Employee Group Health Insurance Plan

21 September 2022 Employee Group Health Insurance Plan Employee Group Health Insurance ITN 21 September 2022 Open 7/5/2022 6:00 PM MDT Type Invitation to Negotiate Close 10/18/2022 5:00 PM MDT Number ITN20221707 Currency US Dollar Sealed Until 10/19/2022 10:30 AM MDT 21 September 2022 Contacts Valerie Bollinger Valerie.Bollinger@adm.idaho.gov Phone +1 208-332-1631 21 September 2022 NIGP Codes NIGP Code Description 953-00 Insurance, All Types 953-48 Health/Hospitalization (Including Dental/Visual Insurance) 21 September 202221 September 202221 September 202221 September 202221 September 202221 September 202221 September 2022 mailto:Valerie.Bollinger@adm.idaho.gov The Division of Purchasing (DOP), on behalf of the Office of Group Insurance, is seeking proposals from qualified vendors to provide a comprehensive, statewide employee group heath insurance

plan. NOTE: THE FULL SOURCING EVENT IS ONLY AVAILABLE BY LOGGING INTO IPRO AT https://solutions.sciquest.com/apps/Router/SupplierLogin?CustOrg=StateofIdaho. SUPPLIERS THAT ONLY VIEW THE DOCUMENTS AVAILABLE FROM THE PUBLIC WEBSITE, AND DO NOT LOGIN TO IPRO, MAY NOT HAVE ACCESS TO ALL DOCUMENTS (INCLUDING ATTACHMENTS, Q AND A, AND MORE). IT IS THE SUPPLIER’S SOLE RESPONSIBILITY TO ENSURE ACCESS TO THE FULL SOURCING EVENT BY LOGGING INTO IPRO; THE STATE WILL NOT BE RESPONSIBLE FOR A SUPPLIER’S INABILITY TO ACCESS INFORMATION THAT IS AVAILABLE BY LOGGING IN. Description https://solutions.sciquest.com/apps/Router/SupplierLogin?CustOrg=StateofIdaho Required to View Event Prerequisites Required to Enter Bid 21 September 2022 1. Download and acknowledge receipt of the attached Invitation to Negotiate. 2. Please download and acknowledge receipt of the attached Solicitation Instructions to Vendors. 3. Download the attached terms and conditions and confirm your acceptance of the terms, subject to negotiations with finalists as detailed in the ITN. 21 September 202221 September 202221 September 202221 September 202221 September 2022 Buyer Attachments 1. Q&A_Cost Proposal.docx 2. 2019 Medical Claims_File 1 of 2.zip 3. 2019 Medical Claims File 2 of 2.zip 4. Q&A final_Rev1.docx 5. Pre Proposal ITN20221707.pptx 6. Attachment 1 - Pre-Proposal Conference Registration Form.docx 7. Attachment 2 - Offeror Questions.docx 8. Attachment 3 - Requested Modification Form.docx 9. Attachment 4 - Health Plan Contract Template.docx 1 0. Attachment 5 - Current Plan Details.docx 1 1. Attachment 6 - SOI Enrollment 2016 - 2022.xlsx 1 2. Attachment 7 - Membership Overview by City.xlsx 1 3. Attachment 8 - Historical Conditions and Risk.xlsx 1 4. Attachment 9 - Aggregate Medical Data by Zip.xlsx 1 5. Attachment 10 - Aggregate Medical and Rx Data by Class.xlsx 1 6. Attachment 11 - June 2018 Large Claimant Summary.pdf 1 7. Attachment 12 - June 2019 Large Claimants Summary.pdf 1 8. Attachment 13 - June 2020 Large Claimant Summary.pdf 1 9. Attachment 14 - June 2021 Large Claimant Summary.PDF 2 0. Attachment 15 - 2022-Standard-4-Tier-Formulary.pdf 2 1. Attachment 16 - UDS Data Format (Appendix A).pdf 2 2. Attachment 17 - VSP Utilization FY21.pdf 2 3. Attachment 18 - VSP Utilization FY22.pdf 2 4. Attachment 19 - EAP Claims Data.xlsx 2 5. Attachment 20 - Discrepancy Roadmap (general).pdf 2 6. Attachment 21 - Supplemental Claims Data.zip 2 7. Attachment 22 - Supplemental Large Claims Summary.PDF 2 8. Attachment 23 - Supplemental Medical and Rx Data by Class.xlsx 