Business Associate acknowledges that, in the event it, or ...da.ks.gov/purch/Contracts/Default.aspx?getfile=EVT... · Web viewMar 06, 2018 · The Contractor shall not open a bank

Exhibit 1 – Technical ProposalBid Event # EVT0005721

Vision RFP (2019, 2020, 2021 Plan Years)Page 1 of 62

SECTION IRegistration, Event Notice and Acknowledgement of Addenda

The Event Document as posted on the Office of Procurement and Contracts website and the acknowledgement of addenda posted for the bid event must be submitted as part of Section I of the Technical proposal.

Vendors may also submit an executive summary not to exceed two pages, explaining why they feel they are the best option for the State Employee Health Plan (SEHP).

The State of Kansas implemented a PeopleSoft Financial Management System (named SMART) in July 2010. In order to submit a response to any bid event, a vendor must be registered in SMART. It is very important for you to register your business with Procurement and Contracts, for the following reasons:

To bid on events, registered bidders must be invited in SMART by the Procurement Officer 24 hours BEFORE the bid closes.

If invited, registered bidders will be able to receive bid event documents via e-mail. If not invited by the Procurement Officer, registered bidders will still receive notification of bid events

based on their category code registration.

Registration may be accomplished by:

1. Identifying the category codes you would like to be associated with your bidder record. This should be completed prior to completing the bidders registration.

A full list of category codes is available at: http://www.da.ks.gov/purch/SMARTCategoryCodes.xls Note that this is a large file (5mb). It may be beneficial to identify the applicable category codes prior to beginning the registration process. The State uses the UNSPSC category code system which includes over 40,000 codes. For ease of identifying codes that may apply to your business, you may search this document by selecting Ctrl+F on your keyboard, then typing key words that may apply to your business. If you find no results, select a different key word. For example, vehicles are listed under automobiles or cars.

2. Completing the form on the following website (to include the category codes that you have selected) http://www.surveymonkey.com/s/ksbiddersurvey

3. Submitting a completed W-9 Form.E-mail a copy of your signed and dated W-9 Form (with a signature no more than six (6) months old) to [email protected] or fax it to 785-296-7240. Your bidder registration will NOT be processed until we have the W-9 Form. You may download a copy of the current W-9 Form at the IRS website: http://www.irs.gov/pub/irs-pdf/fw9.pdf

Please do not submit another application once you have registered. If you need to make changes to your bidder record (i.e. changes to contact information, address changes, add/delete commodity codes, etc.) please email those changes to [email protected]. Please include your company name and taxpayer identification number to assure that the correct record is updated.

After your application has been processed, you will receive an email confirming that your application has been approved. If you have any questions regarding the bidder application, please call: 785-296-2376

mailto:[email protected]

http://www.irs.gov/pub/irs-pdf/fw9.pdf


http://www.surveymonkey.com/s/ksbiddersurvey

http://www.da.ks.gov/purch/SMARTCategoryCodes.xls



SIGNATURE SHEET

Item: Vision Plan for the SEHP Medical PlansClosing Date: X:00 PM Central Time, XXXXX, XX, 201XAgency: Kansas State Employees Health Care Commission

Certification of Capabilities:By submission of a bid and the signatures affixed thereto, the bidder certifies all products and services proposed in the bid meet or exceed all requirements of this specification as set forth in the request and that all exceptions are clearly identified.

Conflict of Interest:I hereby certify that I (we) do not have any substantial conflict of interest sufficient to influence the bidding process on this bid. A conflict of substantial interest is one which a reasonable person would think would compromise the open competitive bid process.

Addendums to the RFP: The undersigned acknowledges receipt of the following addenda:

#1( ) #2( ) #3( ) None ( )

Legal Name of Person, Firm or Corporation

Mailing Address City & State Zip

Toll Free Telephone Local Cell: Fax

Tax Number E-Mail

Signature Date

Typed Name Title

In the event the contact for the bidding process is different from above, indicate contact information below.

Bidding Process Contact Name





E-Mail

Back-up Contact Name



E-Mail

If awarded a contract and purchase orders are to be directed to an address other than above, indicate mailing address and telephone number below.



E-Mail



VENDOR CONTACT INFORMATIONTo facilitate the Request for Proposal (bid event) process, we ask that each Contractor designate a main contact person as well as an alternate contact should the main contact be unavailable. Please complete the following regarding that designated persons. The State has designated contact information listed in this document.

Primary Contact: ____________________________________________

Title: ______________________________________________________

Address: ___________________________________________________

___________________________________________________

Phone Number: ________________ Fax Number: _________________

Email Address: ______________________________________________

Alternate Contact: ___________________________________________

Title: ______________________________________________________

Address: ___________________________________________________ ___________________________________________________

Phone Number: ________________ Fax Number: _________________

Email Address: ______________________________________________



TAX CLEARANCEThe Health Care Commission in process of procurement per K. S. A. 75-6504, requests the Director of Purchases to review tax clearance status of all Contractors. Per KSA 75-3740-(c), the Director of Purchases may reject the bid of any bidder who is in arrears on taxes due the State of Kansas. The Office of Procurement and Contracts will confirm tax status of all potential contractors and subcontractors prior to the release of a purchase order or contract award. The State of Kansas reserves the right to allow a bidder an opportunity to clear tax status within ten (10) calendar days, or to proceed with award to the next lowest responsive bidder, whichever is determined by the Director of Purchases to be in the best interest of the State. The Secretary of Revenue is authorized to exchange such information with the Director of Purchases as is necessary to determine the bidder’s tax clearance status, notwithstanding any other provision of law prohibiting disclosure of the contents of taxpayer records or information.

Instructions on how to check Tax Clearance Status can be found at the following website: http: //www. ksrevenue. org/taxclearance. htm

Information about Tax Registration can be found at the following website: http: //www. ksrevenue. org/busregistration. htm

Contact Information: Please provide the attached contact information for use should the State of Kansas need to contact the appropriate officials within your company to discuss your tax clearance / registration status.

CONTRACTOR

Contact Person for Tax Issues:

Company Name: Tax Number:

Mailing Address

City & State Zip Code


E-Mail

SUBCONTRACTOR(S)

Contact Person for Tax Issues:

Company Name: Tax Number:

Mailing Address

City & State Zip Code


E-Mail

Additional pages may be added, as required, indicating the same information for multiple subcontractors. All subcontractors must be identified.

http://www.ksrevenue.org/busregistration.htm

http://www.ksrevenue.org/taxclearance.htm



Immigration and Reform Control Act of 1986 (IRCA): All Contractors are expected to comply with the IRCA, as may be amended from time to time. This Act, with certain limitations, requires the verification of the employment status of all individuals who were hired on or after November 6, 1986, by the Contractor as well as any subcontractor or sub-subcontractors. The usual method of verification is through the Employment Verification (I-9) Form.

With the submission of this bid, the Contractor hereby certifies without exception that such Contractor has complied with all federal and state laws relating to immigration and reform. Any misrepresentation in this regard or any employment of persons not authorized to work in the United States constitutes a material breach and, at the State’s option, may subject the contract to termination and any applicable damages.

Unless provided otherwise herein, all Contractors are expected to be able to produce to the State any documentation or other such evidence to verify Contractor’s compliance with any provision, duty, certification, or the like under the contract.

Contractor will provide a copy of a signed Certification Regarding Immigration Reform and Control Form (See URL) with the technical proposal.

____________________________________________ ______________________Signature, Title of Contractor Date



Policy Regarding Sexual Harassment

WHEREAS, sexual harassment and retaliation for sexual harassment claims are unacceptable forms of discrimination that must not be tolerated in the workplace; and

WHEREAS, state and federal employment discrimination laws prohibit sexual harassment and retaliation in the workplace; and

WHEREAS, officers and employees of the State of Kansas are entitled to working conditions that are free from sexual harassment, discrimination, and retaliation; and

WHEREAS, the Governor and all officers and employees of the State of Kansas should seek to foster a culture that does not tolerate sexual harassment, retaliation, and unlawful discrimination.

NOW THEREFORE, pursuant to the authority vested in me as Governor of the State of Kansas, I hereby order as follows:

1. All Executive Branch department and agency heads shall have available, and shall regularly review and update at least every three years or more frequently as necessary, their sexual harassment, discrimination, and retaliation policies. Such policies shall include components for confidentiality and anonymous reporting, applicability to intern positions, and training policies.

2. All Executive Branch department and agency heads shall ensure that their employees, interns, and contractors have been notified of the state’s policy against sexual harassment, discrimination, or retaliation, and shall further ensure that such persons are aware of the procedures for submitting a complaint of sexual harassment, discrimination, or retaliation, including an anonymous complaint.

3. Executive Branch departments and agencies shall annually require training seminars regarding the policy against sexual harassment, discrimination, or retaliation. All employees shall complete their initial training session pursuant to this order by the end of the current fiscal year.

4. Within ninety (90) days of this order, all Executive Branch employees, interns, and contractors under the jurisdiction of the Office of the Governor shall be provided a written copy of the policy against sexual harassment, discrimination, and retaliation, and they shall execute a document agreeing and acknowledging that they are aware of and will comply with the policy against sexual harassment, discrimination, and retaliation.

5. Matters involving any elected official, department or agency head, or any appointee of the Governor may be investigated by independent legal counsel.

6. The Office of the Governor will require annual mandatory training seminars for all staff, employees, and interns in the office regarding the policy against sexual harassment, discrimination, and retaliation, and shall maintain a record of attendance.

7. Allegations of sexual harassment, discrimination, or retaliation within the Office of the Governor will be investigated promptly, and violations of law or policy shall constitute grounds for disciplinary action, including dismissal.

8. This Order is intended to supplement existing laws and regulations concerning sexual harassment and discrimination, and shall not be interpreted to in any way diminish such laws and regulations. The Order provides conduct requirements for covered persons, and is not intended to create any new right or benefit enforceable against the State of Kansas.



9. Persons seeking to report violations of this Order, or guidance regarding the application or interpretation of this Order, may contact the Office of the Governor regarding such matters.

Agreement to Comply with the Policy Against Sexual Harassment, Discrimination, and Retaliation.

I hereby acknowledge that I have received a copy of the State of Kansas Policy Against Sexual Harassment, Discrimination, and Retaliation established by Executive Order 18-04 and agree to comply with the provisions of this policy.

____________________________________ ___________________________________ Signature and Date Printed Name



Section IIVendor Qualifications

The SEHP we only accept proposals directly from the carrier. Third-party broker/consultants representing the carrier will not be considered and will be disqualified.

If you believe that a particular question is not applicable to the services you are bidding, please briefly explain why. If you have described a program/service or other content and it applies to multiple questions, simply refer us to the prior description. Please do not repeat your answers.

2.01.1 Provide a brief history of your organization including: date established; ownership (public, partnership, subsidiary, etc.) nature of business, length of time offering voluntary benefits insurance, and any additional programs/products offered in addition to voluntary benefit plans.

Answer: 2.01.2 Is your organization part of a national or regional organization? If yes, provide the

corporation’s name and address. Is your company affiliated with any other company? If so, describe these affiliate relationships. Describe how this relationship impacts your operation and delivery of services.

Answer: 2.01.3 Is your company affiliated with any other company? If so, describe these affiliate

relationships. Identify any subcontractors and the services they provide.Answer: 2.01.4 Provide the name, phone number, email address and professional biography of the

individuals that will be assigned responsibility to manage or service for each of these functions for the SEHP*:

Implementation Coordinator Account Executive Eligibility Coordinator Customer Service

For each of the individuals identified, provide a brief bio about each person who will be assigned responsibility for the SEHP account including their education and work experience, specific experience with administration of voluntary insurance programs years with the company, and areas of specialization, if any.

All members assigned to implementation and account management must attend the Finalist interview.

Some positions may be dedicated and others may be designated. Please indicate which positions are dedicated vs. designated. Please describe your definitions for “dedicated” and “designated”. If designated, please indicate the percentage of time each team member will dedicate to this account vs their other duties.



Answer: 2.01.5 Provide an executive level organizational chart for the company. Provide a unit chart,

including the group of individuals identified above to be assigned responsibility for SEHP Account. In the unit chart, indicate whether the individuals identified above are currently employed by your firm or if they will need to be hired to service this account.

Answer: 2.01.6 Describe the Account Service Team approach and how the following will be addressed

for this account:

Title/level with problem resolution authority Problem resolution process including escalation processes Location of the office that would service this account How is account service satisfaction monitored?

Answer: 2.01.7 What is the annual turnover rate by year for the past five (5) years for each of the

following units: Account Management Customer Service Eligibility Staff

Answer: 2.01.8 Describe any staff relocations, computer systems changes/upgrades, program changes

or telephone system changes in process at this time or proposed within the next 12-24 months?

Answer: 2.01.9 Are there any proposed changes to your organizational structure, operations or mergers

planned or anticipated? Do you anticipate any large acquisitions in the next year? What impact might these changes have on the SEHP plan operation?

Answer: 2.01.10 Provide a copy of the certificate of authority or registration document, if the organization

is licensed or registered with the State of Kansas Insurance Department. Are the plans you are proposing for the SEHP approved for sale in Kansas?

Answer: 2.01.11 Please identify at what location the following services will be provided and whether they

will be provided by your staff or outsourced. If outsourced, list who the provider of service is for each:

Customer Service Claims Processing and EOB generation Certificate of Insurance production and mailing

Answer:

2.02 Experience and References2.02.1 Provide references from three current and three former clients (within last 5 years) to whom

you provided services similar to those proposed in this RFP. Public sector clients with over 25,000 covered lives are preferred. Also preferred would be former clients who have worked with the person to be assigned to this account as well as a history of providing Group Accident



Insurance, Hospital Confinement, Cancer and Critical Illness benefits to public sector plans of similar size. Information should include:

Company Name Contact Person Address Office Phone # Mobile Phone # Email Services Provided Length of voluntary benefits engagement Number of eligible employees Reason for termination

Answer:2.02.2 Indicate the group sizes within your corporate book of business.Answer:

Group Size in Covered Lives

< 5,000

5,001 – 10,000

10,001 – 25,000

25,001 – 50,000

50,000 – 100,000

100,000 +2.02.3 How many public sector groups does your company service?Answer: Types of Public Sector Groups: # of Groups

CityCountyOther Local Government Group - Please describe each typeState Government Public UniversitiesPublic School DistrictsOther – Please describe

ACKNOWLEDGE AND ACCEPT

I have reviewed the Vendor Qualifications section of the Request for Proposal and acknowledge that the document shall become part of the final contract. I hereby acknowledge and accept all of the provisions, requirements, and conditions stated in this section of Request for Proposal, subject to the modifications, conditions and limitations I have listed below.

_________________________________________________Authorized Signature of Vendor



_________________________________________________Printed Name of Signatory

_________________________________________________ Title

_________________________________________________Date



Section IIIDA-146a, Sample Contract, and Business Associate Agreement

Vendors are expected to closely read the DA-146a, sample contract and BAA and provide a binding signature of intent to comply with such terms and conditions. The DA-146 is a required part on all State of Kansas contracts. All Vendors are required to agree to these provisions without modification. Any modifications of the DA-146 will result in the rejection of your bid.

