RFP 24-15-BG - Insurance Broker / Consultant

SCOPE OF WORK

Santa Rosa County District Schools desires to contract with a Health Insurance Broker / Consultant to perform a full range of services related to the design, implementation, maintenance, communication, and improvement of the group health insurance plan, including but not limited to, medical, pharmacy, dental, vision, hospital indemnity, critical illness, accident, and life insurance plans.

SECTION 1 – MINIMUM QUALIFICATION REQUIREMENTS
 

1. Licenses & Certifications: The Contractor must be licensed and appointed in the General Lines of Authority (2- 20 or 9-20). Contractor must maintain license/certification throughout the term of the Agreement.

 

2. Service Requirements: The Contractor shall provide the following insurance broker and insurance consulting services:

• Assign a minimum of two (2) representatives who will coordinate all services with SCHOOL BOARD, one (1) officer and one (1) service representative. Representatives shall not be changed without the consent of SCHOOL BOARD. A backup representative shall be provided during vacations, training, illness and/or other absences.
• In accordance with the renewal timeline provided by SCHOOL BOARD Risk Management, assist SCHOOL BOARD in developing the most effective and cost-efficient strategy for purchasing insurance products.
• Coordinate with SCHOOL BOARD within timeline expectations review of market changes in premium if the plan moves to a fully-funded model, coverage terms, and conditions, etc., and by coordinating collection of needed exposure, data, and other underwriting information.
• Assist the Director of Risk Management in administering all group self-funded health insurance and voluntary product plans, securing stop-loss coverage, responding to questions from and providing information to, and providing other consulting services throughout the course of the plan year.
• Assist the SCHOOL BOARD during new hire orientation event and as needed to provide benefit enrollment education and guidance.
• Assist and guide the SCHOOL BOARD in complying with laws and regulations related to employee benefits.
• Research and advise SCHOOL BOARD of any new developments in the law and employee benefit programs on an ongoing basis.
• Review claims experience claim service and claim administration to ensure maximum benefit and guidance to SCHOOL BOARD.
• Provide actuarial data in relation to claims experience, including clinical assessment to assess and recommend disease management and wellness platforms.
• Determine and recommend the most economical funding methods for the benefit programs.
• Represent SCHOOL BOARD in all discussions with providers on all issues including those related to premiums, benefit levels, plan design, and special terms and conditions.
• Assist in procurement of Summary Plan Descriptions.
• Make recommendations concerning changes in terms, conditions and limits of coverage, based on best industry practices.
• Provide a detailed report of solicited policy renewal options available to the SCHOOL BOARD.
• Develop annual stewardship report, including a schedule of insurance, policy summaries, review of past plan year’s data, and outlook for coming year’s market conditions.
• Meet with and provide reports to various SCHOOL BOARD representatives including the Director of Risk Management, HR Directors, Superintendent, Insurance Committee, and School Board members as requested.
• Interface with insurance carriers and administrative services organizations as needed to assist the SCHOOL BOARD in the resolution of problems associated with benefit programs. Assist with proper application of plan design. Work cooperatively with SCHOOL BOARD Third Party Administrators and consultants.
• Provide general problem solving as needed throughout the year. Respond promptly and accurately to SCHOOL BOARD’s problems, concerns, or questions regarding any insurance product or service. Assist SCHOOL BOARD with any matter affecting the SCHOOL BOARD risk management program, whether insured or self-insured, and provide consultative services utilizing insurance content experts accordingly.
• Assist SCHOOL BOARD with the implementation and communication of new programs or changes to existing programs, which will include attending and presenting information at Open Enrollment meetings. This communication support should include but not be limited to flyers, brochures, BrainShark-type informational videos, benefits guides, etc.
• Provide advice and support during union contract negotiations.
• Assist SCHOOL BOARD in drafting specifications for benefit-related RFPs, contracts, and agreements as requested. Annually review the premium/claims history of SCHOOL BOARD risk management program, whether fully insured or self- insured. If SCHOOL BOARD decides to conduct an RFP process (or engages another party to do so) for any and all of its insurance, promptly provide necessary background and rating data, and premium and claims history information desired for the RFP.
• Collaborate with the SCHOOL BOARD to provide a high-quality wellness/risk-reduction program including but not limited to the coordination of various onsite or virtual events, educational programs, and incentive programs.
• Lead and participate as a member of the SCHOOL BOARD’S Health Insurance Committee which meets monthly and more frequently during plan renewal season. Attend SCHOOL BOARD meetings as requested (Board meetings, Risk Management and other department meetings, and ad-hoc meetings).
• Assess the insurance marketplace and provide SCHOOL BOARD benchmarking data as it relates to entities similar to SCHOOL BOARD and their coverage,
• Market the coverages for stop loss and plans with insurers; advise insurers that quotes shall be delivered in accordance with renewal timeline provided by SCHOOL BOARD Risk Management in order for quotes to be considered by Insurance Committee and the SCHOOL BOARD; and deliver to the Insurance Committee and/or SCHOOL BOARD a listing of all contacted insurers’ responses as detailed in a spreadsheet, including, but not limited to pricing, reason for declination, changes in terms, conditions, deductibles, etc.; submit a final recommendation, well documented and reflecting sound business rationale to the Insurance Committee and/or SCHOOL BOARD Risk Management in accordance with renewal timeline.
• Coordinate with Risk Management to assure that up-to-date exposure data is incorporated into submission to insurers and issuance of procured policies.
• Issue and deliver valid and timely proof of procured insurance coverages (binders, policies, and/or cover notes) and purchases by SCHOOL BOARD.
• Notify insurers that insurance policies being purchased shall be delivered within 60 days of effective date and shall be issued in accordance with the proposal(s) negotiated and/or accepted by SCHOOL BOARD.
• Review and deliver the issued insurance policies and provide written notice of any policy that reflects policy terms, conditions, limits, deductibles, etc. not matching the proposal accepted by SCHOOL BOARD. Immediately notify insurers and collect corrections of any policy deficiencies found by insurance broker or SCHOOL BOARD and deliver to SCHOOL BOARD.
• Maintain and provide a Summary of Insurance in force and historical policy comparison that includes premium and exposure data, as requested by SCHOOL BOARD.
• Promptly and accurately remit insurance policy change requests and collect and review endorsements from insurers for accuracy and forward to SCHOOL BOARD accordingly.
• In accordance with SCHOOL BOARD Risk Management’s preferences, maintain and issue Certificates of Insurance. Renewals are to be issued within three (3) business days of carriers providing policy information. Response to individual requests must be within one (1) business day of the request. Upon request, provide a list of all certificates issued.
• Be proactive by monitoring and anticipating potential changes that may affect SCHOOL BOARD insurance strategies and goals.
• Keep SCHOOL BOARD Risk Management staff informed of all developments and changes in the insurance markets and industry that may affect SCHOOL BOARD.
• Cooperate with SCHOOL BOARD in developing a fair reduction of the contracted agent remuneration in the event SCHOOL BOARD exercises the option to solicit competition for one or more types of insurance outside of the agent contract. Fully disclose all insurance policy premiums and commissions and other remuneration received for the sale of SCHOOL BOARD insurance policies. Disclose remuneration paid to intermediaries, reinsurers, and others. Permit SCHOOL BOARD to conduct an audit of all remuneration/revenues attributable to the SCHOOL BOARD account and to fully cooperate with persons designated by SCHOOL BOARD to perform such audit.