2 9. Attachment 24 - SOI Settlement Report_Redacted.pdf 21 September 202221 September 202221 September 202221 September 2022 https://s3.amazonaws.com/solutions-selectsite-documents/Sourcingevent/1083530-1315122354Q%26A_Cost%20Proposal.docx?AWSAccessKeyId=AKIAJ5HNJE5DFBZ5ONSA&Expires=1726846233&Signature=bHPo%2F3RU4PbBvHl2URpibvRZPSM%3D https://s3.amazonaws.com/solutions-selectsite-documents/Sourcingevent/1083530-13151242082019%20Medical%20Claims_File%201%20of%202.zip?AWSAccessKeyId=AKIAJ5HNJE5DFBZ5ONSA&Expires=1726846233&Signature=%2B4YbotNTXnkh00VZY0kkM5dAneQ%3D https://s3.amazonaws.com/solutions-selectsite-documents/Sourcingevent/1083530-13151232832019%20Medical%20Claims%20File%202%20of%202.zip?AWSAccessKeyId=AKIAJ5HNJE5DFBZ5ONSA&Expires=1726846233&Signature=S2SPp%2FdI1BGMzQ9ut6CTCRW6wqk%3D https://s3.amazonaws.com/solutions-selectsite-documents/Sourcingevent/1083530-1301407025Q%26A%20final_Rev1.docx?AWSAccessKeyId=AKIAJ5HNJE5DFBZ5ONSA&Expires=1726846233&Signature=gqlWPeir70zZmBdXLQPnaJ2p4xM%3D https://s3.amazonaws.com/solutions-selectsite-documents/Sourcingevent/1083530-1295845214Pre%20Proposal%20ITN20221707.pptx?AWSAccessKeyId=AKIAJ5HNJE5DFBZ5ONSA&Expires=1726846233&Signature=dJ5xNpkJmJSquo4RNJhOLAxOrXE%3D https://s3.amazonaws.com/solutions-selectsite-documents/Sourcingevent/1083530-1277032525Attachment%201%20-%20Pre-Proposal%20Conference%20Registration%20Form.docx?AWSAccessKeyId=AKIAJ5HNJE5DFBZ5ONSA&Expires=1726846233&Signature=qiOrg25kyZGvQcf145YYAwZbEdI%3D https://s3.amazonaws.com/solutions-selectsite-documents/Sourcingevent/1083530-1277032718Attachment%202%20-%20Offeror%20Questions.docx?AWSAccessKeyId=AKIAJ5HNJE5DFBZ5ONSA&Expires=1726846233&Signature=2KlwKW3zV9fK3SPLZMJ24BGjlCs%3D https://s3.amazonaws.com/solutions-selectsite-documents/Sourcingevent/1083530-1277032486Attachment%203%20-%20Requested%20Modification%20Form.docx?AWSAccessKeyId=AKIAJ5HNJE5DFBZ5ONSA&Expires=1726846233&Signature=STGgIq2PS9gjPelrMtlsJCTTE%2FA%3D https://s3.amazonaws.com/solutions-selectsite-documents/Sourcingevent/1083530-1277032487Attachment%204%20-%20Health%20Plan%20Contract%20Template.docx?AWSAccessKeyId=AKIAJ5HNJE5DFBZ5ONSA&Expires=1726846233&Signature=C7HVbjsEutSWfrJocnj4yzaMQzM%3D https://s3.amazonaws.com/solutions-selectsite-documents/Sourcingevent/1083530-1277032633Attachment%205%20-%20Current%20Plan%20Details.docx?AWSAccessKeyId=AKIAJ5HNJE5DFBZ5ONSA&Expires=1726846233&Signature=kI1tToriIc4gwJfFVqy5ScYxIsw%3D https://s3.amazonaws.com/solutions-selectsite-documents/Sourcingevent/1083530-1277032440Attachment%206%20-%20SOI%20Enrollment%202016%20-%202022.xlsx?AWSAccessKeyId=AKIAJ5HNJE5DFBZ5ONSA&Expires=1726846233&Signature=9u76ZmSIqjZSx52C4PAnXrimVjY%3D https://s3.amazonaws.com/solutions-selectsite-documents/Sourcingevent/1083530-1277032537Attachment%207%20-%20Membership%20Overview%20by%20City.xlsx?AWSAccessKeyId=AKIAJ5HNJE5DFBZ5ONSA&Expires=1726846233&Signature=VkRphgViBzFbGaZwK0AfAW033ts%3D https://s3.amazonaws.com/solutions-selectsite-documents/Sourcingevent/1083530-1277033107Attachment%208%20-%20Historical%20Conditions%20and%20Risk.xlsx?AWSAccessKeyId=AKIAJ5HNJE5DFBZ5ONSA&Expires=1726846233&Signature=YRyVUEecECkGDKEKPxwUILJUX3U%3D https://s3.amazonaws.com/solutions-selectsite-documents/Sourcingevent/1083530-1277033405Attachment%209%20-%20Aggregate%20Medical%20Data%20by%20Zip.xlsx?AWSAccessKeyId=AKIAJ5HNJE5DFBZ5ONSA&Expires=1726846233&Signature=jgF%2B18AX0T4buF5LjIzHjuUnhw0%3D