The SEHP is not obligated to negotiate the provisions of the contract or BAA and reserves the right to accept or reject any bid that has made revisions or modifications in the required language. These provisions are a standard part of all State Employee Health Plan contracts. Any requested modifications to the contract or BAA must be submitted in red-line format with the bid response. It is acceptable to use color for this purpose.

Bidders agree by submitting a proposal in response to this RFP, the SEHP will draft the contract, including the HIPAA Confidentiality Agreement or Business Associate Agreement (BAA) as appropriate. Any negotiations regarding the contract and BAA documents will occur prior to the contract award. Once a contract is awarded, the State will draft the contract and the vendor is expected to sign it within 10 business days.

Should the SEHP be prevented or enjoined from proceeding with the acquisition before or after contract execution by reason of any litigation or other reason beyond the control of SEHP, Vendor shall not be entitled to make or assess claim for damages by reason of said delay.

Note: If no edits are requested to the contract or BAA documents, please return the document marked “no edits required”



State of KansasDepartment of AdministrationDA-146a (Rev. 06-12)

CONTRACTUAL PROVISIONS ATTACHMENT

Important: This form contains mandatory contract provisions and must be attached to or incorporated in all copies of any contractual agreement. If it is attached to the vendor/contractor's standard contract form, then that form must be altered to contain the following provision:

"The Provisions found in Contractual Provisions Attachment (Form DA-146a, Rev. 06-12), which is attached hereto, are hereby incorporated in this contract and made a part thereof."

The parties agree that the following provisions are hereby incorporated into the contract to which it is attached and made a part thereof, said contract being the _____ day of ____________________, 20_____.

1. Terms Herein Controlling Provisions : It is expressly agreed that the terms of each and every provision in this attachment shall prevail and control over the terms of any other conflicting provision in any other document relating to and a part of the contract in which this attachment is incorporated. Any terms that conflict or could be interpreted to conflict with this attachment are nullified.

2. Kansas Law and Venue : This contract shall be subject to, governed by, and construed according to the laws of the State of Kansas, and jurisdiction and venue of any suit in connection with this contract shall reside only in courts located in the State of Kansas.

3. Termination Due To Lack Of Funding Appropriation : If, in the judgment of the Director of Accounts and Reports, Department of Administration, sufficient funds are not appropriated to continue the function performed in this agreement and for the payment of the charges hereunder, State may terminate this agreement at the end of its current fiscal year. State agrees to give written notice of termination to contractor at least 30 days prior to the end of its current fiscal year, and shall give such notice for a greater period prior to the end of such fiscal year as may be provided in this contract, except that such notice shall not be required prior to 90 days before the end of such fiscal year. Contractor shall have the right, at the end of such fiscal year, to take possession of any equipment provided State under the contract. State will pay to the contractor all regular contractual payments incurred through the end of such fiscal year, plus contractual charges incidental to the return of any such equipment. Upon termination of the agreement by State, title to any such equipment shall revert to contractor at the end of the State's current fiscal year. The termination of the contract pursuant to this paragraph shall not cause any penalty to be charged to the agency or the contractor.

4. Disclaimer Of Liability : No provision of this contract will be given effect that attempts to require the State of Kansas or its agencies to defend, hold harmless, or indemnify any contractor or third party for any acts or omissions. The liability of the State of Kansas is defined under the Kansas Tort Claims Act (K.S.A. 75-6101 et seq.).

5. Anti-Discrimination Clause : The contractor agrees: (a) to comply with the Kansas Act Against Discrimination (K.S.A. 44-1001 et seq.) and the Kansas Age Discrimination in Employment Act (K.S.A. 44-1111 et seq.) and the applicable provisions of the Americans With Disabilities Act (42 U.S.C. 12101 et



seq.) (ADA) and to not discriminate against any person because of race, religion, color, sex, disability, national origin or ancestry, or age in the admission or access to, or treatment or employment in, its programs or activities; (b) to include in all solicitations or advertisements for employees, the phrase "equal opportunity employer"; (c) to comply with the reporting requirements set out at K.S.A. 44-1031 and K.S.A. 44-1116; (d) to include those provisions in every subcontract or purchase order so that they are binding upon such subcontractor or vendor; (e) that a failure to comply with the reporting requirements of (c) above or if the contractor is found guilty of any violation of such acts by the Kansas Human Rights Commission, such violation shall constitute a breach of contract and the contract may be cancelled, terminated or suspended, in whole or in part, by the contracting state agency or the Kansas Department of Administration; (f) if it is determined that the contractor has violated applicable provisions of ADA, such violation shall constitute a breach of contract and the contract may be cancelled, terminated or suspended, in whole or in part, by the contracting state agency or the Kansas Department of Administration.

Contractor agrees to comply with all applicable state and federal anti-discrimination laws.

The provisions of this paragraph number 5 (with the exception of those provisions relating to the ADA) are not applicable to a contractor who employs fewer than four employees during the term of such contract or whose contracts with the contracting State agency cumulatively total $5,000 or less during the fiscal year of such agency.

6. Acceptance Of Contract : This contract shall not be considered accepted, approved or otherwise effective until the statutorily required approvals and certifications have been given.

7. Arbitration, Damages, Warranties : Notwithstanding any language to the contrary, no interpretation of this contract shall find that the State or its agencies have agreed to binding arbitration, or the payment of damages or penalties. Further, the State of Kansas and its agencies do not agree to pay attorney fees, costs, or late payment charges beyond those available under the Kansas Prompt Payment Act (K.S.A. 75-6403), and no provision will be given effect that attempts to exclude, modify, disclaim or otherwise attempt to limit any damages available to the State of Kansas or its agencies at law, including but not limited to the implied warranties of merchantability and fitness for a particular purpose.

8. Representative's Authority To Contract : By signing this contract, the representative of the contractor thereby represents that such person is duly authorized by the contractor to execute this contract on behalf of the contractor and that the contractor agrees to be bound by the provisions thereof.

9. Responsibility For Taxes : The State of Kansas and its agencies shall not be responsible for, nor indemnify a contractor for, any federal, state or local taxes which may be imposed or levied upon the subject matter of this contract.

10. Insurance : The State of Kansas and its agencies shall not be required to purchase any insurance against loss or damage to property or any other subject matter relating to this contract, nor shall this contract require them to establish a "self-insurance" fund to protect against any such loss or damage. Subject to the provisions of the Kansas Tort Claims Act (K.S.A. 75-6101 et seq.), the contractor shall bear the risk of any loss or damage to any property in which the contractor holds title.



11. Information : No provision of this contract shall be construed as limiting the Legislative Division of Post Audit from having access to information pursuant to K.S.A. 46-1101 et seq.

12. The Eleventh Amendment : "The Eleventh Amendment is an inherent and incumbent protection with the State of Kansas and need not be reserved, but prudence requires the State to reiterate that nothing related to this contract shall be deemed a waiver of the Eleventh Amendment."

13. Campaign Contributions / Lobbying: Funds provided through a grant award or contract shall not be given or received in exchange for the making of a campaign contribution. No part of the funds provided through this contract shall be used to influence or attempt to influence an officer or employee of any State of Kansas agency or a member of the Legislature regarding any pending legislation or the awarding, extension, continuation, renewal, amendment or modification of any government contract, grant, loan, or cooperative agreement.


The DA146a has been reviewed by me and shall become part of the final contract. I hereby acknowledge and accept all of the provisions, requirements, and conditions stated in this document.

_________________________________________________Authorized Signature of Contractor


_________________________________________________Title

_________________________________________________Date



Redline Copy of the Sample Contract Note: If no edits are requested to this document, please return the document marked “no edits required”

Sample Contract – Fully Insured Vision Plan

CONTRACT TO PROVIDE______________________________________

FOR THE KANSAS STATE EMPLOYEE HEALTH PLAN FOR2019, 2020, and 2021

THIS CONTRACT is made and entered into this ______ day of _____________, 20_____, by and between the Kansas State Employees Health Care Commission (hereinafter referred to as “HCC”) and _________________________________ (hereinafter referred to as “Contractor”).

WHEREAS, the HCC wishes to provide _________________ for the self-funded Kansas State Employee Health Plan (hereinafter referred to as “Plan”);

WHEREAS, the State Employee Health Plan Staff within the Kansas Department of Health and Environment, Division of Health Care Finance (hereinafter referred to as “SEHP”) has been designated by the HCC to direct the day-to-day operations of the Plan;

WHEREAS, Contractor is a company holding itself out as having expertise in __________________________________ and desires to provide its services and expertise to the HCC; and,

WHEREAS, it has been determined by the HCC that the best interest of the HCC will be served by awarding a contract to Contractor to provide these services.

THEREFORE, in consideration of the mutual agreements contained below, the HCC and Contractor agree as follows:

1. Acceptance: Subject to the terms and conditions of this Contract, the HCC hereby accepts the offer of Contractor as expressed by:

a. Contractor’s Response to Request for Proposal #_______; b. Contractor’s technical proposal; and, c. Contractor’s Response to Request for Proposal #_______ involving pricing, as set forth in

Exhibit A, submitted to the HCC in response to Request for Proposal #_______ (hereinafter referred to as “RFP”).

2. Contract Documents: 1. This Contract consists of the following documents, incorporated herein by direct or indirect

reference and in the following precedential order:a. The DA146a;b. The Business Associate Agreement;c. The terms of this Contract; d. The Addenda to the RFP, if any;e. The RFP, which includes all Exhibits and Attachments; andf. The Contractor’s Technical and Cost Proposal(s), including pricing schedules and

clarifications.



2. In the event of a conflict between or among the terms of the Contract Documents, the term in the Contract Document with the highest precedence will prevail. For example, the DA146a will have the highest precedence in relation to the other listed documents.

3. The documents identified in Section 2.a above constitute the entire agreement between the

parties and supersede all prior oral or written statements or agreements.

3. Term : The term of this Contract shall be 3 years beginning on January 1, ___________ and ending on December 31, ___________.

4. Deliverables: Contractor will provide ___________________ as specified by this Contract and the documents noted in Section 2 above. Pursuant to the RFP and documents noted in Section 2 above, Contractor will:

a. ____________________________________________; b. __________________________________________; c. (as many as needed to describe deliverables);

5. Deliverable Options: Contractor may have provided several options of deliverables to the HCC for services under this Contract in the cost proposal. The HCC reserves the option to select or deselect any of the proposed deliverables contained within the cost proposal during the term of the Contract.

6. Fees: a. For services provided by the Contractor under this Contract, the payment to the Contractor

shall be based on the Contractor’s Best and Final Offer that was presented to and accepted by the HCC and documented by the documents noted in Section 2 of this Contract.

b. The HCC agrees to pay the amount billed by the Contractor that is in conformance with this Contract and fee schedule subject to subsections c and d below.

c. Payment will be made in response to a monthly receipt of an invoice setting forth the total monthly fees and any retroactive adjustments, credits or fees and transmitted by a mutually agreeable method to an address designated by the HCC.

d. Contractor shall also provide the HCC or its delegee, SEHP, the billing data specified by the RFP and/or documents noted in Section 2 of this Contract in a mutually agreeable electronic format. Payment will not be made to the Contractor until the electronic data is submitted in the agreed-upon format to and received by the HCC or its delegee, SEHP.

e. Payment will be made as soon as possible after the receipt of an invoice that meets the requirements of subsections b, c, and d above. The HCC will follow the Kansas Prompt Payment Act (K.S.A. 75-6401 et seq.).

7. Overpayment:

a. HCC assumes that the Contractor shall perform its duties and obligations under this Contract in a timely, careful and reasonable manner.

b. In the event of an overpayment of fees, Contractor shall indemnify the Plan. As used in this Contract, “overpayment” means any amount which has been mistakenly or wrongly paid from the Plan, including duplicate payments, mistaken payments, payments in excess of that actually owed, and any other amount not required to be paid under the terms of the Plan.

c. The HCC and Contractor will cooperate in efforts to recover overpayments when they are as a



result of a third-party. Contractor shall not seek legal action against a Plan participant to collect an overpayment without the HCC’s prior consent.

d. In the case of a dispute on an overpayment between the SEHP and Contractor, there should be an attempt to resolve the dispute by trying to reach an agreement. If the SEHP and Contractor cannot reach agreement, the dispute may be resolved through alternative dispute resolution. The intent is to resolve the dispute at the lowest level possible.

e. Contractor shall not be allowed to collect any overpayment due to its misapplication of the plan’s deductible, co-payment or co-insurance requirements unless it explains the reason for the overpayment in writing to the participant within a reasonable time after the date of service, but not to exceed 15 months after the date of service.

f. The provisions of this section will survive termination of this Contract.

8. Quality and Innovation: The HCC is interested in quality health care and innovative plan designs and projects. During the course of this Contract, the Contractor agrees to work with the HCC in the development, implementation, and evaluation of quality improvement projects and innovative plan designs or projects as authorized by the HCC. Contractors are encouraged to bring ideas on improving the quality of health care and innovative plan design ideas to the HCC for consideration. The HCC may negotiate with Contractors with regard to any expense related to or resulting from pursuit of these projects.

9. Reports: Contractor will work with the SEHP to develop meaningful management reports, making modifications to report structures and contents as necessary to meet the needs of the HCC and SEHP.

10. Retention of Records: a. Unless the HCC specifies in writing a shorter period of time, the Contractor agrees to preserve

and make available all of its books, documents, papers, records and other evidence involving transactions related to this Contract for a period of five (5) years from the date of the expiration or termination of this Contract.

b. Matters involving litigation shall be kept for one (1) year following the termination of litigation, including all appeals, if the litigation exceeds five (5) years.

c. The Contractor agrees that authorized federal and state representatives, including but not limited to, personnel of the using agency and independent auditors acting on behalf of state and/or federal agencies shall have access to and the right to examine records during the Contract period and during the five (5) year post-Contract period. Delivery of and access to the records shall be at no cost to the HCC.

d. State and/or federal law may require the retention of records for longer periods. In which case Contractor will follow applicable law.

11. Review and Hearings: The Contractor agrees to advise the HCC of the number and type of complaints made known to the Contractor for services provided under this Contract. The HCC has the discretion to require the Contractor to participate in any review, appeal, hearing, or litigation involving issues related to this Contract.



12. Solicitation of Members: The Contractor shall not use the names, home addresses or any other information obtained about participants of this plan for the purpose of offering for sale any property or services which are not directly related to services negotiated in this bid event without the express written consent of the HCC.

13. Performance Standards: Service performance standards set forth in the RFP establish expectations regarding certain areas of the Contract between Contractor and the HCC. These performance standards are designed to assure that all parties involved in providing services know what the standards are and that Contractor will provide guarantees based on these standards. Contractor accepts these standards as agreed upon in the RFP, attached hereto.

