HomeMy WebLinkAboutExhibit 1PROFESSIONAL SERVICES AGREEMENT
By and Between
The City of Miami, Florida
and Humana Dental Insurance Company and CompBenefits Company
This Professional Services Agreement ("Agreement") is entered into this day of
, 2011 by and between the City of Miami, a municipal corporation of the State of
Florida, whose address is 444 S.W. 2nd Avenue, 10th Floor, Miami, Florida 33130 ("City"), and
Humana Dental Insurance Company and CompBenefits Company, ("PROVIDER") a Florida
Corporation qualified to do business in Florida whose principal address is 3401 S.W. 160th
Avenue, Miramar, FL 33027.
RECITALS:
WHEREAS, the City of Miami issued a Request for Proposal No. 273288 on October 6th,
2011 (the "RFP" attached hereto, incorporated hereby, and made a part of as Exhibit A) for the
provision of Employee Group Benefit Dental Plan, ("Services" as more fully set forth in the
scope of work "SOW" attached hereto as Exhibit B) for the Risk Management Department and
Provider's proposal ("Proposal", attached hereto, incorporated hereby, and made part of hereof
as Exhibit C), in response thereto, has been selected as the most qualified proposal for the
provision of the Services.
WHEREAS, the Evaluation Committee appointed by the City Manager determined that
the Proposal submitted by the Provider was responsive to the RFP requirements and
recommended that the City Manager negotiate with the Provider; and
WHEREAS, the City wishes to engage the Services of Provider, and Provider wishes to
perform the Services for the City; and
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WHEREAS, the City and the Provider desire to enter into this Agreement under the terms
and condition set forth herein.
NOW, THEREFORE, in consideration of the mutual covenants and promises herein
contained, Provider and the City agree as follows:
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TERMS:
1. RECITALS AND INCORPORATIONS; DEFINITIONS:
A. The recitals are true and correct and are hereby incorporated into and made a part
of this Agreement. The City's RFP is hereby incorporated into and made a part of this
Agreement and attached hereto as Exhibit "A". The Services are hereby incorporated into and
made a part of this Agreement as attached Exhibit "B". The Provider's Response dated, October
18th, 2011, is hereby incorporated into and made a part of this Agreement as attached Exhibit
"C". The Provider's Insurance Certificate is hereby incorporated into and made a part of this
Agreement as Exhibit "D". The order of precedence whenever there is conflicting or inconsistent
language between documents is as follows: (1) Provider's Professional Services Agreement
("PSA") with the Scope of Work; (2) Addenda/Addendum to the Request for Proposals; (3)
Request for Proposals; and (4) Humana Dental Insurance Company and CompBenefits
Company, response to the Request for Proposals.
2. TERM:
The initial term of this Agreement shall commence on the January 1, 2012 and shall
continue in effect for a term of three (3) years ending on December 31,2014.
3. OPTION TO EXTEND:
The City , acting administratively through its City Manager, shall have two (2) option(s)
to extend the term hereof for a period of one (1) year each, subject to availability, allocation and
appropriation of funds and satisfactory performance by the Provider in the opinion of the City
Manager. The City shall exercise its right to extend the term hereof by giving Provider at least
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thirty (30) days written notice prior to the expiration of the previous term. City Commission
approval shall not be required as long as the total extended term does not exceed two (2) years.
4. SCOPE OF SERVICES:
A. Provider agrees to provide the Services as specifically described, and under the
special terms and conditions set forth in Exhibit "A" hereto, which by this referenceis
incorporated into and made a part of this Agreement.
B. . Provider represents to the City that: (i) it possesses all qualifications, licenses and
expertise required for the performance of the Services, including but not limited to full
qualification to do business in Florida; (ii) it is not delinquent in the payment of any sums due
the City, including payment of permits, fees, occupational licenses, etc., nor in the performance
of any obligations to the City, (iii) all personnel assigned to perform the Services are and shall
be, at all times during the term hereof, fully qualified and trained to perform the tasks assigned to
each; (iv) the Services will be performed in the manner described in Exhibit "A"; and (v) each
person executing this Agreement on behalf of Provider has been duly authorized to so execute
the same and fully bind Provider as a party to this Agreement.
C. Provider shall at all times provide fully qualified, competent and physically
capable employees to perform the Services under this Agreement. City may require 'Provider to
remove any employee the City deems careless, incompetent, insubordinate, or otherwise
objectionable and whose continued services under this Agreement is not in the best interest of
the City.
5. COMPENSATION:
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A. The amount of compensation payable by the City to the Provider shall be based
on the rates and schedules described in Exhibit "E" hereto, which by this reference is
incorporated into and made a part of this Agreement.
B. Payment shall be made in arrears based upon work performed to the satisfaction
of the City within forty-five (45) days after receipt of Provider's invoice for Services performed,
which shall be accompanied by sufficient supporting documentation and contain sufficient detail,
to allow a properaudit of expenditures, should the City require one to be performed. Invoices
shall be sufficiently detailed so as to comply with the "Florida Prompt Payment Act", §218.70. -
218.79, Florida Statutes, and other applicable laws. No advance payments shall be made at any
time.
C. Provider agrees and understands that (i) any and all subcontractors providing
Services related to this Agreement shall be paid through Provider and not paid directly by the
City, and (ii) any and all liabilities regarding payment to or use of subcontractors for any of the
Services related to this Agreement shall be borne solely by Provider.
6. OWNERSHIP OF DOCUMENTS:
Provider understands and agrees that any information, document, report or any other
material whatsoever which is given by the City to Provider; its employees; or any subcontractor,
or which is otherwise obtained or prepared by Provider pursuant to or under the terms of this
Agreement, is and shall at all times remain the property of the City. Provider agrees not to use
any such information, document, report or material for any other purpose whatsoever without the
written consent of the City Manager, which may be withheld or conditioned by the City Manager
in his sole discretion. Provider is permitted to make and to maintain duplicate copies of the files,
records, documents, etc. if Provider determines copies of such records are necessary subsequent
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to the termination of this Agreement; however, in no way shall the confidentiality as permitted
by applicable law be breached. The City shall maintain and retain ownership of any and all
documents which result upon the completion of the work and Services under this Agreement.
7. AUDIT AND INSPECTION RIGHTS AND RECORDS RETENTION:
A. Provider agrees to provide access to the City or to any of its duly authorized
representatives, to any books, documents, papers, and records of Provider which are directly
pertinent to this Agreement, for the purpose of audit, examination, excerpts, and transcripts. The
City may, at reasonable times, and for a period of up to three (3) years following the date of final
payment by the City to Provider under this Agreement, audit and inspect, or cause to be audited
and inspected, those books, documents, papers, and records of Provider which are related to
Provider's performance under this Agreement. Provider agrees to maintain any and all such
books, documents, papers, and records at its principal place of business for a period of three (3)
years after final payment is made under this Agreement and all other pending matters are closed.
Provider's failure to adhere to, or refuse to comply with, this condition shall result in the
immediate cancellation of this Agreement by the City. -
B. The City may, at reasonable times during the term hereof, inspect the Provider's
facilities and perform such tests; as the -City deems reasonably necessary, to determine whether
the goods or services required to be provided by Provider under this Agreement confoittt to the
terms hereof and/or the terms of the Administrative Services Agreement, if applicable. Provider
shall make available to the City all reasonable facilities and assistance to facilitate the
performance of tests or inspections by City representatives. All tests and inspections shall be
subject to, and made in accordance with, the provisions of Section 18-101 and 18-102 of the
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Code of the City of Miami, Florida as same may be amended or supplemented, from time to
time.
8. AWARD OF AGREEMENT:
Provider represents and warrants to the City that it has not employed or retained any
person or company employed by the City to solicit or secure this Agreement and that it has not
offered to pay, paid, or agreed to pay any person any fee, commission, percentage, brokerage fee,
or gift of any kind contingent upon or in connection with, the award of this Agreement.
9. PUBLIC RECORDS:
A. Provider understands that the public shall have access, at all reasonable times, to
all documents and information pertaining to City Agreements, subject to the provisions of
Chapter 119, Florida Statutes, and agrees to allow access by the City and the public to all
documents subject to disclosure under applicable laws. Provider's failure or refusal to comply
with the provisions of this section shall result in the immediate cancellation of this Agreement by
the City.
B. Should Provider determine to dispute any public access provision required by
Florida Statutes, then Provider shall do so at its own expense and at no cost to the City.
10. COMPLIANCE WITH FEDERAL, STATE AND LOCAL LAWS:
Provider understands that agreements with local governments are subject to certain laws
and regulations, including laws pertaining to public records, conflict of interest, record keeping,
etc. City and Provider agree to comply with and observe all such applicable federal, state and
local laws, rules, regulations, codes and ordinances, as they may be amended from time to time.
Provider further agrees to include in all of Provider's agreements with subcontractors for
any Services related to this Agreement this provision requiring subcontractors to comply with
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and observe all applicable federal, state, and local laws rules, regulations, codes and ordinances,
as they may be amended from time to time.
11. INDEMNIFICATION:
Provider shall indemnify, defend and hold harmless the City and its officials, employees,
and its designated third-partyadministrator for claims (collectively referred to as "Indemnitees")
and each of them from and against all loss, costs, penalties, fines, damages, claims, expenses
(including attorney's fees) or liabilities (collectively referred to as "Liabilities") by reason of any
injury to or death of any person or damage to or destruction or loss of any property arising out of,
resulting from, or in connection with (i) the negligent performance or non-performance of the
Services contemplated by this Agreement (whether active or passive) of Provider or its
employees or subcontractors (collectively referred to as "Provider") which is directly caused, in
whole or in part, by any act, omission, default or negligence (whether active or passive or in
strict liability) of the Indemnities, or any of them, or (ii) the failure of the Provider to comply
materially with any of the requirements herein, or the failure of the Provider to conform to
statutes, ordinances, or other regulations or requirements of any governmental authority, local,
federal or state, in connection with the performance of this Agreement even if it is alleged
that the City, its officials and/or employees were negligent,. Provider expressly agrees
to indemnify, defend and hold harmless the Indemnitees, or any of them, from and against all
liabilities which may be asserted by an employee or former employee of Provider, or any of its
subcontractors, as provided above, for which the Provider's liability to such employee or former
employee would otherwise be limited to payments under state Workers' Compensation or similar
laws. Provider further agrees to indemnify, defend and hold harmless the Indemnitees form and
against (i) any and all Liabilities imposed on account of the violation of any law, ordinance,
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order, rule, regulation, condition, or requirement, related directly to Provider's negligent
performance under this Agreement, compliance with which is left by this Agreement to Provider,
and (ii) any and all claims, and/or suits for labor and materials furnished by Provider or utilized
in the performance of this Agreement or otherwise.
This section shall be interpreted to comply with Sections 725.06 and/or 725.08, Florida
Statutes. Provider's obligations to indemnify, defend and hold harmless the Indemnitees shall
survive the termination of this Agreement.
Provider understands and agrees that any and all liabilities regarding the use of any
subcontractor for Services related to this Agreement shall be borne solely by Provider throughout
the duration of this Agreement and that this provision shall survive the termination or expiration
of this Agreement, as applicable. .
12. DEFAULT:
If Provider fails to comply materially with any term or condition of this Agreement, or
fails to perform in any material way any of its obligations hereunder, and fails to cure such
failure after reasonable notice from the City, then Provider shall be in default. Provider
understands and agrees that termination of this Agreement under this section shall not release
Provider from any obligation accruing prior to the effective date of termination. Should provider
be unable or unwilling to commence to perform the Services within the time provided or
contemplated herein, then, in addition to the foregoing, Provider shall be liable to the City for all
expenses incurred by the City in preparation and negotiation of this Agreement, as well as all
costs and expenses incurred by the City in the re -procurement of the Services, including
consequential and incidental damages.
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13. RESOLUTION OF AGREEMENT DISPUTES:
Provider understands and agrees that all disputes between Provider and the City based
upon an alleged violation of the terms of this Agreement by the City shall be submitted to the
City Manager for his/her resolution, prior to Provider being entitled to seek judicial relief in
connection therewith. In the event that the amount of compensation hereunder exceeds Twenty -
Five Thousand Dollars and No/Cents ($25,000), the City Manager's decision shall be approved
or disapproved_ .by the- City Commission. Provider shall not be entitled to seek judicial relief
unless: (i) it has first received City Manager's written decision, approved by the City
Commission if the amount of compensation hereunder exceeds Twenty -Five Thousand Dollars
and No/Cents ($25,000), or (ii) a period of sixty (60) days has expired, after submitting to the
City Manager a detailed statement of the dispute, accompanied by all supporting documentation
ninety (90) days if City Manager's decision is subject to City Commission approval); or (iii) City
has waived compliance with the procedure set forth in this section by written instruments, signed
by the City Manager.
14. TERMINATION;OBLIGATIONS UPON TERMINATION:
A. The City, acting by and through its City Manager, shall have the right to terminate
this -Agreement, in its sole discretion,' at any time, by giving written notice to Provider at least
sixty (60) calendar days prior to the effective date of such termination. In such event, the City
shall pay to Provider compensation for Services rendered and approved expenses incurred prior
to the effective date of termination. In no event shall the City be liable to Provider for any
additional compensation and expenses incurred, other than that provided herein, and in no event
shall the City be liable for any consequential or incidental damages. The Provider shall have no
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recourse or remedy against the City for a termination under this subsection except for payment of
fees due prior to the effective date of termination.
B. The City Manager shall have the right to terminate this Agreement, without notice
or liability to Provider, upon the occurrence of an event of a material default hereunder. In such
event, the City shall not be obligated to pay any amounts to Provider for Services rendered by
Provider after the date of termination, but the parties shall remain responsible for any payments
that have become due and owing as of the effective date of termination. In no event shall the City
be liable to Provider for any additional compensation and expenses incurred, other than that
provided herein, and in no event shall the City be liable for any consequential or incidental
damages.
C. This Agreement may be terminated, in whole or in part, at any time by mutual
written consent of the parties hereto. In such event, the City shall not be obligated to pay any
amounts to Provider for Services rendered by Provider after the date of termination, but the
parties shall remain responsible for any payments that have become due and owing as of the
effective date of termination. In no event shall the City be liable to Provider for any additional.
compensation and expenses incurred, other than that provided herein, and in no event shall the
City be liable for any consequential or incidental damages.
D. This Agreement may be terminated, in whole or in part, by either party if there
has been a material default or breach on the part of the other party in any of its representations,
warranties, covenants, or obligations contained in this Agreement and such default or breach is
not cured within ninety (90) days following written notice from the non -breaching party. In such
event, the City shall not be obligated to pay any amounts to Provider for Services rendered by
Provider after the date of termination, but the parties shall remain responsible for any payments
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that have become due and owing as of the effective date of termination. In no event shall the City
be liable to Provider for any additional compensation and expenses incurred, other than that
provided herein, and in no event shall the City be liable for any consequential or incidental
damages.
15. INSURANCE:
A. Provider shall, at all times during the term hereof, maintain . such insurance
coverage(s) as may be required by the City. The insurance coverage(s) required as of the
Effective Date of this Agreement are attached hereto as Exhibit "D" and incorporated herein by
this reference... The City RFP number and title of the RFP must appear on each certificate of
insurance. The Provider shall add the City of Miami as an additional named insured to its
commercial general liability and auto policies and as a named certificate holder on all policies.
Provider shall correct any insurance certificates as requested by the City's Risk Management
Administrator. All such insurance, including renewals, shall be subject to the approval of the
City for adequacy of protection and evidence of such coverage(s) and shall be furnished to the
City Risk Management Administrator on Certificates of Insurance indicating such •insurance to
be in force and effect and providing that it will not be canceled, modified, or changed during the
performance of the Services under this Agreement without thirty(30) calendar days prior written
notice to the City Risk Management Administrator. Completed Certificates of Insurance shall be
filed with the City prior to the performance .of Services hereunder, provided, however, that
Provider shall at any time upon request file duplicate copies of the policies of such insurance
with the City.
B. If, in the reasonable judgment of the City, prevailing conditions in the insurance
marketplace warrant the provision by Provider of additional One Million Dollars ($1,000,000) of
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professional liability insurance coverage, the City reserves the right to require the provision by
Provider of up to such additional amount of professional liability coverage, and shall afford
written notice of such change in requirements thirty (30) days prior to the date on which the
requirements shall take effect. Should the Provider fail or refuse to satisfy the requirement of
additional coverage within thirty (30) days following the City's written notice, this Agreement
shall be considered terminated on the date the required change in policy coverage would
otherwise take effect.
C. Provider understands and agrees that any and all liabilities regarding the use of
any of Provider's employees or any of Provider's subcontractors for Services related to this
Agreement shall be borne solely by Provider throughout the term of this Agreement and that this
provision shall survive the termination of this Agreement. Provider further understands and
agrees that insurance for each employee of Provider and each subcontractor providing Services
related to this Agreement shall be maintained in good standing and approved by the City Risk
Management Administrator throughout the duration of this Agreement.
-D. Provider shall be responsible for assuring that the insurance certificates required
under this Agreement remain in full force and effect for the duration of this Agreement,
including any hereof. If insurance certificates -are -scheduled -to expire during the term
of this Agreement and any extension hereof, Provider shall be responsible for submitting new or
renewed insurance certificates to the City's Risk Management Administrator at a minimum of
ten (10) calendar days in advance of such expiration. In the event that expired certificates are not
replaced, with new or renewed certificates which cover the term of this Agreement and any
extension thereof:
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(i)
the City shall suspend this Agreement until such time as the new or renewed
certificate(s) are received in acceptable form by the City's Risk Management
Administrator; or
(ii) the City may, at its sole discretion, terminate the Agreement for cause and seek
re -procurement damages from Provider in conjunction with the violation of the terms and
conditions of this Agreement.
E. Compliance with the foregoing requirements shall not relieve Provider of its
liabilities and obligations under this Agreement.
16. NONDISCRIMINATION:
Provider represents to the City that Provider does not and will not engage in
discriminatory practices and that there shall be no discrimination in connection with Provider's
performance under this Agreement on account of race, color, sex, religion, age, handicap, marital
status or national origin. Provider further covenants that no otherwise qualified individual shall,
solely by reason of his/her race, color, sex, religion, age, handicap, marital status or national
origin, be- excluded from participation in, be denied services, or be subject to discrimination
under any provision of this Agreement.
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17. ASSIGNMENT:
This Agreement shall not be assigned by Provider, in whole or in part, and Provider shall
not assign any part of its operations, without the prior written consent of the City, which maybe
withheld or conditioned, in the City's sole discretion through the City Manager. Provider may
not change or replace sub -contractors performing work under the Services Agreement identified
in Exhibit "B" without the prior written consent from the City Manager.
18. NOTICES:
All notices or other communications required under this Agreement shall be in writing
and shall be given by hand -delivery or by registered or certified U.S. Mail, return receipt
requested, addressed to the other party at the address indicated herein or to such other address as
a party may designate by notice given as herein provided. Notice shall be deemed given on the
day on which personally delivered; or, if by mail, on the fifth day after being posted or the date
of actual receipt, whichever is earlier.
TO PROVIDER: TO THE CITY:
Raul Marcano -
Humana Dental Insurance Company
CompBenefits Company (Humana)
3401 SW 160th Avenue, 2nd Floor
Johnny Martinez
City Manager
444 SW 2nd Avenue, 10th Floor
Miami, FL 33130-1910Miramar, FL 33027
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17. MISCELLANEOUS PROVISIONS:
A. This Agreement shall be construed and enforced according to the laws of the State
of Florida. Venue in any proceedings between the parties shall be in Miami -Dade County,
Florida. Each party shall bear its own attorney's fees. Each party waives any defense, whether
asserted by motion or pleading, that the aforementioned courts are an improper or inconvenient
venue. Moreover, the parties consent tothe personal jurisdiction of the aforementioned courts
.and irrevocably waive any objections to said jurisdiction. The parties irrevocably waive any
rights to a jury trial.
B. Title and paragraph headings are for convenient reference and are not a part of
this Agreement.
C. No waiver or breach of any provision of this Agreement shall constitute a waiver
of any subsequent breach of the same or any other provision hereof, and no waiver shall be
effective unless made in writing.
D. Should any provision, paragraph, sentence, word or phrase contained in this
Agreement be determined by a court of competent jurisdiction to be invalid, illegal or otherwise
unenforceable under the laws of the State of Florida or the City of Miami, such provision,
paragraph, sentence, word or phrase shall be deemed modified to the extent necessary in order to
conform with such laws, or if not modifiable, then the same shall be deemed severable, and in
either event, the remaining terms and provisions of this Agreement shall remain unmodified and
in full force and effect or limitation of its use.
E. Provider shall comply with all applicable laws, rules and regulations in the
performance of this Agreement, including but not limited to licensure, and certifications required
by law for professional service providers.
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F. This Agreement constitutes the sole and entire agreement between the parties
hereto. No modification or amendment hereto shall be valid unless in writing and executed by
properly authorized representatives of the parties hereto. Except as otherwise set forth in Section
2 above, the City Manager shall have the sole authority to extend, to amend or to modify this
Agreement on behalf of the City.
18. SUCCESSORS AND ASSIGNS: This Agreement shall be binding upon the parties
hereto, their heirs, executors, legal representatives, successors, or assigns.
19. INDEPENDENT CONTRACTORS: Provider has been procured and is being
engaged to provide Services to the City as an independent contractor, and not as an agent or
employee of the City. Accordingly, neither Provider, nor its employees, nor any subcontractor
hired by Provider to provide any Services under this Agreement shall attain, nor be entitled to,
any rights or benefits under the Civil Service or Pension Ordinances of the City, nor any rights
generally afforded classified or unclassified employees. Provider further understands that
Florida Workers' Compensation benefits available to employees of the City are not available to
Provider, its employees, or any subcontractor hired by Provider to provide any Services
hereunder, and Provider agrees to provide or to require subcontractor(s) to provide, as applicable,
workers' compensation insurance for any employee or agent of Provider rendering Services to
the City under this Agreement. Provider further understands and agrees that Provider's or
subcontractors' use or entry upon City properties shall not in any way change its or their status as
an independent contractor.
20. CONTINGENCY CLAUSE: Funding for this Agreement is contingent on the
availability of funds and continued authorization for program activities and the Agreement is
subject to amendment or termination due to lack of funds, reduction of funds, failure to allocate
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or appropriate funds, and/or change in applicable laws or regulations, upon thirty (30) days
written notice.
21. FORCE MAJEURE: A "Force Majeure Event" shall mean an act of God, act
of governmental body or military authority, fire, explosion, power failure, flood, storm,
hurricane, sink hole, other natural disasters, epidemic, riot or civil disturbance, war or
terrorism, sabotage, insurrection, blockade, or embargo. In the event that either party is
delayed in -.the performance of any act or obligation pursuant to or required by the Agreement•
by reason of a Force Majeure Event, the time for required completion of such act or obligation
shall be extended by the number of days equal to the total number of days, .if any, that such
party is actually delayed by such Force Majeure Event. The party seeking delay in
performance shall give notice to the other party specifying the anticipated duration of the
delay, and if such delay shall extend beyond the duration specified in such notice, additional
notice shall be repeated no less than monthly so long as such delay due to a Force Majeure
Event continues. Any party seeking delay in. performance due to a Force Majeure Event shall
use its best efforts to rectify any condition causing such delay and shall cooperate with the
other party to overcome any delay that has resulted.
22. CITY NOT LIABLE FOR DELAYS: Provider hereby 'understands and agrees
that in no event shall the City be liable for, or responsible to Provider or any subcontractor, or
to any other person, firm, or entity for or on account of, any stoppages or delay(s) in work
herein provided for, or any damages whatsoever related thereto, because of any injunction or
other legal or equitable proceedings or on account of any delay(s) for any cause over which
the City has no control.
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23. USE OF NAME: Provider understands and agrees that the City is not engaged in
research for advertising, sales promotion, or other publicity purposes. Provider is allowed, within
the limited scope of normal and customary marketing and promotion of its work, to use the
general results of this project .and the name of the City. The Provider agrees to protect any
confidential information provided by the City and will not release information of a specific
nature without prior written consent of the City Manager or the City Commission.
24. NO CONFLICT OF INTEREST: Pursuant to City of Miami Code Section 2-
611, as amended ("City Code"), regarding conflicts of interest, Provider hereby certifies to City
that individual member of Provider, no employee, and no subcontractor under this Agreement
nor any immediate family member of any of the same . is also a member of any board,
commission, or agency of the City. Provider hereby represents and warrants to the City that
throughout the term of this Agreement, Provider, its employees and its subcontractors will abide
by this prohibition of the City Code.
25. NO THIRD -PARTY BENEFICIARY: No persons other than the Provider and the
City (and their successors and assigns) shall have any rights whatsoever under this Agreement._ -
26. SURVIVAL: All obligations (including but not limited to indemnity and
obligations to defend and hold harmless) and rights of any party arising during orattributableto
the period prior to expiration or earlier termination of this Agreement shall survive such
expiration or earlier termination.
27. TRUTH -IN -NEGOTIATION CERTIFICATION, REPRESENTATION AND
WARRANTY: Provider hereby certifies, represents and warrants to City that on the date of
Provider's execution of this Agreement and so long as this Agreement shall remain in full force
and effect, the wage rates and other factual unit costs supporting the compensation to Provider
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under this Agreement are and will- continue to be accurate, complete, and current. Provider
understands, agrees and acknowledges that the City shall adjust the amount of the compensation
and any additions thereto to exclude any significant sums by which the City determines the
contract price of compensation hereunder was increased due to inaccurate, incomplete, or non-
current wage rates and other factual unit costs. All such contract adjustments shall be made.
within one (1) year of the end of this Agreement, whether naturally expiring or earlier terminated
pursuant to the provisions hereof.