https://s3.amazonaws.com/solutions-selectsite-documents/Sourcingevent/1083530-1277032981Attachment%2010%20-%20Aggregate%20Medical%20and%20Rx%20Data%20by%20Class.xlsx?AWSAccessKeyId=AKIAJ5HNJE5DFBZ5ONSA&Expires=1726846233&Signature=zPJ8yvuFrc5TbtFpqVL7ItTmnLc%3D https://s3.amazonaws.com/solutions-selectsite-documents/Sourcingevent/1083530-1277033412Attachment%2011%20-%20June%202018%20Large%20Claimant%20Summary.pdf?AWSAccessKeyId=AKIAJ5HNJE5DFBZ5ONSA&Expires=1726846233&Signature=52%2F21kun3y0RfcLKi6FPzDYPaOc%3D https://s3.amazonaws.com/solutions-selectsite-documents/Sourcingevent/1083530-1277033356Attachment%2012%20-%20June%202019%20Large%20Claimants%20Summary.pdf?AWSAccessKeyId=AKIAJ5HNJE5DFBZ5ONSA&Expires=1726846233&Signature=kCpNerXBl2Ri2bBsQqVWeDW%2BZG8%3D https://s3.amazonaws.com/solutions-selectsite-documents/Sourcingevent/1083530-1277033323Attachment%2013%20-%20June%202020%20Large%20Claimant%20Summary.pdf?AWSAccessKeyId=AKIAJ5HNJE5DFBZ5ONSA&Expires=1726846233&Signature=u5I%2FMeM5sG40a6C%2F1xHdS2yxYO0%3D https://s3.amazonaws.com/solutions-selectsite-documents/Sourcingevent/1083530-1277033359Attachment%2014%20-%20June%202021%20Large%20Claimant%20Summary.PDF?AWSAccessKeyId=AKIAJ5HNJE5DFBZ5ONSA&Expires=1726846233&Signature=d649%2Fs%2FZrXT8egaiCqTsL22kDFo%3D https://s3.amazonaws.com/solutions-selectsite-documents/Sourcingevent/1083530-1277033552Attachment%2015%20-%202022-Standard-4-Tier-Formulary.pdf?AWSAccessKeyId=AKIAJ5HNJE5DFBZ5ONSA&Expires=1726846233&Signature=jcISKH%2FjQ3HkWKmr3BCzflR4qPQ%3D https://s3.amazonaws.com/solutions-selectsite-documents/Sourcingevent/1083530-1315121786Attachment%2016%20-%20UDS%20Data%20Format%20%28Appendix%20A%29.pdf?AWSAccessKeyId=AKIAJ5HNJE5DFBZ5ONSA&Expires=1726846233&Signature=HWkHDB9FpODIQc%2F81ivLdkpQusc%3D https://s3.amazonaws.com/solutions-selectsite-documents/Sourcingevent/1083530-1295846913Attachment%2017%20-%20VSP%20Utilization%20FY21.pdf?AWSAccessKeyId=AKIAJ5HNJE5DFBZ5ONSA&Expires=1726846233&Signature=SOASOmY9XbbD3AMnSWQOwiK1ozc%3D https://s3.amazonaws.com/solutions-selectsite-documents/Sourcingevent/1083530-1295846720Attachment%2018%20-%20VSP%20Utilization%20FY22.pdf?AWSAccessKeyId=AKIAJ5HNJE5DFBZ5ONSA&Expires=1726846233&Signature=KCWAhLh9PThcU663GeZtPFu%2FOGM%3D https://s3.amazonaws.com/solutions-selectsite-documents/Sourcingevent/1083530-1295846687Attachment%2019%20-%20EAP%20Claims%20Data.xlsx?AWSAccessKeyId=AKIAJ5HNJE5DFBZ5ONSA&Expires=1726846233&Signature=Mvg41EmMJev9gM%2Be9UXBIsiL0Ts%3D https://s3.amazonaws.com/solutions-selectsite-documents/Sourcingevent/1083530-1295847660Attachment%2020%20-%20Discrepancy%20Roadmap%20%28general%29.pdf?AWSAccessKeyId=AKIAJ5HNJE5DFBZ5ONSA&Expires=1726846233&Signature=MmSPNuI2r9za61xIkjV6hfI4gtE%3D https://s3.amazonaws.com/solutions-selectsite-documents/Sourcingevent/1083530-1295847868Attachment%2021%20-%20Supplemental%20Claims%20Data.zip?AWSAccessKeyId=AKIAJ5HNJE5DFBZ5ONSA&Expires=1726846233&Signature=c%2BtFhktM37EqOarTSqXD613Bj38%3D https://s3.amazonaws.com/solutions-selectsite-documents/Sourcingevent/1083530-1295848825Attachment%2022%20-%20Supplemental%20Large%20Claims%20Summary.PDF?AWSAccessKeyId=AKIAJ5HNJE5DFBZ5ONSA&Expires=1726846233&Signature=oL1yS55yuHkDxmTRMh%2Fb2RXaxq8%3D https://s3.amazonaws.com/solutions-selectsite-documents/Sourcingevent/1083530-1301407236Attachment%2023%20-%20Supplemental%20Medical%20and%20Rx%20Data%20by%20Class.xlsx?AWSAccessKeyId=AKIAJ5HNJE5DFBZ5ONSA&Expires=1726846233&Signature=9pEd8RDV30MYVDgwG3dhwxLkBHY%3D https://s3.amazonaws.com/solutions-selectsite-documents/Sourcingevent/1083530-1301409333Attachment%2024%20-%20SOI%20Settlement%20Report_Redacted.pdf?AWSAccessKeyId=AKIAJ5HNJE5DFBZ5ONSA&Expires=1726846233&Signature=FT%2FTvBI%2F%2FgOR884yAjMLGnTbLCo%3D Questions Required Questions Group 1: Mandatory Proposal Instructions: 1.1 Click on the link to download the Cover and Signature Form. Attach your completed form to this question. 