14. Acceptance of RFP Terms & Conditions: All proposals are subject to the terms and conditions outlined in the RFP. All responses will be controlled by such terms and conditions and the submission of other terms and conditions, price lists, catalogs, or other documents or exceptions as part of Contractor’s response are waived and have no effect either on the Request for Proposal or this Contract. By submitting an executed response, the Contractor specifically agreed to the conditions set forth in this paragraph.

15. Warranties: Contractor represents and warrants to the HCC that (a) services shall be rendered in a professional manner consistent with standards of professionals in Contractor’s industry; (b) services will be delivered in compliance with all standards and conditions presented by HCC to Contractor; and (c) Contractor is under no obligation or restriction, nor will it assume any obligation or restrictions that would in any way interfere or be inconsistent with the performance of the services.

16. Conflict Resolution: a. Intent: In the event that there is a dispute between the parties to this Contract, the intent of the

parties is to resolve the dispute at the earliest and lowest level possible. The lowest level would be a mutual agreement between the parties resolving the dispute. If the SEHP and Contractor cannot reach agreement, the dispute may be resolved through alternative dispute resolution. A last resort would be litigation in court.

b. HCC authority on deliverables: In the event the parties cannot mutually agree to a resolution of any controversies or claims between the parties regarding the provision of services and completion of deliverables, the HCC, at its sole discretion and judgment, will make the final determination as to whether deliverables have been satisfactorily completed or other services provided in accordance with the Contract.

c. Jurisdiction: i. Should legal proceedings be required between the parties as a result of this Contract,

the jurisdiction for the legal proceeding will be in the State of Kansas. If the venue would be a state court, the legal proceeding would be in the District Court of Shawnee County, Kansas. The United States District Court for the State of Kansas sitting in Topeka, Shawnee County, Kansas, would be the venue for any appropriate federal action or proceeding arising hereunder.

ii. Contractor waives all defenses of lack of personal jurisdiction and forum non

conveniens to any legal matters that arise between the parties as a result of this



Contract. Process may be served on Contractor in the manner authorized by applicable Kansas law or court rule.

d. Eleventh Amendment: The Eleventh Amendment of the United States Constitution is an inherent and incumbent protection held by the State of Kansas and need not be reserved, but prudence requires the HCC to reiterate that nothing related to this Contract shall be deemed a waiver by the HCC or SEHP of the protections accorded a state entity under the Eleventh Amendment.

17. Employment of Counsel and Resolution of Litigation and Legal Fees:a. In the event of litigation involving the services under this Contract not covered by Section 16

above and where the HCC, SEHP, State of Kansas, or the Contractor are named as a party to the litigation (“Litigation” hereafter), the HCC and Contractor each:

1. Reserve the right to select and retain counsel at its own expense to protect its interests;

2. Will promptly notify the other party to this Contract after learning of the Litigation;

3. Will cooperate fully by providing the other party with all non-confidential relevant information and documents within its control as requested; and

4. Will reasonably assist the other party in the defense of the Litigation.

b. In the event the HCC, the State of Kansas or any of its staff, or Contractor is the sole named defendant in Litigation related to the services provided under this Contract, such party shall have discretion to defend, settle, compromise or otherwise resolve such Litigation consistent with the terms of this Contract and of the SEHP. Such party shall keep the other party informed of the status of the Litigation and any decision to settle, compromise or otherwise resolve the Litigation shall be communicated to and discussed with the other party prior to any such settlement, compromise or other resolution.

c. In the event the HCC, the State of Kansas or any of its staff and Contractor are codefendants in Litigation, the parties will cooperate fully with each other to defend, settle, compromise or otherwise resolve such Litigation consistent with the terms of this Contract and the SEHP.

d. In the event any entity other than the HCC, the State of Kansas, any of its staff or Contractor, is named as a defendant in Litigation, the HCC can elect to defend, settle, compromise or otherwise resolve such Litigation with respect to those other entities consistent with the terms of this Contract and of the SEHP.

e. The provisions of this section will survive termination of this Contract.

18. Conformance with Law: Contractor shall comply with all applicable federal, state and local laws, rules and regulations as they exist or as they may be amended, including those not specifically mentioned in this Contract.

19. Contractor: The Contractor shall be deemed the sole source of contact for the Contract. Contractor shall include all subcontractors, subsidiaries, affiliates, partners and sister corporations, etc. Contractor is solely responsible for all actions and work performed by other entities involved in performing work under this Contract. All terms, conditions and requirements of the Contract shall apply without qualification to any services and work performed on behalf of the Contractor under this Contract.



20. Kansas Open Records Act: The laws of the State of Kansas require public information be placed in the public domain at the conclusion of the selection process, and be available for examinations by all interested parties. Contractor acknowledges that its response to the RFP under this Contract is considered an open record under the Kansas Open Records Act, K.S.A. 45-215 et seq.

21. Banking: The Contractor shall not open a bank account in the name of the State of Kansas, the HCC, or the Kansas State Employee Health Plan. Any bank account that the Contractor opens for the administration of this program or under this Contract shall be in the name of the Contractor only and solely the responsibility of the Contractor.

22. Duty to Mitigate: The parties to this Contract acknowledge their duty to mitigate damages when appropriate and reasonable.

23. Electronic Accessibility Protocols: The State policy on accessibility standards can be found at: http://oits.ks.gov/kito/itec/Policies/itecitpolicy1210.htm. All web and print based services available to Plan Participants must be handicap accessible and meet the state accessibility policy.

24. Advertising: The Contractor will not use the award of a contract as part of any news release or commercial advertising without the HCC’s prior written permission.

25. Implied Requirements : All products and services not specifically mentioned in the RFP, response and this Contract, but which are necessary to provide the functional capabilities described by the specifications, shall be included.

26. Off-Shore Sourcing: If, during the term of the Contract, the Contractor moves work previously performed in the United States to a location outside of the United States, the Contractor shall immediately notify the HCC in writing, indicating the new location and the percentage of work relocated.

27. Criminal or Civil Offense by Contractor: Any conviction for a criminal or civil offense that indicates a lack of business integrity or business honesty must be disclosed to the HCC. This includes:

a. Conviction of a criminal offense as an incident to obtaining or attempting to obtain a public or private contract or subcontract or in the performance of such contract or subcontract;

b. Conviction under state or federal statutes of embezzlement, theft, forgery, bribery, falsification or destruction of records, or receiving stolen property;

c. Conviction under state or federal antitrust statutes; and

d. Any other offense that reasonably would be expected to affect the ability to function as a State Contractor.

e. For the purpose of this section, an individual or entity shall be presumed to have control of a company or organization if the individual or entity directly or indirectly, or acting in concert with one or more individuals or entities, owns or controls 25 percent or more of its equity, or otherwise controls its management or policies. Failure to disclose an offense may result in termination of the Contract.

http://oits.ks.gov/kito/itec/Policies/itecitpolicy1210.htm



28. Confidentiality and Access : Contractor shall not disclose to any other person, firm, or corporation or entity (other than to the HCC) or use for its own benefit, except as provided in this Contract and the Business Associate Agreement, any data, Protected Health Information (hereinafter referred to as “PHI”) and/or other confidential information it receives from the HCC. Notwithstanding the Business Associate Agreement, such data and information may be disclosed to contract workers, employees, consultants and agents of the Contractor who have a need to know or have access to such data or information in the performance of this Contract and who have executed written agreements with the Contractor obligating them to treat such information in a manner consistent with the terms of this Contract. Contractor shall return any and all data furnished by the HCC promptly at the request of the HCC in whatever form required by the HCC. On the termination of this Contract, Contractor will not use any of such data or any material derived from the data for any purpose and, where so instructed by the HCC, will destroy or render such data or material unreadable. In the event Contractor discloses any of the HCC’s proprietary and/or personal identifiable information, the HCC may immediately terminate the Contract and pursue legal action recourse. The restrictions and obligations contained herein shall continue in perpetuity from the date of this Contract unless the HCC provides a written release to Contractor.

29. Data Ownership: The Contractor understands and agrees that all data provided by the HCC, or by the HCC’s contracted vendors authorized by the HCC, is owned by the HCC and will be used by the Contractor solely for the purposes described in this Contract. All data created in any form as part of this Contract will be the property of the HCC and will be available to the HCC at all times. Upon termination of the Contract, and to the extent feasible, all data associated with this Contract will be transferred to and accepted by the HCC prior to final payment to the Contractor. Under no circumstances will the Contractor share the data with any other entity without the HCC’s prior written authorization.

30. Copyrights: All deliverable items produced pursuant to this Contract that are produced solely and exclusively for the HCC are the exclusive property of the HCC. The Contractor will not assert a claim of copyright or other property interest in such deliverables. The Contractor shall indemnify the HCC against any and all claims for infringement of any copyright or patent occurring in connection with or in any way incidental to or arising out of the occupancy, use, service, operations or performance of work under this Contract.

31. Termination Right:

a. Notwithstanding any other provisions of this Contract, the HCC reserves the right to terminate this Contract at the end of any month by giving thirty (30) days advance notice thereof in writing to Contractor.

b. In the event of termination of this Contract, Contractor will, unless the HCC directs and Contractor otherwise agrees:

1. Complete the pricing of all deliverables incurred prior to the effective date of termination and the HCC shall pay Contractor for all applicable fees in respect to such deliverables priced.

2. Release to the HCC, in a format acceptable to the HCC, all records and files relating to deliverables priced under the SEHP health plan pursuant to this Contract.



c. If Contractor uses any patented, trademarked or copyrighted designs, devices, materials or other property, tangible or intangible in connection with its performance of its obligations under this Contract it shall provide for such use in an approved legal manner by making a proper agreement with the patentee or owner of such trademark or copyright and shall defend and hold the HCC harmless on any claim relating to such items. Contractor also grants the State of Kansas, and its departments, agencies, affiliates, agents, employees and licensees a non-exclusive, royalty-free, non-revocable perpetual license to use and copy for any reason Contractor’s bid and proposal and any other document(s) submitted to the HCC that may be related to this Contract.

32. Independent Contractor : Both Contractor and the HCC, in the performance of this Contract, are and shall be acting in an individual capacity and not as agents, employees, partners, joint ventures or associates of one another. The employees or agents of one party shall not be deemed or construed to be the employees or agents of the other party for any purpose whatsoever except the Contractor's employees shall be deemed agents of the State of Kansas for the purpose of maintaining confidentiality of private or confidential data, software and equipment maintained by the HCC.

33. Indemnification: The Contractor will hold and save the State, its officers, agents, and employees acting within the scope of their employment, harmless from liability of any kind, including all claims and losses accruing or resulting to any other person, firm, or corporation furnishing or supplying work, services, materials, or supplies in connection with the performance of this Contract, and from any and all claims and losses accruing or resulting to any person, firm or corporation that may be injured or damaged by the Contractor in the performance of this Contract. The Contractor acknowledges that any liability of the State’s agents or employees while acting within the scope of their employment is covered by the Kansas Tort Claims Act, K.S.A. 75-6101 et seq.

34. Accounts Receivable Set-Off Program: If, during the course of this Contract the Contractor is found to owe a debt to the State of Kansas, agency payments to the Contractor may be intercepted / setoff by the State of Kansas. Notice of the setoff action will be provided to the Contractor. Pursuant to K.S.A. 75-6201 et seq., Contractor shall have the opportunity to challenge the validity of the debt. If the debt is undisputed, the Contractor shall credit the account of the agency making the payment in an amount equal to the funds intercepted. K.S.A. 75-6201 et seq. allows the Director of Accounts and Reports to setoff funds the State of Kansas owes Contractors against debts owed by the Contractors to the State of Kansas. Payments setoff in this manner constitute lawful payment for services or goods received. The Contractor benefits fully from the payment because its obligation to the State is reduced by the amount subject to setoff.

35. Liability: Subject to the limitations set forth below, Contractor shall assume full responsibility for damage, including mitigation expenses, security breaches, or misuse of all State and Contractor property, including any private or confidential data, software and equipment maintained by Contractor and any equipment, supplies, accessories, software or parts furnished by Contractor while such property is in Contractor’s care. Contractor shall also assume full responsibility for compliance with the standards for security of privacy of confidential records, data, software, software code, or equipment used or maintained by the Contractor, as set forth in federal and State statutes which mandate implementation of strict measures to ensure physical and electronic security of the same.



36. Hold Harmless : Contractor shall save, hold harmless and indemnify the HCC against any and all liability, claims for injury to, or death of any persons and for loss or damage to any property and for infringement of any copyright or patent occurring in connection with or in any way incidental to or arising out of Contractor’s performance under the terms of this Contract.

37. Survival of Promises: All promises, requirements, terms, conditions, provisions, representations, guarantees, and warranties contained herein will survive the Contract expiration or termination date unless specifically provided otherwise herein, or unless superseded by applicable federal or State statutes of limitation.

38. Waiver : In the event of breach of this Contract, or any provision hereof, failure of the HCC to exercise any of its rights or remedies under the Contract shall not be construed as a waiver of any such provision of the Contract breached or as acquiescence in the breach. The remedies herein reserved shall be cumulative and in addition to any other remedies at law or in equity.

39. Legislative Requests: Contractor will provide support to the HCC in responding to information requests and fiscal notes or impact statements needed by the Legislature. Responses shall be given within two (2) business days.

40. Audits and Access to Records: The HCC reserves the right to conduct annual, or more frequently if needed audits of Contractor’s records and files related to the performance or cost of this Contract. The Contractor will make available to the HCC any person, record or file deemed necessary by the HCC to validate either performance or cost. The Legislative Division of Post Audit will have access to persons and records as a result of all contracts or grants entered into by State agencies or political subdivisions. There will be no fee from the Contractor to complete such audits. All third-party auditors will enter into a confidentiality agreement reasonably acceptable to Contractor and permitted under the Kansas Open Records Act.

41. Beneficiaries: Except as herein specifically provided otherwise, this Contract will inure to the benefit of and be binding upon the parties hereto and their respective successors. It is expressly understood and agreed that the enforcement of the terms and conditions of this Contract, and all rights of action relating to such enforcement, will be strictly reserved to the HCC and the named Contractor. Nothing contained in this document will give or allow any claim or right of action whatsoever by any other third person. It is the express intention of the HCC and Contractor that any such person or entity, other than the HCC or the Contractor, receiving services or benefits under this Contract will be deemed an incidental beneficiary only.

42. Amendment: This Contract shall be amended only by the written agreement of the parties. No alteration or variation of the terms and conditions of this Contract shall be valid unless made in writing and signed by the parties. Every amendment shall specify the date on which its provisions shall be effective.

43. Option to Renew: The HCC shall have the option, by mutual written agreement of the HCC and Contractor, to renew this Contract in such a manner mutually agreed upon, in writing, by the parties.



44. Joint Drafting: No provision of this Contract shall be construed more harshly or unfavorably against any party hereto regardless of which party drafted the provision or for whose benefit the provision was included.

45. Captions: The captions or heading in this Contract are for reference only and do not define, describe, extend or limit the scope or intent of this Contract.