28. COUNTERPARTS: This Agreement may be executed in three or more -
counterparts, each of which shall constitute an original but all of which, when taken together,
shall constitute one and the same agreement.
29. ENTIRE AGREEMENT: This instrument and its attachments constitute the sole and
only agreement of the parties relating to the subject matter hereof and correctly set forth the
rights, duties, and obligations of each to the other as of its date. Any prior agreements, promises,
negotiations, or representations not expressly set forth in this Agreement are of no force or
effect.
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IN WITNESS WHEREOF, the parties hereto have caused this instrument to be executed by
their respective officials thereunto duly authorized, this the day and year above written.
"City"
CITY OF MIAMI, a municipal
ATTEST: corporation
By:
Priscilla A. Thompson, City Clerk Johnny Martinez, City Manager
"Provider"
ATTEST: Humana Dental Insurance Company and
CompBenefits Company
By:
Print Name: Raul Marcano
Title: Business Development Executive,
Commercial Sales
(Corporate Seal)
(Authorized Corporate Officer)
APPROVED AS TO LEGAL FORM APPROVED AS TO INSURANCE
AND CORRECTNESS: REQUIREMENTS:
Julie O. Bru
City Attorney
Calvin Ellis
Risk Management Director
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CORPORATE RESOLUTION
WHEREAS, Humana Dental Insurance Company and CompBenefits Company, a
Florida corporation, desires to enter into an agreement with the City of Miami for the purpose of
performing the work described in the contract to which this resolution is attached; and
WHEREAS, the Board of Directors at a duly held corporate meeting has considered the
matter in accordance with the bylaws of the corporation;
This Resolution needs to authorize the signatory to sign
4
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EXHIBIT A
ADMINISTRATIVE SERVICES AGREEMENT
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City of Miami
Request for Proposals
(RFP)
Purchasing Department
Miami Riverside Center
444 SW 2nd Avenue, 6th Floor
Miami, Florida 33130
Web Site Address: http://ci,miami.fl.us/procurement
RFP Number: 273288
Title:
Request for Proposals for Employee
Benefit Dental Plan
Issue Date/Time: 06-OCT-2011
RFP Closing Date/Time: 10/26/2011 @ 13:00:00
Pre -Bid Conference: None
Pre -/Bid Date/Time:
Pre -Bid Location:
Deadline for Request for Clarification: Friday, October 14, 2011 at 12:00 P.M.
Noon
Buyer: Suarez, Maritza
Hard Copy Submittal Location: City of Miami - City Clerk
3500 Pan American Drive
Miami FL 33133 US
Buyer E-Mail Address: msuarez@ci.miami.fl.us
Buyer Facsimile: (305) 400-5025
Page 1 of 33
Certification Statement
Please quote on this form, if applicable, net prices for the item(s) listed. Return signed original and
retain a copy for your files. Prices should include all costs, including transportation to destination. The
City reserves the right to accept or reject all or any part of this submission. Prices should be firm for a
minimum of 180 days following the time set for closing of the submissions.
In the event of errors in extension of totals, the unit prices shall govern in determining the quoted
prices.
We (I) certify that we have read your solicitation, completed the necessary documents, and propose to.
furnish and deliver, F.O.B. DESTINATION, the items or services specified herein.
The undersigned hereby certifies that neither the contractual party nor any of its principal owners or
personnel have been convicted of any of the violations, or debarred or suspended as set in section
18-107 or Ordinance No. 12271.
All exceptions to this submission have been documented in the section below (refer to paragraph and
section).
EXCEPTIONS:
We (I) certify that any and all information contained in this submission is true; and we (I) further certify
that this submission is made without prior understanding, agreement, or connection with any
corporation, firm, or person submitting a submission for the same materials, supplies, equipment, or
service, and is in all respects fair and without collusion or fraud. We (I) agree to abide by all terms and
conditions of this solicitation and certify that I am authorized to sign this submission for the submitter.
Please print the following and sign your name:
SUPPLIER NAME:
ADDRESS
PHONE: FAX -
EMAIL: BEEPER:
SIGNED BY.
TITLE: DATE
FAILURE TO COMPLETE, SIGN, AND RETURN THIS FORM SHALL DISOUALIFY THIS BID.
Page 2 of 33
Certifications
Legal Name of Firm:
Entity Type: Partnership, Sole Proprietorship, Corporation, etc.
Year Established:
Office Location: City of Miami, Miami -Dade County, or Other
Occupational License Number:
Occupational License Issuing Agency:
Occupational License Expiration Date:
Respondent certifies that (s) he has read and understood the provisions of City of Miami Ordinance No.
10032 (Section 18-110 of the City Code) pertaining to the implementation of a "First Source Hiring
Agreement.": (Yes or No)
Do you expect to create new positions in your company in the event your company was awarded a
Contract by the City? (Yes or No)
In the event your answer to question above is yes, how many new positions would you create to
perform this work?
Please list the title, rate of pay, summary of duties, number of positions, and expected length or duration
of all new positions which might be created as a result of this award of a Contract.
Will Subcontractor(s) be used? (Yes or No)
Page 3 of 33
Line: 1
Description: Disregard this line item. Please refer to Attachment A
Category: 94620-10
Unit of Measure: Dollar
Unit Price: $ Number of Units: 1 Total: $
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Request for Proposals (RFP) 273288
Table of Contents
Terms and Conditions 6
1. General Conditions 6
1.1. GENERAL TERMS AND CONDITIONS
2. Special Conditions 24
2.1. PURPOSE 24
2.2. DEADLINE FOR RECEIPT OF REQUEST FOR ADDITIONAL
INFORMATION/CLARIFICATION 24
2.3. TERM OF CONTRACT 24
2.4. CONDITIONS FOR RENEWAL 24
2.5. NON -APPROPRIATION OF FUNDS 24
2.6. MINIMUM QUALIFICATION REQUIREMENTS 24
2.7. CONTRACT EXECUTION 25
2.8. FAILURE TO PERFORM 25
2.9. INSURANCE REQUIREMENTS 25
2.10. PRE-BID/PRE-PROPOSAL CONFERENCE 27
2.11. CONTRACT ADMINISTRATOR 27
2.12. SUBCONTRACTOR(S) OR SUBCONSULTANT(S) 27
2.13. COMPLETE PROJECT REQUIRED 27
2.14. TERMINATION 27
2.15. ADDITIONAL TERMS AND CONDITIONS 28
2.16. CHANGES/ALTERATIONS 28
2.17, COMPENSATION PROPOSAL 28
2.18. EVALUATION/SELECTION PROCESS AND CONTRACT AWARD 28
2.19. ADDITIONAL SERVICES 29
2.21. RECORDS 29
2.22. AMENDMENTS TO THE CONTRACT 29
2.23. TRUTH IN NEGOTIATION CERTIFICATE 29
3. Specifications 30
3.1. SPECIFICATIONS/SCOPE OF WORK 30
4. Submission Requirements 31
4.1. SUBMISSION REQUIREMENTS 31
5. Evaluation Criteria 33
5.1. EVALUATION CRITERIA 33
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Request for Proposals (RFP) 273288
ti
Terms and Conditions
1. General Conditions
1.1. GENERAL TERMS AND CONDITIONS
Intent: The General Terms and Conditions described herein apply to the acquisition of
goods/equipment/services with an estimated aggregate cost of $25,000.00 or more.
Definition: A formal solicitation is defined as issuance of an Invitation for Bids, Request for Proposals,
Request for Qualifications, or Request for Letters of Interest pursuant to the City of
Miami Procurement Code and/or Florida Law, as amended. Formal Solicitation and Solicitation shall be
defined in the same manner herein.
1.1. ACCEPTANCE OF GOODS OR EQUIPMENT - Any good(s) or equipment delivered under this
formal solicitation, if applicable, shall remain the property of the seller until a physical inspection and
actual usage of the good is made, and thereafter is accepted as satisfactory to the City. It must comply with
the terms herein and be fully in accordance with specifications and of the highest quality. In the event the
goods/equipment supplied to the City are found to be defective or does not conform to specifications, the
City reserves the right to cancel the order upon written notice to the Contractor and return the product to the
Contractor at the Contractor's expense.
1.2. ACCEPTANCE OF OFFER - The signed or electronic submission of your solicitation response shall
be considered an offer on the part of the bidder/proposer; such offer shall be deemed accepted upon
issuance by the City of a purchase order.
1.3. ACCEPTANCE/REJECTION — The City reserves the right to accept or reject any or all responses or
parts of after opening/closing date and request re -issuance on the goods/services described in the formal
solicitation. In the event of such rejection, the Director of Purchasing shall notify all affected
bidders/proposers and make available a written explanation for the rejection. The City also reserves the
right to reject the response of any bidder/proposer who has previously failed to properly perform under the
terms and conditions of a contract, to deliver on time contracts of a similar nature, and who is not in a
position to perform the requirements defined in this formal solicitation. The City further reserves the right
to 'waive any irregularities or minor informalities or technicalities in any or all responses and may, at its
discretion, re -issue this formal solicitation.
1.4. ADDENDA — It is the bidder's/proposer's responsibility to ensure receipt of all Addenda. Addenda are
available at the City's website at: http://www.ci.miami.fl.us/procurement
1.5. ALTERNATE RESPONSES MAY BE CONSIDERED - The City may consider one (1) alternate
response from the same Bidder/Proposer for the same formal solicitation; provided, that the alternate
response offers a different product that meets or exceeds the formal solicitation requirements. In order for
the City to consider an alternate response, the Bidder/Proposer shall complete a separate Price Sheet form
and shall mark "Alternate Response". Alternate response shall be placed in the same response. This
provision only applies to formal solicitations for the procurement of goods, services, items, equipment,
materials, and/or supplies.
1.6. ASSIGNMENT - Contractor agrees not to subcontract, assign, transfer, convey, sublet, or otherwise
dispose of the resulting Contract, or any or all of its right, title or interest herein, without City of Miami's
prior written consent.
1.7. ATTORNEY'S FEES - In connection with any litigation, mediation and arbitration arising out of this
Contract, the prevailing party shall be entitled to recover its costs and reasonable attorney's fees through
and including appellate litigation and any post judgment proceedings.
1.8. AUDIT RIGHTS AND RECORDS RETENTION - The Successful Bidder/Proposer agrees to
provide access at all reasonable times to the City, or to any of its duly authorized representatives, to any
books, documents, papers, and records of Contractor which are directly pertinent to this formal solicitation,
for the purpose of audit, examination, excerpts, and transcriptions. The Successful Bidder/Proposer shall
maintain and retain any and all of the books, documents, papers and records pertinent to the Contract for
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Request for Proposals (RFP) 273288
three (3) years after the City makes final payment and all other pending matters are closed. Contractor's
failure to or refusal to comply with this condition shall result in the immediate cancellation of this contract
by the City.
1.9. AVAILABILITY OF CONTRACT STATE-WIDE - Any Governmental, not -for -profit or
quasi -governmental entity in the State of Florida, may avail itself of this contract and purchase any and all
goods/services, specified herein from the successful bidder(s)/proposer(s) at the contract price(s)
established herein, when permissible by federal, state, and local laws, rules, and regulations.
Each Governmental, not -for -profit or quasi -governmental entity which uses this formal solicitation and
resulting bid contract or agreement will establish its own contract/agreement, place its own orders, issue its
own purchase orders, be invoiced there from and make its own payments, determine shipping terms and
issue its own exemption certificates as required by the successful bidder(s)/proposer(s).
1.10. AWARD OF CONTRACT:
A. The Formal Solicitation, Bidder's/Proposer's response, any addenda issued, and the purchase order shall
constitute the entire contract, unless modified in accordance with any ensuing contract/agreement,
amendment or addenda.
B. The award of a contract where there are Tie Bids will be decided by the Director of Purchasing or
designee in the instance that Tie Bids can't be determined by applying Florida Statute 287.087, Preference
to Businesses with Drug -Free Workplace Programs.
C. The award of this contract may be preconditioned on the subsequent submission of other documents as
specified in the Special Conditions or Technical Specifications. Bidder/Proposer shall be in default of its
contractual obligation if such documents are not submitted in a timely manner and in the form required by
the City. Where Bidder/Proposer is in default of these contractual requirements, the City, through action
taken by the Purchasing Department, will void its acceptance of the Bidder's/Proposer's Response and may
accept the Response from the next lowest responsive, responsible Bidder or Proposal most advantageous to
the City or re -solicit the City's requirements. The City, at its sole discretion, may seek monetary restitution
from Bidder/Proposer and its bid/proposal bond or guaranty, if applicable, as a result of damages or
increased costs sustained as a result of the Bidder's/Proposer's default.
D. The term of the contract shall be specified in one of three documents which shall be issued to the
successful Bidder/Proposer. These documents may either be a purchase order, notice of award and/or
contract award sheet.
E. The Cityreserves the right to automatically.extend this.contract for up to one hundred twenty (120)
calendar days beyond the stated contract term in order to provide City departments with continual service
and supplies while a new contract is being solicited, evaluated, and/or awarded. If the right. is exercised,
the City shall notify the Bidder/Proposer, in writing, of its intent to extend the contract at the same price,
terms and conditions for a specific number of days. Additional extensions over the first one hundred
twenty (120) day extension may occur, if, the City and the Successful Bidder/Proposer are in mutual
agreement of such extensions.
F. Where the contract involves a single shipment of goods to the City, the contract term shall conclude
upon completion of the expressed or implied warranty periods.
G. The City reserves the right to award the contract on a split -order, lump sum or individual -item basis,
or such combination as shall best serve the interests of the City unless otherwise specified.
H. A Contract/Agreement may be awarded to the Bidder/Proposer by the City Commission based upon
the minimum qualification requirements reflected herein. As a result of a RFP, RFQ, or RFLI, the City
reserves the right to execute or not execute, as applicable, an Agreement with the Proposer, whichever is
determined to be in the City's best interests. Such agreement will be furnished by the City, will contain
certain terms as are in the City's best interests, and will be subject to approval as to legal form by the City
Attorney.
1.11. BID BOND/ BID SECURITY - A cashier's or certified check, or a Bid Bond signed by a recognized
surety company that is licensed to do business in the State of Florida, payable to the City of Miami, for the
amount bid is required from all bidders/proposers, if so indicated under the Special Conditions. This check
or bond guarantees that a bidder/proposer will accept the order or contract/agreement, as bid/proposed, if it
is awarded to bidder/proposer. Bidder/Proposer shall forfeit bid deposit to the City should City award
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Request for Proposals (RFP) 273288
contract/agreement to Bidder/Proposer and Bidder/Proposer fails to accept the award. The City reserves the
right to reject any and all surety tendered to the City. Bid deposits are retumed to unsuccessful
bidders/proposers within ten (10) days after the award and successful bidder's/proposer's acceptance of
award. If sixty (60) days have passed after the date of the formal solicitation closing date, and no contract
has been awarded, all bid deposits will be returned on demand.
1.12. RESPONSE FORM (HARDCOPY FORMAT) -.All forms should be completed, signed and
submitted accordingly.
1.13. BID SECURITY FORFEITED LIQUIDATED DAMAGES - Failure to execute an Agreement
and/or file an acceptable Performance Bond, when required, as provided herein, shall be just cause for the
annulment of the award and the forfeiture of the Bid Security to the City, which forfeiture shall be
considered, not as a penalty, but in mitigation of damages sustained. Award may then be made to the
next lowest responsive, responsible Bidder or Proposal most advantageous to the City or all responses may
be rejected.
1.14. BRAND NAMES - If and wherever in the specifications brand names, makes, models, names of any
manufacturers, trade names, or bidder/proposer catalog numbers are specified, it is for the purpose of
establishing the type, function, minimum. standard of design, efficiency, grade or quality of goods only.
When the City does not wish to rule out other competitors' brands or makes, the phrase "OR EQUAL" is
added. When bidding/proposing an approved equal, Bidders/Proposers will submit, with their response,
complete sets of necessary data (factory information sheets, specifications, brochures, etc.) in order for the
City to evaluate and determine the equality of the item(s) bid/proposed. The City shall be the sole judge of
equality and its decision shall be final. Unless otherwise specified, evidence in the form of samples may be
requested if the proposed brand is other than specified by the City. Such samples are to be furnished after
formal solicitation opening/closing only upon request of the City. If samples should be requested, such
samples must be received by the City no later than seven (7) calendar days after a formal request is made.
1.15. CANCELLATION - The City reserves the right to cancel all formal solicitations before its
opening/closing. In the event of bid/proposal cancellation, the Director of Purchasing shall notify all
prospective bidders/proposers and make available a written explanation for the cancellation.
1.16. CAPITAL EXPENDITURES - Contractor understands that any capital expenditures that the firm
makes, or prepares to make, in order to deliver/perform the goods/services required by the City, is a
business risk which the contractor must assume. The City will not be obligated to reimburse amortized or
unamortized capital expenditures, or to maintain the approved status of any contractor. If contractor has
been•unable to recoup its capital expenditures .during the time it is rendering such goods/services, it shall
not have any claim upon the City.
1.17. CITY NOT LIABLE FOR DELAYS = It is further expressly agreed that in no event shall the City
be liable for, or responsible to, the Bidder/Proposer/Consultant, any sub-contractor/sub-consultant, or to
any other person for, or on account of, any stoppages or delay in the work herein provided for by injunction
or other legal or equitable proceedings or on account of any delay for any cause over which the City has no
control.
1.18. COLLUSION —Bidder/Proposer, by submitting a response, certifies that its response is made without
previous understanding, agreement or connection either with any person, firm or corporation submitting a
response for the same items/services or with the City of Miami's Purchasing Department or initiating
department. The Bidder/Proposer certifies that its response is fair, without control, collusion, fraud or other
illegal action. Bidder/Proposer certifies that it is in compliance with the Conflict of Interest and Code of
Ethics Laws. The City will investigate all potential situations where collusion may have occurred and the
City reserves the right to reject any and all bids/responses where collusion may have occurred.
1.19. COMPLIANCE WITH FEDERAL, STATE AND LOCAL LAWS - Contractor understands that
contracts between private entities and local governments are subject to certain laws and regulations,
including laws pertaining to public records, conflict of interest, records keeping, etc. City and Contractor
agree to comply with and observe all applicable laws, codes and ordinances as that may in any way affect
the goods or equipment offered, including but not limited to:
A. Executive Order 11246, which prohibits discrimination against any employee, applicant, or client
because of race, creed, color, national origin, sex, or age with regard to, but not limited to, the following:
employment practices, rate of pay or other compensation methods, and training selection.
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Request for Proposals (RFP) 273288
B. Occupational, Safety and Health Act (OSHA), as applicable to this Formal Solicitation.
C. The State of Florida Statutes, Section 287.133(3)(A) on Public Entity Crimes.
D. Environment Protection Agency (EPA), as applicable to this Formal Solicitation.
E. Uniform Commercial Code (Florida Statutes, Chapter 672).
F. Americans with Disabilities Act of 1990, as amended.
G. National Institute of Occupational Safety Hazards (NIOSH), as applicable to this Formal Solicitation.
H. National Forest Products Association (NFPA), as applicable to this Formal Solicitation.
I. City Procurement Ordinance City Code Section 18, Article III.
J. Conflict of Interest, City Code Section 2-611;61.
K. Cone of Silence, City Code Section 18-74.
L. The Florida Statutes Sections 218.73 and 218.74 on Prompt Payment.
M. First Source Hiring Agreement, City Ordinance No. 10032, as applicable to this Formal Solicitation.
Implemented to foster the creation of new and permanent jobs for City of Miami residents; requires as a
condition precedent to. the execution of service contracts including professional services.
Lack of knowledge by the bidder/proposer will in no way be a cause for relief from responsibility.
Non-compliance with all local, state, and federal directives, orders, and laws may be considered grounds
for termination of contract(s).
Copies of the City Ordinances may be obtained from the City Clerk's Office.
1.20. CONE OF SILENCE - Pursuant to Section 18-74 of the City of Miami Code, a "Cone of Silence" is
imposed upon each RFP, RFQ, RFLI, or IFB after advertisement and terminates at the time the City
Manager issues a written recommendation to the Miami City Commission. The Cone of Silence shall be
applicable only to Contracts for the provision of goods and services and public works or improvements for
amounts greater than $200,000. The Cone of Silence prohibits any communication regarding RFPs, RFQs,
RFLI or IFBs (bids) between, among others:
Potential vendors, service providers, bidders, lobbyists or consultants and the City's professional staff
including, but not limited to, the City Manager and. the City Manager's staff.; the Mayor, City
Commissioners, or their respective staffs and any member of the respective selection/evaluation committee.
The provision does not apply to, among other communications:
oral communications with the City purchasing staff, provided the communication is limited strictly to
matters of process or procedure already contained in the formal solicitation document; the provisions of the
Cone of Silence do not apply to oral communications at duly noticed site visits/inspections, pre -proposal or
pre -bid conferences, oral presentations before selection/evaluation committees, contract negotiations during .
any duly noticed public meeting, or public presentations made to the Miami City Commission during a duly
noticed public meeting; or communications in writing or by email at any time with any City employee,
official or member of the City Commission unless specifically prohibited by the applicable RFP, RFQ,
RFLI or IFB (bid) documents (See Section 2.2. of the Special Conditions); or communications in
connection with the collection of industry comments or the performance of market research regarding a
particular RFP, RFQ, RFLI OR IFB by City Purchasing staff.
Proposers or bidders must file a copy of any written communications with the Office of the City Clerk,
which shall be made available to any person upon request. The City shall respond in writing and file a copy
with the Office of the City Clerk, which shall be made available to any person upon request. Written
communications may be in the form of e-mail, with a copy to the Office of the City Clerk.
In addition to any other penalties provided by law, violation of the Cone of Silence by any proposer or
bidder shall render any award voidable. A violation by a particular Bidder, Proposer, Offeror, Respondent,
lobbyist or consultant shall subject same to potential penalties pursuant to the City Code. Any person
having personal knowledge of a violation of these provisions shall report such violation to the State
Attorney and/or may file a complaint with the Ethics Commission. Proposers or bidders should reference
Section 18-74 of the City of Miami Code for further clarification.
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Request for Proposals (RFP) 273288
This language is only a summary of the key provisions of the Cone of Silence. Please review City of
Miami Code Section 18-74 for a complete and thorough description of the Cone of Silence. You may
contact the City Clerk at 305-250-5360, to obtain a copy of same.
1.21. CONFIDENTIALITY - As a political subdivision, the City of Miami is subject to the Florida
Sunshine Act and Public Records Law. If this Contract/Agreement contains a confidentiality provision, it
shall have no application when disclosure is required by Florida law or upon court order.
1.22. CONFLICT OF INTEREST — Bidders/Proposers, by responding to this Formal Solicitation, certify
that to the best of their knowledge or belief, no elected/appointed official or employee of the City of Miami
is financially interested, directly or indirectly, in the purchase of goods/services specified in this Formal
Solicitation. Any such interests on the part of the Bidder/Proposer or its employees must be disclosed in
writing to the City. Further, you must disclose the name of any City employee who owns, directly or
indirectly, an interest of five percent (5%) or more of the total assets of capital stock in your firm.
A. Bidder/Proposer further agrees not to use or attempt to use any knowledge, property or resource
which may be within his/her/its trust, or perform his/her/its duties, to secure a special privilege, benefit, or
exemption for himself/herself/itself, or others. Bidder/Proposer may not disclose or use information not
available to members of the general public and gained by reason of his/her/its position, except for
information relating exclusively to governmental practices, for his/her/its personal gain or benefit or for the
personal gain or benefit of any other person or business entity.
B. Bidder/Proposer hereby acknowledges that he/she/it has not contracted or transacted any business
with the City or any person or agency acting for the City, and has not appeared in representation of any
third party before any board, commission or agency of the City within the past two years. Bidder/Proposer
further warrants that he/she/it is not related, specifically the spouse, son, daughter, parent, brother or sister,
to: (i) any member of the commission; (ii) the mayor; (iii) any city employee; or (iv) any member of any
board or agency of the City.
C. A violation of this section may subject the Bidder/Proposer to immediate termination of any
professional services agreement with the City, imposition of the maximum fine and/or any penalties
allowed by law. Additionally, violations may be considered by and subject to action by the Miami -Dade
County Commission on Ethics.
1.23. COPYRIGHT OR PATENT RIGHTS —Bidders/Proposers warrant that there has been no violation
of copyright or patent rights in manufacturing, producing, or selling the goods shipped or ordered and/or
services provided as a result of this formal solicitation, and bidders/proposers agree to hold the City
harmless from any and all liability, loss, or expense occasioned by any such violation.
1.24. COST INCURRED BY BIDDER/PROPOSER - All expenses involved with the preparation and
submission of Responses to the City, or any work performed in connection therewith shall be borne by the
Bidder(s)/Proposer(s).
1.25. DEBARMENT AND SUSPENSIONS (Sec 18-107)
(a) Authority and requirement to debar and suspend. After reasonable notice to an actual or prospective
Contractual,Party, and after.reasonable.opportunity for.suchparty to be heard, the CityManager,,after .., .,
consultation with the Chief Procurement Officer and the city attorney, shall have the authority to debar a
Contractual Party, for the causes listed below, from consideration for award of city Contracts. The
debarment shall be for a period of not fewer than three years. The City Manager shall also have the
authority to suspend a Contractual Party from consideration for award of city Contracts if there is probable
cause for debarment, pending the debarment determination. The authority to debar and suspend contractors
shall be exercised in accordance with regulations which shall be issued by the Chief Procurement Officer
after approval by the City Manager, the city attorney, and the City Commission.
(b) Causes for debarment or suspension. Causes for debarment or suspension include the following:
(1) Conviction for commission of a criminal offense incident to obtaining or attempting to obtain a
public or private Contract or subcontract, or incident to the performance of such Contract or
subcontrat.
(2) Conviction under state or federal statutes of embezzlement, theft, forgery, bribery, falsification
or destruction of records, receiving stolen property, or any other offense indicating a lack of business
integrity or business honesty.