 

3. QUALIFICATIONS OF FIRM

• Describe the makeup of your client base, including your largest client (both corporate and public entity).
• Explain and give examples of the experience your organization has in providing insurance broker and consulting services, including  the following:
• Length of time performing such services;
• Retention of clientele;
• Access to additional services, such as loss prevention, actuarial, and claims consulting services. Provide a minimum of three (3) references, with at least one (1) non-governmental entity for which you have provided similar services. Please include reference organization name, contact person, title, and phone number. Please do not include SCHOOL BOARD or any reference to SCHOOL BOARD employees in your proposal.
• Provide your organization’s mission and goals.
• Provide your organization’s structure, including parent, sister, and subsidiaries.
• Provide your organization’s recent annual report or financial report, showing consistent generation of premium volume per fiscal year.
• Describe any other qualifications or factors that your organization would like SCHOOL BOARD to consider in the selection process.

 

4. QUALIFICATION OF STAFF/ASSIGNED TEAM

• Provide an organization chart for the office/location that will be assigned to provide these services.
• Provide team assignment and competency that reflects each staff member that will be assigned to provide these services. Please include summary of experience within your organization and any additional work history for:
• Principal broker (Account Executive) responsible for the accountability of the service of the account services provided to SCHOOL BOARD.
• Service representative (Account Manager) responsible for the day-to-day servicing of the account provided to SCHOOL BOARD.
• Content expert (if any) whether local, regional or national that may be available for consulting services upon request that may be available for consulting services as needed.
• Other staff members, whether local, regional or national that may be available for insurance broker or consulting services upon request.
• Describe availability of staff to travel to SCHOOL BOARD locations for meetings upon request.
• Describe any other qualifications or factors about the team assigned to SCHOOL BOARD that your organization would like SCHOOL BOARD to consider in the selection process.