46. Validity and Waiver: The invalidity in whole or in part of any provision of this Contract shall not affect the validity of other provisions. A waiver of a breach of any provision or performance guaranty of this Contract shall not constitute a waiver of any subsequent breach of that provision or a breach of any other provision of this Contract. The failure of the HCC to enforce at any time or from time to time any provision of this Contract shall not be construed as a waiver thereof.

47. Force Majeure: Contractor or the HCC shall be excused from performance under this Contract for any period that Contractor or the HCC is prevented from performing any services, in whole or part, as a result of an act or event not within the reasonable control of the party prevented from performing.

48. Travel Expenses: Contractor will be responsible for all expenses, including travel mileage, meals, lodging and other travel expenses incurred in the performance of this Contract.

49. Notices: The notice addresses of the parties are as follows:

HCC:Director of the State Employee Health Plan900 SW Jackson St., Ste. 900-NTopeka, KS 66612

Contractor:(Name of Contractor) ___________________________(Address of Contractor) ___________________________

___________________________

50. Transition Assistance : In the event of Contract termination or expiration, Contractor shall provide all reasonable and necessary assistance to the State to allow for a functional transition to another vendor.

51. Signatures: Signatures herein shall serve to bind the parties to this Contract. The parties represent and warrant that they have read and thoroughly understand the terms and conditions and they are represented by counsel and the terms and conditions of the RFP and Contract have been fully explained to them by counsel. This Contract shall be binding on any person or entity that is a successor or purchaser of Contractor.

SIGNATURES ON NEXT PAGE

CONTRACTOR - (Name of Contractor)



By: ____________________________________ Date: ______________________

Printed Name: ____________________________

Title: ____________________________________

KANSAS STATE EMPLOYEES HEALTH CARE COMMISSION

By: _____________________________________ Date: ______________________

(Printed Name) _______

(Title)____________________________ Date



BUSINESS ASSOCIATE AGREEMENT

THIS AGREEMENT is made and entered into by and between the Kansas Department of Health and Environment (hereinafter referred to as “KDHE”) and ------------------------------------------------------------- (hereinafter referred to as “Business Associate”).Notwithstanding Section V of this Business Associate Agreement (hereinafter referred to as “BAA”), the term of this BAA shall run concurrently with the Underlying Contract between the parties and shall have the same effective date and termination date as the Underlying Contract.

RECITALSThe Parties to this BAA have a relationship whereby KDHE may provide the Business Associate access to Protected Health Information (hereinafter referred to as “PHI”), which may include electronic Protected Health Information, that Business Associate will use to fulfill its contractual obligations to KDHE. KDHE and Business Associate acknowledge that each party has certain obligations under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), as amended, including those provisions of the American Recovery and Reinvestment Act of 2009 (“ARRA”), specifically the Health Information Technology for Economic and Clinical Health Act (“HITECH”), and the statutes implementing regulations to maintain the privacy and security of PHI, and the parties intend this BAA to satisfy those obligations including, without limitation, the requirements of 45 CFR 164.504(e).KDHE, with its three divisions, self-identifies as a Hybrid Entity under HIPAA with the Division of Health Care Finance containing Covered Entity functions. Therefore, a Business Associate would not be permitted to use or disclose health information in ways that KDHE could not. This protection continues as long as the data is in the hands of Business Associate. Business Associate acknowledges that for the purposes of this BAA, Business Associate is a “business associate” as that term is defined in 45 CFR § 160.103, and therefore the requirements of HIPAA apply to Business Associate in the same manner that they apply to KDHE pursuant to 42 USC § 17931(a).NOW THEREFORE, in consideration of the mutual promises below and other good and valuable consideration the parties agree as follows:I. DEFINITIONS

a) “Administrative Safeguards” shall mean the administrative actions, policies and procedures to manage the selection, development, implementation and maintenance of security measures to protect PHI and to manage the conduct of Business Associate’s workforce in relation to the protection of that PHI.

b) “Breach” shall mean any disclosure which compromises an individual’s protected health information (PHI) in a way that creates risk of harm to the individual.

c) “Business Associate” shall have the same meaning as the term “Business Associate” as defined in 45 CFR 160.103.

d) “Data Aggregation Services” shall mean, with respect to PHI created or received by Business Associate in its capacity as a Business Associate of KDHE, the combining of such PHI by the Business Associate with the PHI received by the Business Associate in its capacity as a business associate of another covered entity, to permit data analyses that relate to the health care operations of the respective covered entities, as defined in 45 CFR § 164.501 and as such term may be amended from time to time in this cited regulation.

e) “Designated Record Set” shall mean a group of records maintained by or for KDHE that consists of the following: (a) medical records and billing records about Individuals maintained by or for a health care provider; (b) enrollment, payment, claims adjudication, and case or medical management record systems maintained by or for a



health plan; or (c) records used in whole or in part, by or for KDHE to make decisions about Individuals. For these purposes, the term “record” means any item, collection, or group of information that includes PHI and is maintained, collected, used, or disseminated by or for KDHE.

f) “Disclosure” shall mean the release, transfer, provision of, access to, or divulging in any other manner of PHI outside the entity holding the information.

g) “HIPAA” shall mean the Health Insurance Portability and Accountability Act of 1996, the implementation regulations promulgated thereunder by the U.S. Department of Health and Human Services, the HITECH (as defined below) and any future regulations promulgated thereunder, all as may be amended from time to time.

h) “Individual” shall have the same meaning as the term “individual” as defined in 45 CFR 160.103, and any amendments thereto, and shall include a person who qualifies as a personal representative in accordance with 45 CFR 164.502(g).

i) “Physical Safeguards” shall mean the physical measures, policies and procedures to protect KDHE’s electronic information systems and related buildings and equipment from natural and environmental hazards and unauthorized intrusion.

j) “Privacy Rule” shall mean the Standards for Privacy of Individually Identifiable Health Information at 45 CFR Part 160 and Part 164.

k) “Protected Health Information” shall have the same meaning as the term “protected health information,” as defined in 45 CFR 160.103 and any amendments thereto, limited to the information created or received by Business Associate from or on behalf of KDHE.

l) “Required by Law” shall have the same meaning as the term “required by law” in 45 CFR 164.103.

m) “Secretary” shall mean the Secretary of the United States Department of Health and Human Services or his/her designee.

n) “Security Incident” shall mean the attempted or successful unauthorized access, use, disclosure, modification or destruction of information or interference with system operations in an information system.

o) “Security Rule” shall mean the Standards for Security of Electronic Protected Health Information at 45 CFR Parts 160, 162 and 164.

p) “Technical Safeguards” shall mean the technology and the policy and procedures for its use that protect PHI and control access to it.

q) “Underlying Contract” means any written contract for services between KDHE and Business Associate.

r) “Use” shall mean, with respect to PHI, the sharing, employment, application, utilization, examination, or analysis of such information within any entity that maintains such information.

s) Capitalized terms used, but not otherwise defined, in this BAA shall have the same meaning ascribed to them in HIPAA, the Privacy Rule, the Security Rule, or HITECH or any future regulations promulgated or guidance issued by the Secretary.



II. OBLIGATIONS AND ACTIVITIES OF BUSINESS ASSOCIATEa) Use and Disclosure . Business Associate agrees to not use or disclose PHI other than as

permitted or required by this BAA or as Required by Law.

b) Safeguards to be in Place . Business Associate agrees to use appropriate safeguards to prevent the use or disclosure of PHI other than as provided for by this BAA. Additionally, Business Associate shall implement Administrative, Physical and Technical Safeguards that reasonably and appropriately protect the confidentiality, integrity and availability of the PHI that it creates, receives, maintains or transmits on behalf of KDHE as required by the Security Rule.

c) HIPAA Training . Business Associate agrees to ensure all members of its workforce, including subcontractor workforce members, that will or potentially will provide services pursuant to the Underlying Contract will be appropriately trained on the requirements of HIPAA.

d) Duty to Mitigate . Business Associate agrees to mitigate, to the extent practicable, any harmful effect that is known to Business Associate of a use or disclosure of PHI by Business Associate in violation of the requirements of this BAA or the Privacy Rule and to communicate in writing, such procedures to KDHE.

e) Business Associate’s Agents and Subcontractors . Business Associate agrees to ensure that any agent, including a subcontractor, to whom it provides PHI received from, or created or received by Business Associate on behalf of KDHE agrees, in writing in the form of a Business Associate Agreement, to the same restrictions and conditions that apply through this BAA to Business Associate with respect to such information, including implementation of reasonable and appropriate safeguards to protect PHI. Business Associate agrees that it is directly liable for any actions of its subcontractors that result in a violation of this Agreement. Business Associate also agrees to make available to KDHE any contracts or agreements Business Associate has with any subcontractors to whom Business Associate provides PHI under this BAA. Business Associate may redact proprietary and financial information from said contracts before providing them to KDHE.

f) Duty to Provide Access . To the extent Business Associate has PHI in a Designated Record Set, Business Associate agrees to provide access, at the request of KDHE, to the PHI in the Designated Record Set to KDHE or, as directed by KDHE, to the Individual, in order to meet the requirements under 45 CFR 164.524. Any denial by Business Associate of access to PHI shall be the responsibility of, and sufficiently addressed by, Business Associate, including, but not limited to, resolution of all appeals and/or complaints arising therefrom.

g) Amendment of PHI . Business Associate agrees to make any amendment(s) to PHI in its possession contained in a Designated Record Set that KDHE directs or agrees to pursuant to 45 CFR 164.526 at the request of KDHE or an Individual, and within a reasonable time and manner.

h) Duty to Make Internal Practices Available . Business Associate agrees to make its internal practices, books and records, including policies and procedures relating to the use and disclosure of PHI, and any PHI received from, or created or received by Business Associate on behalf of KDHE, available to the Secretary, in a time and manner designated by the Secretary, for purposes of the Secretary determining KDHE’s compliance with the Privacy Rule.



i) Documenting Disclosures/Accounting . Business Associate agrees to document any disclosures of PHI and information in its possession related to such disclosures as would be required for KDHE to respond to a request by an Individual for an accounting of disclosures of PHI in accordance with 45 CFR 164.528. Business Associate agrees to provide to KDHE information collected in accordance with Section II(f) of this BAA, to permit KDHE to respond to a request by an Individual for an accounting of disclosures of PHI in accordance with 45 CFR 164.528.

j) Reporting Breaches and Security Incidents to KDHE . In addition to the duty to mitigate under Section II(d), Business Associate agrees to report to KDHE any use or disclosure which compromises PHI and creates risk of harm including any Security Incident of which it becomes aware, as soon as practicable but no longer than five (5) business days after the discovery of such event(s). Notice to KDHE shall consist of notifying the KDHE Privacy Officer by phone or email of the occurrence of an unauthorized use, disclosure or security incident.

k) Notification of Breach . Business Associate shall notify Covered Entity within three (3) business days after it, or any of its employees, subcontractors, or agents, reasonably suspects that a breach of unsecured PHI as defined by 45 CFR 164.402 may have occurred, irrespective of any occurrence or non-occurrence of harm. Notice to KDHE shall consist of notifying the KDHE Privacy Officer by phone or email of the occurrence of a Breach or suspected occurrence of a Breach. Business Associate shall exercise reasonable diligence to become aware of whether a breach of unsecured PHI may have occurred and, except as stated to the contrary in this Section, shall otherwise comply with 45 CFR 164.410 in making the required notification to Covered Entity. Business Associate shall cooperate with Covered Entity in the determination as to whether a breach of unsecured PHI has occurred and whether notification to affected individuals of the breach of unsecured PHI is required by 45 CFR 164.400 et seq., including continuously providing the Covered Entity with additional information related to the suspected breach as it becomes available. In the event that Covered Entity informs Business Associate that (i) Covered Entity has determined that the affected individuals must be notified because a breach of unsecured PHI has occurred and (ii) Business Associate is in the best position to notify the affected individuals of such breach, Business Associate shall immediately provide the required notice (1) within the time frame defined by 45 CFR 164.404(b), (2) in a form and containing such information reasonably requested by Covered Entity, (3) containing the content specified in 45 CFR 164.404(c), and (4) using the method(s) prescribed by 45 CFR 164.404(d). In addition, in the event that Covered Entity indicates to Business Associate that Covered Entity will make the required notification, Business Associate shall promptly take all other actions reasonably requested by Covered Entity related to the obligation to provide a notification of a breach of unsecured PHI under 45 CFR 164.400 et seq. Business Associate shall indemnify and hold Covered Entity harmless from all liability, costs, expenses, claims or other damages that Covered Entity, its related corporations, or any of its or their directors, officers, agents, or employees, may sustain as a result of Business Associate’s breach, or Business Associate’s subcontractor’s or agent’s breach, of its obligations under this Agreement.

III. PERMITTED USES AND DISCLOSURES BY BUSINESS ASSOCIATEa) General Use and Disclosure Provisions . Except as otherwise limited in this Agreement,

Business Associate may use or disclose PHI on behalf of, or to provide services to, Covered Entity for the purposes set forth in III(b), if such use or disclosure of PHI would not violate the Privacy Rule if done by Covered Entity.



b) Specific Use and Disclosure Provisions .

1. Business Associate may use and disclose PHI to perform services for Covered Entity, including specific services, as set out in the Underlying Contract, and any additional services necessary to carry out those specific services in the Underlying Contract.

2. Business Associate may use PHI in its possession for the proper management and administration of Business Associate and to carry out the legal responsibilities of Business Associate.

Business Associate may disclose PHI in its possession for the proper management and administration of Business Associate, provided that disclosures are Required by Law. Business Associate may only de-identify PHI in its possession obtained from Covered Entity with Covered Entity’s prior written consent, in accordance with all de-identification requirements of the Privacy Rule.

3. Business Associate may use PHI to report violations of law to appropriate federal and state authorities, consistent with 45 CFR 164.502(j)(1). Covered Entity shall be furnished with a copy of all correspondence sent by Business Associate to a federal or state authority.

4. Except as otherwise limited in this Agreement, Business Associate may use PHI to provide Data Aggregation Services to Covered Entity.

5. Any use or disclosure of PHI by Business Associate shall be in accordance with the minimum necessary policies and procedures of Covered Entity and the regulations and guidance issued by the Secretary on what constitutes the minimum necessary for Business Associate to perform its obligations to Covered Entity under this Agreement and the Underlying Contract.

IV. OBLIGATIONS OF COVERED ENTITYa) Covered Entity shall notify Business Associate of any limitation(s) in its Notice of

Privacy Practices of Covered Entity in accordance with 45 CFR 164.520, to the extent that such limitation(s) may affect Business Associate’s use or disclosure of PHI.

b) Covered Entity shall notify Business Associate in a timely manner of any changes in, or revocation of, permission by an Individual to use or disclose PHI to the extent that such change may affect Business Associate’s permitted or required use or disclosure of PHI.

c) Covered Entity shall notify Business Associate in a timely manner of any restriction to the use and/or disclosure of PHI, which the Covered Entity has agreed to in accordance with 45 CFR 164.522, to the extent that such restriction may affect Business Associate’s use or disclosure of PHI.

d) Covered Entity shall not request Business Associate to use or disclose PHI in any manner that would not be permissible under the Privacy Rule if done by Covered Entity.