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Request for Proposals (RFP) 273288
(3) Conviction under state or federal antitrust statutes arising out of the submission of Bids or
Proposals.
(4) Violation of Contract provisions, which is regarded by the Chief Procurement Officer to be
indicative of nonresponsibility. Such violation may include failure without good cause to perform in
accordance with the terms and conditions of a Contract or to perform within the time limits provided in
a Contract, provided that failure to perform caused by acts beyond the control of a party shall not be
considered a basis for debarment or suspension.
(5) Debarment or suspension of the Contractual Party by any federal, state or other governmental
entity.
(6) False certification pursuant to paragraph (c) below.
(7) Found in violation of a zoning ordinance or any other city ordinance or regulation and for
which the violation remains noncompliant.
(8) Found in violation of a zoning ordinance or any other city ordinance or regulation and for
which.a civil penalty or fine is due and owing to the city.
(9) Any other cause judged by the City Manager to be so serious and compelling as to affect the
responsibility of the Contractual Party performing cityContracts.
(c) Certification. All Contracts for goods and services, sales, and leases by the city shall contain a
certification that neither the Contractual Party nor any of its principal owners or personnel have been
convicted of any of the violations set forth above or debarred or suspended as set forth in paragraph (b)(5).
(d) Debarment and suspension decisions. Subject to the provisions of paragraph (a), the City Manager shall
render a written decision stating the reasons for the debarment or suspension. A copy of the decision shall
be provided promptly to the Contractual Party, along with a notice of said party's right to seek judicial
relief.
1.26. DEBARRED/SUSPENDED VENDORS —An entity or affiliate who has been placed on the State of
Florida debarred or suspended vendor list may not submit a response on a contract to provide goods or
services to a public entity, may not submit a response on a contract with a public entity for the construction
or repair of a public building or public work, may not submit response on leases of real property to a public
entity, may not award or perform work as a contractor, supplier, subcontractor, or consultant under contract
with any public entity, and may not transact business with any public entity.
1.27. DEFAULT/FAILURE TO PERFORM - The City shall be the sole judge of nonperformance, which
shall include any failure on the part of the successful Bidder/Proposer to accept the award, to furnish
required documents, and/or to fulfill any portion of this contract within the time stipulated.
Upon default by the successful Bidder/Proposer to meet any terms of this agreement, the City will notify
the Bidder/Proposer of the default and will provide the contractor three (3) days (weekends and holidays
excluded) to remedy the default. Failure on the contractor's part to correct the default within the required
three (3) days shall result in the Contract being terminated and upon the City notifying in writing the
contractor of its intentions and the effective date of the termination. The following shall constitute default:
A. Failure to perform the work or deliver the goods/services required under the Contract and/or within the
time required or failing to use the subcontractors, entities and personnel as identified and set forth, and to
the degree specified in the Contract.
B. Failure to begin the work under this Contract within the time specified.
C. Failure to perform the work with sufficient workers and equipment or with sufficient materials to
ensure timely completion.
D. Neglecting or refusing to remove materials or perform new work where prior work has been rejected as
nonconforming with the terms of the Contract.
E. Becoming insolvent, being declared bankrupt, or committing any act of bankruptcy or insolvency, or
making an assignment for the benefit of creditors, if the insolvency, bankruptcy, or assignment renders the
successful Bidder/Proposer incapable of performing the work in accordance with and as required by the
Contract.
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Request for Proposals (RFP) 273288
F. Failure to comply with any of the terms of the Contract in any material respect.
All costs and charges incurred by the City as a result of a default or a default incurred beyond the time
limits stated, together with the cost of completing the work, shall be deducted from any monies due or
which may become due on this Contract.
1.28. DETERMINATION OF RESPONSIVENESS - Each Response will be reviewed to determine if it
is responsive to the submission requirements outlined in the Formal Solicitation. A "responsive" response is
one which follows the requirements of the formal solicitation, includes all documentation, is submitted in
the format outlined in the formal solicitation, is of timely submission, and has appropriate signatures as
required on each document. Failure to comply with these requirements may deem a Response
non -responsive.
1.29. DISCOUNTS OFFERED DURING TERM OF CONTRACT - Discount Prices offered in the
response shall be fixed after the award by the Commission, unless otherwise specified in the Special Terms
and Conditions. Price discounts off the original prices quoted in the response will be accepted from
successful Bidder(s)/Proposer(s) during the term of the contract. Such discounts shall remain in effect for
a minimum of 120 days from approval by the City Commission Any discounts offered by a manufacturer
to Bidder/Proposer will be passed on to the City.
1.30. DISCREPANCIES, ERRORS, AND OMISSIONS - Any discrepancies, errors, or ambiguities in
the Formal Solicitation or addenda (if any) should be reported in writing to the City's Purchasing .
Department. Should it be found necessary, a written addendum will be incorporated in the Formal
Solicitation and will become part of the purchase agreement (contract documents). The City will not be
responsible for any oral instructions, clarifications, or other communications.
A. Order of Precedence — Any inconsistency in this formal solicitation shall be resolved by giving
precedence to the following documents, the first of such list being the governing documents.
1) Addenda (as applicable)
2) Specifications
3) Special Conditions
4) General Terms and Conditions
1.31. EMERGENCY / DISASTER PERFORMANCE - In the event of a hurricane or other emergency
or disaster situation, the successful vendor shall provide the City with the commodities/services defined
within the scope of this formal solicitation at the price contained within vendor's response: 'Further,
successful vendor shall deliver/perform for the city on a priority basis during such times of emergency.
1.32. ENTIRE BID CONTRACT OR AGREEMENT - The Bid Contract or Agreement consists of this
City of Miami Formal Solicitation and specifically this General Conditions Section, Contractor's Response
and any written agreement entered into by the City of Miami and Contractor in cases involving RFPs,
RFQs, and RFLIs, and represents the entire understanding and agreement between the parties with respect
to the subject matter hereof and supersedes all, other negotiations, understanding and representations, if any,
made by and between the parties. To the extent that the agreement conflicts with, modifies, alters or
changes any of the terms and conditions contained in the Formal Solicitation and/or Response, the Formal
Solicitation and then the Response shall control. This Contract may be modified only by a written
agreement signed by the City of Miami and Contractor.
1.33. ESTIMATED QUANTITIES —Estimated quantities or estimated dollars are provided for your
guidance only. No guarantee is expressed or implied as to quantities that will be purchased during the
contract period. The City is not obligated to place an order for any given amount subsequent to the award
of this contract. Said estimates may be used by the City for purposes of determining the low bidder or most
advantageous proposer meeting specifications. The City reserves the right to acquire additional quantities
at the prices bid/proposed or at lower prices in this Formal Solicitation.
1.34. EVALUATION OF RESPONSES
A.Rejection of Responses
The City may reject a Response for any of the following reasons:
1) Bidder/Proposer fails to acknowledge receipt of addenda;
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2) Bidder/Proposer mistates or conceals any material fact in the Response ;
3) Response does not conform to the requirements of the Formal Solicitation;
4) Response requires a conditional award that conflicts with the method of award;
5) Response does not include required samples, certificates, licenses as required; and,
6) Response was not executed by the Bidder's/Proposer(s) authorized agent.
The foregoing is not an all inclusive list of reasons for which a Response may be rejected. The City may
reject and re -advertise for all or any part of the Formal Solicitation whenever it is deemed in the best
interest of the City.
B. EIimination From Consideration •
1) A contract shall not be awarded to any person or firm which is in arrears to the City upon any debt or
contract, or which is a defaulter as surety or otherwise upon any obligation to the City.
2) A contract may not be awarded to any person or firm which has failed to perform under the terms and.
conditions of anyprevious contract with the City or deliver on time contracts of a similar nature.
3) A contract may not be awarded to any person or firm which has been debarred by the City in
accordance with the,City's Debarment and Suspension Ordinance.
C. Determination of Responsibility
1) Responses will only be considered from entities who are regularly engaged in the business of providing
the goods/equipment/services required by the Formal Solicitation. Bidder/Proposer must be able to
demonstrate a satisfactory record of performance and integrity; and, have sufficient financial, material,
equipment, facility, personnel resources, and expertise to meet all contractual requirements. The terms
"equipment and organization" as used herein shall be construed to mean a fully equipped and well
established entity in line with the best industry practices in the industry as determined by the City.
2) The City may consider any evidence available regarding the financial, technical and other qualifications
and abilities of a Bidder/Proposer, including past performance (experience) with the City or any other
governmental entity in making the award.
3) The City may require the Bidder(s)/Proposer(s) to show proof that they have been designated as an
authorized representative of a manufacturer or supplier which is the actual source of supply, if required by
the Formal Solicitation.
1.35. EXCEPTIONS TO GENERAL AND/OR SPECIAL CONDITIONS OR SPECIFICATIONS -
Exceptions to the specifications shall be listed on.the Response and.shall reference the section. Any
exceptions to the General or Special Conditions shall be cause for the bid (IFB) to be considered
non -responsive. It -also may be cause for a RFP, RFQ, or RFLI to be considered non -responsive; and, if
exceptions are taken to the terms and conditions of the resulting agreement it may lead to terminating
negotiations.
1.36. F.O.B. DESTINATION - Unless otherwise specified in the Formal Solicitation, all prices
quoted/proposedby the bidder/proposer must be F.O.B. DESTINATION, inside delivery,, with all delivery
costs and charges included in the bid/proposal price, unless otherwise specified in this Formal
Solicitation. Failure to do so may be cause for rejection of bid/proposal.
1.37. FIRM PRICES - The bidder/proposer warrants that prices, terms, and conditions quoted in its
response will be firm throughout the duration of the contract unless otherwise specified in the Formal
Solicitation. Such prices will remain firm for the period of performance or resulting purchaseorders or
contracts, which are to be performed or supplied over a period of time.
1.38. FIRST -SOURCE HIRING AGREEMENT (Sec. 18-110)
(a) The Commission approves implementation of the first -source hiring agreement policy and requires
as a condition precedent to the execution of service contracts for facilities, services, and/or receipt of grants
and loans, for projects of a nature that create new jobs, the successful negotiation of first -source hiring
agreements between the organization or individual receiving said contract and the authorized representative
unless such an agreement is found infeasible by the city manager and such finding approved by the City
Commission at a public hearing.
(b) For the purpose of this section, the following terms, phrases, words and their derivations shall have
the following meanings:
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Authorized representative means the Private Industry Council of South Florida/South Florida Employment
and Training Consortium, or its successor as local recipient of federal and state training and employment
funds.
Facilities means all publicly financed projects, including but without limitation, unified development
projects, municipal public works, and municipal improvements to the extent they are financed through
public money services or the use of publicly owned property.
Grants and loans means, without limitation, urban development action grants (UDAG), economic
development agency construction loans, loans from Miami Capital Development, Incorporated, and all
federal and state grants administered by the city.
Service contracts means contracts for the procurement of services by the city which include professional
services.
Services includes, without limitation, public works improvements, facilities, professional services,
commodities, supplies, materials and equipment.
(c) The authorized representative shall negotiate each first -source hiring agreement.
(d) The primary beneficiaries of the first -source hiring agreement shall be participants of the city
training and employment programs, and other residents of the city.
1.39. FLORIDA MINIMUM WAGE - The Constitution of the State of Florida, Article X, Section 24,
states that employers shall pay employee wages no less than the minimum wage for all hours worked in
Florida. Accordingly, it is the contractor's and its' subcontractor(s) responsibility to understand and
comply with this Florida constitutional minimum wage requirement and pay its employees the current
established hourly minimum wage rate, which is subject to change or adjusted by the rate of inflation using
the consumer price index for urban wage earners and clerical workers, CPI-W, or a successor index as
calculated by the United States Department of Labor. Each adjusted minimum wage rate calculated shall
be determined and published by the Agency Workforce Innovation on September 30th of each year and
take effect on the following January 1st.
At the time of responding, it is bidder/proposer and his/her subcontractor(s), if applicable, full
responsibility to determine whether any of its employees may be impacted by this Florida Law at any given
point in time during the term of the contract. If impacted, bidder/proposer must furnish employee name(s),
job title(s), job description(s), and current pay rate(s). Failure to submit this information at the time of
submitting a response constitute successful bidder's/proposer's aclmowledgement and understanding that
the Florida Minimum'Wage Law•will notimpact its prices throughout the term of contract and waiver of ' ' ` . '
any contractual price increase request(s). The City reserves the right to request and successful . . .
bidder/proposer must provide for any -and all information to make a wage and contractual price increase(s)
determination.
1.40. GOVERNING LAW AND VENUE The validity and effect of this Contract shall be govemed by
the laws of the State of Florida. The parties agree that any action, mediation or arbitration arising out of this
Contract shall take place in Miami -Dade County, -Florida. • ` -
1.41. HEADINGS AND TERMS - The headings to the various paragraphs of this Contract have been
inserted for convenient reference only and shall not in any manner be construed as modifying, amending or
affecting in any way the expressed terms and provisions hereof.
1.42. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPPA) - Any
person or entity that performs or assists the City of Miami with a function or activity involving the use or
disclosure of "individually identifiable health information (BHT) and/or Protected Health Information (PHI)
shall comply with the Health Insurance Portability and Accountability Act (BIPAA) of 1996 and the City
of Miami Privacy Standards. HIPAA mandates for privacy, security and electronic transfer standards,
which include but are not limited to:
A. Use of information only for performing services required by the contract or as required by law;
B. Use of appropriate safeguards to prevent non -permitted disclosures;
C. Reporting to the City of Miami of any non -permitted use or disclosure;
D. Assurances that any agents and subcontractors agree to the same restrictions and conditions that apply to
the Bidder/Proposer and reasonable assurances that UHI/PHI will be held confidential;
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E. Making Protected Health Information (PHI) available to the customer;
F. Making PHI available to the customer for review and amendment; and incorporating any amendments
requested by the customer;
G. Making PHI available to the City of Miami for an accounting of disclosures; and
A. Making internal practices, books and records related to PHI available to the City of Miami for
compliance audits.
PHI shall maintain its protected status regardless of the form and method of transmission (paper records,
and/or electronic transfer of data). The Bidder/ Proposer must give its customers written notice of its
privacy information practices including specifically, a description of the types of uses and disclosures that
would be made with protected health information.
1.43. INDEMNIFICATION - Contractor shall indemnify , hold harmless and defend the City, its
officials, officers, agents, directors, and employees, from liabilities, damages, losses, and costs, including,
but not limited to reasonable attorney's fees, to the extent caused by the negligence, recklessness or
intentional wrongful misconduct of Contractor and persons employed or utilized by Contractor in the
performance of this Contract and will indemnify, hold harmless and defend the City, its officials, officers,
agents, directors and employees against, any civil actions, statutory or similar claims, injuries or damages
arising or resulting from the permitted work, even if it is alleged that the City, its officials and/or
employees were negligent, unless such injuries or damages are ultimately proven to be the result of grossly
negligent or willful acts or omissions on the part of the City, its officials and/or employees... These
indemnifications shall survive the term of this Contract. In the event that any action or proceeding is
brought against City by reason of any such claim or demand, Contractor shall, upon written notice from
City, resist and defend such action or proceeding by counsel satisfactory to City. The Contractor expressly
understands and agrees that any insurance protection required by this Contract or otherwise provided by
Contractor shall in no way limit the responsibility to indemnify, keep and save harmless and defend the
City or its officers, employees, agents and instrumentalities as herein provided.
The indemnification provided above shall obligate Contractor to defend at its own expense to and through
appellate, supplemental or bankruptcy proceeding, or to provide for such defense, at City's option, any and
all claims of liability and all suits and actions of every name and description which may be brought against
City whether performed by Contractor, or persons employed or utilized by Contractor.
This indemnity will survive the cancellation or expiration of the Contract. This indemnity will be
interpreted under the laws of the State of Florida, including without limitation and which conforms to the
limitations of.§725..06. and/or §725.08, Fla. ,Statues,.as amended from time.to time as applicable.. .
Contractor shall require all Sub -Contractor agreements to include a provision that they will indemnify the
- City
The Contractor agrees and recognizes that the City shall not be held liable or responsible for any claims
which may result from any actions or omissions of the Contractor in which the City participated either
through review or concurrence of the Contractor's actions. In reviewing, approving or rejecting any
submissions by the Contractor or other acts of the Contractor, the City in no way assumes or shares any
responsibility or liability Of the Contractor or Sub -Contractor, under this'Agreement. • •
1.44. INFORMATION AND DESCRIPTIVE LITERATURE—Bidders/Proposer must furnish all
information requested in the spaces provided in the Formal Solicitation. Further, as may be specified
elsewhere, each Bidder/Proposer must submit for evaluation, cuts, sketches, descriptive literature, technical
specifications, and Material Safety Data Sheets (MSDS)as required, covering the products offered.
Reference to literature submitted with a previous response or on file with the Buyer will not satisfy this
provision.
1.45. INSPECTIONS - The City may, at reasonable times during the term hereof, inspect Contractor's
facilities and perform such tests, as the City deems reasonably necessary, to determine whether the goods
and/or services required to be provided by the Contractor under this Contract conform to the terms and
conditions of the Formal Solicitation. Contractor shall make available to the City all reasonable facilities
and assistance to facilitate the performance of tests or inspections by City representatives. All tests and
inspections shall be subject to, and made in accordance with, the provisions of the City of Miami Ordinance
No. 12271 (Section 18-79), as same may be amended or supplemented from time to time.
1.46. INSPECTION OF RESPONSE - Responses received by the City pursuant to a Formal Solicitation
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will not be made available until such time as the City provides notice of a decision or intended decision or
within 10 days after bid closing, whichever is earlier. Bid/Proposal results will be tabulated and may be
furnished upon request via fax or e-mail to the Sr. Procurement Specialist issuing the Solicitation.
Tabulations also are available on the City's Web Site following recommendation for award.
1.47. INSURANCE - Within ten (10) days after receipt of Notice of Award, the successful Contractor,
shall furnish Evidence of Insurance to the Purchasing Department, if applicable. Submitted evidence of
coverage shall demonstrate strict compliance to all requirements listed on the Special Conditions entitled
"Insurance Requirements". The City shall be listed as an "Additional Insured."
Issuance of a Purchase Order is contingent upon the receipt of proper insurance documents. If the
insurance certificate is received within the specified time frame but not in the manner prescribedin this
Solicitation the Contractor shall be verbally notified of such deficiency and shall have an additional five (5)
calendar days to submit a corrected certificate to the City. If the Contractor fails to submit the required •
insurance documents in the manner prescribed in this Solicitation within fifteen (15) calendar days after
receipt Notice of Award, the contractor shall be in default of the contractual terms and conditions and shall
not be awarded the contract. Under such circumstances, the Bidder/Proposer may be prohibited from
submitting future responses to the City. Information regarding any insurance requirements shall be directed
to the Risk Administrator, Department of Risk Management, at 444 SW 2nd Avenue, 9th Floor, Miami,
Florida 33130, 305-416-1604.
The Bidder/Proposer shall be responsible for assuring that the insurance certificates required in
conjunction with this Section remain in effect for the duration of the contractual period; including any and
all option terms that may be granted to the Bidder/Proposer.
1.48. INVOICES - Invoices shall contain purchase order number and details of goods and/orservices
delivered. (i.e. quantity, unit price, extended price, etc); and in compliance with Chapter 218 of the Florida
Statutes (Prompt Payment Act).
1.49. LOCAL PREFERENCE
A. City Code Section 18-85, states, "when a responsive, responsible non -local bidder submits the lowest
bid price, and the bid submitted by one or more responsive, responsible local bidders who maintain a local
office, as defined in Section 18-73, is within fifteen percent (15%) of the price submitted by the non -local
bidder, then that non -local bidder and each of the aforementioned responsive, responsible local bidders
shall have the opportunity to submit a best and final bid equal to or lower than the amount of the low bid
previously submitted by the non -local bidder. Contract award shall be made to the lowest responsive,
responsible bidder submitting the lowest best•and final bid. In.the case offatie.in the best and. final bid
between a local bidder and a non -local bidder, contract award shall be made to the local bidder."
B. City Code Section 18-86, states, "the RFP, RFLI or RFQ, as applicable, may, in the exercise of the
reasonable professional discretion of the City Manager, director of the using agency, and the Chief
Procurement Officer, include a five (5%) percent evaluation criterion in favor of proposers who maintain a
local office, as defined in Section 18-73. In such cases, this five (5%) percent evaluation criterion in favor
of proposers who maintain a local office will be specifically defined in the RFP, RFLI or RFQ, as
applicable; otherwise, it will not apply.
1.50. MANUFACTURER'S CERTIFICATION - The City reserves the right to request from
bidders/proposers a separate Manufacturer's Certification of all statements made in the bid/proposal.
Failure to provide such certification may result in the rejection of bid/proposal or termination of
contract/agreement, for which the bidder/proposer must bear full liability.
1.51. MODIFICATIONS OR CHANGES IN PURCHASE ORDERS AND CONTRACTS - No
contract or understanding to modify this Formal Solicitation and resultant purchase orders or contracts, if
applicable, shall be binding upon the City unless made in writing by the Director of Purchasing of the City
of Miami, Florida through the issuance of a change order, addendum, amendment, or supplement to the
contract, purchase order or award sheet as appropriate.
1.52. NO PARTNERSHIP OR JOINT VENTURE - Nothing contained in this Contract will be deemed
or construed to create a partnership or joint venture between the City of Miami and Contractor, or to create
any other similar relationship between the parties.
1.53. NONCONFORMANCE TO CONTRACT CONDITIONS - Items may be tested for compliance
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with specifications under the direction of the Florida Department of Agriculture and Consumer Services or
by other appropriate testing Laboratories as determined by the City. The data derived from any test for
compliance with specifications is public record and open to examination thereto in accordance with
Chapter 119, Florida Statutes. Items delivered not conforming to specifications may be rejected and
returned at Bidder's/Proposer's expense. These non -conforming items not delivered as per delivery date in
the response and/or Purchase Order may result in bidder/proposer being found in default in which event
any and all re -procurement costs may be charged against the defaulted contractor. Any violation of these
stipulations may also result in the supplier's name being removed from the City of Miami's Supplier's list.
1.54. NONDISCRIMINATION —Bidder/Proposer agrees that it shall not discriminate as to race, sex,
color, age, religion, national origin, marital status, or disability in connection with its performance under
this formal solicitation. Furthermore, Bidder/Proposer agrees that no otherwise qualified individual shall
solely by reason of his/her race, sex, color, age, religion, national origin, marital status or disability be
excluded from the participation in, be denied benefits of, or be subjected to, discrimination under any
program or activity.
In connection with the conduct of its business, including performance of services and employment of
personnel, Bidder/Proposer shall not discriminate against any person on the basis of race, color, religion,
disability, age, sex, marital status or national origin. All persons having appropriate qualifications shall be.
afforded equal opportunity for employment. •
1.55. NON-EXCLUSIVE CONTRACT/ PIGGYBACK PROVISION - At such times as may serve its
best interest, the City of Miami reserves the right to advertise for, receive, and award additional contracts
for these herein goods and/or services, and to make use of other competitively bid (governmental) .
contracts, agreements, or other similar sources for the purchase of these goods and/or services as may be
available.
It is hereby agreed and understood that this formal solicitation does not constitute the exclusive rights of
the successful bidders)/proposer(s) to receive all orders that may be generated by the City in conjunction
with this Formal Solicitation.
In addition, any and all commodities, equipment, and services required by the City in conjunction with
construction projects are solicited under a distinctly different solicitation process and shall not be purchased
under the terms, conditions and awards rendered under this solicitation, unless such purchases are
determined to be in the best interest of the City.
1.56. OCCUPATIONAL LICENSE - Any person, firm, corporation or joint venture, with a business
location in the City of Miami and is submitting a Response under this Formal Solicitation shall meet the
'
City's Occupational License Tax requirements in accordance with Chapter 31.1, Article I of the City of
Miami Charter. 'Others -with a location outside the City of Miami shall meet their local Occupational
License Tax requirements. A copy of the license must be submitted with the response; however, the City
may at its sole option and in its best interest allow the Bidder/Proposer to supply the license to the City
during the evaluation period, but prior to award.
1.57. ONE PROPOSAL =Only one (1) Response from an individual,•firm, partnership, corporation or
joint venture will be considered in response to this Formal Solicitation. When submitting an alternate
response, please refer to the herein condition for "Alternate Responses May Be Considered".
1.58. OWNERSHIP OF DOCUMENTS - It is understood by and between the parties that any documents,
records, files, or any other matter whatsoever which is given by the City to the successful Bidder/Proposer
pursuant to this formal solicitation shall at all times remain the property of the City and shall not be used by
the Bidder/Proposer for any other purposes whatsoever without the written consent of the City.
1.59. PARTIAL INVALIDITY - If any provision of this Contract or the application thereof to any person
or circumstance shall to any extent be held invalid, then the remainder of this Contract or the application of
such provision to persons or circumstances other than those as to which it is held invalid shall not be
affected thereby, and each provision of this Contract shall be valid and enforced to the fullest extent
permitted by law.
1.60. PERFORMANCE/PAYMENT BOND —A Contractor may be required to furnish a
Performance/Payment Bond as part of the requirements of this Contract, in an amount equal to one hundred
percent (100%) of the contract price.
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1.61. PREPARATION OF RESPONSES (HARDCOPY FORMAT) —Bidders/Proposers are expected to
examine the specifications, required delivery, drawings, and all special and general conditions. All
bid/proposed amounts, if required, shall be either typewritten or entered into the space provided with ink.
Failure to do so will be at the Bidder's/Proposer's risk.
A. Each Bidder/Proposer, shall furnish the information required in the Formal Solicitation. The
Bidder/Proposer shall sign the Response and print in ink or type the name of the Bidder/Proposer, address,
and telephone number on the face page and on each continuation sheet thereof on which he/she makes an
entry, as required. .