 

5. QUALIFICATION TO PROVIDE SERVICES

In addition to the Contractor affirming its ability to meet the scope of services, the Risk Management department is seeking a Contractor that can demonstrate its capabilities from a technical perspective.

• Describe specific techniques that the Contractor has developed or uses for exposure identification and loss forecasting.
• Provide a brief description of the approach the Contractor and assigned team would take in reviewing SCHOOL BOARD’s risk management program in order to provide recommendations for risk controls, whether risk transfer, mitigation, retention or risk financing techniques.
• Describe how the Contractor and assigned team keeps its clients informed of current market conditions, developments affecting the client’s industry, other factors that could affect its risk management program
• Give an example of a creative or innovative approach the Contractor took to solve a specific service need or significant cost savings to a client.

Loss Control Services

• Within the annual fee, describe any ancillary services or resources that the Contractor can provide to assist its clients with loss prevention, loss control, loss forecasting. Clarify if such services will be provided by parent, sister, or subsidiary company or third-party provider.

Claims Consulting/Mitigation

• Within the annual fee, describe any ancillary services or resources that the Contractor can provide to assist its clients with the mitigation of claims and claims consulting in coordination or addition to SCHOOL BOARD’s third-party administrator. Clarify if such services can be provided by parent, sister or subsidiary company or third-party provider.
• Not included in the fee but can be made available for additional fee, describe any ancillary services or resources that the Contractor can provide or help facilitate that could assist SCHOOL BOARD with mitigation of claims and claims consulting. Clarify if such services will be provided by parent, sister, or subsidiary company or third-party provider. Please include example and associated costs. If proposing these services on an hourly rate basis, please include hourly rate, number of hours annually, estimated maximum cost.

COST OF SERVICES

• The Contractor will present their preferred method of compensation, outlining annual cost to the district/self-funded plan and scope of work items included in the compensation.
• Commissions paid by insurers – The Contractor shall disclose other commissions, compensation, gifts, or special considerations received from stop loss, Rx, ancillary products, wellness/EAP platforms, or any other product/platform/program presented to the SCHOOL BOARD for consideration.
• Services Added – SCHOOL BOARD and the Contractor acknowledge that the needs of SCHOOL BOARD may warrant the need for additional services outside of the existing Scope of Services provided herein. Broker services, whether for existing or new coverages, shall not alter the agreed upon flat annual fee. Consulting services, as provided within the scope of services here, shall not alter the agreed upon flat annual fee. However, should SCHOOL BOARD require additional services, the Contractor and SCHOOL BOARD Risk Management will negotiate the scope and fee to apply for such additional services. The Contractor agrees to provide a breakdown of hours, clerical and professional services for services provided as a Services Added, no matter if billed as flat fee or hourly fee.
• SCHOOL BOARD agrees to pay the preferred method of compensation through a monthly billing within 30 days from the date of the contract effective date.
• Make recommendations concerning changes in terms, conditions, and limits of coverage, based on best industry practices.

 
Task 1 – Work Plan/Technical Approach

• This task should establish your firm’s understanding of SRCDS’s objectives and requirements, demonstrate your firm’s ability to meet all identified requirements, and outline clearly and concisely the plan for accomplishing the specified work.
• Describe succinctly how your firm would accomplish the work and satisfy SRCDS’s objectives described in the Request for Proposal (RFP). If appropriate, divide the work into segments or tasks to represent milestones for measuring progress.
• Describe the firm’s technical expertise in underwriting and actuarial analyses of premium/claims data. Include clinical data on medical claims, frequency, cost trends, and Pharmacy Benefit Management.
• Provide an action plan and timetable for assuming responsibilities as well as future design/cost containment plan.
• Provide details of services that will be provided to SRCDS.
• Provide samples of newsletters and benefit communication materials, such as brochures, to introduce new or changed benefits and summary plan descriptions.
• Provide examples of HIPAA and other compliance-related notices to employees.
• Attach as an appendix a sample stop-loss insurance renewal proposal your firm prepared for a client the size and complexity of SRCDS. You may deduct any identifying data or references as needed to protect the client’s privacy.
• Describe the firm’s resources and strategies to address compliance issues related to Healthcare Reform, including PPACA, HCFRA, etc. It is SRCDS’s interest to select a firm which can perform all identified services.

 
Task 2 – Term of Contract and Proposed Fee for Services

• Explanation of carrier commissions for your firm under this proposal related to all services provided.
• Indicate any alternate billing arrangements you would be willing to consider and under what circumstances they would be most appropriate.
• Within detailed cost proposal, provide cost for the initial one- year term of the contract (considering current operation on a fiscal calendar year of January to December, allowing ample time for setup and market).