V. TERMINATIONa) Term. The term of this Agreement shall run concurrently with the Underlying Contract

with Covered Entity and shall terminate upon termination of the Underlying Contract and when all of the PHI provided by Covered Entity to Business Associate, or created or received by Business Associate on behalf of Covered Entity, is destroyed or returned to Covered Entity, or, if it is infeasible to return or destroy the PHI, protections are



extended to such information, in accordance with the termination provisions of Section V(c)(2).

b) Termination for Cause. Upon either party’s knowledge of a material breach by the other party, such party shall either:

1. Provide an opportunity for the breaching party to cure the breach, end the violation, or terminate this Agreement if the breaching party does not cure the breach or end the violation within five (5) business days;

2. Immediately terminate the Agreement if the breaching party has breached a material term of this Agreement and cure is not possible; or

3. If neither termination nor cure is feasible, the non-breaching party shall report the violation to the Secretary.

c) Effect of Termination.

1. Except as provided in paragraph V(c)(2) of this Agreement, upon termination of this Agreement, for any reason, Business Associate shall return or destroy all PHI received from Covered Entity, or created or received by Business Associate on behalf of Covered Entity. This provision shall apply to PHI that is in the possession of subcontractors or agents of Business Associate. Business Associate shall retain no copies of the PHI.

2. In the event that Business Associate determines that returning or destroying the PHI is infeasible, Business Associate shall provide to Covered Entity notification in writing of the conditions that make return or destruction infeasible. Upon verification that return or destruction of PHI is infeasible, Business Associate shall extend the protections of this Agreement to such PHI and limit further uses and disclosures of such PHI to those purposes that make the return or destruction infeasible, for so long as Business Associate maintains such PHI. If it is infeasible for Business Associate to obtain from a subcontractor or agent, any PHI in the possession of the subcontractor or agent, Business Associate must provide a written explanation to Covered Entity and require the subcontractors and agents to agree to extend any and all protections, limitations and restrictions contained in this Agreement to the subcontractors’ and/or agents’ use and/or disclosure of any PHI retained after the termination of this Agreement, and to limit any further uses and/or disclosures to the purposes that make the return or destruction of the PHI infeasible.

d) Judicial or Administrative Proceedings. Notwithstanding any other provision herein, Covered Entity may terminate the applicable Underlying Contract, effective immediately, upon a finding or stipulation in any criminal, administrative or civil proceeding in which the Business Associate is a named party that Business Associate violated any applicable standard or requirement of the Privacy Rule or the Security Rule or any other applicable laws related to the security or privacy of PHI, relating to the Underlying Contract.

VI. MISCELLANEOUS

a) Regulatory References . A reference in this Agreement to a section in the Privacy Rule or Security Rule means the section as in effect or as amended and for which compliance is required.



b) Amendment . No change, amendment, or modification of this Agreement shall be valid unless set forth in writing and agreed to by both parties, except as set forth in Section VI(l) below.

c) Indemnification . Business Associate shall indemnify Covered Entity for any and all claims, inquiries, costs or damages, including but not limited to any monetary penalties, that Covered Entity incurs arising from a violation by Business Associate, or a subcontractor or agent of Business Associate, of its obligations hereunder.

d) Survival. The respective obligations of Business Associate under this Agreement shall survive the termination of this Agreement.

e) Interpretation . Any ambiguity or inconsistency in this Agreement shall be resolved in favor of a meaning that permits Covered Entity to comply with the Privacy Rule, the Security Rule, and the HITECH sections contained within ARRA.

f) No Third-Party Beneficiaries . Nothing express or implied in this Agreement is intended to confer, nor shall anything herein confer, upon any person other than Covered Entity and its respective successors or assigns, any rights, remedies, obligations or liabilities whatsoever.

g) Notices . Any notices to be given to either party under this Agreement shall be made in writing and delivered via e-mail at the address(es) given below:

Business Associate: General Counsel –

Privacy Officer –

Covered Entity:Brian M. Vazquez – [email protected]

h) Headings . The section headings are for convenience only and shall not be construed to define, modify, expand, or limit the terms and provisions of this Agreement.

i) Governing Law and Venue . This Agreement shall be governed by, and interpreted in accordance with, the internal laws of the State of Kansas, without giving effect to its conflict of law provisions.

j) Binding Effect . This Agreement shall be binding upon, and shall inure to the benefit of, the parties hereto and their respective permitted successors and assigns.

k) Effect on Underlying Contract . If any portion of this Agreement is inconsistent with the terms of the Underlying Contract, the terms of this Agreement shall prevail. Except as set forth above, the remaining provisions of the Underlying Contract are ratified in their entirety.

l) Modification . The parties acknowledge that state and federal laws relating to electronic data security and privacy are rapidly evolving and that amendment of this Agreement may be required to ensure compliance with such developments. The parties specifically agree to take such action as may be necessary to implement the standards and requirements of HIPAA and other applicable state and federal laws relating to the security or confidentiality of PHI as determined solely by Covered Entity.

In the event that a federal or state law, statute, regulation, regulatory interpretation or court/agency determination materially affects this Agreement, as is solely determined by Covered Entity, the parties agree to negotiate in good faith any necessary or appropriate revisions to this Agreement. If the parties are unable to reach an agreement concerning such




revisions within the earlier of sixty (60) days after the date of notice seeking negotiations or the effective date of the change in law or regulation, or if the change in law or regulation is effective immediately, the Covered Entity, in its sole discretion, may unilaterally amend this Agreement to comply with the change in law upon written notice to Business Associate.

VII. OBLIGATIONS OF BUSINESS ASSOCIATE PURSUANT TO HITECHa) Access to PHI in an Electronic Format . If Business Associate uses or maintains PHI in an

Electronic Health Record, Business Associate must provide access to such information in an electronic format if so requested by an Individual. Any fee that Business Associate may charge for such electronic copy shall not be greater than Business Associate’s labor costs in responding to the request. If an Individual makes a direct request to Business Associate for access to a copy of PHI, Business Associate will promptly inform the Covered Entity in writing of such request.

b) Prohibition on Marketing Activities . Business Associate shall not engage in any marketing activities or communications with any individual unless such marketing activities or communications are allowed by the terms of the Underlying Contract and are made in accordance with HITECH or any future regulations promulgated thereunder. Notwithstanding the foregoing, any payment for marketing activities should be in accordance with HITECH or any future regulations promulgated thereunder.

c) Application of the Security Rule to Business Associate . Business Associate shall abide by the provisions of the Security Rule and use all appropriate safeguards to prevent use or disclosure of PHI other than as provided for by this Agreement. Without limiting the generality of the foregoing sentence, Business Associate shall:

(i) Adopt written policies and procedures to implement the same administrative, physical, and technical safeguards required of the Covered Entity; and

(ii) Abide by the most current guidance on the most effective and appropriate technical safeguards as issued by the Secretary.

If Business Associate violates the Security Rule, it acknowledges that it is directly subject to civil and criminal penalties.

VIII. ADDITIONAL OBLIGATIONS OF BUSINESS ASSOCIATE Business Associate shall not receive any remuneration, directly or indirectly, in exchange for any PHI, unless so allowed by the terms of the Underlying Contract and in accordance with HITECH and any future regulations promulgated thereunder.

IX. ENFORCEMENTBusiness Associate acknowledges that, in the event it, or its subcontractor or agent, violates any applicable provision of the Security Rule or any term of this Agreement that would constitute a violation of the Privacy Rule, Business Associate will be subject to and will be directly liable for any and all civil and criminal penalties that may result from such violation.



IN WITNESS WHEREOF, the parties have executed this Agreement as of the date last noted below and for a term specified by Section V(a) above.

On behalf of:

KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT

By: _______________________________________ Date: _______________________Jeff AndersonActing Secretary Kansas Department of Health and Environment

BUSINESS ASSOCIATE - (Name of Contractor)

By: __________________________________________ Date: _______________________

Printed Name: ____________________________

Title: _____________________________________



Section IVScope of Work

PURPOSE OF PROJECT

This RFP will open negotiations with Contractors for voluntary fully insured vision coverage offered by the State Employee Health Plan (SEHP). This RFP is requesting proposals for fully insured products only. All benefits eligible State of Kansas employee and eligible dependents can enroll in the stand alone vision benefit. The contract period will be for 3-years with the option for renewal in such a manner mutually agreed upon, in writing, by the parties.

As the framework surrounding the requirements for employer sponsored health plans is evolving, the SEHP is seeking to partner with vendors who demonstrate not only knowledge and ability to administer the SEHP but we are also interested in Contractors that demonstrate flexibility, innovation and problem solving skills. The SEHP reserves the right to change the number of plan and benefit offerings.

The current plan design includes both a basic and enhanced benefit plan design administered by Surency Vision. All vendors must quote and be prepared to administer the current plan design as written and requested in this RFP. Vendors may provide suggestions on alternative plan design options in addition to the two options currently offered.

Bid Information:Multiple year rate guarantees are preferred. Such guarantees should be clearly outlined in your proposal. The SEHP is requesting a minimum 24-month rate guarantee. Longer rate guarantee periods would be preferred. Rates and any cost associated with this RFP must be disclosed in Exhibit 2 the Cost Proposal.

Should the SEHP be prevented or enjoined from proceeding with the acquisition before or after contract execution by reason of any litigation or other reason beyond the control of SEHP, Vendor shall not be entitled to make or assess claim for damages by reason of said delay.

BACKGROUND

The Kansas State Employees Health Care Commission (Commission) provides for the purchase and administration of a comprehensive health benefit program for State of Kansas employees and retirees as well as employees and retirees of other public employers who have elected to participate in the State Employee Health Plan (SEHP). The SEHP is staffed by employees that work in the SEHP.

Vision Plan: Vision is a voluntary offering. Eligible persons may enroll themselves and eligible dependents in Vision coverage even if they are not enrolled with the State Employee Health Plan medical coverage. Currently there are two plans offered – a Basic Plan and an Enhanced Plan.

The current Certificates of Coverage are located on the web at http://www.kdheks.gov/hcf/sehp/BenefitDescriptions/surency/2018_State_of_Kansas_Basic.pdf

Census:Total Active State and Non State Plan Enrollment for 2018: Data regarding the enrollment is attached as Exhibit 5- Census.

Utilization:Utilization for Active State, Direct Bill and Non State is attached as Exhibit 7-Claims Summary Report.

Employee Guidebook for the State Employee Health Plan: The Employee Guidebooks provide insights into membership eligibility rules for the SEHP and are located at: http://www.kdheks.gov/hcf/sehp/default.htm

http://www.kdheks.gov/hcf/sehp/default.htm

http://www.kdheks.gov/hcf/sehp/BenefitDescriptions/surency/2018_State_of_Kansas_Basic.pdf



Waiting Periods: A thirty-day waiting period for State Employee Health Plan (SEHP) coverage for newly hired employees.

Plan Year: Coverage for all plan participants is monthly. For active State of Kansas employees, payroll deductions are taken monthly. For Non State employees and Direct Bill members (retirees), contributions are paid monthly.

Open Enrollment: Open enrollment for the active State of Kansas and Non State members is traditionally conducted October 1 through October 31 each year. Open Enrollment for COBRA members also have annual enrollment in October each year. Direct bill Open Enrollment is October 16 to November 15 each year.

Continuation Options: The SEHP offers former employees the opportunity to continue participation in the group health insurance program in the following ways:

COBRA : The SEHP offers an extension of Group Health Insurance coverage in accordance with COBRA, Consolidated Omnibus Budget Regulation Act of 1986, provided they meet one of the qualifying events. Program membership has been outsourced to a Third Party Administrator.

Direct Bill : The SEHP allows retirees, former elected state officials and persons on approved leave without pay to participate. The State does not contribute toward the cost of direct bill member’s coverage.

Information on Current Benefits and PoliciesInformation about the current Vision plan(s) offered to plan participants is available on the web at: http://www.kdheks.gov/hcf/sehp/Surency.htm . This includes Benefit Descriptions for self-insured plans, links to provider directories and other benefit information. Proposals for coverage should be based upon the current vison plan design. As stated alternative options can be quoted but must be marked accordingly so that we can compare equally.

Documents:The Event Document as posted on the Office of Procurement and Contracts website and the acknowledgement of addenda posted for the bid event must be submitted as part of section one of this Technical proposal. There are a number of forms included in this section that must be completed and submitted with the bid response

Required ServicesIn this section the SEHP is outlining the services being requested in this RFP. You do not need to accept each item. You do need to highlight in Redline any item or service which you will not able to provide. You may use color to designate your exceptions to the requested services.

4.1 General Requirements4.1.01 Administer the current plan designs and programs as well as any other future benefit structure

developed as directed by the State Employee Health Plan (SEHP).4.1.02 Administer the plans subject to the insurance laws of the State of Kansas.4.1.03 Vendor shall be responsible for compliance with the privacy and security provisions of the

Health Insurance Portability and Accountability Act (HIPAA) and shall comply with other HIPAA provisions and regulations applicable to the SEHP, including all terms of the applicable Business Associate Agreement (hereinafter referred to as the “BAA”), as well as applicable terms of the Financial Services Modernization Act of 1999, the HITECH Act of 2009, and any

http://www.kdheks.gov/hcf/sehp/Surency.htm



other federal or State law pertaining to the protection of personally identifiable information. The Contractor shall accept full responsibility for providing adequate supervision and training to its agents and employees to ensure compliance with the Act.

4.1.04 If the Vendor elects not to proceed with performance under any such contract with the State, the Contractor assigns to the SEHP all its rights to and interests in any causes of action it has or may acquire under the antitrust laws of the United States and the State of Kansas relating to the particular product or services purchased or acquired by the State pursuant to this contract.

4.1.05 The Vendor shall not assign, convey, encumber, or otherwise transfer its rights or duties under this contract without the prior written consent of the SEHP, which consent will not be unreasonably withheld or delayed. The SEHP may immediately terminate the contract in the event of its assignment, conveyance, encumbrance or other transfer by the Contractor without the prior written consent of the SEHP.

4.1.06 Vendor must comply with the State policy on accessibility standards found at: http//oits.ks.gov/docs/default-source/kitodocumentlibrary/ITEC-Policies/.

4.1.07 Vendor must comply with the State policy on computer security found at: http//oits.ks.gov/docs/default-source/kitodocumentlibrary/ITEC-Policies/ as well as with encryption standards specified in applicable state and Federal policy and law, including State of Kansas ITEC, HIPAA, HITECH, FISMA, NIST, and FIPS standards for the storage and transmission of confidential or restricted data.

4.1.08 Offer a broad network of vision providers throughout Kansas and the United States. Vendor shall maintain and adequate network of providers in the State of Kansas including independent optical providers, chain stores and retail locations. Vendor shall provide annual updates to the SEHP on changes in the provider network.