B. If so required, the unit price for each unit offered shall be shown, and such price shall include
packaging, handling and shipping, and F.O.B. Miami delivery inside City premises unless otherwise
specified. Bidder/Proposer shall include in the response all taxes, insurance, social security, workmen's.
compensation, and any other benefits normally .paid by the Bidder/Proposer to its employees. If
applicable, a unit price shall be entered in the "Unit Price" Column for each item. Based upon estimated
quantity, an extended price shall be entered in the "Extended Price" column for each item offered. In case
of a discrepancy between the unit price and extended price, the unit price will be presumed correct.
C. The Bidder/Proposer must state a definite time, if required, in calendar days for delivery of goods
and/or services.
D. The Bidder/Proposer should retain.a copy of all response documents for future reference.
E. All responses, as described, must be fully completed and typed or printed in ink and must be signed in
ink with the firm's name and by an officer or employee having authority to bind the company or firm by
his/her signature. Bids/Proposals having any erasures or corrections must be initialed in ink by person
signing the response or the response may be rejected.
F. •Responses are to remain valid for at least 180 days. Upon award of a contract, the content of the
Successful Bidder's/Proposer's response may be included as part of the contract, at the City's discretion.
G. The City of Miami's Response Forms shall be used when Bidder/Proposer is submitting its response in
hardcopy format. Use of any other forms will result in the rejection of the response. IF SUBMITTING
HARDCOPY FORMAT, THE ORIGINAL AND THREE (3) COPIES OF THESE SETS OF FORMS,
UNLESS OTHERWISE SPECIFIED, AND ANY REQUIRED ATTACHMENTS MUST BE
RETURNED TO THE CITY OR YOUR RESPONSE MAY BE DEEMED NON -RESPONSIVE.
1.62. PRICE ADJUSTMENTS — Any price decrease effectuated during the contract period either by
reason of market change or on the part of the contractor to other customers shall be passed on to the City of
Miami.
1.63. PRODUCT SUBSTITUTES - In the event a particular awarded and approved manufacturer's
product becomes unavailable during the term of the Contract, the Contractor awarded that item may
arrange with the City's authorized representative(s) to supply a substitute product at the awarded price or
lower, provided that a sample is approved in advance of delivery and that the new product meets or exceeds
all quality requirements. • • • • ..• .. -
1.64. CONFLICT OF INTEREST, AND UNETHICAL BUSINESS PRACTICE PROHIBITIONS -
Contractor represents and warrants to the City that it has not employed or retained any person or company
employed by the City to solicit or secure this Contract and that it has not offered to pay, paid, or agreed to
pay any person any fee, commission, percentage, brokerage fee, or gift of any kind contingent upon or in
connection with, the award of this Contract.
1.65. PROMPT PAYMENT —Bidders/Proposers may offer a cash discount for prompt payment; however,
discounts shall not be considered in determining the lowest net cost for response evaluation purposes.
Bidders/Proposers are required to provide their prompt payment terms in the space provided on the Formal
Solicitation. If no prompt payment discount is being offered, the Bidder/Proposer must enter zero (0) for
the percentage discount to indicate no discount. If the Bidder/Proposer fails to enter a percentage, it is
understood and agreed that the terms shall be 2% 20 days, effective after receipt of invoice or fmal
acceptance by the City, whichever is later.
'When the City is entitled to a cash discount, the period of computation will commence on the date of
delivery, or receipt of a correctly completed invoice, whichever is later. If an adjustment in payment is
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Request for Proposals (RFP) 273288
necessary due to damage, the cash discount period shall commence on the date final approval for payment
is authorized. If a discount is part of the contract, but the invoice does not reflect the existence of a cash
discount, the City is entitled to a cash discount with the period commencing on the date it is determined by
the City that a cash discount applies.
Price discounts off the original prices quoted on the Price Sheet will be accepted from successful
bidders/proposers during the term of the contract.
1.66. PROPERTY - Property owned by the City of Miami is the responsibility of the City of Miami. Such
property furnished to a Contractor for repair, modification, study, etc., shall remain the property of the City
of Miami. Damages to such property occurring while in the possession of the Contractor shall be the
responsibility of the Contractor. Damages occurring to such property while in route to the City of Miami •
shall be the responsibility of the Contractor. In the eventthat such property is destroyed or declared a.total
loss, the Contractor shall be responsible for replacement value of the property at the current market value,
less depreciation of the property, if any.
1.67. PROVISIONS BINDING - Except as otherwise expressly provided in the resulting Contract, all
covenants, conditions and provisions of the resulting Contract shall be binding upon and shall inure to the
benefit of the parties hereto and their respective heirs, legal representatives, successors and assigns.
1.68. PUBLIC ENTITY CRIMES - A person or affiliate who has been placed on the convicted vendor list
following a conviction for a public entity crime may not submit a response on a contract to provide any
goods or services to a public entity, may not submit a response on a contract with a public entity for the
construction or repair of a public building or public work, may not submit responses on leases of real
property to a public entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or
consultant under a contract with any public entity, and may not transact business with any public entity in
excess of the threshold amount provided in Section 287.017, for CATEGORY TWO for a period of 36
months from the date of being placed on the convicted vendor list.
1.69. PUBLIC RECORDS - Contractor understands that the public shall have access, at all reasonable
times, to all documents and information pertaining to City contracts, subject to the provisions of Chapter
119, Florida Statutes, and City of Miami Code, Section 18, Article III, and agrees to allow access by the
City and the public to all documents subject to disclosure under applicable law. Contractor's failure or
refusal to comply with the provision of this section shall result in the immediate cancellation of this
Contract by the City.
1.70. QUALITY OF GOODS, MATERIALS, SUPPLIES, PRODUCTS, AND EQUIPMENT - All
materials used in the manufacturing or construction of supplies, materials, or equipment covered by this
solicitation shall be new. The items bid/proposed must be of the latest make or model, of the best quality,
and of the highest grade of workmanship, unless as otherwise specified in this Solicitation.
1.71. QUALITY OF WORK/SERVICES - The work/services performed must be of the highest quality
and workmanship. Materials furnished to complete the service shall be new and of the highest quality
except as otherwise specified in this Solicitation.
1.72. REMEDIES PRIOR TO AWARD (Sec. 18-106) - If prior to Contract award it is determined that -a
formal solicitation or proposed award is in violation of law, then the solicitation or proposed award shall be
cancelled by the City Commission, the City Manager or the Chief Procurement Officer, as may be
applicable, or revised to comply with the law.
1.73. RESOLUTION OF CONTRACT DISPUTES (Sec. 18-105)
(a) Authority to resolve Contract disputes. The City Manager, after obtaining the approval of the city
attorney, shall have the authority to resolve controversies between the Contractual Party and the city which
arise under, or by virtue of, a Contract between them; provided that, in cases involving an amount greater
than $25,000, the City Commission must approve the City Manager's decision. Such authority extends,
without limitation, to controversies based upon breach of Contract, mistake, misrepresentation or lack of
complete performance, and shall be invoked by a Contractual Party by submission of a protest to the City
Manager.
(b) Contract dispute decisions. If a dispute is not resolved by mutual consent, the City Manager shall
promptly render a written report stating the reasons for the action taken by the City Commission or the City
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Manager which shall be final and conclusive. A copy of the decision shall be immediately provided to the
protesting party, along with a notice of such parry's right to seek judicial relief, provided that the protesting
party shall not be entitled to such judicial relief without first having followed the procedure set forth in this
section.
1.74. RESOLUTION OF PROTESTED SOLICITATIONS AND AWARDS (Sec. 18-104)
(a) Right to protest. The following procedures shall be used for resolution of protested solicitations and
awards except for purchases of goods, supplies, equipment, and services, the estimated cost of which does
not exceed $25,000.
Protests thereon shall be governed by the Administrative Policies and Procedures of Purchasing.
1.Protest of Solicitation.
i. Any prospective proposer who perceives itself aggrieved in connection with the solicitation of a Contract
may protest to the Chief Procurement Officer. A written notice of intent to file a protest shall be filed with
the Chief Procurement Officer within three days after the Request for Proposals, Request for Qualifications
or Request for Letters of Interest is published in a newspaper of general circulation. A notice of intent to
file a protest is considered filed when received by the Chief Procurement Officer; or
H. Any prospective bidder who intends to contest the Solicitation Specifications or a solicitation may
protest to the Chief Procurement Officer. A written notice of intent to file a protest shall be filed with the
Chief Procurement Officer within three days after the solicitation is published in a newspaper of general
circulation. A notice of intent to file a protest is considered filed when received by the Chief Procurement
Officer.
2. Protest of Award..
i. A written notice of intent to file a protest shall be filed with the Chief Procurement Officer within two
days after receipt by the proposer of the notice of the City Manager's recommendation for award of
Contract, which will be posted on the City of Miami Purchasing Department website, in the Supplier
Corner, Current Solicitations and Notice of Recommendation of Award Section. The notice of the City
Manager's recommendation can be found by selecting the details of the solicitation and is listed as
Recommendation of Award Posting Date and Recommendation of Award To fields. If "various" is
indicated in the Recommendation of Award To field, the Bidder/Proposer must contact the buyer for that
solicitation to obtain the suppliers name. It shall be the responsibility of the Bidder/Proposer to check this
section of the website daily after responses are submitted to receive the notice; or
ii. Any actual Responsive and Responsible Bidder. whose Bid is lower than. that of the recommended bidder
may protest to the Chief Procurement Officer. A written notice of intent to file a protest shall be filed with
the Chief Procurement Officer within two days after receipt by the bidder of the notice of the city's
determination of non responsiveness or non responsibility. The receipt by bidder of such notice shall be
confirmed by the city by facsimile or electronic mail or U.S. mail, return receipt requested. A notice of
intent to file a protest is considered filed when received by the Chief Procurement Officer.
iii. A written protest based on any of theforegoing must be submitted to the Chief Procurement Officer
within five (5) days after the date the notice of protest was filed. A written protest is considered filed when
received by the Chief Procurement Officer. •
The written protest may not challenge the relative weight of the evaluation criteria or the formula for
assigning points in making an award determination.
The written protest shall state with particularity the specific facts and law upon which the protest of the
solicitation or the award is based, and shall include all pertinent documents and evidence and shall be
accompanied by the required Filing Fee as provided in subsection (f). This shall form the basis for review
of the written protest and no facts, grounds, documentation or evidence not contained in the protester's
submission to the Chief Procurement Officer at the time of filing the protest shall be permitted in the
consideration of the written protest.
No time will be added to the above limits for service by mail. In computing any period of time prescribed
or allowed by this section, the day of the act, event or default from which the designated period of time
begins to run shall not be included. The last day of the period so computed shall be included unless it is a
Saturday, Sunday or legal holiday in which event the period shall run until the end of the next day which is
neither a Saturday, Sunday or legal holiday. Intermediate Saturdays, Sundays and legal holidays shall be
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excluded in the computation of the time for filing.
(b) Authority to resolve protests. The Chief Procurement Officer shall have the authority, subject to the
approval of the City Manager and the city attorney, to settle and resolve any written protest. The Chief
Procurement Officer shall obtain the requisite approvals and communicate said decision to the protesting
party and shall submit said decision to the City Commission within 30 days after he/she receives the
protest. In cases involving more than S25,000, the decision of the Chief Procurement Officer shall be
submitted for approval or disapproval thereof to the City Commission after a favorable recommendation by
the city attorney and the City Manager.
(c) Compliance with filing requirements. Failure of a party to timely file either the notice of intent to file a
protest or the written protest, together with the required Filing Fee as provided in subsection (f), with the
Chief Procurement Officer within the time provided in subsection (a), above, shall constitute a forfeiture of
such parry's right to file a protest pursuant to this section. The protesting party shall not be entitled to seek
judicial relief without first having followed the procedure set forth in this section
(d) Stay of Procurements during protests. Upon receipt of a written protest filed pursuant to the
requirements of this section, the city shall not proceed further with the solicitation or with the award of the
Contract until the protest is resolved by the Chief Procurement Officer or the City Commission as provided
in subsection (b) above, unless the City Manager makes a written determination that the solicitation process
or the Contract award must be continued without delay in order to avoid an immediate and serious danger
to the public health, safety or welfare.
(e) Costs. All costs accruing from a protest shall be assumed by the protestor.
(f) Filing Fee. The written protest must be accompanied by a filing fee in the form of a money order or
cashier's check payable to the city in an amount equal to one percent of the amount of the Bid or proposed
Contract, or $5000.00, whichever is less, which filing fee shall guarantee the payment of all costs which
may be adjudged against the protestor in any administrative or court proceeding. If a protest is upheld by •
the Chief Procurement Officer and/or the City Commission, as applicable, the filing fee shall be refunded
to the protestor less any costs assessed under subsection (e) above. If the protest is denied, the filing fee
shall be forfeited to the city in lieu of payment of costs for the administrative proceedings as prescribed by
subsection (e) above.
1.75. SAMPLES - Samples of items, when required, must be submitted within the time specified at no •
expense to the City. If not destroyed by testing, bidder(s)/proposer(s) will be notified to remove samples,
at their expense, within 30 days after notification..Failure toremove the samples will result in the samples
becoming the property of the City.
1.76; SELLING, TRANSFERRING OR ASSIGNING RESPONSIBILITIES - Contractor shall not sell,
assign, transfer or subcontract at any time during the term of the Contract, or any part of its operations, or
assign any portion of the performance required by this contract, except under and by virtue of written
permission granted by the City through the proper officials, which may be withheld or conditioned, in the
City's sole discretion.
1.77. SERVICE AND WARRANTY —When specified, the bidder/proposer shall define all warranty,
service and replacements that will be provided. Bidders/Proposer must explain on the Response to what
extent warranty and service facilities are available. A copy of the manufacturer's warranty, if applicable,
should be submitted with your response.
1.78. SILENCE OF SPECIFICATIONS - The apparent silence of these specifications and any
supplemental specification as to any detail or the omission from it of detailed description concerning any
point shall be regarded as meaning that only the best commercial practices are to prevail and that only
materials of first quality and correct type, size and design are to be used. All workmanship and services is
to be first quality.
All interpretations of these specifications shall be made upon the basis of this statement.
If your firm has a current contract with the State of Florida, Department of General Services, to supply the
items on this solicitation, the bidder/proposer shall quote not more than the contract price; failure to comply
with this request will result in disqualification of bid/proposal.
1.79. SUBMISSION AND RECEIPT OF RESPONSES - Responses shall be submitted electronically via
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the Oracle System or responses may be submitted in hardcopy format to the City Clerk, City Hall, 3500
Pan American Drive, Miami, Florida 33133-5504, at or before, the specified closing date and time as
designated in the IFB, RFP, RFQ, or RFLI. NO EXCEPTIONS. Bidders/Proposers are welcome to attend
the solicitation closing; however, no award will be made at that time.
A. Hardcopy responses shall be enclosed in a sealed envelope, box package. The face of the envelope,
box or package must show the hour and date specified for receipt of responses, the solicitation number and
title, and the name and return address of the Bidder/Proposer. Hardcopy responses not submitted on the
requisite Response Forms may be rejected. Hardcopy responses received at any other location than the
specified shall be deemed non -responsive.
Directions to City Hall:
FROM THE NORTH: I-95 SOUTH UNTIL IT TURNS INTO US1. US1 SOUTH TO 27TH AVE.,
TURN LEFT, PROCEED SOUTH TO SO. BAYSHORE DR. (3RD TRAFFIC LIGHT), TURN LEFT, 1
BLOCK TURN RIGHT ON PAN AMERICAN DR. CITY HALL IS AT THE END OF PAN
AMERICAN DR. PARKING IS ON RIGHT.
FROM THE SOUTH:. US 1 NORTH TO 27TH AVENUE, TURN RIGHT, PROCEED SOUTH TO SO.
BAYSHORE DR. (3RD TRAFFIC LIGHT), TURN LEFT, 1 BLOCK TURN RIGHT ON PAN.
AMERICAN DR. CITY HALL IS AT THE END OF PAN AMERICAN DR. PARKING IS ON RIGHT.
B. Facsimile responses will not be considered.
C. Failure to follow these procedures is cause for rejection of bid/proposal.
D. The responsibility for obtaining and submitting a response on or before the close date is solely and
strictly the responsibility of Bidder/Proposer. The City of Miami is not responsible for delays caused by
the United States mail delivery or caused by any other occurrence. • Responses received after the
solicitation closing date and time will be returned unopened, and will not be considered for award.
E. Late responses will be rejected.
F. All responses are subject to the conditions specified herein. Those which do not comply with these
conditions are subject to rejection.
G. Modification of responses already submitted will be considered only if received at the City before the
time and date set for closing of solicitation responses. All modifications must be submitted via the Oracle
System or in writing. Once a solicitation closes (closed date and/or time expires), the City will not consider
any subsequent submission which 'alters the responses. •
H. If hardcopy responses are submitted at the same time for different solicitations, each response must be
placed in a separate envelope, box, or package and each envelope, box or package must contain the
information previously stated in 1.82.A.
1.80. TAXES - The City of Miami is exempt from any taxes imposed by the State and/or Federal
Government. Exemption certificates will be provided upon request. Notwithstanding, Bidders/Proposers
should be aware of the fact that all materials and supplies which are purchased by' the Bidder/Proposer'for
the completion of the contract is subject to the Florida State Sales Tax in accordance with Section 212.08,
Florida Statutes, as amended and all amendments thereto and shall be paid solely by the Bidder/Proposer.
1.81. TERMINATION —The City Manager on behalf of the City of Miami reserves the right to terminate .
this contract by written notice to the contractor effective the date specified in the notice should any of the
following apply:
A. The contractor is determined by the City to be in breach of any of the terms and conditions of the
contract.
B. The City has determined that such termination will be in the best interest of the City to terminate the
contract for its own convenience;
C. Funds are not available to cover the cost of the goods and/or services. The City's obligation is
contingent upon the availability of appropriate funds.
1.82. TERMS OF PAYMENT - Payment will be made by the City after the goods and/or services
awarded to a 13idder/Proposer have been received, inspected, and found to comply with award
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specifications, free of damage or defect, and properly invoiced. No advance payments of any kind will be
made by the City of Miami.
Payment shall be made after delivery, within 45 days of receipt of an invoice and authorized inspection
and acceptance of the goods/services and pursuant to Section 218.74, Florida Statutes and other applicable.
law.
1.83. TIMELY DELIVERY - Time will be of the essence for any orders placed as a result of this
solicitation. The City reserves the right to cancel such orders, or any part thereof, without obligation, if
delivery is not made within the time(s) specified on their Response. Deliveries are to be made during
regular City business hours unless otherwise specified in the Special Conditions.
1.84. TITLE - Title to the goods or equipment shall not pass to the City until after the City has accepted
the goods/equipment or used the goods, whichever comes first.
1.85.TRADE SECRETS EXECUTION TO PUBLIC RECORDS DISCLOSURE- All Responses
submitted to the City are subject to public disclosure pursuant to Chapter 119, Florida Statutes. An
exception may be made for "trade secrets."
If the Response contains information that constitutes a "trade secret", all material that qualifies for
exemption from Chapter 119 must be submitted in a separate envelope, clearly identified as "TRADE
SECRETS EXCEPTION," with your firm's name and the Solicitation number and title marked on the
outside.
Please be aware that the designation of an item as a trade secret by you may be challenged in court by any
person. By your designation of material in your Response as a "trade secret" you agree to indemnify and
hold harmless the City for any award to a plaintiff for damages, costs or attorney's fees and for costs and
attomey's fees incurred by the City by reason of any legal action challenging your claim.
1.86. UNAUTHORIZED WORK OR DELIVERY OF GOODS- Neither the qualified
Bidder(s)/Proposer(s) nor any of his/her employees shall perform any work or deliver any goods unless a
change order or purchase order is issued and received by the Contractor. The qualified
Bidder(s)/Proposer(s) shall not be paid for any work performed or goods delivered outside the scope of the
contract or any work performed by an employee not otherwise previously authorized.
1.87. USE OF NAME - The City is not engaged in research for advertising, sales promotion, or other
publicity purposes. No advertising, sales promotion or other publicity materials containing information
obtained from this. Solicitation are to be. mentioned; orimply the. name of the City,-withoutprior express
written permission of the City Manager or the City Commission.
1.88. VARIATIONS OF SPECIFICATIONS - For purposes of solicitation evaluation, bidders/proposers
must indicate any variances from the solicitation specifications and/or conditions, no matter how slight. If
variations are not stated on their Response, it will be assumed that the product fully complies with the
City's specifications.
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2. Special Conditions
2.1. PURPOSE
The purpose of this Solicitation is to establish a contract, for Employee Benefit Dental Plan, as specified
herein, from a source(s) of supply that will give prompt and efficient service fully compliant with the terms,
conditions and stipulations of the solicitation.
2.2. DEADLINE FOR RECEIPT OF REQUEST FOR ADDITIONAL
INFORMATION/CLARIFICATION
Any questions or clarifications concerning this solicitation shall be submitted by email or facsimile to the
Purchasing Department, Attn: Maritza Suarez, CPPB; fax: (305) 400-5025 or
email: msuarez@ci.miami.fl.us. The solicitation title and number shall be referenced on all
correspondence. All questions must be received no later than Friday, October 14, 2011 at 12:00 P.M.
Noon. All responses to questions will be sent to all prospective bidders/proposers in the form on an
addendum. NO QUESTIONS WILL BE RECEIVED VERBALLY OR AFTER SAID DEADLINE.
2.3. TERM OF CONTRACT
The proposer(s) qualified to providethe service(s) requested herein (the "Successful Proposer(s)") shall be
required to execute a contract ("Contract") with the City, which shall include, but not be limited to, the .
following terms:
(1) The term of the Contract(s) shall be for three (3) years with an option to renew for two (2) additional
one (1) year periods.
(2) The City shall'have the option to extend or terminate the Contract.
Continuation of the contract beyond the initial period is a City prerogative; not a right of the
bidder/proposer. This prerogative will be exercised only when such continuation is clearly in the best
interest of the City.
2.4. CONDITIONS FOR RENEWAL
Each renewal of this contract is subject to the following:
(1) continued satisfactory performance compliance with the specifications, terms and conditions
established herein and
(2) Availability of funds.
In the event the Contractor is unable to extend the contract for any subsequent period, advance written
notice and explanation shall be submitted to the Chief Procurement Offieer no later than ninety (90) days
prior to the expiration date of the contract period in effect at such time and shall be subject to the City's
acceptance. Failure to comply with these requirements may render the Contract in default of this contract.
2.5. NON -APPROPRIATION OF FUNDS
In the event no funds or insufficient funds are appropriated and budgeted or are otherwise unavailable in
any fiscal period for payments due under this contract, then the City, upon written notice to Contractor or
his assignee of such occurrence, shall have the unqualified right to terminate the contract without any
penalty or expense to the City. No guarantee, warranty or representation is made that any particular or any
project(s) will be awarded to any firm(s).
2.6. MINIMUM QUALIFICATION REQUIREMENTS
For a Proposer to be deemed responsive the following minimum qualification requirements cited below
shall be satisfied. In determining said responsiveness, each such minimum qualification requirement shall
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Request for Proposals (RFP) 273288
be addressed in detail in the Proposal submittal. Failure to meet each such following minimum
qualification requirements and/or failure to provide sufficient detailed documentation concerning the
same, shall result in the Proposal being deemed non -responsive:
(a) All Companies submitting Proposals must be licensed by the State of Florida and have a
demonstrated level of good performance with public entities of equivalent size, including
municipalities, for a minimum of two (2) years.
(b) Proposers must have an organization that has demonstrated the ability to deliver cost-effective
service, and efficient loss control and claims processing.
(c) Provide sufficient telephone service, including toll -free and local service 8-5 EST, to handle inquiries
directly from plan participants as well as authorized City representatives.
(d) Must disclose the following if broker fees are paid: (1) Name of agency and address; (2) Name of
agent/broker; and (3) Broker's fee whether flat fee or percentage of premium. If not applicable,
indicate that the proposal is quoted on a no -commission basis. It is the intention of the City for all
contracts to be awarded on a no -commission basis.
(e) Must assume current policy benefit structure and provide a "no loss/no gain" assumption of risk and
credit for all annual deductibles.
(f) Must comply with all federal legislation including but not limited to HIPAA and COBRA.
(g) Proposer must agree to allow the City or its representative the right to audit all claims, financial data,
and other information relevant to the City's account.
(h) The City requires that the pre-existing condition limitations and the actively at work provision be
waived for the initial enrollment for those employees who have already satisfied the waiting period
for pre-existing conditions under the current plan.
(i) Proposer must have bilingual capabilities in the customer service and enrollment assistance areas as
well as in communications materials. English and Spanish are mandatory. Creole is desired as well.
(j) Proposer shall have no record of judgments or pending lawsuits against the City and/or bankruptcy,
and not have any conflicts of interest that have not been waived by the City Commission.
(k) Neither Proposer nor any member, officer, or stockholder of Proposer shall be in arrears or in
default of any debt or contract involving the City, (as a party to a contract, or otherwise); nor have
failed to perform faithfully on any previous contract with the City.
2.7. CONTRACT EXECUTION
The selected Proposer(s) evaluated and ranked in accordance with the requirements of this Solicitation,
shall be•awarded an opportunity to negotiate a contract ("Contract") with the City: The City reserves the
right to execute or not execute, as applicable a Contract with the selected Proposer(s) that is determined to
be most advantageous and in the City's best interest. Such Contract will be furnished by the City, will
contain certain terms as are in the City's best interests, and will be subject to approval as to legal form by
the City Attorney.
2.8. FAILURE TO PERFORM
Should it not be possible to reach the contractor or supervisor and/or should remedial action not be taken
within 48 hours of any failure to perform according to specifications, the City reserves the right to declare
Contractor in default of the contract or make appropriate reductions in the contract payment.
