroe County?
List Address:
Telephone Number:
B. Does the vendor/prime contractor intend to subcontract 50% or more of the goods, services or construction to
local businesses meeting the criteria above as to licensing and location?
If yes, please provide:
1. Copy of Receipt of the business tax paid to the Monroe County Tax Collector by the subcontractor dated at least
one year prior to the notice or request for bid or proposal.
2. Subcontractor Address within Monroe County from which the subcontractor operates:
Signature and Title of Authorized Signatory for
Bidder/Responder
STATE OF:
COUNTY OF:
Subscribed and sworn to (or affirmed) before me on
(date) by_
produced _
identification.
Tel. Number
Print Name:
ame of affiant). He/She is personally known to me or has
(type of identification) as
NOTARY PUBLIC
My Commission Expires:
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