 
Task 3 – Strategic Planning and Renewal Assessment Provide an Annual Work Plan

• Develop a comprehensive plan detailing annual objectives, strategies, and key actions. This plan should align with organizational goals and include timelines, responsible parties, and performance metrics for each initiative.
• Plan and Schedule Insurance Committee and Pre-Renewal Meetings
  • Organize and coordinate meetings in preparation for monthly Insurance Committee Meetings, including actuarial data for monthly plan performance and financial statement.
  • Organize and coordinate meetings in preparation for policy renewal. These meetings should involve relevant stakeholders and focus on reviewing current policies, discussing upcoming renewal requirements, and setting expectations for the renewal process.
• Renewal, Negotiation, Analysis and Recommendations
  • Conduct a thorough analysis of current benefit plans at renewal, comparing plans against market trends and organizational needs, negotiate with providers to secure the best possible terms and present recommendations for plan adjustments or renewals based on this analysis to Insurance Committee and School Board. Negotiate with stop-loss providers for optimal pricing and re-insurance protections for specific and aggregate coverage.
• Procurement of Alternative Cost Saving Initiatives and Options
  • Identify and evaluate alternative cost-saving options for benefit plans. This could include exploring different administrative services organizations at renewal of contract, negotiating better stop loss rates, or restructuring benefits to maximize value and minimize costs.
•  Advise on access to Public Entity Joint Purchasing Programs
  • If requested, leverage access to joint purchasing programs, which could offer more favorable pricing and terms due to the collective bargaining power of multiple public entities. Assess and recommend participation in such programs where it aligns with organizational needs and financial objectives if shifting to this model is advisable.

 
Task 4– Legislative Compliance Enhancement and Process Optimization Compliance Support and Contract Review

• Legislative updates, including passed legislation and proposed legislation.
• Regulatory expertise including federal legislation regarding ERISA, HIPAA, COBRA, Medicare etc.
• Compliance/reporting
• Review Summary Plan Documents (SPDs) and Evidence of Coverage (EOC) for compliance and accuracy.
• Research and assist on compliance for all plans. Assist with government or IRS filings as needed.
• Assist with Medicare compliance.
• Offer expertise in navigating legislative requirements affecting benefit programs.
• Review contracts in coordination with SRCDS Purchasing Department for compliance with local, state, and federal laws, ensuring all agreements are legally sound and align with current regulations.
• Provide written updates on new State or Federal legislation or judicial decisions impacting SRCDS and suggested action or changes in operations or procedures to ensure compliance including, but not limited to the Affordable Care Act and/or any subsequent healthcare legislation which may impact the healthcare and employee benefit industries.
• Ongoing support as it relates to interpreting coverage as applied to claim issues, legislative compliance and contract review and healthcare reform compliance and consulting.
•  ACA Compliance Audit Document
  • Conduct a thorough audit to ensure adherence to the Affordable Care Act (ACA) requirements. This involves reviewing current health plans, documenting compliance status, and identifying any areas of non-compliance with corrective action recommendations.
• Health Care Reform Compliance and Consulting
  • Provide guidance on adapting to ongoing health care reform changes. Offer consulting services to ensure organizational health benefit plans are compliant with evolving regulations and propose strategies to efficiently implement necessary changes.
• Employer and Employee Advocacy
  • Act as a mediator and advocate for SRCDS. Ensure fair representation of both SRCDS and carriers’ interests.
  • Ensure that employees have a resource for multifaceted support, navigation, and advocacy for their wellbeing, through a third-party vendor if necessary.
•  Open Enrollment Support
  • Provide comprehensive support during open enrollment periods. This support includes developing an implementation timeline, assisting with the development of open enrollment materials and coordinating/participating in open enrollment meetings as reasonably requested. Preparing communication materials, assisting with plan selection processes, answering employee queries, and ensuring a seamless transition for enrollees.

Task 5 - Data-Driven Insights and Communication Enhancement Provide Customized Reports

• Develop and deliver customized reports tailored to SRCDS’s specific needs. These reports should analyze various aspects of the benefits program, including cost analysis, utilization patterns, and employee satisfaction, providing actionable insights for decision-making.
• Public Entity Benchmarking
  • Conduct benchmarking studies comparing SRCDS’s benefits, offerings and practices with similar public entities. This benchmarking should help identify areas of strength and opportunities for improvement, ensuring competitive and effective benefits strategies.
•  Communications Support
  • Offer comprehensive support in creating and distributing various communication materials. This support includes designing and producing brochures, notices, videos, posters, and email campaigns. These materials should effectively communicate benefits information to employees, enhancing their understanding and engagement.
•  Employee Benefit Surveys and Inflation/Trend Surveys
  • Design and administer employee surveys to gather feedback on the current benefits program. Use this feedback to gauge employee satisfaction, understand their needs, and identify areas for enhancement in the benefits offerings.