2.9. INSURANCE REQUIREMENTS
INDEMNIFICATION
Bidder shall pay on behalf of, indemnify and save City. and its officials harmless, from and against any and
all claims, liabilities, losses, and causes of action, which may arise out of bidder's performance under the
provisions of the contract, including all acts or omissions to act on the part of bidder, including any person
performing under this Contract for or on bidder's behalf, provided that any such claims, liabilities, losses
and causes of such action are not attributable to the negligence or misconduct of the City and, from and
against any orders, judgments or decrees which may be entered and which may result from this Contract,
unless attributable to the negligence or misconduct of the City, and from and against all costs, attorneys'
fees, expenses and liabilities incurred in the defense of any such claim, or the investigation thereof.
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Request for Proposals (RFP) 273288
The bidder shall furnish to City of Miami, c/o Purchasing Department, 444 SW 2nd Avenue, 6th Floor,
Miami, Florida 33130, Certificate(s) of Insurance which indicate that insurance coverage has been obtained
which meets the requirements as outlined below:
(1) Worker's Compensation
A. Limits of Liability
Statutory - State of Florida
Waiver of Subrogation
Commercial General Liability:
A. Limits of Liability
Bodily Injury and Property Damage Liability - Each Occurrence: $1.000.000
General Aggregate Limit: $2,000,000
Personal and Adv. Injury: $1.000.000.
Products/Completed Operations: $1,000,000.00.
B. Endorsements Required:
City of Miami included as an Additional insured.
Primary Insurance Clause
Contigent "& Contractual Liability .
Premises and Operations Liability
BusinessAutomobiie Liability
A. Limits of Liability
Bodily injury and property damage Iiability combined single limits. Owned/Scheduled Autos,
including, including hired, borrowed or non -owned autos. Any one accident - $1.000.000
B. Endorsements Required:
City of Miami included as .an Additional Insured
(4) Employer's. Liability
A. Limits of Liability
$100,000 for bodily injury caused by an accident, each accident
$10.0,000 for bodily.injury.caused by disease, each employee .. . ............... .
$500,000.for bodily injury caused by disease, policy limit
(5) Professional Liability/Errors and Omissions Coverage:
A. Limits of Liability
Combined Single Limit
Each Claim - $1,000,000
General Aggregate I:imif - S1,000,000
Deductible - not to exceed 10%
BINDERS ARE UNACCEPTABLE.
The insurance coverage required shall include those classifications, as listed in standard liability insurance
manuals, which most nearly reflect the operations of the bidder.
All insurance policies required above shall be issued by companies authorized to do business under the
laws of the State of Florida, with the following qualifications:
The Company must be rated no less than "A" as to management, and no less than "Class V" as to financial
strength, by the latest edition of Best's Insurance Guide, published by A.M. Best Company, Oldwick, New
Jersey, or its equivalent. All policies and/or certificates of insurance are subject to review and verification
by Risk Management prior to insurance approval.
Certificates will indicate no modification or change in insurance shall be made without thirty (30) days
written advance notice to the certificate holder.
NOTE: CITY BID NUMBER AND/OR TITLE OF BID MUST APPEAR ON EACH CERTIFICATE.
Compliance with the foregoing requirements shall not relieve the bidder of his liability and obligation
(2)
(3)
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under this section or under any other section of this Agreement.
—If insurance certificates are scheduled to expire during the contractual period, the Bidder shall be
responsible for submitting new or renewed insurance certificates to the City at a minimum of ten (10)
calendar days in advance of such expiration.
--In the event that expired certificates are not replaced with new or renewed certificates which cover
the contractual period, the City shall:
(4) Suspend the contract until such time as the new or renewed certificates are received by the City in
the manner prescribed in the Invitation To Bid.
(5) The City may, at its sole discretion, terminate this contract for cause and seek re -procurement
damages from the Bidder in conjunction with the General and Special Terms and Conditions of the Bid.
The Bidder shall be responsible for assuring that the insurance certificates required in conjunction with this
Section remain in force for the duration of the contractual period; including any and all option terms that
may be granted to the Bidder.
2.10. PRE-BID/PRE-PROPOSAL CONFERENCE
None
2.11. CONTRACT ADMINISTRATOR
Upon award, contractor shall report and work directly with Mr. Richard Kaufman, and Ms. Barbara Pick,
AON Hewitt, who shall be designated as the Contract Administrator.
2.12. SUBCONTRACTOR(S) OR SUBCONSULTANT(S)
A Sub -Consultant, herein known as Sub-Contractor(s) is an individual or firm contracted by the Proposer
or Proposer's firm to assist in the performance of services required under this Solicitation. A
Sub -Contractor shall be paid through Proposer or Proposer's firm and not paid directly by the City.
Sub -Contractors are allowed by the City in the performance of the services delineated within this
Solicitation. Proposer must clearly reflect in its Proposal. the major Sub -Contractors to be utilized in the
performance of required services. The. City, retains the right. to acceptor rejectany .Sub -Contractors . . . ..... . ..........
proposed in the response of Successful Proposer or prior to contract execution. Any and all liabilities
regarding the use. of a_Sub-Contractor shall be borne solely by the Successful Proposer and insurance for
each Sub -Contractors must be maintained in good standing and approved by the City throughout the
duration of the Contract. Neither Successful Proposer nor any of its Sub -Contractors are considered to be
employees or agents of the City. Failure to list all Sub -Contractors and provide the required information
may disqualify any proposed Sub -Contractors from performing work under this Solicitation.
Proposers shall include in their Responses the requested Sub -Contractor information and include all
relevant information required of the Proposer. In addition, within five (5) working days after the
identification of the award to the Successful Proposer, the Successful Proposer shall provide a list
confirming the Sub -Contractors that the Successful Proposer intends to utilize in the Contract, if applicable.
The list shall include, at a minimum, the name, location of the place of business for each Sub -Contractor,
the services Sub -Contractor will provide relative to any contract that may result from this Solicitation, any
applicable licenses, references, ownership, and other information required of Proposer.
2.13. COMPLETE PROJECT REQUIRED
These specifications describe the various items or classes of work required, enumerating or defining the
extent of same necessary, but failure to list any item or classes under scope of the several sections shall not
'relieve the contractor from furnishing, installing or performing such work where required by any part of
these specifications, or necessary to the satisfactory completion of the project.
2.14. TERMINATION
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A. FOR DEFAULT
If Contractor defaults in its performance under this Contract and does not cure the default within 30 days
after written notice of default, the City Manager may terminate this Contract, in whole or in part, upon
written notice without penalty to the City of Miami. In such event the Contractor shall be liable for
damages including the excess cost of procuring similar supplies or services: provided that if, (1) it is
determined for any reason that the Contractor was not in default or (2) the Contractor's failure to perform is
without his or his subcontractor's control, fault or negligence, the termination will be deemed to be a
termination for the convenience of the City of Miami.
B. FOR CONVENIENCE
The City Manager may terminate this Contract, in whole or in part, upon 30 days prior written notice when
it is in the best interests of the City of Miami. If this Contract is for supplies, products, equipment, or
software, and so terminated for the convenience by the City of Miami the Contractor will be compensated
in accordance with an agreed upon adjustment of cost. To the extent that this Contract is for services and so
terminated, the City of Miami shall be liable only for payment in accordance with the payment provisions
of the Contract for those services rendered prior to termination.
2.15. ADDITIONAL TERMS AND CONDITIONS
No additional terms and conditions included with the solicitation response shall be evaluated or
considered, and any and all such additional terms and conditions shall have no force or effect and are
inapplicable to this solicitation. If submitted either purposely, through intent or design, or inadvertently,
appearing separately in transmittal letters, specifications, literature, price lists or warranties, it is understood
and agreed that the General and Special Conditions in this solicitation are the only conditions applicable to
this solicitation and that the bidder's/proposer's authorized signature affixed to the bidder's/proposer's
acknowledgment form attests to this.
2.16. CHANGES/ALTERATIONS
Proposer may change or withdraw a Proposal at any time prior to Proposal submission deadline; however,
no oral modifications will be allowed. Written modifications shall not be allowed following the proposal
deadline.
2.17. COMPENSATION PROPOSAL
Each Proposer shall detail any and all fees and costs to provide the required services as listed herein.
Proposer shall additionally provide a detailed list of all costs to provide all services as detailed in Section
III Scope.of Services, as proposed. The City reserves. the right to add or delete any service, at any time.
Should the City determine to add an additional service for which pricing was not previously secured, the
City shall seek the Successful Proposer to provide reasonable cost(s) for same. Should the City determine
the pricing unreasonable, the City reserves the right to negotiate cost(s) or seek another vendor for the
provision of said service(s).
Failure to submit compensation proposal as required shall disqualify Proposer from consideration.
2.18. EVALUATION/SELECTION PROCESS AND CONTRACT AWARD
The procedure for response evaluation, selection and award is as follows:
(1) Solicitation issued. -
(2) Receipt of responses.
(3) Opening and listing of all responses received.
(4) Purchasing staff will review each submission for compliance with the submission requirements of the
Solicitation, including verifying that each submission includes all documents required.
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Request for Proposals (RFP) 273288
(5) An Evaluation Committee comprised of members of the Audit Advisory Committee, as codified in
Section 2-950(1), (2) and (3) of the City Code, shall meet to evaluate each response in accordance
with the requirements of this Solicitation and based upon the evaluation criteria as specified herein.
(6) The Evaluation Committee reserves the right, in its sole discretion, to request Proposers to make oral
presentations before the Committee as part of the evaluation process. The presentation may be scheduled at
the convenience of the Evaluation Committee and shall be recorded.
(7) The Evaluation Committee reserves the right to rank the Proposals and shall submit its
recommendation to the City Manager for acceptance. If the City Manager accepts the Committee's
recommendation, the City Manager's recommendation for award of contract will be posted on the City of
Miami Purchasing Department website, in the Supplier Comer, Current Solicitations and Notice of
Recommendation of Award Section. The notice of the City Manager's recommendation can be found by
selecting the details of the solicitation and is listed as Recommendation of Award Posting Date and
Recommendation of Award To fields. If "various" is indicated in the Recommendation of Award To field,
the Bidder/Proposer must contact the buyer for that solicitation to obtain the suppliers name. The City
Manager shall make his recommendation to the City Commission requesting the authorization to negotiate
and/or execute an agreement with the recommended Proposer(s). No Proposer(s) shall have any rights
against the City arising from such negotiations or termination thereof.
(8) The City Manager reserves the right to reject the Committee's recommendation, and instruct the
Committee to re-evaluate and make another recommendation, reject all proposals, or recommend that the
City Commission reject all proposals. •
(9) The City Commission shall consider the City Manager's and Evaluation Committees'
recommendation(s) and, if appropriate and required, approve the City Manager's recommendation(s). The
City Commission may also reject any or all response.
(10) If the City Commission approves the recommendations, the City will enter into negotiations with the
selected Proposer(s) for a contract for the required services. Such negotiations may result in contracts, as
deemed appropriate by the City Manager.
(11) The City Commission shall review and approve the negotiated Contract with the selected
Proposer(s).
2.19. ADDITIONAL SERVICES
Services not specifically identified in this request may be added to any resultant contract upon successful
negotiation and mutual consent of the contracting parties.
2.21. RECORDS
During the contract period, and for a least five (5) subsequent years thereafter, Successful Proposer shall
provide City access to all files and records maintained on the City's behalf.
2.22. AMENDMENTS TO THE CONTRACT
The City Manager shall have the right and authority to amend this Contract on behalf of the City.
2.23. TRUTH IN NEGOTIATION CERTIFICATE
Execution of the resulting agreement by the Successful Proposer shall act as the execution of
truth -in -negotiation certificate stating that wage rates and other factual unit costs supporting the
compensation of the resulting Agreement are accurate, complete, and current at the time of contracting.
The original contract price and any additions thereto shall be adjusted to exclude any significant sums by
which City determines the contract price was increased due to inaccurate, incomplete, or non -current wage
rates and other factual unit costs. All such contract adjustments shall be made within one (1) year
following the end of the Agreement.
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Request for Proposals (RFP) 273288
3. Specifications
3.1. SPECIFICATIONS/SCOPE OF WORK
3.1.1. Background Information
The City of Miami is seeking to qualify dental care providers for. its Employee Benefit Dental Plan. The
City currently has a total of 3243 employees and retirees eligible for the dental plan. The City currently
offers a fully insured dental DMO (DHMO) through Solstice Benefits. This plan has approximately 2,699.
participants. The City also offers a fully -insured PDO plan through MetLife for employees. This plan has
approximately 495 participants. The City also offers a fully -insured Executive PDO (DPPO) plan which
has approximately 121 participants.
The managed dental plan and the preferred dental plan for the general employees are voluntary and
supported one hundred percent (100%) by employee contributions. The Executive PPO is funded fully by
the City of Miami.
Please refer to the attached exhibits for details on the City's current dental benefits plan(s).
3.1.2. Dental Plan(s) Solicited
It is the City's intent to offer their employees/retirees the following options:
1. An affordable dental HMO product (DMO) (DHMO.
2. An affordable dental PPO product (PDO) (DPPO).
The City is seeking Proposals on both a fully insured and self -insured basis for the dental care coverage.
The City is requesting Proposals to be based upon the current dental plan designs offered, but will accept
and review alternatives. All alternate plans must clearly designate deviations from the current schedule of
benefits.
The City will be evaluating the Proposals to access the capabilities in each of the following areas:
Fully Insured Dental Plans
1. Financial stability and experience
2. Network Disruption Report
3. Overall plan costs (fees, claims and/or premiums) and discount arrangements
4. Reporting capabilities
5. Communications and enrollment capabilities
6. Claims administration capabilities
7. Ability to offer requested plan designs/alternatives
8. Account management staff
9. Banking
3.1.3. Attachments and Exhibits
To assist you in the preparation of your Proposal, the City is attaching the following documentation:
List of Exhibits provided as information/documentation to prepare Proposal
1. DMO (DHMO) Census
2. PDO (DPPO) Census
3. Listing of Top Utilized Providers
4. Current rates
5. Summary of benefits for current programs (DMO benefits, PDO fee schedules)
6. 2008-2011 claims experience for current programs.
7. PPO Plan Designs
NOTE: Attachment A (Questionnaire) must be completed and returned with Proposal. Failure to complete
and return Attachment will deem any submitted Proposal non -responsive.
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Request for Proposals (RFP) 273288
4. Submission Requirements
4.1. SUBMISSION REQUIREMENTS
Proposers shall carefully follow the format and instruction outlined below, observing format requirements
where indicated. Proposals should contain the information itemized below and in the order indicated. This
information should be provided for the Proposer and any Sub -Consultants to be utilized for the work
contemplated by this Solicitation. Proposals submitted which do not include the following items may be
deemed non -responsive and may not be considered for contract award.
Proposers shall submit responses in a hardcopy format, consisting of one (1) original and ten (10)
copies, and in an electronic format via a CD-ROM. On-line submittals, via the Oracle System, shall
not be accepted. Failure to do so may deem the Proposal non -responsive. .
PROPOSAL FORMAT
The response to this solicitation should be presented in the following format. Failure to do so may deem
your Proposal non -responsive.
1. Cover Page .
The Cover Page should include the Proposer's name; Contact Person for the RFP; Firm's Liaison for the
Contract; Primary Office Location; Local Business Address, if applicable; Business Phone and Fax
Numbers, if applicable Email addresses; Title of RFP; RFP Number; Federal Employer Identification
Number or Social Security Number.
2. Table of Contents
The table of contents should outline, in sequential order, the major sections of the Proposal as listed below,
including all other relevant documents requested for submission. All pages of the Proposal, including the
enclosures, should be clearly and consecutively numbered and correspond to the table of contents.
3. Executive Summary:
Provide an Executive Summary describing elements contained within Proposer's Proposal, including such
factors as Organization, Qualifications and Capabilities; Proposed Network and Plan(s) Designs; Customer
Service, Banking, Reporting Capabilities, and Benefit Administration; and Price and Cost Effectiveness.
4. Proposer's Organization. Oualifications. Capabilities & Financial Stability
a) Describe the Proposer's organizational history and structure; years Proposer and/or firm has been in
.... _ . , .... business providing a similar service(s), and indicate whether the. City has previously awarded any contracts .......
to the Proposer/firm. Proposer should include the name of the organization, business phone/fax/email
address, contact person and federal tax ID.
b) Provide a list of all principals, owners or directors.
c) Provide copy of current license to provide said services in the State of Florida.
d) Provide (1) the number of years in existence of Proposer, both nationally and in the Florida market;
(2) the current number, of employees enrolled in the Proposer's plan, both nationally and in Florida, and (3) .
the primary markets served. Also, discuss specifically Proposer's involvement in providing dental care
benefits, particularly in the South Florida market.
e) Disclose whether broker's fees are paid: (1) Name of agency and address; (2) Name of agent/broker;
and (3) Broker's fee whether flat fee or percentage of premium. If not applicable, indicate that the proposal
is quoted on a no -commission basis. It is the intention of the City for all contracts to be awarded on a
non -commission basis. Consideration will be given during evaluation of same.
f) Provide the current number of employees of Proposer; its depth and experience, and number and job
classifications of employees anticipated to be assigned to the City's account, particularly in Miami -Dade
and Broward Counties, including the overall qualifications of assigned staff particularly its experience with
dental benefit administration in Florida. Include discussion of employees' diversity and ability of speaking
more than one language.
g) Provide a list of 2 clients of equivalent size who, for whatever reason, discontinued to use
Proposer's services within the past year, and indicate the reasons for the same. Include contact name and
number, as well as two current clients. The City reserves the right to contact any reference as part of the
evaluation process. Also include your company's total enrollment for 2010 vs. your 2011 enrollment.
h) List the subcontractors or sub consultants and include a brief history of their background and
Page 31 of 33
Request for Proposals (RFP) 273288
experience.
i) Provide detailed responses to Attachment A, as applicable. Failure to complete. in full, Attachment -
and return same with Proposal shall deem anv Proposal received non -responsive. (Note: Proposers may
submit partial proposals based on the products offered through their company.)
j) Provide any other information which the Proposer deems relevant to its organization and/or its
ability to provide quality dental care services to the City. .
5. Proposed Network and Plans) Designs
a). Provide detailed responses to Attachment A, as applicable. Failure to complete. in full, Attachment
and return same with Proposal shall deem anv Proposalreceived non -responsive. (Note: Proposers may
submit partial proposals based on the products offered through their company.)
b). Provide any other information which the Proposer deems relevant to its organization and/or its ability
to provide quality health care services to the City.
6. Customer Service, Banking, Reporting Capabilities, &Benefit Administration
a). Provide detailed responses to Attachment A, as applicable. Failure to complete, in full, Attachment_
and return same with Proposal shall deem any Proposal received non -responsive. (Note: Proposers may.
submit partial proposals based on the products offered through their company.)
b). Provide any other information which the Proposer deems relevant to its organization and/or its ability
to provide quality health care services to the City. .
7. Price and Cost Effectiveness
a). Provide detailed responses to Attachment A, as applicable. Failure to complete. in full, Attachment and
return same with Proposal shall deem anv Proposal received non -responsive. (Note: Proposers may submit
partial proposals based on the products offered through their company.) It is the intention of the City for all
contracts to be awarded on a non -commission basis. Consideration will be given during evaluation of same.
b). Provide any other information which the Proposer deems relevant to its organization and/or its ability
to provide quality health care services to the City.
8. Local Preference
For Proposers seeking local preference consideration in the evaluation process, the following information
must be provided with proposal, pursuant to Section 1.49 of the General Conditions:
a) State the Primary Office Location of the Proposer
...... b) Provide location from which the Proposer will be based to perform the work.
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Request for Proposals (RFP)273288
5. Evaluation Criteria
5.1. EVALUATION CRITERIA
The City's Selection Committee will evaluate proposals and will select the proposer which meets the best
interests of the City. The City shall be the sole judge of its own best interests, the proposals, and the
resulting negotiated agreement. Proposals received shall be evaluated on the. criteria noted below. In
performing the evaluation, only information contained within the Proposal will be considered, unless
otherwise stipulated and/or other clarifying information is requested by the City. Proposals from firms that
do not meet the minimum qualifications set forth will not be considered further. The proposer granted the
contract will be required to maintain the minimum qualification requirements during the term of the
contract and any. renewals.
Each member of the Selection Committee shall independently review each proposal using the criteria listed
below. Proposers meeting the Minimum Qualifications criteria will have their proposals evaluated and
scored. The Selection Committee will rank and recommend proposer deemed to be the most highly
qualified to perform the required services.
The following criteria will be utilized to select the firms submitting proposals:
CRITERIA PERCENTAGE
Proposer's Organization, Qualifications, Capabilities 15
and Financial Stability
Proposed Network and Plan(s) Designs 30
Customer Service, Banking, Reporting Capabilities, and Benefit 20
Administration
Price and Cost Effectiveness
Local Preference, if applicable
30
5
100 %
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RFP No. 273288 - Employee Benefit Dental Plan
ATTACHMENT A
Questionnaire. for Employee Benefit Dental Plan(s)
This Ouestionnaire must be fully completed, in the order stipulated and returned with Proposal.
Failure to answer all questions and provide with Proposal shall deem Proposal non -responsive.
Financial Stability and Experience
1. Please provide the full business name of your company, mailing and physical address,
telephone and fax number, email address, and web site address.
2. Which location would be the primary office to service the City's . account and what
services will be provided through this office?
3. Please list other companies with whom you have financial interest (i.e. insurance
companies, PPOs,HMO, MGUs, Brokerage operations, etc.). •
4. In the last five years; has your business entity ever been involved in a merger or had a
change of ownership? If yes, please describe.
5. Within the last five years, has your business entity had a change of naive, and/or used a
d.b.a. or is it operating under an assumed name?
6. If an insurance company, what is your current rating with A.M. Best or Standard & Poor's?
7. Describe any previous or pending lawsuits and/or bankruptcies in the last 7 years.
' ' ' ' ' ... 8:. Have any of the principals in' your' firm or any of your employees • (former or current , .. .
ever been indicted or convicted of mishandling/misappropriating any insurance company
or client funds? If yes, please provide details.
9. Describe your current procedures for handling client or insured complaints and State
Insurance Department complaints.
10. Has the company (IPA) or its principals ever been adjudged bankrupt? If yes, please
explain.
11. Have you ever been involved in an audit by the Department of Labor (DOL)? If yes,
please provide details.
12. Do you carry a TPA errors & omissions policy?
m If yes, who is the carrier?
e What is the expiration date of the policy?
• What are the limits of coverage for the policy?
RFP No. 273288 - Employee Benefit Dental Plan
• What is the deductible?
Is contract a claims made policy?
13. Do you carry a comprehensive general liability policy?
• If yes; who is the carrier?
• What is the expiration date of the policy?
What are the limits of coverage for the policy?
• What is the deductible?
14. Do you cany a fidelity bond?
• If yes, who is the carrier?
• What is the expiration date of the policy?
• What are the limits of coverage for the policy?
• What is the deductible?
• What are the total annual aggregate funds handled for all clients?
15. Have claims been made against any of the above policies in the past two (2) years? If
yes, please provide details.
16. Provide a list of 5 references of clients of similar size. Please include contact name and
telephone number.
Adequacy of Network and Qualifications of Providers
1. Please provide the Geo Access summaries for employees who fall both within and outside
the network. The City would like to use 2 providers in 15 miles as the access. standard.
Provide this "report for General Dentists, Endodontists, Periodontists, Oral Surgeons and
Orthodontists.
2. Complete the following tables regarding your network:
Number of Providers
County
General
Ortho
Endo
Oral/Max
Ped
Periodontics
Miami Dade
Broward
Monroe
Palm Beach
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RFP No. 273288 - Employee Benefit Dental Plan
Number of Providers Accepting New Patients
County
General
Ortho
Endo
Oral/Max
Ped
Periodontics
Miami Dade
Broward
Monroe
Palm Beach
3. How often are provider contracts renegotiated?
4. Do your contracts include a specific clause which limits the amount of increase? Are there
automatic annual increase provisions included in any of your contracts?
5. Are you able to service participants/dependents out of the Miami area through your DMO
(DHMO) network? How?
6. What is your standard process and advance notification timeframe to notify the City and its
members of network changes?
7. Do you have a system for maintaining credentialing information? How often is each
provider re-credentialed?
8. Please list your 2010 annual network turnover rates (percentages) for both voluntary and
involuntary turnover.
. Enter the percentage of providers that are reimbursed by the following methods in the table
below:
Method of Reimbursement
% Reimbursed by Method
Salary
Discounted Fee for Service
wNVithhold
Fee for Service w/Bonus
Fee Schedule
Capitation
Capitation w/Withhold
Capitation w/Bonus
Percentage Discount
Other, please specify
10. Is your plan licensed by the State of Florida?
11. When physicians are eliminated from the network, what is the timeframe given to allow
participants to elect a new dentist? What is done for those that require a transition of care?
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RFP No. 273288 - Empioyee Benefit Dental Plan
12. Can employees nominate their dentist to become a part of your network?
13. When is an area considered a network? What is the minimum number of dentists and
specialists required necessary to constitute a network?
14. If a provider leaves the network and doesn't notify the participant, who is responsible for
the claim payment?
15. How will your company interact with the medical provider on claims that are both medical
and dental in nature?
16. Are your network providers. prohibited from balance billing the patient for any excess of
contracted amount, except for deductibles and coinsurance?
17..Are network directories on-line?
18. Are printed directories available? At what cost? How often are they updated?
19. What is the network access fee? Is this included in the administrative services fee or
included in claims, or in other?
Overall Plan Costs and Discount Arrangements
1. Is a rate/fee guarantee included? For what time period?
2. If you areproposing a self -insured plan, will you administer run -out? For how long? At
what cost?