4.1.09 Complete administrative and support services for the SEHP including:Printing and mailing

ID cards, from Vendor’s card stock to each member of the program at no cost to the SEHP. Replacement cards shall also be issued at no cost to the SEHP or members. Cards must contain plan information necessary for the provider to submit claims and any other plan information directed by the SEHP.

During the course of this contract, if the Vendor’s name is changed for any reason or if other relevant information changes, is incomplete or contains errors, the Vendor must provide new ID cards for all members at the Vendor’s expense.

Benefit Descriptions must be provided to all members as needed and to new members as they become eligible for the Plan at no cost to the SEHP.

Vendors may offer employees the option to not receive paper benefit descriptions so long as they comply with the requirements of Kansas Insurance Department require for electronic documents as specified in K.S.A.40-5801.

Other required notices Complete administration, accounting, data processing, cost control, quality assurance, utilization review, marketing, claims processing, customer service, fiscal and other services related to the vision insurance.

4.1.10 Assist in a consultative capacity with regard to the benefits and provisions under the SEHP and any subsequent revisions of the SEHP design as deemed appropriate from time to time.

4.1.11 Act in an advisory capacity to the Employee Advisory Committee upon request. 4.1.12 Design communications materials as mutually agreed by the parties to be necessary to

communicate the program to participants and for use by the Commission in developing summary plan descriptions, or other program materials. Advise and assist the Commission in the preparation of forms and other documentation necessary to fulfill reporting and disclosure requirements. Vendor will also develop and mail materials for provider education as reasonably needed to ensure the smooth and efficient use of plan resources.

4.1.13 Vendor must have a minimum of five years continuous experience providing equipment/services comparable in scope and complexity to those specified in this RFP and to groups of similar size to the SEHP.



4.1.14 All products and services not specifically mentioned in this solicitation, but which are necessary to provide the functional capabilities described by the specifications, shall be included.

4.1.15 All Vendors will provide support to the SEHP in responding to information requests and fiscal notes or impact statements needed by the Legislature. Response is required within two (2) business days.

4.1.16 Vendor shall warrant that all persons assigned by it to the performance of this contract shall be employees of the Vendor (or specified Subcontractor) and shall be fully qualified to perform the work required.

4.1.17 Vendor shall commit that during the length of the contract, to provide advance written notice to the SEHP of any major conversion or related system(s) changes for the systems used to deliver services to the SEHP under this RFP. This does not apply to any program fixes, modifications and enhancements.

4.1.18 In the event of contract termination or expiration, Vendor shall provide, in a format acceptable to the SEHP and/or replacement Vendor, and at no additional cost to the SEHP and/or replacement Vendor, all reasonable and necessary materials, files and assistance to SEHP to allow for a functional transition to another Vendor.

4.1.19 Vendor will be responsible for all expenses, including travel, mileage, meals, lodging and other travel expenses incurred in the performance of this Contract.

4.1.20 Vendor agrees, if selected as a finalist, to pay reasonable transportation, lodging and reimbursement to the SEHP for up to three (3) SEHP personnel to visit the site where administrative activities for this account will occur and meet and assess the team to be assigned to this project.

4.2 Account Management4.2.01 The Account Executive and service representative(s) will deal directly with the SEHP on all

aspects of the program. The account management team must be able to devote the time needed to the account, including being available for frequent telephone and on-site consultation with SEHP.

4.2.02 The account management team must be comprised of individuals with specialized knowledge of the Vendor’s networks, claims and eligibility systems, system reporting capabilities, claims adjudication policies and procedures, administrative services contracts and relations with third parties.

4.2.03 The account management team must be thoroughly familiar with virtually all of the Vendor’s functions that relate directly or indirectly to this account.

4.2.04 The account management team must act on behalf of the SEHP in effectively advancing the interests of the State. The Account management team must be able to effectively address questions, concerns and problems through the Vendor’s corporate structure.

4.2.05 All materials, including all notices and mailings, must be pre-approved by the SEHP prior to distribution to SEHP members.

4.2.06 Each Vendor shall upon request and at no cost to the SEHP, have a representative at planning meetings, Health Care Commission meetings, Employee Advisory Committee meetings or other meetings as requested through and approved by the SEHP.

4.2.07 The account management team must be able to work within his/her organization in resolving issues of interaction with other Vendor of the SEHP to ensure that the member receives prompt and correct claims services on all platforms.

4.2.08 Provide consultation with the SEHP’s health benefits consultant concerning projecting future claims costs, developing benefit design(s) and related benefit matters.

4.2.09 Work with the SEHP as required by the legislature to develop and monitor pilot benefit programs and to report back the utilization and experience with these benefits. This may



include so none traditional benefits or services.4.2.10 Vendor shall notify SEHP of any disruption in customer service center availability or toll free or

website access regardless of the reason for disruption, as soon as the problem is identified. Failure to notify the SHEP will result in liquidated damages.

4.2.11 The SEHP reserves the right to request the removal of any individual associated with the SEHP’s account for unsatisfactory performance as determined by SEHP.

4.2.12 Vendors will establish and maintain secured e-mail communications protocols to facilitate program operations with SEHP.

4.2.13 No reports regarding this program may be published with the expressed written consent of the SEHP and the HCC.

4.3 Member Services4.3.01 Quality customer service for our members is a critical component of this contract. Important

characteristics will include promptness, courtesy and accuracy of responses. Customer service representatives (CSRs) should be able to handle questions and concerns regarding claims submissions, provider networks, utilization review, plan design, etc. Customer service should be able to troubleshoot any system issues and make appropriate referrals to others within the company to resolve any member issues. CSRs should be willing to initiate call-backs to customers when appropriate. Customer services needs to take ownership of Contractor’s decisions and respond to members concerns. Customer service is not to refer members to the SEHP, Agencies or Non-State Entities to resolve issues other than eligibility.

4.3.02 The SEHP requires a dedicated customer service team. A toll-free number must be available for eligibility certification and customer service inquiries. At minimum the toll-free number must be available between the hours of 8:00 AM and 5:00 PM Central Time, Monday through Friday.

In the event the customer service center is closed during these hours or the phone line is unavailable, the Vendor will provide the State with timely notification of the reason for the closure or disruption and estimated time to restore service or function. If the Vendor elects to close due to inclement weather, natural disasters or other business reason, they should notify the Senior Manager of Health Ops of the closing as soon as possible. Customer service will need to be staffed and ready to take calls before October 1 of the year prior to the start of the contract benefit year. Such staffing and all operational costs associated with operating the customer service center is the responsibility of the Vendor.

4.3.03 Provide Open Enrollment Support and staffing during September and October. Personnel Officer Training sessions are held in September (6-10 different sessions).

Open Enrollment meetings for employees are held between the last full week of September and the last full week of October of each year.

Open Enrollment meetings for retirees and other Direct Bill members are held in the last have of October with the Open Enrollment period running from November 1 through November 30, each year.

4.3.04 Contract will prepare the certificates of coverage for fully insured plans with the goal to have these approved by the Kansas Insurance Department (KID) prior to September 1 of each year. The SEHP must review any changes prior to filing of the changes with KID for approval by the group.

4.3.05 Certificates of Coverage must be maintained on the World Wide Web. Certificates of Coverage must be made available to eligible participants of the SEHP upon request, regardless of enrollment status.

4.3.06 Vendor shall not use the names, home addresses or any other information obtained bout participants of this plan for the purpose of offering for sale any property or services which are



not directly related to services negotiated in this RFP without the express written consent of the SEHP.

4.4 Website4.4.01 Vendor must provide to the SEHP at a minimum an integrated website that allows for secure

sign-on to all aspects of the Vendor’s services (claims, customer service, network, ancillary services, etc.)

4.4.02 The website structure, pages and content shall be available by September 1 of the year prior to the start of the contract benefit year for review and usability testing. On and after the launch date, the web structure, pages and content shall be available 24 hour per day, seven days per were except for reasonable maintenance periods.

In the event of downtime, the Vendor shall immediately notify the SEHP of the nature of the delay and the expected duration of the downtime. If possible, a notice should be posted on the website to notify users. Substantial changes to the website structure or content shall be coordinated with the SEHP staff prior to implementation.

4.4.03 Website must include a network provider search function so members can find network providers anywhere within the United States.

4.4.04 Vendor shall provide plan information such as certificates of coverages and notices that the member can access as needed, as well as claim access and payment access.

4.4.05 Website shall be ADA compliant with 508 and WC3 standards.

4.5 Claim Administration4.5.01 Vendor shall advise the SEHP with respect to claims issues and procedures. Develop

procedures for submission and payment of claims. Vendor shall, at its own expense, provide paper claim forms to members when necessary. Paper claim forms will meet all national standards.

4.5.02 Vendor is responsible for the processing and administration of all claims incurred while the coverage is in effect and during the run-out period after the contract expires. Vendor shall compute and verify the amount of benefits available for claims payment, perform coordination of benefits with other plans and have processes in place to ensure that claims are processed correctly whether primary or secondary payment is appropriate.

4.5.03 Make payment of approved claims or amounts due to Vendor’s network providers or members, as appropriate.

4.5.04 The SEHP may submit to Vendor any request it receives for review of a claim for benefits. Upon request, Vendor shall provide the SEHP with all information necessary to review claims and benefit determinations made by the Vendor.

4.5.05 Provide all levels of full and fair review of claims, claim denials and appeals made by participants. Determination of payment or denial of claims or of appealed claims shall be made by Vendor following appropriate analysis and review, which may include consultation with the SEHP. The SEHP may submit to Vendor any request it receives for a review of a claim for benefits which has been denied, in order that Vendor may provide a full and fair review of the claim. The SEHP retains the right to uphold, overturn or modify in writing any denial of a claim by Vendor.

4.5.06 Perform Coordination of Benefits inquiries and activities.4.5.07 Vendor agrees to advise the SEHP of the number and type of complaints made known to the

Vendor. 4.5.08 The SEHP has the discretion to require the Vendor to participate in any review, appeal,

hearing or litigation involving issues related to this contract.



4.6 Billing and Payment4.6.01 Vendor will bill the plan on company letterhead or official company invoice and submit the

invoice to SEHP for payment. Preference is for the bills to be sent in electronic media to designated SEHP staff. Payment will be made to the Vendor within three business days of the SEHP’s reconciliation of the invoice.

4.6.02 Bills and any supporting documents should be sent in electronic media to the designated SEHP staff. If the invoice is received on a normal business day of the State, payment will be made to the Vendor by wire transfer into the Vendor’s bank account within three business days of the SEHP’s receipt of the invoice.

4.6.03 The SEHP does not pay finder’s fees, service fees, commissions or other fee arrangements to any person or organization.

4.6.04 In the event of contract termination or non-renewal, Vendor will be responsible for processing claims during the 15-month run-out period specified by the Kansas Insurance Department. Reporting to the SEHP’s Data Management Vendor during the run-out period will be provided on the 15th of the month following the completion of the first six months of the run-out period with a final report provided on the 15th of the month following the completion of the 15-month run-out period.

Membership changes and corrections not processed during the term of the contract will continue to be processed by the Vendor during the entire 15-month run-out period.During the entire run-out period, all performance standards and liquidated damages remain in force.

4.7 Eligibility4.7.01 The SEHP will make all determinations with regard to eligibility to participate in the health

plan. The Vendor shall work quickly and efficiently to resolve all eligibility issues with the SEHP staff.

4.7.02 Vendor will receive the eligibility file from the SEHP twice each week. The Vendor will work with SEHP and the eligibility system administrator to develop an approved file format. Any modifications to the file format must be pre-approved by SEHP before implemented by the Vendor.

4.7.03 The SEHP and the Vendor must agree on the eligibility file layout. Any requests to modify this layout must be approved by the SEHP. The standard 834 layout is preferred but the SEHP will work with the Vendor to establish the eligibility file layout to be used.

4.7.04 Vendor must be able to accept eligibility information on daily change files or daily full files in the agreed upon layout.

4.7.05 Vendor must be able to retrieve the change-only eligibility files from the SEHP secure FTP site daily. Files will be placed on the FTPP site by 11:00 AM Central Time every Monday and Thursday unless Vendor is otherwise notified of a schedule change. Vendor must notify SEHP administrative staff within twenty-four (24) hours if information on the file received is incomplete or unreadable. Vendor will provide eligibility load reports to the SEHP Membership staff in a timely manner.

4.7.06 Vendor is responsible for establishing, maintaining and accurately updating eligibility records. Vendor agrees to process enrollment additions, changes and deletions within two (2) business days of the release date of the file. Eligibility files sent correctly by the SEHP staff but not processed correctly by the Vendor will be retroactively corrected back to the original effective date, even if the correction occurs more than sixty (60) days following the date of the original changes. Vendor will provide eligibility load reports to the SEHP staff within twenty-four (24) hours of file processing.

4.7.07 If regularly receiving change files, Vendor shall receive a monthly full file eligibility file for the



comparison purposes. SEHP may change the delivery schedule of the full file with notice to the Vendor. Vendor shall compare the full file with their eligibility records and provide the SEHP with a mismatch and reconciliation reports within ten (10) business days of receipt of file. Incomplete or unreadable information must be reported to the SEHP within twenty-four (24) hours. Once this report has been reviewed by SEHP Membership staff, the vendor may be directed to modify, terminate or add members as need to bring the eligibility in to alignment.

4.7.07 Vendor shall notify SEHP of any enrolled persons who, to the knowledge of the Vendor, do not appear to meet the eligibility criteria set forth by the SEHP. SEHP will research and make final determination on eligibility.

4.7.08 Reporting and Eligibility tracking on the following membership divisions:o State Of Kansaso Non State Entities

4.8 Data, Reporting and Integration4.8.01 Vendor agrees to exchange data with SEHP using SEHP’s secure FTPP server (passive

mode FTP/SSL, RFC 4217). Vendor shall pick up eligibility files from the SEHP’s FTP site. Details available on request.

4.8.02 Vendor shall provide SEHP such claim and/or statistical information as needed for plan operation or to respond to requests from the Health Care Commission or required for research or legal reasons.

4.8.03 Vendor shall provide complete and accurate paid monthly claims files in the format specified by the SEHP. Files will be submitted to the data management Vendor prior to the tenth (10 th) of the month following the end of the month being reported. A copy of the current required file layout is located as Exhibit 8A.The SEHP is anticipating some file layout changes in the future but these changes will be provided to the vendors in a timely manner to allow adequate time for programming. Vendor agrees to:

Provide enrollment, claims, and utilization data to the data management vendor in a format specified by the SEHP with the understanding that the data shall be owned by the SEHP and may be used or shared with other parties as needed to meet the business objectives of the SEHP.

Provide data in an electronic form through secure means and within the time frame specified by the SEHP.

Place no restrictions on the use of the data, provided the SEHP and data management Vendor have in place procedures to protect the confidentiality of the data consistent with HIPAA requirements.