1.2 Click on the link to download the Mandatory Coverage Form. Attach your completed form to this question. 1.3 Click on the link to download the Technical Proposal Response Form. Attach your completed form to this question 1.4 Medical Claims - Part A. All Offerors must submit UDS discount data directly to DOP, as detailed in Attachment 16, Appendix A, for all medical carriers included in the proposal. UDS files may be submitted as text files. Attach UDS files in the Supplier Attachment section of IPRO or send to DOP as detailed in ITN Section 3.4. Have you submitted UDS discount data for all medical carriers included in this proposal? 1.5 Medical Claim - Part B. All Offerors must submit a re-pricing of the state's 2019 medical claims for each medical carrier included in the proposal, based on that carrier's current UDS discounts. 2019 Medical Claims are attached in 2 files in the Buyer Attachments section of IPRO. Attach re-priced medical claims data (complete column P of the 2019 Medical Claims files) in the Supplier Attachment section of IPRO or submit to DOP as detailed in ITN Section 3.4 Have you submitted re-priced medical claims for each medical carrier included in your proposal? 1.6 Medical Claims - Part C. Offerors must have an independent, third-party actuary complete the attached opinion for each medical carrier included in the proposal. Upload the completed Actuary Opinion in response to this question. Additional opinions may be attached in the Supplier Attachment section of IPRO if necessary. Actuary Opinion(s) may be submitted in PDF format. 1.7 Pharmacy Cost - Part A. Click on the link to download the PBM Pricing Template. All Offerors must submit a completed PBM Pricing Template for each PBM offered as part of the proposal. Upload the completed PBM Pricing Template in response to this question. Additional PBM Pricing Templates may be attached in the Supplier Attachments section of IPRO. 1.8 Pharmacy Claims - Part B. All Offerors must submit a re-pricing of the state's 2021 pharmacy claims for each PBM offered as part of the proposal. Click on the link to download the 2021 claims and complete the offered PBM's pricing. Attach the completed re-pricing in the Supplier Attachments section of IPRO or submit to DOP as detailed in ITN section 3.4. Have you submitted re-pricing of the 2021 pharmacy claims for each PBM included in this proposal? 1.9 Pharmacy Claims - Part C. Offerors must have an independent, third-party actuary complete the attached opinion for each PBM included in the proposal. Upload the completed Actuary Opinion in response to this question. Additional opinions may be attached in the Supplier Attachments section of IPRO if necessary. Actuary Opinions may be submitted in PDF format. 