3. Are there any initial set-up fees?
4. Confirm you will provide 120 days notice for rate/fee changes.
5. Describe any programs that you have developed to address special areas of focus, in
particular, detection of overcharges and overpayments.
® How is criteria developed for these programs?
® . Are outside dentists/consultants retained to review questionable claims?
6. Please respond to the following with respect to claim overpayments:
• If errors that resulted in overpayments to providers were detected in such samples,
would our client be able to recover these overpayments directly from your
organization?
4
RFP No. 273288 - Employee Benefit Dental Plan
If not, how would such overpayments be recovered?
How would you keep our client apprised of your efforts to recover overpayments?
6. Please complete the following Claims Administration and Member Services chart
Claim Administration and Member Services
Included
. Additional
Cost Amt
Toll free telephone access to claim and member services
Cost Containment programs, specify
Claim adjudication
Production and distribution of standard drafts, EOBs
Network Access
Multilingual language line
Coordination of benefits
Member satisfaction surveys
ran Sponsor Services
Included
'Additional
;ICost Amt.'.'
Drafting of plan documents
Printing /mailing of plan documents to employee homes
Counseling with respect to federal and state regulatory requirements
Initial system set up and administration of plan year revisions
Consultation with respect to benefits and plan design
Financial underwriting for both new business and ongoing revision
Initial and ongoing eligibility and enrollment services
Production and issuance of standard enrollment forms and ID cards to
employee homes
.
• Billing/premium collection
Provision of expected costs for budgeting purposes
Provision of information for 5500 reporting
Claim fiduciary responsibility
Communication/A►dministrative -Materials `:
; :
Included.:
Additional
Cost Art ..
Production and distribution of standard provider directories
Productions of standard claim forms
Production of standard employee communication materials
Shipping of communication materials to employees
Banking
cue
In I d d
onal
Additi1
Cost Amt
Outgoing wire requests and bank draft handling charge
Bank reconciliation charges
Other banking charges, specify
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RFP No. 273288 - Employee Benefit Dental Plan
Additional Services
Included in
EPP
Additional
Cost Amt
COBRA administration and direct billing
HIPPA certification/comnliance
Internet services
8. Please complete the appropriate section below:
DMO Third Party Administrator Fees
Total Fees
Employee
Family
Fully Insured Premiums DMO
Premiums
Employee
Employee + Child
Employee + Spouse
Family
Fully. Insured Premiums Other
Premiums -
Employee
Employee + Child
Employee + Spouse
Family
9. If you have proposed a self -insured plan, please indicate projected claims:
Plan Option:
DMO
Projected ClaimsBased- on.:Plan Designs
Other
. 10. Other than those listed on the administrative services chart, are there any other fees or
charges that the City would incur if the City accepted your proposal? . If so, please indicate
here.
11. Please complete the following in -network Negotiated Fees chart for the designated
counties as it applies to the DMO:
ADA
Code
Procedure
Description
Negotiated Fee (What Patient Pays)
Broward
County
Miami
Dade
County
Palm Beach
County
Monroe
County
0120
Adult Exam
1110
Adult cleaning
2150
Amalgam Restoration
7110
Simple Extraction
3310
Anterior Root Canal
ADA
Code
Procedure
Description •
Negotiated
Fee (What
Patient Pays)
Broward
County
Miami
Dade
County
Palm Beach
County
Monroe
County
2750
Porcelain/Gold Crown
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RFP No. 273288 - Employee Benefit Dental Plan
5110
6240
6750
Complete Upper Denture
Porcelain/Gold Bridge Abutment
Porcelain/Gold Bridge Pontic
12. Please attach any corresponding fee schedules that will apply.
13. Is more than one fee schedule utilized on a national basis? If so, please explain.
14. Are you willing to offer the executive plans as stand alone plans?
Reporting Capabilities
1. Attach sample copies of your proposed reporting packages. Include proposed reports for
financial, claims, utilization, billing, accounting, banking, etc.
2. What reporting is available on-line?
3. Is on-line reporting accessible to individuals designated by the City (and approved via
HIPAA)?
Communications and Enrollment Capabilities
1. Describe your interne capabilities in regards to the following areas:
• Customization to City of Miami plan design information
• Enrollment
Forms
• Change of status .
. ' ' ' ... ' . Erriployee personal access information (claims; EOBs, dependent inforinatioia etc.)
• Banking
• Employer/consultant reporting
• Comparative dental cost information
• Other
2. What communication materials/assistance are included in your quoted fees/premiums
(include materials, staffing and on-line capabilities)?
3. Can the City's logo be included on these materials? Is there an additional charge?
4. Describe your enrollment options (paper, on-line, recorded media, etc.).
5. Describe the communications that are available, and in what format for:
• Enrollment
• Network information
• Claims information
6. Please attach samples (including ID card)
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RFP No. 273288 - Employee Benefit Dental Plan
Claims Administration Capabilities
1. How many months of historical claim data are stored in your claims system?
2. How far back in time can claims be processed on your system?
3. Is your system an on-line, direct access system or a plan/claims information storage and
retrieval system? Provide a flowchart or brief description of its operation.
4. How long has your claims payment system been operational?
5. Can eligibility and claims transactions be accessed by the same person?
6. Describe enhancements made in the last 12 months and those planned for the next 12
months.
7. Describe the mechanics/process of screening for duplicate claims.
8. Can your system accept and. track full eligibility data?
9. Can your system track each dependent by the dependent's name and social security
number?
10. What is your process for establishing student eligibility? Incapacitated dependent status?
11. Under what conditions and by which individuals can your claims system be manually
overridden?
12. How are manual overrides (if any) to your claims system are reviewed by claims
managers?
13. What are the minimum requirements for claims history transferred to your system(s) on a
new account basis?
14. What system platforms are utilized for plan administration? Please describe.
15. Will a direct claims payment system be utilized?
16. How long has the claims payment system been in place?
17. What percentage of claims are automatically adjudicated.?
18. What are the claims administration standards?
19. How are non -network and out -of -area provider claims identified and paid?
20. What are the Eastern Standard Time hours of operation for the claims unit?
21. How are claims staffing levels established?
8
RFP No. 273288 - Employee Benefit Dental Plan
22. Is there a dedicated claims unit for the City?
23. How many bilingual customer service staff members do you have, and what languages do
they speak?
24. Provide a copy of all certificates, procedures and protocol for HIPAA compliance as
required to date and for future scheduled compliance.
25. Do you maintain Performance Standards? If so, please describe.
Ability to Administer Requested Plan Designs/Alternatives
1. Are you able to administer the dental plan designs as designated in this proposal?
2. If not, please indicate the deviations per plan. All deviations must be indicated in your
response.
Account Management Staff
1. Complete the following, chart with information on the management and service team you
propose for our clients.
Role
Name
Title
Percent of Time Commitment to
City of Miami
Through
Implementation
After
Implementation
Account Manager
Day to Day Liaison
Implementation Coordinator
Customer Service Supervisor
Claim Administration
Supervisor
Network Management
Liaison
Other
2. Include the resumes of the above proposed team members.
3. Is designated staff expected to maintain measurable client satisfaction standards? If so,
please describe.
Banking
1. What are your billing and premium payment procedures?
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RFP No. 273288 - Employee Benefit Dental Plan
2. What financial reporting is included?
3. What are the funding requirements (i.e., checks issued, checks cleared?)
4. Is bank reconciliation included in your fees/premiums?
5. Please give the following information for your principal banking relationship (to be used as
reference):
• Banlc name
Address
• Phone number
• Contact name and title
10
CITY OF MIAM[ OFFICE OF THE CITY CLERK
BID SECURITY LIST
BID ITEM: Employee Benefit Dental Plan
Bit) NUMBER: RFP No..273288
DATE BII) OPENED: Wednesday, October 26, 2011
TIME:
1 :00pm
BIDDER
BASE BID
BID BOND (ER)
AMOUNT
CASHIER'S
CHECK
Fort Dearborn Life (1 box)
See Attached
N/A
Al '1NA (1 box)
See Attached
N/A
Delta Dental Ins. (1 box)
See Attached
N/A
Humana (2 boxes)
See Attached
N/A
Metlilc (3 boxes)
See Attached
N/A
Solstice Benefits Inc. (2 boxes)
See Attached
:
N/A
Always Care — Florida Dental Benefits (1 box)
See Attached
N/A
Assurant Employee
Benefits (2 poxes)
See Attached
N/A
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PREPARED BY: .
Deputy City Clerk
IONNETH ROBERTSON JOHNNY MARTINEZ, P.E.
Chief Procurement Officer City Manager
•
ADDENDUM NO. 2
RFP No..273288 October 19, 2011
Request for Proposals (RFP) for Employee Benefit Dental Plan
'TO: ALL PROSPECTIVE PROPOSERS:
The following changes, additions, clarifications, and deletions amend the RFP documents of the above captioned RFP,
and shall become an integral part of the Contract Documents. Words and/or figures stricken through shall be
deleted. Underscored words and/or figures shall be added. The remaining provisions are now in effect and remain
unchanged. Please note the contents herein and reflect same on the documents you have on hand.
Section .2:7. Contract Execution is amended as follows:
The selected Proposer(s) evaluated and ranked in accordance with the requirements of this Solicitation, shall be
awarded an opportunity to negotiate a contract ("Contract") with the City. The City reserves the right to execute ornot
execute, as applicable a Contract Professional Services Agreement ("Agreement") with the selected Proposer(s) in
substantially the same form as the Aareement included as part of this solicitation (refer to Attachment B). Such
Contract Agreement will be furnished by the City, will contain certain terms as are in the City's best interest, and will be
subject to approval as to legal form by the City Attorney.
Additionally, please find below Questions from prospective proposers and the .City's Answers to those Questions
received before.the stipulated due date:
Q1: Are rates.to benet of commissions? .
Al: Yes. Rates are -to be net of commissions. --
.Q2: -Please provide full description of benefits of the PPO Voluntary Plan and PPO Executive Plan
A2: The booklet and premium rates for Metlife (PDO) is attached, marked as Exhibit 8.—The booklet and premium
rates for Solstice (DMO) is already a partof the RFP, marked as Exhibit 5.
Q3: Please confirm that the Dental Monthly Claims is the combination of the two plans and, if so, can you split out
the information by PPO plan?
A3: Voluntary Plan Claims Experience, Exhibit 6 (Updated) •is attached. Executive Plan Claims Experience is
attached, marked as Exhibit 10. There is no claims experience for the DMO.
Q4: Have your current carriers recommended any rate changes going forward and, if so, please provide those rates.
A4:. No changes are being recommended in regard to plan design or rates.
Q5: Before we can begin working on these two RFPs, we will need the censuses in Excel and questionnaires in
Word.
A5: Attachment A, in Word format, and Exhibits 1-3, in Excel format, were provided to all prospective proposers
under Addendum No. 1 issued on October 12, 2011. Exhibit 2 has been updated and it is attached to this
addendum.
Q6: Please provide the census information (Exhibit 2) in Excel format so we can sort the data effectively.
A6: Exhibit 2 (Updated) is attached. -.
Page 1
Addendum No. 2 October 19, 2011
RFP No. 273288 — Employee Benefit Dental Plan
Q7: Please provide a complete booklet of the dental plans.
A7: Refer to Q2.
Q8: Please provide the listing of dental providers (Exhibit 3) in Excel format so we may compare them with providers
in our network data base. Also, if possible the provider TIN numbers, a unique number that identifies each
provider, would be helpful to have by each name on the listing. This will allow us to sort more accurately
matching unique numbers as opposed to matching last names, to see which providers we currently have in our
network.
A8: DHMO Top Dental Providers, marked as Exhibit 3 (Updated), and PPO Top Dental Providers, marked as Exhibit
9, in Excel -format, are attached. ProviderTlN numbers are included. •
.Q9: Please provide Attachment A, the questionnaire, in WORD format so that we may insert the answers to your
questions.
A9: Refer to Q5.
Q10: Please confirm the effective date is 01/01/12.
MO: Yes. The effective date of the new contract is scheduled to be January 1, 2012.
Q11: The dental monthly claims, premiums and lives do not indicate if this information is for the DMO, PPO or
Executive PPO or if they are separate or combined. Is actual claims and premiums available by each separate
product fine?
A11: Refer to Q3.
Q12:; is MetLife's SPD available to correctly attempt to match their plan design? This information is required to quote
apples to apples; is perio and endo included in basic or major; how are out -of -network claims paid; is the plan
U&C or MAC; other essential contractual provisions (i.e., composites, replacements, age Limits, etc.). This
information will be outlined in the plan summary, certificate of coverage or SPD.
Al2:• Refer to the .attached. Class I• Executive Booklet,• marked as Exhibit 11. .
...................................
Q13: The experience provided shows 877 enrolled as of May.2011. It appears the experience for the executives is
missing. Can you provide the same type of experience report -for the executives?
A13: Refer to the attached Exhibit 6 (Updated) reflecting Voluntary Plan Claims Experience, and to the newly added
Exhibit 10 for the Executive Plan Claims' Experience.
Q14: Can we request the cdmplete•SPD's for both PPO plans, and verify all plan changes,since 2007 and the
effective date of any of those plan changes? .. .
A14: Refer to Q12. There has been no plan changes.
Q15: Can we get the census file in an Excel format that includes zip codes in order to run the requested Geo Access?
A15: The DMO (DHMO) Census, marked as Exhibit 1, provided to all prospective proposers under Addendum No. 1
issued on October 12,.2011, includes the zip codes. The PPO Census, marked as Exhibit 2 (Updated),
containingzip codes, is attached.
Q16: Can you provide the rate history from 2007 until present on all plans.
A16: Refer to Exhibit 4 and to the newly added Exhibit 12, Dental PPO Rate History, attached.
Q17: Please confirm the rates provided as current rates are net of commission?
A17: The current Dental PPO rates are net of commission.
Q18: Can you please provide a list of top utilized providers in excel separated by top PPO & DMO providers?
A18: Please refer to Q8.
Page 2
Addendum No. 2 October 19, 2011
RFP No. 273288 — Employee Benefit Dental Plan
Q19: The DHMO census has about 500 people, but the Current Costs Summary in the RFP shows almost 1800 are
enrolled in the DHMO?
A19: The only census available indicates an individual's multiple coverage, i.e. if an employee has medical, dental
and life, he will be shown on a census three (3) times.
Q20: The DPPO census has about 1,100 people, but the claims experience report only shows 877 for the month of
May, so it looks like a portion of the employees (perhaps the executives?) are missing from the experience.
A20: Refer to Q11.
Q21: The DPPO census is missing the zip codes. Can you include those?
A21: Refer to Exhibit 2 (Updated), attached.
Q22: Is there more currentclaims experience available?
A22: Refer to the newly added Exhibit 14, attached.
Q23: Can you tell us how many employees in total are eligible for Dental benefits? The censuses provided only show
enrolled.
A23: Refer to the RFP, Section 3.1.1. Background Information.
Q24: How many of the total enrolled are retirees and COBRA?
A24: This information is unavailable.
Q25: RFP questionnaire in a word document.
A25: Refer to Q9.
Q26: Provide census (DHMO & PPO) in excel file for GEO Access Report.
A26: Refer to Q15.
•Q27: PPO.census•.doesn't include zip -codes will•need:zip•codes.to create-GEO Access -Report.
A27: Refer to Q21.
Q28: Please clarify the difference in enrollment from the RFP (Section 3:1.1) to the separate census data provided?
A28: Refer to Q19.
029: Please provide the census for the DHMO and PPO programs in an Excel file with the employee's gender, DOB,
and -tier enrollment with premiums.
A29: Refer to Exhibit 1, provided under Addendum No..1, and to the attached Exhibit 2 (Updated). Please note that
instead of a DOB there is an actual age.
Q30: Please confirm whether or not the executive plan claims are included in the PPO Claim report. If they are not,
please provide claims for the Executive Plan. If they are, please provide claims split out for each plan.
A30: Yes. The Executive Plan claims are included in the PPO Claims Report.
Q31: Please'confirm that all plans are voluntary, except the Executive plan.
A31: All plans are voluntary, except the Executive Plan.
Q32: Please confirm no commissions should be included.
A32: No commissions should be included.
Q33: Does the City want to incorporate a MBE vendor?
A33: Please refer to Section 5. Evaluation Criteria. •
Page 3
Addendum No. 2 October 19, 2011
RFP No. 273288 - Employee Benefit Dental .Plan
Q34: Please provide an Excel Census
A34: Refer to Q29.
Q35: 'The RFP and renewal rate doc has 6 classes. We don't have the class description or plan design for each.
Please provide.
A35: Refer to Exhibit 11.
Q36: On Exhibit 6 - Dental Monthly Claims, EOB's, Premium and Lives spreadsheet, there are two dates; which is the -
correct date.
A36: Column one (1) has the correct paid date.
Q37: Does the City of Miami contribute toward the employee's premium for dental? If so, how much is contributed for
each plan offering?
A37: The City of Miami contributes toward the Executive employees only.
038: a) How are dentists reimbursed on the Dental PPO for the Voluntary and Executive Plans- in network and out
of network? . v
b) Is there a fee schedule in network?
c) If the reimbursement is based on a percentile, what is the percentile used?
A38: a) In Network only,.
b) No.
c) The out of network reimbursement is 90th percentile of UCR for the Executive plan and the 80th percentile
of UCR for the voluntary plan.
Q39: At what level is MetLife reimbursing out of network claims?
A39: The City does not pay out of network claims.
• .Q40: •is there a carryover deductible .benefit•for•the Dental PPO.plans?
A40: Yes.
Q41: Are there any commissions included in the current DHMO and PPO plan rates?
A41: No.
Q42: What is the amount required for the Bid Bond? Is this the same as the request for a Performance Bond?
A42: There is no Bid Bond Or Performance Bond requirement for this RFP..-
Q43: What is the total number of retirees participating in the Executive & Voluntary PPO plans?
A43: This information is unavailable.
Q44: What is the reason for the enrollment discrepancy between the claims report, census .file and the census
included for the PPO in the RFP?
A44: Refer to Q19.
Q45: a) The census shows 2-tier rates for the'DHMO, 4-tier rates for the PPO and 2 ter rates for the Executive plan.
Please confirm that these are the current rate structures being offered?
b) Please clarify what tier structure should be quoted for each of the requested plan coverages.
A45: a) Yes.
b) Refer to the RFP, Section 3.1.2. Dental Plan Solicited.
Q46: Please provide prior rates for the last 3 years?
- A46! Refer to-Exhibits.6-and 1-0- - - -- ----...-------------...- - - =
Page 4
Addendum No. 2 October 19, 2011
RFP No. 273288 — Employee Benefit Dental Plan
047: The RFP under— Section 2.9 "Insurance Requirements" states that the company must lie rated no less that "A"
as to management. Will the City consider an "A-" rated group.
A47: Yes.
Q48: What is the effective date of coverage for the dental plans?
A48: January 1, 2012.
Q49: What plan does the claims report reflect? Can claims experience be separated for the Metlife PDO plan and the
Executive plan?
A49: Refer to Q3.
Q50: Can we receive the PPO census in excel format with zip codes?
A50: Refer to Q21.
Q51: Exhibit 4 has the "Total'*" listed as "*Monthly Total", yet theamounts seem to reflect annual totals. Can you
confirm if this is monthly or annual?
A51: The total indicated is "annual".
Q52: What does the claims report (Exhibit 6) represent (DPPO only or DPPO & Executive DPPO combined)?
A52: Refer to Q3. •
Q53: If Exhibit 6 is the combined claims for. both the Executive DPPO and DPPO, are separate monthly claims reports
available for both DPPOs?
A53: Refer to Q3.
Q54: On Exhibit 6, does the "Lives" column represent subscribers only or subscribers and dependents combined?
A54: The "Lives" column represents Subscribers only.
Q55: Is the rnonthly_clairns experience availabie•for June•20.10 to current?
A55: Refer to 622.
Q56: In Attachment A, question 1 under "Adequacy of Network and Qualifications of Providers" requests Geo Access
summaries for all types of dentists except for pediatric. The chart in question 2 does reference pediatric
dentists. Does the City want a Geo Access summary for Pediatric dentists as well?
A56: Yes.
Q57: There is a top provider list and the addendum added an Excel version with TINs. Do you wish to have a
disruption report included in the proposal? Is there separate report for the DPPO listing the top providers?
A57: Yes, a disruption report is requested. DPPO listing of top providers has already been provided (Exhibit 9).
Q58: Please provide the current benefit details (SPD/COC) for both DPPOs, including the out -of -network
reimbursement.
A58: Refer to Exhibit 11.
Q59: Have there been any benefit changes in the past 3 years?
A59: No.
Q60: Please advise on the cause for the enrollment fluctuation between Jan 2010 and June 2010.
A60: Information is unavailable.
Q61: Is a utilization report that identifies the in -network vs. out -of -network utilization and the in -network discounts
available for both of the DPPOs?
---A61: -Refer-to.the-attached .Dental-PP-O-Utilization: Repor-t—marked•as-F=xhibit-1.3:•----.- - -- •-------------- ---
Page 5
Addendum No. 2 October 19, 2011
RFP No. 273288 — Employee Benefit Dental Plan
Q62: Please provide an Active & Retiree census in excel format for each product. Dental Census will need to include
DOB, Gender, Zip, Tier selected and plan breakout since dual option.,
A62: The Census provided includes both and cannot be broken out.
Q63: Please provide a copy o the Dental policy: We need to determine where services are being paid (Prey, Basic or
Major). All X-Rays and Endo & Perio paid in Basic or Major? Implants covered?
A63: Refer to Exhibit 11.
Q64: Does group have rollover coverage today?
A64: Refer to Q40.
Q65: Please confirm how out of network dental claims are paid: Fee Schedule or Percentile. If percentile, what
percentage (80th, 90th etc.).
A65: Refer to Q38..
ALL OTHER TERMS AND CONDITIONS OF THE RFP REMAIN THE SAME.
Sincerely,
Kerifneth Robertson
Director/Chief Procurement Officer
KR/ ms
Cc: RFP File
................................................
Page 6
EXHIBIT B
PROVIDER PROPOSAL RESPONSE AS TO TERMS & CONDITIONS
Employee Benefit Dental Plan
24
RFP No. 273288 — Employee Benefit Dental Plan Attachment A
ATTACHMENT A
Questionnaire for Employee Benefit Dental Plan(s)
This Questionnaire must be fully completed, in the order stipulated, and returned with Proposal.
Failure to answer all questions and provide with Proposal shall deem Proposal non -responsive.
Financial Stability and Experience
1. Please provide the full business name of your company, mailing and physical address, telephone
and fax number, email address, and web site address.
HumanaDental Insurance Company, Humana's dental PPO subsidiaries' home office is located at:
325 Reid Street
De Pere, Wisconsin 54115
CompBenefits Company, Humana's dental HMO subsidiary's home office is located at:
100 Mansell Court East, Suite 400
Roswell, Georgia 30076
Local service is provided from Humana's Miramar market office, located at:
3401 SW 160`h Avenue, Building A, 2' Floor
Miramar, Florida 33027
Account Management is provided by the following:
Michelle Alvarez, Account Executive
Phone: 305-626-5333
Email: malvarez2@humana.com
Alejandra Fox, Account Advisor
Phone: 305-626-5786
Email: afox7@humana.com.
2. Which location would be the primary office to service the City's account and what services will
be provided through this office?
Local account management is provided from Humana's Miramar market office, located at:
3401 SW 160th Avenue, Building A, 2"d Floor
Miramar, Florida 33027
Humana services all of the City's dental PPO financial, marketing, claims, customer service, billing,
and enrollment needs from its headquarters in De Pere, Wisconsin, near Green Bay.
Humana services all of the City's dental HMO financial, marketing, billing, and enrollment needs
from its headquarters in De Pere, Wisconsin, near Green Bay.
Humana's DHMO claims center is located in the Chicago, Illinois office. Humana's DHMO
Customer Care center is located within two service center offices, one in Tampa, Florida and the
other in Atlanta, Georgia.
10
IZ!:P No. 27_t?88 --- I.nlpluycc Benefit Dental Plan Attachment A
�. Please list other companies with whom you have financial interest (i.e. insurance companies,
I'I'Us,1IMO, IVl(:l)s, Brokerage operations, etc.).
Please refer to Attachment 13 for I-lumana's subsidiaries org:utir.ational chart, which displays its
corporate .structure.
4. In the last five years, has your business entity ever beef► involved in a merger or had a change of
ownership'' If yes, please describe.
''es, Humana ;ictittirctl CI -IA Health in 2000 and in 2007, ('oinpl3cnel its ('orporation and KMG,
America Corporation.
In 200S, acquired Unitedl-Ic,tlth Group individual Medicare Advantage husines.s in I:,ts
Vegas, Nevada, ()SE I-Ic;tlthPlans, Inc., Mctcarc Health Plans, Inc., and Caritcn Healthcare.
In July 2010, Humana acquired Hummingbird Coaching Services. I-luntana offers its members it vast
rrray of health and \wcllncss tools, including personal nurses, disease nianagclncrlt progr iIns, and
health coaching. The addition of•l-Itrmminthird'S highly integrated platform for health and \wellness
coaching will allow fluniana to offer nrcu1hcrs more targeted, lifestyle -specific assistance as they
work to reach their personal {&oals.
In December 2010, Humana completed its acquisition of Concentra Inc., a privately held healthcare
< �utit-�:ui•., hn,i I in ^v(I(licnn Te n T Penh h ('cn(•r'ntr.i (i•'iiv,NrQ n� r•��i�•.it�..,,-�1
medicine. urgent care, physical therapy and wellness services to workers and the general public: from
mule titan 300 medical centers in 4 2 stales. Nearly 3 million Humana medical members live near a
Concentra center. in addition to its medical center locations, Concentra serves employer customers by
providing , broad range of health advisory servf,ve`; and operating more than 240 wor;isite medical
facilities,
Most recently in 201 I, Humana announced a joint venture with Discovery Holdings Ltd. to offer a
wellness and loyalty program called 1-lumanaVitality.