Costs associated with changes to data formats supplied to the data management Vendor that are Vendor initiated, are paid by the Vendor. Cost associated with the reprocessing of files due to lateness, incompleteness or inaccurate submission to the data management Vendor will be paid by the Vendor. These costs are in addition to any performance standard and liquidated damages that may apply.

SEHP agrees to: Put in place policies and procedures to protect the confidentiality of the data consistent

with HIPAA requirements; Costs associated with changes in data formats resulting from regulatory changes or

changes in Data Management Vendor will be shared as determined by the SEHP.



4.8.04 Vendor coordination and cooperation: The SEHP contracts with several vendors to meet the needs of the SEHP. All Vendors are deemed partners and are expected to share information and data with one another to achieve a cohesive member experience for claims processing across all lines of business. These may include but not be limited to:

Vendor agrees to exchange data feeds with other Vendors of the SEHP as required to advance the program integration of the SEHP. This may include but is not limited to wellness and transparency tool Vendors.

Submit complete, accurate and timely data feeds to the SEHP data warehouse vendor on behalf of the SEHP.

Copies of files currently shared with other vendors include: Exhibit 9- Vision Plan to FSA File Specs

4.8.05 If requested by the SEHP, Vendor must supply any spreadsheets, calculations, formulas and information used to support any (1) rate requests and/or (2) Program recommendations.

4.8.06 Prepare and file Form 1099 with the Internal Revenue Service of the United States Department of the Treasury and send separate statements to providers of services furnishing information, as required by the Internal Revenue Code and Regulations there under, regarding amounts paid to those providers on behalf of the program.

4.8.07 In a format acceptable to and/or in a format defined and designated by the SEHP, the SEHP shall be entitled, at no cost and in a timely manner, to all data and written or recorded material pertaining to this contract, except as may be precluded by applicable federal or state law privacy restrictions.

4.8.08 Vendor will work with SEHP account team to develop meaningful reporting, making modifications to report structures and contents as necessary to meet the needs of SEHP.

4.8.09 In the event that the SEHP terminates this contract and moves to another vendor, the vendor is expected to cooperate in the transition process. As part of this transition, the vendor shall timely provide at no cost and in a format approved as acceptable to the SEHP all data and materials necessary to transition the plan services to another vendor with minimal member disruption. All data transfers shall be in accordance with applicable federal or state law privacy restrictions.

4.9 Right to Audit

4.9.01 Vendor must agree to the SEHP or its designated representatives, the right to audit all claims, and any other administrative programs or information relevant to this account. The audit shall also entail a review of the Vendor’s records to determine whether the service and financial performance guarantees were achieved. Vendor agrees to reasonably cooperate in having any such audit conducted and to provide all data necessary for the audit.

4.9.02 Vendor must cooperate with the audit process as needed for the auditors to complete their functions. A signed confidentiality agreement may be required between Auditor and Vendor as long as such agreement also complies with the Kansas Open Records Act.

4.9.03 Requested claim data will be provided in an industry-standard format within 15 business days of the request.

4.9.04 Copies of all Vendor documents and records requested will be provided within 15 business days of the request.

4.9.05 Auditor requested meetings with Vendor are to be scheduled within 10 business days of receiving the request. Meetings that are cancelled at the Vendor’s request must be rescheduled within 10 days of the original meeting date.

4.10.06 Denial of requests for documents or data related to SEHP business, the failure to allow the



SEHP or selected sub vendor, to conduct an audit, or the failure to provide the information requested in the time-frame established are grounds for immediate contract termination.

4.10.07 Vendor will research discrepancies identified by the auditor and report the results of this research within 15 business days of the identification of the discrepancies.

4.10.08 All monies owed to the SEHP as a result of an audit shall be paid within 30 days of agreement between SEHP and the Vendor of the amount owed. If the Vendor fails to adhere to this timeframe, the SEHP shall be eligible to receive liquidated damages due to the Vendor’s failure to pay.

.


I have reviewed the Scope of Work associated with the Request for Proposal, and acknowledge that the document shall become part of the final contract. I hereby acknowledge and accept all of the provisions, requirements, and conditions stated in this section of Request for Proposal, subject to the modifications, conditions and limitations I have listed below.

_________________________________________________Authorized Signature of Vendor


_________________________________________________ Title

_________________________________________________



SECTION VQuestions

The questions in all subdivisions of Section V should be answered by all vendors. If you believe that a particular question is not applicable to the services you are bidding, please briefly explain why.

5.1 Implementation and Transition 5.1.1 Provide a proposed implementation plan that includes both a project overview

and details on specific tasks, timeliness and responsibilities. Clearly delineate the tasks you expect the State to perform and the information you expect the State to provide. At a minimum, address the following:

Training Key Staff Detailed benefit set up Testing of eligibility files and eligibility logic Date to begin receiving eligibility files ID card production and distribution Prepare Certificates of Coverage Develop Open Enrollment materials for approval by the State of Kansas Training of Customer Service representatives Provider communications regarding plan designs and expectations

Answer:5.1.2 If the implementation coordinator and on-going account manager will be two

different people, describe how they work together during the process and the procedures for transfer of responsibility.

Answer:5.1.3 If selected as a finalist, will the implementation coordinator and designated

account management team be part of the team present for the interview? Why or why not.

Answer:5.1.4 Discuss planned procedures and schedule to have the Customer Service unit in

place and trained to receive calls by mid-September prior to the start of the contract year?

Answer:5.1.5 State what records, belong to the State upon contract termination.Answer:5.1.6 In the event of contract termination, when would records that are property of the

plan be released to the party or organization designated by the State? Describe your termination notice requirement.

Answer:

5.2 Customer Service 5.2.1 Will you provide dedicated customer service to the State? If so, where will this

unit be located and what are the hours of operation? Will this account be the only client served by this dedicated unit? Where will this unit be located?



Answer:5.2.2 What are your normal customer service hours? The State requires a minimum of

Customer Service access from 8:00am to 5:00pm Central time, Monday through Friday. Will you be able to meet this minimum?

Answer:5.2.3 How does your organization handle after-hours and weekend customer service

calls? Can plan participants submit questions via a secured e-mail or web location?

Answer:5.2.4 Do Customer Service representatives have online access to real-time claim

processing information from all sources?Answer:5.2.5 Do you use an automated phone system? If yes, does the menu or options

include talking to a ‘real person’ or CSR?Answer:5.2.6 Does your CSR system support TTY/TDD technologies?Answer:5.2.7 Can participants access their own or their covered dependents claim utilization

histories, including coinsurance and out-of-pocket accumulators? For what period of time are these histories available? Do the utilization profiles for each participant show billed charges, allowed charges, member responsibility, plan payment and any discounts?

Answer:5.2.8 Describe the procedure for live recording of Customer Service calls and how

long are they retained?Answer:5.2.9 Describe the procedure for retrieving recorded Customer Service calls.Answer:5.2.10 How frequently are Customer Service calls monitored by a team lead? Describe

the procedure for CSR feedback by the team lead.Answer:

5.3 Complaints and Grievances 5.3.1 Describe your organization’s procedures for handling customer service

complaints.Answer:5.3.2 Provide a detailed description of the grievance and appeals process for benefits

provided by your organization.Answer



:5.3.3 Describe the appeals procedures and time frames that a member would follow.Answer:5.3.4 What is the policy and procedure for ‘escalated’ calls – those referred to a

supervisor or manager?Answer:

5.4 Member Communications 5.4.1 Provide a copy of all written materials to be used in administering the vision plan. Answer:5.4.2 Will you be able to provide personnel who will attend potential open enrollment

meetings?Answer:5.4.3 Does your organization’s CSR and communications system support Spanish

speaking participants?Answer:5.4.4 Describe your procedures and time frame to prepare for open enrollment.

Indicate how long it will take to print and distribute benefits literature, and membership cards.

Answer:5.4.5 As requested by our employees, the State has adopted certain language

standards for our plan documents to ensure that words are spelled and used the same way with the same meaning. Describe the procedures you have in place to accommodate these language standards.

Answer:

5.5 Claims Administration If claims will be administered by more than one service provider for different lines of business, please specify and respond to these questions for all areas or lines of business.

5.5.1 From what city will claims be administered?Answer:5.5.2 Describe your company’s performance standards with respect to:

Employee inquiries (both written and telephonic) Claims turnaround times Claims accuracy Timeliness of grievance process Financial accuracy

Please indicate your actual performance during the 2016 calendar year in attaining these standards. Are these standards measured on a client specific, claims-office specific, regional, or other basis? Provide all formulas used to derive these numbers.

Answer:5.5.3 Who submits a claim for network services? Answer:



5.5.4 Who submits a claim for out of network services? To whom is payment made?

Answer:5.5.5 Can a claims processor or customer service representative view historical

claims information online?Answer:5.5.6 Describe your company’s quality assurance and internal audit procedures and

programs. Are you willing to provide the client with quarterly audit reports on its claims?

Answer:5.5.7 What percent of claims are auto-adjudicated? Specify the types of claims that

require manual processing. Discuss in detail the extent to which you will require manual intervention to effectively and accurately process claims, based on the current plan design.

Answer:5.5.8 Can your claims system administer varying copayments on different services? Answer:5.5.9 How does your organization determine usual, customary and reasonable

charges for network providers? Answer this question in specific detail by area (Kansas, national, worldwide). How often is this data updated?

Answer:5.5.10 How does your organization determine usual, customary and reasonable

charges for non-network? Answer this question in specific detail by area (Kansas, national, worldwide). How often is this data updated? Is there any fee reduction applied to non-network claims? If so, explain.

Answer:5.5.11 Submit a sample of your proposed claim and Explanation of Benefits (EOB)

forms. Please distinguish the types of EOBs available/used. Would you be willing to customize the information contained in these forms?

Answer:5.5.12 Provide samples of claim utilization and payment reports that are available.

Describe the ad hoc reporting capabilities of your organization. It is requested that all reporting requirements be included in your premium quote.

Answer:5.5.14 Explain how hold-harmless provisions and network agreements are enforced

with providers.Answer:5.5.15 Describe the processes by which claims are reviewed for fraud and abuse.

What types of claims are generally screened for potential fraud/abuse issues? Explain the review process for both provider and member fraud or abuse.

Answer:

5.6 Eligibility/Membership Processing 5.6.1 Explain how data is entered into your eligibility system. Provide a data flow

diagram of the process to receive, audit and load eligibility datasets including indication of whether the diagram refers to a current or proposed system. If proposed, the proposed implementation date should be included.

Answer:5.6.2 Can your system produce an error report that indicates records which have

been accepted and those that have been rejected? Will you provide such



reports following each eligibility transmission? If so, provide a sample report.Answer:5.6.3 Discuss the staffing and capabilities of your information systems team that

would be responsible for managing data for the proposed plan.Answer:5.6.4 How soon after receiving eligibility data would any updates be reflected in your

eligibility system?Answer:5.6.5 Provide a copy of your preferred eligibility file layout. Answer:5.6.6 Do you have the capability for SEHP staff to access your claims and eligibility

system through a secure on-line system? Answer:5.6.7 Does your system handle member files as opposed to subscriber files? Provide

samples of “per member” utilization reports which reflect this capability. Answer:5.6.8 Will you agree to follow the State’s guidelines for eligibility and reinstatement of

coverage? How will eligibility be verified? Answer:5.6.9 Can your system process eligibility files with multiple transaction rows for one

participant?Answer:5.6.10 Describe your process for generating ID numbers for members. Under no

circumstances may the Social Security Number be used for the plan Identification Number.

Answer:5.6.11 Describe your reporting capability. Provide current samples of utilization and

administrative performance reports available. How often are these reports prepared?

Answer:

5.7 Systems Backup and Disaster Recovery 5.7.1 Describe mechanisms in place for systems backup? Do these procedures vary

by system (i.e. claims versus membership versus customer service inquiries)?Answer:5.7.2 Describe the mechanisms in place for disaster recovery.Answer:

5.8 Web Access 5.8.1 Does your plan have established standards for web access? Please describe in

detail.Answer:5.8.2 Describe in detail your internet capabilities for:

Member inquiry capabilities Employer/Consultant inquiry capabilities Providers



Future plans/timeframes for enhancements.Answer:5.8.3 How do you maintain a secure environment for communicating and transacting

business with each audience (members, providers, plan sponsors)? Answer:5.8.4 Do you have the capability and willingness to create a personalized web

experience (content and transactions), at no additional cost, for the State of Kansas?

Answer:5.8.5 How do you ensure that the personalized web page is user friendly and meeting

the needs of plan members and administrators?Answer:5.8.6 Can members send questions and inquiries to Customer Service via secure web

or internet?Answer:5.8.7 Provide your web address and a web address of a customized/personalized

employer site. Describe the features available.Answer:5.8.8 Has your website been tested for ADA compliance with 508 and W4C

standards? Answer:

5.9 HIPAA Section (These questions must be answered by all Vendors.)5.9.1 Please confirm your compliance with HIPAA privacy and security rules for data

transferred to outside parties. If you cannot confirm, please explain below.Answer:

5.10 Network 5.10.1 Is the network proposed for this project leased or owned or a combination? If a

combination, what percent is leased and what percent is owned? If any portion of the network is leased, discuss the impact this has on preauthorization, quality assurance and hold harmless arrangements. If leased, provide the name of the organization and the amount your organization pays for leasing its network. Will your firm agree to performance guarantees relating to the operation of the subcontracted organization? Disclose any and all network access or related fees in the cost proposal.

Answer:5.10.2 Please describe in detail any restrictions or exclusive requirements for offering

your network. Are there any differences, in terms of premiums, fees or negotiated provider arrangements, based on varying degrees of restriction or exclusivity?

Answer



:5.10.3 If your organization’s network is not adequate to provide the access and services

described herein, discuss the process you will follow in expanding the network. How much expansion do you anticipate? Provide a timeframe for accomplishing these tasks and attach performance guarantees with proposed liquidated damages to be included in the contract for network development.

Answer:5.10.4 Provide a detailed description of your process for credentialing and re-

credentialing network vision care providers. Do you independently verify licenses, board certificate, etc.? Do you obtain peer evaluation as a part of the credentialing and re-credentialing process? In the credentialing process, how do you assure that a practitioner will make an adequate portion of his practice available to participants? Confirm any requirements relating to ownership of dispensing facilities and inventory levels.

Answer:5.10.5 What minimum periods are included in your vision care provider contracts

concerning: Provider’s notice to not accept new patients? Provider’s intent to terminate? Vendor’s intent to terminate? Provider’s required continuation of care to existing network patients?

Answer:5.10.6 What is the average annual turnover of participating practitioners? What has

been your provider turnover rate for each of the past three years?Answer:5.10.7 Describe the growth of your network over the past three years and if there are

plans for future development of the network.Answer:5.10.8 Will you agree to notify the contract holder immediately if the network, or any

part thereof, loses any accreditation, licenses or liability insurance coverage, security or bonding or the capacity to service the State of Kansas enrollment?

Answer:5.10.9 Network accessibility and provider disruption is a key concern. Completion of

Exhibit 6-Regional Access Chart is required to allow for comparison of networks across vendors. Please do not respond with the GEO-Access Report. For each network proposed, list the number of providers by type and by county.