1.10 Administrative Cost. Download the Administrative Cost Proposal using the link. Complete the form and upload in response to this Question. Group 2: Optional Alternate Proposal Instructions: 2.1 Click on the link to download the Cover and Signature Form. Attach your completed form to this question 2.2 Click on the link to download the Mandatory Coverage Form. Attach your completed form to this question 2.3 Click on the link to download the Optional Alternate Technical Proposal Form. Attach your completed form to this question 2.4 Medical Claims - Part A. Follow instructions for Question 1.4. Have you submitted UDS discount data for all medical carriers included in this proposal? 2.5 Medical Claims - Part B. Follow instructions for Question 1.5. Have you submitted re-priced medical claims for each carrier included in this proposal? 2.6 Medical Claims - Part C. Follow instructions for Question 1.6. Upload your completed Actuary Opinion. 2.7 Pharmacy Claims - Part A. Follow instructions for Question 1.7. Upload your completed PBM Template. 2.8 Pharmacy Claims - Part B. Follow instructions and use attachment for Question 1.8. Have you submitted re-priced pharmacy claims for all PBMs included in the proposal? 2.9 Pharmacy Claims - Part C. Follow instructions for Question 1.9. Upload Actuary Opinion. 21 September 202221 September 202221 September 2022 2.10 Administrative Cost. Download the Administrative Cost Proposal using the link. Complete the form and upload in response to this Question. Group 3: Acknowledgments Instructions: 3.1 Please acknowledge the following: Disclosure of Abortion Related Matters. The State is subject to the No Public Funds for Abortion Act, Idaho Code title 18, chapter 87 (the “Act”) and State employees who intentionally violate the provisions of the Act are subject to criminal prosecution. This provision is included in the Solicitation to aid in compliance with the Act. The State requests that Offeror disclose, unless Offeror is within one of the exemptions provided in the Act, if it or an affiliate is or becomes, during the term of the Contract (if Offeror is the awarded Contractor), an abortion provider and if it will use State facilities or public funds to provide, perform, participate in, promote or induce, assist, counsel in favor, refer or train a person for an abortion related activity. Please refer to the Act for definitions of the terms used in this section. 3.2 Amendment 1. The ITN is hereby amended as follows: 1) The deadline for submitting questions has been extended to July 28, 2022 at 11:59 MDT; 2) The ITN document (attached in the prerequisite section of IPRO) has been replaced with an updated version "ITN20221707 Employee Group Health Insurance_REV1"; 3) Two additional attachments have been added to the Buyer Attachments section of IPRO ("PBM Pricing Template" and "Prescription Claims Cost") - both of these attachments are required submission documents; and 4) Questions regarding the cost proposal have been added to Question Group 1 and Question Group 2. Questions 1.4 - 1.7 are mandatory questions for all Offerors. Questions 2.4 - 2.7 are mandatory questions only for those Offerors submitting an optional alternate proposal. Acknowledge receipt of Amendment 1 to this ITN and associated attachments. 3.3 Amendment 2. The ITN is hereby amended as follows: A revised version of the Mandatory Coverage form has been attached to Questions 1.2 and 2.2. Additionally, please note the following regarding Amendment 1: the updated version of the ITN document ("ITN20221707 Employee Group Health Insurance_Rev1") in the prerequisites section of IPRO is provided with changes tracked (redlined) to make it easier from vendors to recognize revisions. Please acknowledge receipt of this amendment and associated documents. 