Please refer to I-Humana's most recent quarterly (10-Q) and annual (10-K) financial and business
reports filed with the Securities and Exchange Commission (SEC) for any pending or recently
completed publicly announced transactions, these documents can also he found online at
. lumana.com under Investor Relations — SEC Filings.
S. Within the last five years, has your business entity had a change of name, and/or used a d.b.a.
or is it operating under an assumed name?
Humana has not had a name change and/or used a dba or assumed name over the past five years.
6. If an insurance company, what is your current rating with A.M. Best or Standard & Poor's?
,. f as-t¢ '3rt..�ngc�d „ v #} • _•
�
�
d . f "f ,ci,
Ratings Agenes
, r'in
( 4Last Rating
Date
k ®fferin , omp an ;„
44'M• Best
Si.&Pn
"M Best
r S►&P
CompBenefits Company
A-
Not rated
9/20/2011
Not rated
HumanaDental Insurance Company
A-
Not rated
9/20/2011
Not rated
ii
RFP No. 273288 — Employee Benefit Dental Plan Attachment A
7. Describe any previous'or pending lawsuits and/or bankruptcies in the last 7 years.
Humana health plans and insurance subsidiaries have been involved in several legal actions primarily
concerning claim disputes. Humana does not believe any of these disputes have a material impact on
the plans or their operations. Please refer to Attachment E for the latest annual'report, which contains
details' on pending lawsuits and litigations.
8. Have any of the principals in your firm or any of your employees (former or current), ever been
indicted or convicted -of mishandling/misappropriating any insurance company or` client funds?
If yes, please provide details.
To the best of Humana's knowledge, no owner, director, orofficer of Humana has been convicted of
a felony. As to the thousands of employees of those entities, Humana performs an extensive criminal
background check on each new hire and an annual certification of the criminal record of each
employee. If Humana discovers an employee or candidate for hire has had a felony conviction,
Humana considers &variety of factors in determining whether to employ the individual, including the
nature of the crime and its relatedness to the individual's role.
9. Describe your current procedures for handling client or insured complaints and State
Insurance Department complaints.
Client/insured complaints
For members with complaints, Humana's dental Customer Care department has atoll -free number.
Humana's dental associates resolve 90,,percent of disputes during their first contacts with members.
If the complaint is about quality of care, timeliness, available services, or the provider's attitude, the
complaint is forwarded to the Quality Assurance department.
If a verbal complaint is not resolvable, the member has the right to submit a written grievance.
Humana abides by the Employee Retirement Income Security Act (ERISA) rules for appeals. Denial
letters and the reverse side of the explanation of benefits statement (EOB) indicate the steps a
member should follow to request a review of a claim.
Initial denial,
Initial denial of a claim occurs when Humana processes a dental claim and determines that services
are not covered. The denial can occur at any level of claims processing.
First -level appeals review
A claimant appealing a claims payment decision must submit the appeal in writing within 180 days of
receiving the denial. A claims specialist reviews the appeal using ERISA rules as a guideline and
recommends a decision to the supervisor. Humana may contact the professional dental claims review
firm of the American Dental Examiners (ADE) for an opinion. The supervisor:
O Reviews pertinent information to determine if a decision can be made or if additional information
is necessar0079
• Requests additional information
o Sends an interim response when necessary
After receiving the necessary information, the supervisor either reverses the decision and allows
payment of the charges, or upholds the denial based on the contract and/or benefit language.
12
RIHI' N. _'71'xh—Employee Benefit Dental Plan Attachment A
I himan;r's dental goal is to respond to 98 percent of appeals in writing within 30 days of receipt by
sending a letter to the claimant and a copy to the I1)Cnlber. If a menlhcr is appealing the claim, a letter
goes to the member and a copy to the dentist.
Second -level appeals review (subject to state nuuulates)
If the claimant does not agree wiili the first -level review decision, Ile or she may have (he right ureter
ERISA Arles and regulations to submit an appeal for a second -level review, in which the grievance
and appeal analyst reviews the information submitted. le grievance ;nut appeal analyst requests
additional information and reviews (he case. BBasec.fon the information received and background of •
the case, (he grievance' aml appeal analyst fills the option to:
• Reverse the previous decision
• Refer the case to another area
• • Reaffirm the denial •
Exhaustion
After completing the appeals process, a claimant has exhausted his or her administrative remedies
under the plan. I(.Humana fails to complete a claims determination or appeal within the estahlisht;d
time limits, the claim is considered denied.
After exhaustion, a claimant may pursue any other legal remedies available, which may include
!ir!!1g!no L!v!I a1t10r? Linder h <rl A soction ltr2(:t) tor 1ud!ctaf reviev' 0t 11!e ICI•," s determination. At
or the following (MIS( apply:
• The claimant has exhausted his or her ERISA appeal rights
The claim was not approved on appeal
State Insurance Department complaints
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the course of business by the Centers for Medicare & Medicaid Services (CMS), various departments
of insurance, departments of health, accrediting bodies, and other entities that periodically conduct
reviews. None of these is expected .to have any material effect on the company's operations or results.
10. Has the company (TPA) or its principals ever been adjudged bankrupt? If yes, please explain.
Neither Humana nor its principals have been adjudged bankrupt.
11. Have you ever been involved in an audit by the Department of Labor (DOL)? If' yes, please .
provide details.
Each of Humana's subsidiary companies is subject regularly to various audits and investigations in
the course of business by the CMS, various departments of insurance, departments of health,
accrediting bodies, and other entities that periodically conduct reviews. None of these is expected to
have any material effect on the company's operations or results.
12. Do you carry a TPA errors & omissions policy?
• If yes, who is the carrier? — Yes, Errors and Omissions coverage is provided by Managed Care
Indemnity, Inc.
• What is the expiration date of the policy? — The expiration date of the policy is January 1
20I2.
is
RFP No. 273288 — Employee Benefit Dental Plan Attachment A
What g policy?
' � ' Errors and Omissions,carry limits of, _.
• ; tare the limits.of covers a for the, olic Erro
$3,000,000 per occurrence.
• What is the deductible? — Humana's errors and omissions coverage does not have a deductible.
• Is contract a claims made policy? — The contract for Humana's errors and omissions coverage
is not a "claims made" policy.
13. Do you carry a comprehensive general liability policy?
-• If yes, who is the carrier? Yes, Professional and General Liability protection is provided by
Managed Care Indemnity, Inc.
• What is the expiration date of the policy? - The expiration date of the policy is January 1,
2012.
• What are the limits of coverage for the policy? — General Liability carries limits of $3,000;000
per occurrence.
• What is the deductible? — Humana's general liability and professional liability coverages do not
have a deductible.
14. Do you carry a fidelity bond?
• If yes, who is the carrier? — Yes, Fidelity and Crime protection is provided by National Union.
• What is the expiration date of the policy? — The expiration date of the policy is April 1, 2012.
• What are the limits of coverage for the policy? — Humana carries a bond with a limit that is
reasonable to its size and operating structure. The bond protects Humana from loss, damage, or
expense resulting from or arising out of the dishonest, fraudulent, or criminal act or acts of its
employees.
• What is the deductible? — Humana's fidelity bond has a deductible of $1,000,000.
• What are the total annual aggregate funds handled for all clients? — Employee Dishonesty
coverage is provided by National Union with primary limits of $15,000,000.
15. Have claims been made against any of the above policies in the past two (2) years? If yes, please
provide details.
There have not been any claims made against the policies in the past two years.
16. Provide a list of 5 references of clients of similar size. Please include contact name and
telephone number.
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115 S Andrews Avenue,
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Fort Lauderdale, Florida
33301
Kevin Kelleher, Benefits
Manager
954-357-6090
954-728-2702
Kkelleher@Bro
ward.org
City of Fort
Lauderdale
100 N Andrews Avenue
Fort Lauderdale,
Florida33301
Dennis Stone, Benefits
Director
954-828-5436
954-828-5328
dstone@fortlau
derdale.gov
Miami -Dade
County
Government/Public
Health Trust
111 Northwest 1st Street,
Suite 2410
Miami, Florida 33128
Hazel Grace-Dansoh,
Insurance Benefits
Manager
Merrie Gonzalez, Insurance
Benefits Supervisor
305-375-4288
305-375-1633
hgrace@miami
dade.gov
Miami Dade
College
i
1 1011SW 104th Street
Miami, Florida 33176
Martha Arrieta, Director,
Compensation, Benefits
and HRIS
305-237-0363
305-237-0322
marrietl @mdc.
edu
14
I.l l' N11. 27.12ti8 — [mploycc 13cnclit Dental Ilan
Attachment A
Yn1
i 1 1
! I (rY.4
�..�
n:A
1
aAA
Fraternal ( )rdcr o1'
Police. Miami
I .odd 1120
400 NV)/ 2nd Avenue
Miami, Florida 33128
I.isscnc I'ricgues-Granado,
Benefits Manager
305-372-4605
305-372-4604
lop20instir,in
(r''carthlink.nct
Adequacy of Network and Qualifications of Providers
1. !'lease provide the (;eo Access summaries for employees who fall both within and outside the
network. The City would like to use 2 providers in 15 miles as the access standard.• Provide this
report for General Dentists, I?ndodontists, Periodontists, Oral Surgeons and Orthodontists.
Please refer to Attachment C for Humana's completed network accessibility reports.
2. Complete the following tables regarding your network:
PP(.):
Coun
Gencril ,,,,
01.7. ho.1
' n OR,
Oi ii:' ax ; :
, l't l
fit.
I?erii iloniics
Miami Dade
I ,604
127
56
87
74
79
Broward
1,604
• 97
116
113
109
135
Munroe
1 - 13
0
0
!
1
0
Palm Beach
I ,204
82
137
117 "
95
103
Miami Dade
Broward
--r
Y,1..„11 ,a e
Palm Beach
DHMO:
.eneral Pndo : #(alral/Niax� �PPsl" P,rt il�nttCc;= _
If their practice is al capacity, dentists must notify Flumana so changes can he
made in the provider directory and on Dentist Finder at 1-iumanaDental.cont.
Humana's contracts do not contain laniluaiic rcouirinl! providers maintain
existing patients; however, most dentists do maintain patient base and keep
existing, members.
l
Genera
®ro
;
,tCJunty
(at,x
ot®lVIx
e4
enolontics
Miami Dade
676
104
63
88
99
91
Broward
1047
95
1 1 1
123
1 1 1
127
Monroe
4
10
1
1
1
Palm Beach
839
119
124
119
96
127
fdJ f ..- .. iG
*` t g)
County) _,,,
_..
a itnber
p General
&
of t,ruva
A060::
•. a Ste{
• , tmgaNew,11'�attents
s(O+ ral/',1VIax,,,-,
is
, ���
e y
1
Periodontics
ers °cc
F Endo
Miami Dade
666
104
62
88
99
91
Broward
936
89
107
114
109
118
Monroe
4
1
0
1
1
0
Palm Beach
834
82
123
119
96
125
3. How often are provider contracts renegotiated?
Humana's provider contracts are evergreen, so there are no formal projects for systematic renegotiation.
Humana continually reviews and negotiates with providers in order to maintain a high -value network.
15
RFP No. 273288 — Employee Benefit Dental Plan Attachment A
4. Do your contracts include a specific clause which limits the amount of increase? Are there
automatic annual increase provisions included in any of your contracts?
Humana's'dental contracts do not contain a clause or provision limiting annual increases or providing
automatic increases.
5. Are you able to service participants/dependents out of the Miami area through your DMO
(DHMO) network? How?
Dependent children attending school in their home state can seek services from any participating dentist
in their area. Students outside their home state and those in areas of the state without a participating
dentist are eligible for emergency care.
The plan covers dental emergencies 24 hours a day, seven days a week, no matter where the member
is located: If a member has a dental emergency, they are covered for palliative (emergency) treatment.
Palliative treatment involves only what is necessary to control unexpected pain or more -than -usual
bleeding, prevent complication related to an infection, or prevent the loss of a tooth from a traumatic
injury.
Emergency dental service is intended to relieve pain caused by an acute condition until the
participating dentist can see the member. The member's emergency care benefit does not include
procedures that are required but are not necessary for the relief of pain. For example, root canals and
crowns may be necessary treatments but are not covered under emergency care benefits. If a member
has an emergency that involves extensive accidental or traumatic injury to the teeth or mouth, or that
affects the member's ability to breathe or swallow, they should contact a medical physician.
When more than 100 miles from the nearest participating dentist, a member obtains reimbursement
for expenses for emergency care by any licensed dentist, less applicable copayments, up to $100 per
member per year, after presenting an itemized statement of emergency services from the dental office.
Humana must be notified of the treatment within 90 days to receive reimbursement.
6. What is your standard process and advance notification timeframe to notify the City and its
members of network changes?
PPO: Humana's online network dentist list is updated daily at HumanaDental.com. Members may
also call Humana's Customer Care specialists for the names of area dentists.
DHMO: All DHMO members affected by the termination of their selected participating general
dentists are notified by mail at least 45 days before the effective date of the termination. At that time,
members are encouraged to select another participating dentist to ensure continuity of their dental
care. Members can contact the Customer Care department or by accessing HumanaDental.com to
use Dentist Finder for current dentist directory information.
In rare cases where a termination is immediate, Humana transfers plan participants to the nearest
participating dental office to ensure access to service as quickly as possible. When this occurs, plan
participants are notified of the transfer and given the opportunity to select another participating
dentist. Humana does not notify members who may be affected by the termination of a participating
specialist.
16
1<I:I' Nn. .7.t2Kh — Employee Benefit Dental Plan Attachment A
7. 1)o you have a system 1'or maintaining credentialing information:' How often is each provider re-
credentialed?
1-Ittnutna reviews cash dentist's application and supporting documentation to determine participation
in the network. Documentation may include, but is not limited to, the applicant's education, training,
experience, licensure, certifications, professional ii:thility insurance, malpractice history and
professional competency.
credentialing criteria
The decision to credential a dentist is based on the following criteria:
• A valid state license
• A valid Drug Enforcement Administration (DI -?A) certificate and/or Controlled Dangerous
Substance (CI)S) certification, if applicable
• Professional liability insurance in contracted amounts
• Appropriate education and training for applied specially.
• Appropriate employment history _
• Acceptable malpractice liability claims history
• I,ack of physical or mental impairment, including those due to chemical dependency that may
affect the dentist's ability to practice or that pose a risk to patients
• Acceptable office survey results when completed., site visits are not performed routinely for
network providers hut are performed when warranted
.I�L.L.,1. ii C.iiiiuiliij :if i:.l.i Lil i:�� lL.l it iL ail i\. iilliu YY n.l Vt-.'„ it Li 1)t/i lilt{ iuLL..
• Application is emmpleto and attestation is cigne.d and dater( within 180 roe:
Dentist explains any adverse actions listed on the application
• Proof of specialty training
• Malpractice insurance with limits required by Humana
• Primary Source Verification of License (query the applicable state hoard)
• Primary Source Verification of DEA certificate through the National Technical information
Service-(NTIS)
• Check National Practitioner DataBank for any malpractice claims and state disciplinary actions
• Review complaint history of dentist during the recredentialing process
Credentialing Committee
The Humana dental credentialing committee, composed of primary -care dentists and specialists -
participating in the plan, approves or denies an applicant's completed request for credentialing or
recredentialing. Members of the committee sign confidentiality agreements.
Approved participation
After the dentist is approved, he or she is added to Humana's dental claims system as a network
dentist.
Denied participation
Humana notifies the dentist in writing of the reason for denial.
Recredentialing process
Humana's dental Network Administration department maintains a database that automatically
generates requests for current credentials every three years. Humana verifies state license status, GSA
(to determine if there Medicare/Medicaid sanctions) and OIG (to determine if there are potential fraud
issues). Failure to comply with Humana's quality assurance guidelines may be grounds for
i%
RFP No. 273288 — Employee Benefit Dental Plan Attachment A
termination. In North Carolina, Virginia, and Vermont, providers are required to complete
recredentialing applications, per state regulation.
Office evaluation: site visits
Site visits are not routine for network dentists but are done when warranted.
Dentist performance
As part of the recredentialing process, each dentist's complaint history is reviewed.
Adherence to community standards
Humana uses dental consultants for peerreview functions. Any confirmeddeviations from the
standard of care may result in provider termination.
8. Please list your 2010 annual network turnover rates (percentages) for both voluntary and
involuntary turnover.
PPO:
'.
, inn F el
a ' '
„ % votunt2r 1
% J 'want -day.:
2010
878
0.6%
0.1%
DHMO:
-'IGene :
Wientist
' V a 5.' ecialists '
Year
Voluntary
Involuntary
Voluntary
Involuntary
2010
0.74%
0.12%
0.54%
0.09%
9. Enter the percentage of providers that are reimbursed by the following methods in the table
below:
PPO:
i , : ° : , , . ,,
°
% eunburse ° , �. etboar
Salary
Discounted Fee for Service w/Withhold
Fee for Service w/Bonus
Fee Schedule
80% - non -orthodontia
Capitation
Capitation w/Withhold
Capitation w/Bonus
Percentage Discount
20% - Orthodontia
Other, please specify
DHMO:
%ilie iniiin a °lb1Nleth"od`
Salary
Discounted Fee for Service w/Withhold
Fee for Service w/Bonus
Fee Schedule
Capitation
Capitation w/Withhold
1 00%
Capitation w/Bonus
Percentage Discount
18
III' No. 27.t254 — f:intployee 13cnclii Dental flan Attachment A
t huburscuri ent
Other, please specify
10. Is your plan licensed by the State of Florida?
Yes, I luntana's prupnsed plans are licensed hy the state of Florida.
I I. !Alien physicians are eliminated from the network, what is the timeframe given to allow
participants Io elect a new dentist? What is done for those that require a transition of care':
I'1'O: Dentists terminate participation in the network as they retire: if' they change their practice
philosophy and drop all PPOs; or if they arc unwilling to provide a reasonable discount to Humana
members. In the last Iwo instances, Humana's contract includes a 90-day termination clause that allows
time to renegotiate. Every dentist who sends in a termination notice is contacted by a network service
representative Io try and retain the dentist.
1)I-I1V1O: All NAM() members affected hy the termination of their selected participating general
dentists are notified by mail at least 45 days hefore the effective date of the termination. Al that lime,
members are encouraged to select ;mother participating dentist to ensure continuity of their dental
care. lviemhers can contact the Customer Care department or by accessing HumanaDental.com to
use i- inner fur eurre•:ui eirn(isi. directory itirorm;Ii it►n.
in r ,t' • , , war tr> ;; t ••-trim(ttr,n is ,
participating dental office to ensure access to service as quickly as possible. When this occurs, plate
participants are notified of the transfer and given the opportunity to select another participating
dentist. Humana does not notify members who may he affected hy the termination of a participating
specialist.
12. Can employees nominate their dentist to become a part of your network?
l-lumana encourages members to nominate dentists through Dental Referral Cards (which can be used
during open 'enrollment), -via Humana's dental website, or by calling the Customer Care team toil -free
number. Humana follows up on dentist referrals from members and employers within 48 business
hours.
13. When is an•area-considered a network? What is the minimum number of dentists and specialists•
required necessary to constitute a network?
PPO: An area is considered a network when access standards are closely matched. The minimum
number of dentists/specialists varies due to membership in an area. For example, for every 100
members, there should be at least one to two available network dentists.
DHMO: One dentist can service a specific area, and it is therefore considered part of the Humana
network. Humana's ratio is usually one general practitioner to 2,000 members and one specialist to
5,000 members.
14. If a provider leaves the network and doesn't notify the participant, who is responsible for the
claim payment?
Humana works with members directly to determine payments based on the circumstances.
i9
RFP No. 273288 — Employee Benefit Dental Plan Attachment A
15. How will your company interact with the medical provider on claims that are both`medical and
dental in nature?
PPO: Humana coordinates benefits as -a secondary carrierto the medical plan. Humanacollects other
insurance information at enrollment and enters and stores the information into the system.
Additionally, Humana utilizes Voice Automated Technology (VAT) to obtain other insurance
information'once•a year for dependents. When,Humana receives confirmation of other insurance,
records are updated accordingly. Other insurance information remains on file and is applied when
processing payment until Humana is notified otherwise.
Humana applies the birthday rule provision for dependents. The birthday rule works as follows: If a
dependent has dental coverage under both biological parents, and those parents are still -married, the
subscriber whose birthday (based on month and day) occurs the earliest in the calendar year is
considered to be the primary provider of coverage.
The claims specialist continues processing the claim if Humana is the primary carrier. If Humana is
the secondary carrier and no EOB is attached from the primary insurance carrier, the claims specialist
soft denies the claim, and the required information is requested. Humana reopens the claim and
resumes processing when the necessary documentation is received.
Coordination of benefits (COB) information expires after one year for dependents. Once updated for
the employee it does not expire. Humana researches COB when processing the next claim after
expiration.
DHMO: There is no coordination of benefits for the proposed DHMO plans.
16. Are your network providers prohibited from balance billing the patient for any excess of
contracted amount, except for deductibles and coinsurance?
PPO: A hold harmless clause is part of the contractual agreement signed by a network dentist that
prohibits balance billing for any unpaid amounts for covered services beyond unpaid copayments,
coinsurance, and deductibles. Members who receive balance bills for these items may contact the
Customer Care team for assistance. If members seek treatment from non -participating dentists,
however, there are no balance billing restrictions.
DHMO: Dentists are contractually obligated not to charge or bill the member for costs beyond the
copayment schedule.
17. Are network directories on-line?
Yes, Humana maintains dental directories online, which are updated daily. Members can access the
most up-to-date information and customize the directory selection for their needs at
HumanaDental.com. If members do not have Internet access, a directory may be obtained by
contacting the Customer Care team.
18. Are printed directories available? At what cost? How often are they updated?
Humana takes its environmental impact and responsibilities seriously. As such, Humana does not
provide printed dental directories. Humana maintains dental directories online, which are updated daily.
20
1:1 1' No. 2.7.QT8 - 1 i iIo'ce Benefit Dental Plan Attachment A
19. What is the network access fee? Is this included in the administrative services fee or included in
claims, or in other?
Self -funded: Humana's proposed fees include a `iO.30 network access fee. Please refer to Section V for
I lumana's proposed ices.
Fully insured: Humana's proposed rates include the nctwnrk access fee: please refer to Section V for
fumana's.proposed rates and fees.
Overall flan Costs and Ui.scount Arrangements
I. Is a rate/fee guarantee included? For what time period?
Yes, 1-lunetini's proposed) rates and fees are guaranteed for three years.
2. 11' you are proposing a self -insured plan, will you administer run -out? For how long'? At what
cost?
I lumana provides three and 12 month options to administer the run-off claims. The fee is determined by
multiplying the average: enrollment for the prts( six months by the propose renewal base lee. Multiplied
by three for three months Of rL n-O f adiiiitll trattUti, or IiltliiiOiic d by i iui I n i 2 months ui run-ui i
administration. The run-off fee includes one standard reporting package, with timing and delivery
<ii•t,,r'Iom,, 1 ht; Ihr• (Thy
Are there any initial set-up fees:
Humana . { tr,,e any set-up fees. .-lt...lt...�. does not.. u. ..., .If, ...,.
4. Confirm you will provide 120 day's notice for rate/fee changes.
Confirnied.
5. Describe any programs that you have developed to address special areas of focus, in particular,
detection of overcharges and overpayments.
Humana maintains.a highly skilled staff that pursues claims fraud investigations on its behalf. This •
special investigations unit (SIU) is responsible for detecting, investigating, and seeking prosecution
against those who perpetrate fraud against Humana. Humana's objective is to investigate all
complaints or suspicions seriously and to investigate them to the fullest extent to prove or disprove
any accusations.
The SIU is notified of potential claim fraud in a variety of ways, including by the FBI, other
insurance carriers, Humana members, and other branches of law enforcement as well as via analysis
of Humana's database. Humana also has a variety of automated system tools which facilitate fraud
detection and aid in investigative follow-up.
When the SIU receives notice of possible claims fraud, the investigators gather information, conduct
interviews with Humana members and/or providers, review records and claims, and make
recommendations for claims processing. The special investigations unit works to resolve the problem
by contacting the providers and following up to ensure that the recommendations have been
Il
RFP No. 273288 — Employee Benefit Dental Plan Attachment A
implemented. In addition, the unit also complies with state anti -fraud requirements and reports
"suspected" fraud to the appropriate law enforcement agencies.
When Humana detects a claim overpayment through an internal quality audit or external
communication, it forwards the documentation to the Claims Financial Recovery team. The team
sends a letter to the dentist and member; with the amount Of the overpayment, reason'for the
overpayment, and directions for reimbursement:
• How is criteria developed forthese programs?
Humana uses standard dental protocol approved by the American Dental Association (ADA).
This information includes utilization frequency on a national basis. If a dentist is identified as
being over utilized (i.e. submitted a higher percentage of procedure codes relative to the
population), this is considered by the Credentialing Committee. The Credentialing Committee,
which is comprised of both general and specialty practitioners, determines whether, in their
professional judgment, an excessive pattern has occurred. If over utilization is determined, the
network provider is contacted for further explanation and potentially terminated from Humana's
dental network. This same review process occurs for non -network dentists. Contracted dental
consultants are not employees of Humana, therefore they provide an objective review of a
dentist's practice patterns relative to network participation.