Task 6 - Wellness Program Development and Support Wellness Program Consulting, Analysis, and Advice

• Provide expert consulting services to assess the current state of the organization’s wellness initiatives. Offer analysis and advice on how to improve or implement effective wellness programs that align with organizational goals and employee needs. This analysis should include identifying key health and wellness areas, suggesting program types, and advising on implementation strategies.
• No Cost/Low-Cost Resource Guide
  • Develop a comprehensive guide of resources and activities that can be implemented with minimal or no cost. This guide should include creative ideas for promoting health and wellness in the workplace, including physical, mental, nutrition, and financial wellness that can be easily adopted by employees.
• Wellness and Health & Productivity Toolkit
  • Create a toolkit that provides practical tools and resources to support wellness initiatives. This could include templates for wellness challenges, educational materials on health and productivity, guidelines for setting up a wellness committee, and resources for tracking and measuring program success.
• Mental Health Resources
  • Identify mental health resources to provide ongoing support for SRCDS employees, especially if there is a gap or void in mental health coverage in the medical insurance plan.

 
​​​​​​​Task 7- Comprehensive Implementation, Negotiation Management Total Benefit Statement Creation

• Develop comprehensive statements that clearly outline the total value of the benefit package offered to employees, including all benefits and additional perks to provide employees with a complete understanding of the value of the benefit offerings.
• Negotiation Assistance
  • Provide expert support during negotiations with benefit providers and other relevant parties including bargaining units. This assistance includes strategizing to achieve the best possible terms and conditions, leveraging market knowledge, and ensuring alignment with organizational objectives and budget constraints.
  • Negotiate Annual Benefit Renewals ensuring all providers (ASO, voluntary products, stop loss) meet SRCDS needs and standard, receive proposals and proactively seek alternative coverage as appropriate.
•  Program Implementation Support
  • Offer direct assistance in rolling out new programs and initiatives. This assistance encompasses overseeing the implementation process, ensuring smooth integration into existing systems, addressing any technical or logistical challenges, and facilitating communication between all stakeholders.
•  Ongoing Monitoring and Client Service
  • Establish a system for continuous monitoring and evaluation of implemented programs to ensure they remain effective and aligned with organizational goals. Provide ongoing client service support to address any issues or changes required, ensuring programs evolve in response to organizational or regulatory changes.
• Assist with setting up the timing for renewals schedule annually.
• Prepare, review, and advise on contract renewals.
• Advise and assist SRCDS in evaluating and selecting from coverage alternatives such as plan design (self-funded) or coverage, deductibles, co-payments, out of pocket payments, etc. (fully funded).
• Continuously monitor experience trends, providing alerts on changing patterns and mitigation SRCDS should undertake.
• Assist SRCDS with benefit plan design to contain coast and maximize benefit effectiveness.
• Identify and research new programs for SRCDS’s consideration based on assessment of current SRCDS program offerings, emerging changes, and costs.
• Conduct inflation/trend surveys
• Assist SRCDS as requested in submitting claims and interpreting coverage as applied to claims.

• Identify and assign a senior member of the team to SRCDS’s account who has experience with public health sector benefits administration; provide timely response to questions and requests.

• Ensure more than one individual within the firm can address possible concerns of SRCDS and can respond within 24 hours to requests.
• Evaluation of Additional Service Providers by SRCDS and Ongoing Support
  • Assist in the assessment and selection of additional service providers as required by SRCDS. This assistance includes evaluating proposals, analyzing service offerings, ensuring compliance with legal and organizational standards, and recommending providers that best meet the specific needs of the organization.

DOCUMENTS REQUIRED
    The following is a list of required documents to be submitted with your proposal. Your proposal and documents must be submitted using BidNet Direct.
Envelope #1 (***NO PRICING IN THIS ENVELOPE***)

1. Proposal Form
2. E-Verify Form
3. Drug Free Workplace Form
4. Public Entity Crimes Form
5. Certification Regarding Lobbying Form
6. Disclosure of Lobbying Activities Form, if applicable
7. Conflict of Interest Certification Form
8. Human Trafficking Affidavit for Nongovernmental Entities
9. Business Proposal including:
   • A company history
   • References from at least three (3) clients
   • A brief summary of the services offered

Envelope #2 (PRICING ONLY)
-    Pricing