3.4 Amendment 3. The ITN is hereby amended as follows: 1) The deadline for submitting proposals has been extended to September 1, 2022 at 5:00 pm MDT; 2) The state's answers to all timely submitted questions are found in the file titled "Q&A final" which is attached to this Question and in the Buyer Attachments section of IPRO; 3) The ITN Document (attached in the prerequisites section of IPRO) has been replaced with an updated version "ITN20221707 Employee Group Health Insurance_Rev3" (all changes from the original document are redlined); 4) new Attachments 17 - 22 have been added to the Buyer Attachments section of IPRO along with the Pre-Proposal Presentation; and 5) The names of Question Groups 1 and 2 have been updated to match the revised language in the ITN. Acknowledge receipt of this Amendment 3 and all associated document. 3.5 Amendment 4. The ITN is hereby amended as follows: 1) The deadline for submitting proposals has been extended to September 8, 2022 at 5:00 pm MDT; 2) The state has provided updated answers to some previously submitted questions and has answered some recently submitted questions that it has deemed vital to ensure that vendors can successfully respond to the ITN as provided in the file titled "Q&A final_Rev1", which is redlined to show changes from the previous version and attached in the Buyer Attachments section of IPRO; 3) new Attachments 23 and 24 have been added to the Buyer Attachments section of IPRO; 4) the two attachments required for submitting pharmacy claims costs have been renamed for clarity; and 5) The text of Questions 1.6 and 2.6 have been updated to provide clarity related to the required attachments. Acknowledge receipt of this Amendment 4 and all associated documents. 3.6 Amendment 5. The ITN is hereby amended as follows: 1) The Cost Proposal information has been updated: An updated version of the ITN document has been uploaded in the Prerequisites section as "ITN20221707 Employee Group Health Insurance Plan_Rev.3" with updates to the Administrative Information and Section 2.8; and cost-related questions in IPRO have been updated (Qs 1.4 - 1.7 and 2.4 - 2.7 have been replaced by new Qs 1.4 - 1.11 and 2.4 - 2.11); 2) Vendors may submit questions related to the new Cost Proposal information before the new Q&A Deadline (9/19/22) using Attachment 2 or the IPRO Q&A Board; and 3) the closing date of the ITN has been extended to 10/18/22. PLEASE NOTE: the State is in the process of compiling its 2019 medical claims data, which is required to respond to new Qs 1.6 and 2.6. The State expects to upload this data by 9/20/22. Acknowledge receipt of Amendment 5 to this ITN and associated attachments. 21 September 202221 September 202221 September 2022 3.7 Amendment 6. The ITN is hereby amended as follows: 1) An updated version of the ITN document has been uploaded in the Prerequisites section as "ITN20221707 Employee Group Health Insurance Plan_Rev.4" with updates to Section 2.8; 2) The cost-related questions in IPRO have been updated, including updated attachments; 3) The State has uploaded a new version of Attachment 16 in the Buyer Attachments section of IPRO; and 4) The state has uploaded the 2019 Medical Claims data (2 files) in the Buyer Attachments section of IPRO. Acknowledge receipt of Amendment 6 to this ITN and associated attachments. 21 September 202221 September 202221 September 2022