Answer:5.10.10 Can you guarantee access to Walmart?Answer:5.10.11 Do you have mail order contacts and lenses available in your network?Answer:5.10.12 Are providers free to select the optical lens providers of their choice? Do you

have any requirements in your contracts that would limit their ability to use



providers or hardware of their choice? Explain.

5.11 Benefits Management5.11.1 How do you determine medical necessity for contact lenses?Answer:5.11.2 Describe the types of frames that would be provided with no member out of

pocket from network providers. If there is a limitation by brand name, include the brand name.

Answer:5.11.3 Are costs and discounts calculated on a wholesale or retail basis?Answer:5.11.4 Are any network providers required to maintain a certain inventory level and

variety of frames? If there are different requirements for some providers, please explain.

Answer:5.11.5 Are there any restrictions placed upon the network provider that a plan

participant may select? Answer:5.11.6 Do you allow network provider to substitute a more costly frame or lens if the

plan participant is willing to pay any additional cost out of pocket?Answer:5.11.7 Can a plan participant receive an exam from one provider and materials (frames,

lenses, or contacts) for another provider?Answer:5.11.8 Describe any additional vision discount program(s) available under your

program.Answer:5.11.9 What percentages of providers in your network in the State of Kansas are at full

capacity or are not accepting new patients?Answer:5.11.10 Can plan participants nominate certain providers to be included in the network?

Explain how this process works.Answer:




This section of the Request for Proposal has been reviewed by me and shall become part of the final contract by reference. I hereby acknowledge and accept responsibility for the accuracy of all responses, requirements, and conditions stated in this section of Request for Proposal, subject to the modifications, conditions and limitations I have listed below.

________________________________________________________Authorized Signature of Vendor

________________________________________________________Printed Name of Signatory

________________________________________________________Title

________________________________________________________Date



SECTION VI

PERFORMANCE STANDARDS, GUARANTEES, LIQUIDATED DAMAGES

LIQUIDATED DAMAGES – Failure to meet Performance Requirements

The purpose of liquidated damages is to ensure adherence to the performance requirements in the contract. No punitive intention is inherent. It is agreed by the State and the Vendor that, in the event of a failure to meet the performance requirements listed below, damage shall be sustained by the State, and that it is and shall be impractical and extremely difficult to ascertain and determine the actual damages which the State shall sustain in the event of, and by reason of, such failure; and it is therefore agreed that the Vendor shall pay the State for such failures at the sole discretion of the State according to the following:

Damages assessments are linked to performance of system implementation or operational responsibilities. Where an assessment is defined as an ‘up to “$,$$$” amount, the dollar value shall be set at the discretion of the State.

For all self reported metrics, Vendor will include a check for liquidated damages as specified, with the report due for the metric. Written notification of each failure to meet a performance requirement that is measured by the SEHP shall be given to the Vendor prior to assessing liquidated damages. The Vendor shall have five (5) business days from the date of receipt of written notification of a failure to perform to specifications to cure the failure. However, additional days can be approved by the SEHP Contract Manager if deemed necessary. If the failure is not resolved within this warning/cure period, liquidated damages may be imposed retroactively to the date of failure to perform. Late reports will incur additional liquidated damages to the state. Liquidated damage amounts will double for each five (5) business days that a report is delayed. The imposition of liquidated damages is not in lieu of any other remedy available to the State.

If SEHP elects to not exercise a damage clause in a particular instance, this decision shall not be construed as a waiver of the State’s rights to pursue future assessment of that performance requirement and associated damages.

6.1 PERFORMANCE GUARANTEES: The following requirements are areas where the Vendor will guarantee performance for each plan offered. Failure to meet the required standards will result in the liquidated damages. Prompt resolution of problems or issues is expected but will not reduce or eliminate any liquidated damages imposed due to failure to meet the performance standards outlined below.

Liquidated Damages may be enforced by reducing the administrative fees or other amounts owed to the Vendor. Some items will require the Vendor to supply a recommendation. Proposal must include Vendor recommendations regarding liquidated damage amounts for each incident with an annual maximum for each performance standard for discussion during negotiations.

If there are other performance standards that your company has in place with other clients, please provide the language and guarantees that are used.

Service Performance Standards Liquidated DamagesAnnual Guarantee

6.1.1 Implementation:(a) Membership Tape testing protocols completed October

1, 2018.$2,000 per incident



Service Performance Standards Liquidated Damages(b) ID cards mailed to members by December 26 of each

year that ID cards are issued to all members.(c) Certificate booklets completed by September 15 of each

year.(d) Customer service center with trained representatives and

toll free number must be open for members to call by September 15, 2018.

(e) Customized communications for Open Enrollment completed by September 1 of each year, contingent upon staff having the final draft back to carrier by August 15.

$1,000 per incident

$1,000 per incident

$1,000

$1,000 per incident

6.1.2 Network Access: The provider network available for SEHP plan members shall not decrease by more than 5% in any of the six regions in Exhibit 6.

$500 per region per year

Claims Processing6.1.3 Claims Processing Time: Turn-around-time (TAT) Claims

processed within:(a) Ninety-five (95) percent within fourteen (14) business

days(b) Ninety-nine (99) percent within thirty (30) business daysTAT is measured from the date a claim is received by the administrator (either via paper or electronic data interchanges) to the date it is processed for payment, denied, or pended for external information.

$500 per calendar quarter


6.1.4 Claims Processing Accuracy: Quality review checking: A statistically valid internal audit sample to yield results at the ninety-five (95) percent confidence level will be taken of all State of Kansas Health Plan claims each quarter and reviewed for accuracy (financial and statistical)

(a) Financial Payment: Accuracy of paid benefit dollars equals Ninety-nine and a quarter (99.25) percent of State of Kansas Vision Plan paid benefit dollars. The formula to measure financial accuracy will be: (Claims paid in the sample less Overpayments plus Underpayments) less (Overpayments plus Underpayments) divided by (Claims paid in the sample less Overpayments plus Underpayments)

(b) Claims processing (total) accuracy: Incidence of claims processed without any error equals Ninety-seven (97) percent. Calculated as the total number of audited claims minus the number of claims processed with error, divided by the total number of audited claims. Definition of ‘error’ includes any type of error (coding, procedural, system, payment, etc.), whether a payment or non-payment error. Each type of error is counted as one full error and no more than one error can be assigned to one claim.



Customer Service



Service Performance Standards Liquidated Damages6.1.5 Customer Service for the State of Kansas Plan:

(a) First call resolution rate: Ninety (90) percent of calls are handled to conclusion on first call. Percentage of calls that are completed on first call. Measured by the number of calls that are completed without need for referral or follow-up actions, divided by the total number of calls received.

(b) Open Call Resolution Turn-around-time: One hundred (100%) of calls that require follow-up or research will be resolved within forty-eight (48) hours. Measured by the percent of open calls resolved in 2 number of business days.

(c) E-mail response: One hundred (100) percent of emails responded to within five (5) business days

(d) Call Center Access: Toll-free telephone access to customer service center available between 8:00 a.m. and 5:00 p.m., Central Time, Monday through Friday, except for legal holidays or notice to SEHP has been provided of closing due to weather or other issues.

(e) Notice of Service Disruption: Vendor shall notify SEHP of any disruption in customer service center availability or toll free access regardless of reason for disruption, as soon as the problem is identified. Failure to notify SEHP of the problem will result in liquidated damages.





$500 per incident

6.1.6 Website Availability: The website structure, pages and content shall be available no later than September 15, 2018 and continuously thereafter. In the event of downtime, the Vendor shall immediately notify the SEHP of the expected duration of the downtime and post a notice on the website, if possible. The Vendor will notify the Contract Manager in SEHP of any substantial changes being made to the website prior to implementation.

$500 per incident

6.1.7 Website Accuracy: The website information and provider directories shall be updated at a minimum bi-weekly to provide members the most up to date and accurate benefit and provider information.

Accuracy in provider directory listings will include:(a) New providers added within ten (10) business days of

the effective date as a plan provider.(b) Deceased, retired providers and closed offices or

practices are to be removed within fifteen (15) business days of notice.

$500 per incident of inaccurate or out dated information



Service Performance Standards Liquidated Damages(c) Information regarding providers accepting new patients

or established patients only must be accurate.

Account Management6.1.8 Service to State of Kansas Contract Management

Team:(a) One hundred (100) percent of calls returned by account

service representative by 5:00 p.m. on the next business day.

(b) One hundred (100) percent of issues received by phone call or email resolved within three (3) business days of receipt.

(c) Respond to one hundred (100) percent of written inquiries within five (5) business days.

$250 per incident

$500 per incident

$250 per incident

6.1.9 Participant Inquiries:If a participant has a claim or other issue with a provider or Vendor that they have made a good faith effort to resolve with the Vendor and are unable to resolve the matter, the Vendor will be assessed liquidated damages of $250 for each instance where the staff of SEHP becomes involved in the investigation and/or resolution of the problem and finds that error lies on the part of the Vendor. This provision shall only apply if the participant has previously contacted the Vendor and the Vendor has had the opportunity to address the problem.

$250 per incident

6.1.11 Money Owed to the State of Kansas: Money owed to the State of Kansas shall be paid within thirty (30) calendar days from determination of Liquidated damages or monies owed, for all self reported measures and within thirty (30) calendar days from notification by SEHP staff for staff measured performance standards. Vendor has thirty (30) calendar days to document any dispute of amounts owed. Amounts owed that are not received within thirty (30) calendar days will be subject to liquidated damages of $25 per day until paid. After thirty (30) days, SEHP may collect owed funds by deducting the amounts from the administrative fees or other payments made to the Vendor.

$25 per day will be added until payment is received by SEHP

6.1.12 Approval of Materials: All materials must be pre-approved by SEHP prior to distribution to members of the State of Kansas Health Plan.

$1,000 per incident

6.1.13 Solicitation of Members: The Vendor shall not use the names, home addresses or any other information obtained about members of this plan for the purpose of offering for sale any property or services that is not directly related to the services negotiated in this RFP without the express written consent of the State Employee Health Benefit Plan

1 – 100 sent $1,000101 – 500 sent $2,000501 – 1,000 sent $3,0001,001 – 5,000 sent $5,0005,001 – 10,000 sent $10,000



Service Performance Standards Liquidated Damagesstaff. Over 10,001 sent is

$25,0006.1.14 Legislative Requests: Vendor will provide support to the

Commission and SEHP staff in responding to information requests made by the Legislature. Responses to Legislative Requests are due to the SEHP staff within forty-eight (48) hours of the request. If a 48 turnaround time is not accessible notification to the SEHP staff should be notified to discuss other options.

$500 per incident

Data Management6.1.15 Identification Cards: Vendor will mail ID cards as

appropriate within five (5) business days following the date of the bi-weekly eligibility file.

Vendor will mail certificates of coverage and other plan materials to the home of each member within five (5) business days of the weekly eligibility file unless the member has opted to use electronic media per Kansas Insurance Department protocols as specified in K.S.A.40-5801.

$200 per incident

$200 per incident

6.1.16 Daily Eligibility File: The Vendor agrees to process enrollment additions, changes, and deletions correctly within two (2) business days of the generation date of the file. Vendor must notify SEHP within twenty-four (24) hours if information received is incomplete or unreadable.

Additions, changes, and deletions sent correctly by the SEHP but not processed correctly by the Vendor will be retroactively corrected back to original date, even if correction occurs more than sixty (60) days following date of the membership change.

$1,000 per incident

6.1.17 Comparison Eligibility File: SEHP will periodically send a full eligibility file on a predetermined schedule. This schedule may change based on SEHP needs with notice to the vendor. Currently monthly by the second Thursday of the month.

Vendor shall not load this file. Vendor will compare files to their membership database and provide an enrollment mismatch report to the SEHP within ten (10) business days of the creation date of the full file.

SEHP will respond with information to make corrections in Vendor’s membership system. Vendor will make needed corrections within ten (10) business days of receipt of information. Premium and claims adjustments will be made by the Vendor and reported to the SEHP. Incomplete or unreadable information must be reported to the SEHP within twenty-four (24) hours.

$1,000 per mismatch report not received.

$1,000 per mismatch report not received.

$1,000 per correction not completed within the timeframe.



Service Performance Standards Liquidated Damages6.1.18 Monthly Claims Files: Vendor will provide complete and

accurate paid monthly claims files in the format specified by SEHP’s claims database Vendor with the understanding that the data shall be owned by the Office of the SEHP. The Vendor will place no restraints on the use of the data provided the office of SEHP has in place procedures to protect the confidentiality of the data consistent with HIPAA requirements. The claims files will contain the data elements and file layout as agreed upon between the Commission’s Data Management contractor and the Vendor. Files will include capitated/encounter claims. The files will be submitted electronically to the Commission’s Data Management contractor in a layout and method determined acceptable to the database contractor. Files must be received by the fifteenth (15th) of each month.

Incorrect File Layout: The database contractor will notify SEHP if the Vendor’s

files were submitted in an incorrect or incomplete file format. Health Benefits or the database contractor will request a new file in the proper format from the Vendor and liquidated damages will be assessed.

Unauthorized Changes: In addition to the liquidated damages described above, the

Vendor will pay any applicable fees assessed by the SEHP’s claims database Vendor due to any unauthorized changes made to an already agreed upon file layout that are initiated by the Vendor or due to complying with new regulations.

Incomplete Files: The database contractor will notify Health Benefits if the

files submitted are incomplete or inaccurate. The database contractor will request a new file. If the new file is submitted within two (2) business days of notification of the incomplete/inaccurate file, no liquidated damages will be assessed. If the new file is submitted more than two (2) business days after notification, liquidated damages will be assessed per incident. In all cases, Vendor will be responsible for the cost of reprocessing the replacement files.

$1,000 per incident

$1,000 per incident plus Vendor pays the database Vendor reprocessing fee.

$1,000 per incident plus Vendor pays the database reprocessing fee.

$1,000 per incident plus Vendor pays the database reprocessing fee.

$500 per incident6.1.19 Personal Health Information: If a Contractor transmits

Personal Health Information (PHI) using non secure transmission protocols such as an unencrypted email or a breach in security results in PHI of State members being released or obtained by others, the carrier will be subject to penalty. This penalty will apply in addition to any other penalties or requirements of law and provisions of this

$150 per member PHI record to a maximum of $15,000 per incident.



Service Performance Standards Liquidated Damagescontract.

6.2 Reporting : A reporting format for the performance standards is attached as Exhibit 8A. Please use this format to report performance on a quarterly basis.


The Performance Guarantee and Liquidated Damages section of the Request for Proposal has been reviewed by me. I hereby acknowledge and accept all of the provisions, requirements, and conditions stated in this section of Request for Proposal, subject to the modifications, conditions and limitations I have listed below.

________________________________________________________Authorized Signature of Vendor

________________________________________________________Printed Name of Signatory

________________________________________________________Title

________________________________________________________Date