There are some claims submittal instances which trigger an investigation of a provider, outside of
Humana's normal grievance procedures:
• Claims for procedures that do not have universal professional endorsement
• Claims for procedures that have a poor prognosis (i.e. crowns or bridges on teeth with
significant periodontal problems)
• Claims for an excessive number of services on the same day
• Claims for retreatment of work previously performed that falls within Humana's frequency
limitations (i.e. replacement of crowns within five years of the previous placement)
• Claims using invalid or made-up CDT codes, multiple codes for what appears to be the same
procedures, or valid codes submitted with a different descriptor -
In any of the above situations, the professional consultants contact Humana's special
investigation unit to determine if there is a pattern or if it is an isolated occurrence. If there
. appears to be a pattern, the provideris flagged and all claims reviewed. The provider is contacted.:
and questioned, and all subsequent claims received from the provider are reviewed prior to
payment. If the problem continues, the dentist is brought before the Peer Review Committee. If
the committee determines the provider is not performing to universally accepted standards, they
recommend the Credentialing Committee remove the provider from Humana's dental network.
Retreatment also prompts investigation. If a new dentist submits an appeal because work
performed was denied due to frequency, the dentist is contacted by Humana's professional
consultants to determine if there was a problem with the original work. Once it is established that
there may be a quality issue, the original dentist is contacted for additional input. Depending on
the situation, the original provider may be asked for a refund or some type of adjustment if the
work appears to be substandard. Further action occurs if the work in question appears to be more
than an isolated occurrence.
• Are outside dentists/consultants retained to review questionable claims?
KIT 27.t2X8 — Employee licnclil Ucntal flan Attachnlcni A
Yes, I-Itnitana has been partnering wily Healthcare Insi;hl. (I-I(:I) for more than five years. In
partnering with I -ICI, Humana has facilitated the implementation of more exacting reimbursement
programs, working to ensure the acctirae:y anc1 proper coding of billed services. llnhnnclled and
fragmented services are. identified, and global dental i►ackages are accurately tracked.
Along with Hui i tna's dental clinical team, !-ICI provides actively licensed dental eunsitllants,
including board -certified specialists and coding analysts, to assess and evaluate the coding of
cI itii s.These enhancements to the claims adjudication processes enable Humana to sour
effectively Mill Universally implement lair reinthursentent rules and guidelines aimed. at
preventing unnecessary resuhntission of claims, providing more consistent and logical claims
processing, and providing eduitahle reimbursements. Humana remains committed to being fair
and consistent to all clients, patients, and providers as Humana pursues payment integrity in the
administration of benefits.
•
6. Please respond to tile following with respect to claim overpayments:
• If errors that. resulted in overpayments to providers were detected in such samples, would
our client be able to recover these overpayments directly from your organization?
For self -funded clients, if the overpayment is due to Htiiii ura s error, the stoney is recovered and
returned to the City's account_ Humana reimburses stoney recovered from a claim payment error
of till uii L!11 1.11 l)I'u ilt1U11 eilurk t.0 the City by It1Uhiiily check. The nleni0er s deni:1i cl:lims hisrl )rV
is adjusted to show the actual reimbursement. A monthly generated self -funded adjustment report
If not, how would such overpayments he recovered'"
For hilly insured clients, when Humana detects a claim overpaymenntthrough an interil;li totality
tudit or external communication, it forwards the documentation t0 the Claims Financial Recovery
team. The team sends a letter to the dentist and member with the amount of the overpayment,
reason for the overpayment, and directions for reimbursement.
• How would you keep our client apprised of your efforts to recover overpayments?
Humana notifies the City in writing if adjustments are substantial.
7. Please coniplete the following Claims Administration and Member Services chart
�� `, t� <'
�'� x
g. 1
Additional.
Y
x aC aim stnationt em I mile ;r K
o -V n --
Toll free telephone access to claim and member services
X
Cost Containment programs, specify
X
Claim adjudication
X
Production and distribution of standard drafts, EOBs
X
Network Access
X
Multilingual language line
X
Coordination of benefits
X
Member satisfaction surveys
X
23
RFP No. 273288 — Employee Benefit Dental Plan
Attachment A
2 - t ' IA--ft.,E � ; °aIt'
,Ian,S,ponsor�{�S,`ervicest,'
� i�
eluded
- ..,
A Mona
/ s�
i� V oa t nit
s'�'t , . , v ' '' °s. i�H - ' k y.' 'b#- _ :`�'
Drafting of; plan documet ts...,
Printing /mailing of plan documents to employee homes
Counseling::with-respect .to federaliand state regulatory requirements
X
Initial%system set upand"administration of plan year revisions
X
Consultation with respect to benefits and; plan design
X
Financial underwriting forboth new business and ongoing revision
X
Initial and ongoing eligibility and enrollment services
X
Production and issuance of standard enrollment forms. and ID cards
to employee homes .. .
X
Billing/premium collection
X
Provision of expected costs for budgeting purposes
X
Provision of information for 5500 reporting
X
Claim fiduciary responsibility
..
x �
r ce�
1 lit
�Ad i 'timid '(
Production and distribution of standard provider directories
X - Online
Productions of standard claim forms
X - Online
Production of standard employee communication materials
X
Shipping of communication materials to employees
X
an n
4..t.ate �"',''
- -s u�e r.^
[llilOIIal ,•
Outgoing wire requests and bank draft handling charge
X
Bank reconciliation charges
X
Other banking charges, specify
X
COBRA administration and direct billing
HIPPA certification/compliance
X
Internet services
X
8. Please complete the appropriate section below:
DMO'litit t? ;�A lmimst 46it ees
A F ., F
, �
�,., x
AV
otS6.es .t
Employee ....:...
....
.Not applicable .
Family
Not applicable
0611,41411 PrAiar®
- e,.. ,.
;tLz 4
i
,4,
i
a� t $
":z Prt6muMe.Sei 4- 4. ,
Employee
HS205 = $12.13
HS195=$13.36
Employee + Child
Not applicable
Employee + Spouse
Not applicable
Family
HS205 = $35.53
HS195 = $39.16
riF'tullyInsurted,Premiums1Otiher`'
fleTtliitit4VA..
Employee
Executive = $31.87
Non -executive = $24.47
Employee + Child
Executive = NA
Non -executive = $50.40
Employee + Spouse
Executive = NA
Non -executive = $49.96
Family
Executive = $97.40
24
I:I1' M,. 273288 — Employee Benefit Dental Plan
Attachment A
Non -executive = Sti9.1
9. 11' you have proposed a sell' -insured plan, phase indicate projected claims:
I � r ....
t -@ a r t '1 e
UM()
This is not applicahlc to the proposal plans.
()flier
Please refer to Section V for Humana's projected
claims.
Ill. Other than those listed. on the administrative services chart, are there any other fees or charges
that the City would incur if the City accepted your proposal? If so, please indicate here.
I-lumana's services :Ire bundled in one price so the City is not surprised by separate changes for
materials and processing, which can significantly raise costs from the original quote. l-ltnnana's
adntiai`ar;tive fees ...Jude:
• "fransfcr of claims and eligibility data from the prior administrator
• Group iiiiplenientation meetings
• Actuarial assistance
• -Rate establishment (active, retirees, (:OHRA)
Development of claims cost projections (paid, incurred)
• Summary plan description (SPD) or Certificates of Benefits/Subscriber Agreements, available
�•I�' Crtn ir;tll '
• HIPAA compliance
• o Hitrollment forms and materials
a Claims forms
• I)elltiSt ciirectorres, available via the wehsite
▪ Ill r,trds
• Quarterly member newsletter, 13ru.c11h1p, available electronically
• Proactive claims processing (Humana calls for missing information):
• Automated pretreatment review
• Coordination of benefits
• Dependent status verification
• EOBs to members
• Subrogation
• Duplicate claims -edits
• Fraud detection
o Toll -free access to Customer Care team
• Automated information line
• Utilization/code review
• Completion of Schedule A for Federal Tax Form 5500
• Financial management reporting
• Web -based services (claims inquiry, dentist directories, ID cards, secured e-mail messages)
25
RFP No. 273288 - Employee Benefit Dental Plan
Attachment A
11. Please complete the following in -network Negotiated Fees chart for the designated counties as it
applies to the DMO:
Humana's proposed HS 205 plan includes the following copays:._
xCA-
ode
ProcediirDescrapon
a
L e otiated§Fee'' t-
,hat..aiient t' a
si ;.. .`
rowar
tamiIa`de
_., Ittr
alGiBeas
,t.
oun
'onre
tr4r
{Coup
,�_
r
, . t
ounty
ounty
0120
Adult Exam
$0 .., .
$0
'$0
1110
Adult cleaning
$0
$0
$0,
$0
2150
Amalgam Restoration
$5
$5
$5
$5
7110
Simple Extraction
$0
$0
$0
$0
3310
Anterior Root Canal
$110
$110
$110
$110
2750
Porcelain/Gold Crown
$270 plus lab
$270 plus lab
$270 plus lab
$270 plus lab
5110
Complete Upper Denture
$375 plus lab
$375 plus lab
$375 plus lab
$375 plus lab
6240
Porcelain/Gold Bridge Abutment
$270 plus lab
$270 plus lab
$270 plus lab
$270 plus lab
6750
Porcelain/Gold Bridge Pontic
$270 plus lab
$270 plus lab
$270 plus lab
$270 plus lab
Humana's proposed HS 195 plan includes the following copays:
a otiatedlFiee +WJfati14hentP.ays ?7
� �1V iamiiDade4
i "r'i �3^'C Y�
, ounty r
x,„tP.�alm eaeh' �' on tee
E liotifrwi d � k —0
: Countya ` oun . f
t.
.�y
s
1pr urell.)esp
bon' Y.
q t3row,and �
khCAF
1Goun , ,
�
Code
- a ..
k..) ,
' u
�� Yd 3i,
w � a ' a
$0
$0
$0
0120
Adult Exam
$0
1110
Adult cleaning
$0
$0
$0
$0
2150
Amalgam Restoration
$0
$0
$0
$0
7110
Simple Extraction
$5
$5
$5
$5
3310
Anterior Root Canal
$100
$100
$100
$100
2750
Porcelain/Gold Crown
$245 plus lab
$245 plus lab
$245 plus lab
$245 plus lab
5110
Complete Upper Denture
$325 plus lab
$325 plus lab
$325 plus lab
$325 plus lab
6240
Porcelain/Gold Bridge Abutment
$245 plus lab
$245 plus lab
$245 plus lab
$245 plus lab
6750
Porcelain/Gold Bridge Pontic
$245 plus lab
$245 plus lab
$245 plus lab
$245 plus lab
12. Please attach any corresponding fee schedules that will apply.
Please refer to Section V for Humana's rates and benefits.
13. Is more than one fee schedule utilized on a national basis? If so, please explain.
Humana's fee schedules and capitation rates vary by plan and geographic area. Specialty copayments
vary by plan.
14. Are you willing to offer the executive plans as standalone plans?
Yes, Humana's proposed executive plans are offered on a standalone basis.
Reporting Capabilities
1. Attach sample copies of your proposed reporting packages. Include proposed reports for
financial, claims, utilization, billing, accounting, banking, etc.
With 45 standard reports available, Humana is confident in its ability to meet City's dental reporting
expectations. As part of the implementation process, the required reports, timing, and method of
26
I:I I' Nil. �7-i?KR Employcc Reach! Dental Ilan Auacluncni A
delivery are mutually agrecd upon. Please refer to Attachment D fo!LIm tna',s sample reporting
package.
2. What reporting is availublc on-line''
Humana understands that employers need readily accessible information to manage the. administrative
aspects of their health benefits plans. Asa technology company, Humana developed online reporting
capabilities. Some of the online reports available include:
• Full-time student verification status report
• F3eneficiary changes report
• Demographic changes report
• L:ntployee and member benefits reports
• Employee and member status/changes reports
• Extended family registration report
• Login report •
• EnrotIment reports • .
• Waive reason report
• Web changes report
3. Is on-line renorting accessible to individuals designated by the City (and approved via HII'.AA )''
1-In' wilt currently has severalsyirL.fl,n that provide group l...1 reporting Ftme tioiilily; 1.n.-w.„vC.
iii ulUe 1 1itllllana to get speuilie uetalls arotiilu tut lelative system, 1-lumana requires aaulUUnat
information arrllnd the specific reporting needs.
Communications and Enrollment Capabilities;
i. i.iesci°ii a your Hite' uei ��►�➢: iii ucgaids ie► iile it►iiuwill areas;
• Customization to City plan design information
• Enrollment
• Forms
• Change of status
• Employee personal access information (claims, EOBs, dependent information, etc.)
• Banking
• Employer/consultant reporting
• Comparative dental cost information
• Other
Humana's dental website, HumanaDental.com, allows members to:
• View eligibility details — General information about the plan selected at enrollment
• View plan design summary — Summary of benefits including co -pays and deductibles
• View claims status and/or explanation of benefits for recent claims — View the last 18 months of
claims data
• Send questions to Customer Care specialists — Exchange secure messages with Humana's
Customer Care team
• Access provider directories — Use Dentist Finder to find a dentist (listing is updated daily)
• Refer a dentist
• Check annual accumulated benefits
• Request a replacement ID card
2/
RFP No. 273288 — Employee Benefit Dental Plan Attachment A
• Check predeterminations — View the last 18 months of claims data
• Check waiting periods
• View the EyeMed vision discount program and 1ocate a provider
• Locate Humana contact information
• View compleinentaryand alternative medicine (CAM) discount services
• Submit a web feedback form
Humana's dental website, HumanaDental.com, provides the following tools and information for the
City's administrator:
• Find a dentist
• Add, edit, delete employee and/or dependent information
• Update coverage
• View enrollment information
• View and print enrollment forms
• View a bill
• Exchange secure messages with Humana's Customer Care team
• Access an administration guide
• Check eligibility information and the SPD or Certificate of Benefits/Subscriber Agreement
• Request a replacement ID card
• Change company contact and billing information
• View a summary of benefits
• View the EyeMed vision discount program
• Administer website security access
• Locate Humana contact information
• View complementary and alternative medicine (CAM) discount services
.• Request reports
Humana continually adds new functions and enhances current features to make the website effective
and give customers the information and insight they need.
2. What communication materials/assistance are included in your quoted fees/premiums (include
materials, staffing and on-line capabilities)?
Humana provides standard benefit materials to the City at no additional cost. Humana also works with
the City to develop customized material.
3. Can the City's logo be included on these materials? Is there an additional charge?
Humana works with the City to develop customized materials that can include the City's logo.
4. Describe your enrollment options (paper, on-line, recorded media, etc.).
Humana accepts eligibility in the following formats:
• Through the employer portal of HumanaDental.com
• Electronic Data Interchange (EDI) — l 00 employees or more
• List Enrollment Spreadsheet — 25 employees or more
• Paper enrollment form
• Secured messaging
• Phone
28
• Itl l' No. 27.t?84 -- liinployce Bencht Dental Plan Attachment A
• l.ax
Iltlltal c:hglblhty for the ( Ily can be 1(y(dred electronically Or manually, depending on the enrollment
size, data elements available. and format compatibility oldie provided file. IC the file contains all
necessary enrollment data elements and is provi(.le(I in a compatible format, I-lurnana generates ongoing
maintenance reports for additions, changes, and terminations by comparing the Cily's full file against
Humana's system enrollment.
5. Describe the communications that arc available, and in %dial format for:
• Enrollment
Humana schedules enrollment meetings to meet the unique needs of the City's workplace and
nlaxinlize employee participation. An enrollment cuor(linator trained Io address employee concerns
conducts these meetings.
The coordinator distributes enrollment kits that contain the information employees need to use the
plan effectively;
• A schedule of dental benefits
• An enrollment application
:�. I'ft!!llatla accOutlt. itpre.tientatn /e :S avaffabl:; t(? ''O U ttlC ! Ity throughout the plan year for
uld answer sessions with employees.
• Network information
Humana takes its environmental impact and responsihiiities seriously. As such, Humana does not
provide prllltctl dental directories. (Humana maintains dental directories online, Which are updated
daily. Members can access the most Hp -to -claw Infor rnticm ;old rnctnn)iyr Ihi ((iFo..r•tnr•v c lrrti„{
for their needs at HumanaDental.com. If members do not have Internet access, a directory may
be obtained by contacting the Customer Care team.
• Claims information
Humana generates an explanation of benefits (FOB) to the member on every claim excluding the
following:
• When the member responsibility is zero and the payee is not the member or an alternate
payee
• The claim is being denied as a duplicate
• The provider is participating and Humana's net paid is Tess than or equal to $50.00
• A claim was adjusted and there is no additional payment or change to the benefit amount
In addition, members access claims submissions and payment histories through Humana's secure
website at HumanaDental.com.
6. Please attach samples (including ID card)
Please refer to Attachment E for Humana's sample ID cards.
29
RFP No. 273288 — Employee Benefit Dental Plan Attachment A
Claims Administration Capabilities
1. How many months of historical claim data are stored in your claims.' system?
The City's information is available online for seven years..
2. How far back in time can claims be processed'on your system?
The City's information is available online for seven years.
3. Is your system an on-line, direct access system or a plan/claims information storage and
retrieval system? Provide a flowchart or brief description of its operation.
Humana's custom -designed system, developed and serviced internally, is integrated with other
systems and updated in a real-time online mode..Key features are:
• EDI enables dentists to submit charges through a clearinghouse, billing service, or directly to
Humana, eliminating paper claims
• Humana receives more than 62 percent of claims electronically; the automatic claims entry
through the dental processing system reduces errors and processes claims faster
• Humana's state-of-the-art system automatically settles the majority of claims, most do not need
manual intervention
• "Dental logic" protocol of more than 200 edits is applied to each claim (examples include
applying frequency limitations, eligibility determination, coordination of benefits, dental
necessity, duplicate submissions, and alternate benefits)
• Automatic editing of plan benefits includes deductibles, coinsurance, and benefit maximums
• The code review system catches billing and coding errors by detecting old, obsolete, or
inappropriate information
• The system automatically detects unbundled services and applies the American Dental
Association's (ADA) established criteria
• Dental pretreatment estimates are automated
When Humana receives benefit inquiries, the claims specialist has online access to all the City's
information. Calls are documented in member files for online tracking. The dental system provides
online adjustment of claims if Humana receives additional information on a previously processed
claim.
4. How long has your claims payment system been operational?
Humana's claims system has been operational for more than 15 years.
5. Can eligibility and claims transactions be accessed by thesame person?
Yes, both Customer Care and claims specialists have access to Humana's dental processing system,
which contains benefit and eligibility information for all members.
6. Describe enhancements made in the last 12 months and those planned for the next 12 months.
Humana's claims processing system was updated in April 2010. The system was upgraded with the
latest version. There have been no major eligibility system changes in the past 12 months.
30
27.l?X8 - Employee Benefit Dental Plain Attachnleni A
1 Itllllalla does not expect to make any major system changes in the next 12.nulull's. I-luntana regularly
upgrades its claims system with new functionality and follows a lour to six week integrated testing
process prior to the implementation of each release of enhancentents.
7. I)escrihe the mechanics/process of screening for duplicate claims.
I luntana denies a claim if an exact duplicate %vas paid more than 30 days from receipt. The
system venerates an explanation of benefits 0-;Olt) showing the previously submitted (_Inlrge ;tad
maximum benefit issue((.
I)uplicate claims received for rejected or pended claims generate an kOB showing that Humana's
determination was sent or will he sent. soon. Utlplicate claims received within 3() days of the original
claim do not generate ;in FOB.
Duplicates on the s;tltle document generate art FOB .showing the plan menthe'. IS not IIaIlle for
duplicate charges or hints!, errors.
I)FlMO: This is not applicable to Humana's proposed plan.
S. Can your system accept and track full eligibility data'?
Humana updates eligibility data when it is received. A weekly receipt of changes is preferred to keep
fnnl;Minn ('urgent hit' other time frtimei; mill he (-ow:it-ler-et-I Glhen Finmana moot file •.
discrepancy report is sent to the City.
9. tan your system track each dependent by the dependent's name and social security number:'
Humana tracks dependent eligibility and requires the dependent's name, gender, and date of birth. 11
the dependent is 19 or older, Humana needs verification o1' full-time student status.
10. What is your process for establishing student eligibility? Incapacitated dependent status'?
An indicator in Humana's dental claims processing system captures full-time student classifications.
When proof of eligibility status is provided, receipt is captured through system screens and logged.
Member eligibility status is defined for the claims payment system as meeting full-time student
qualifications. Missionary programs are not considered an accredited school, therefore that individual
does not qualify for full-time student status.
Humana sends a letter to policyholders annually (65 days prior to the dependent's birthday), asking
members to complete and return an enclosed affidavit by the dependent's birthday attesting that the
dependent meets the criteria for full-time students, part-time students, or other dependent eligibility
depending on the City contract. The affidavit eliminates the need for policyholders to provide proof
of student status through other documentation including a current class schedule, tuition payment
receipt, or letter from the institution confirming full-time or part-time enrollment.
If the affidavit has not been returned by the dependents birthday, coverage is cancelled according to
the City's contract.
3i
RFP No. 273288 — Employee Benefit Dental Plan • Attachment A
11. Under what conditions and by which individuals can your claims system be manually
overridden?
Claims specialists have.the authority to override limited dental logic edits based on their role. Higher
level edits are only released by a senior level specialists. or &supervisor.-
12. How are manual overrides (if.any)-to your.,claims system aresrevieweilby claims managers?
An experienced lead claims specialist; has thecapacity to releaseclaims up to $10,000. A supervisor
releases claims over $10,000 up to $25,000. The manager releases claims up to $30,000. Anything in
excessof the manager's limit is reviewed -and released by the director of dental operations. In
addition, Humana's state-of-the-art dental claims system incorporates a hierarchy of edits to process
claims automatically according to dental protocol. A weekly automated report identifies whether
system parameters were overridden.
13. What are the minimum- requirements for claims history transferred to your system(s) on anew
account basis?
Humana works closely with City to ensure accurate and timely data transfer. An electronic transfer is
preferred, and a record layout is required to test the data before the transfer is completed. If the
electronic feed is not available, Humana accepts paper reports.
14. What system platforms are utilized for plan administration? Please describe.
PPO: Humana's custom -designed system streamlines the adjudication process at all levels. It
adjudicates 80 percent of dental claims and minimizes processing time. Extensive online claims edits
are satisfied before a claim is adjudicated, ensuring that claims are paid according to dental protocol
and contract provisions.
Humana accepts claims and attachments by mail or electronically. Documents received through the
mail are directed to Humana's national mailroom where they are imaged, keyed, and transmitted into
the claims processing system within 48 hours of the received date. Each claim runs through more than
200 edits, including validation of American Dental Association (ADA) CDT procedure codes.
Processing system edits include checking for duplicates,. applying dental logic, identifying related
pended claims, and verifying the usual, customary, and reasonable/maximum allowable fee charge.
The system checks automatically for other insurance information so benefits are coordinated when
necessary. The system applies maximum annual benefit edits before any claims payment is released.
If claims lack necessary information for processing, Humana's claims specialists investigate further
for the required information by sending letters to the appropriate parties. Claims are closed and
processing resumes when all information is collected.
DHMO: Humana's custom -designed system streamlines the adjudication process at all levels. It
adjudicates approximately 60 percent of dental claims, minimizing processing time. Extensive online
claims edits must be satisfied before a claim is paid, ensuring that claims are paid according to dental
protocol and contract provisions.
Humana utilizes QicLink claims processing software licensed by Trizetto to process claims. QicLink
is a fully integrated system that stores plan parameters, eligibility records, provider records, processes
dental claims for adjudication, and includes reporting. capabilities. -
32
I.I I' N. 27_t2XX Iinaployce Benclit Dental Plan Attachment A
Prior Io dental claims processing, the Billing and h.nroIlnlent department enters the subscriber :Ind/or
dependent eligible for claims payment into the proprietary claims system. The system maintains
rli, ihilit r p!'rt11!(I!11, and capitation tar Humana. L:rtrr llrrirr){ is ,Mere, in two ‘ways:
I) ;\n electronic file from the City js received and uploaded into the claims system hy the
Informaiion'I'cchnoloi,,:y (11) department.,
2) Individual applications from suhscrihers are keyed no the claims system hy the Enrollment
department. ()nly the Billing and Enrollment department has access to acid nlenlhers into the
system. Further, only the Claims department can process claims. This segregation of.dulies serve,
as a control over the routine processes for metfhershit) and claims.
There are two separate sets of procedures for adding a claim to the QicLink system for processing,
electronic claims received from the claims clearing house and remote data entry, which utilizes the
auto -adjudication process.
15. Will a direct claims payment system he utilized?
Yes, Humana uses a direct claims payment system.
16. How long has the claims payment system been in place?
iiuncnut . claims sy..lem has deem operaiionai tug more than '15 years,
i 7. What percentage of claims are automatically adjudicated?
PPO: 1-iumana's dental claims processing system streamlines the adjudication process at all levels. It
adjudicates 80 percent oldental claims and minimizes processing time. Extensive online claims edits
are satisfied before a claim is adjudicated, ensuring that claims are paid according to dental protocol
and contract provisions.
1) -CMO: Hunein;i's denial claims processing system .streamlines the adjudication process at all levels. It
adjudicates approximately 60 percent of dental claims, minimizing processing time. Extensive online
claims edits must be satisfied before a claim is paid, ensuring that claims are paid according to dental
protocol and contract provisions.
18. What are the claims administration standards?
PPO:
Gc4044CategorY ... `+t
t ► -
l k D
Turnaround time— 90% in 10 business days
95.5%
96.0%
Turnaround time — 98% in 30 days
99.5%
99.4%
Financial Accuracy — 99%
99.6%
99.5%
Payment Accuracy — 98%
99.5%
99.3%
DHMO:
Goa1s.& G`a#egai�y �"
1 �t�
0 iiliraWit
Turnaround time — 90% in 10 business days
93.9%
97.9%
Turnaround time — 98% in 30 days
100.0%
99.8%
Financial Accuracy — 99%
99.8%
99.6%
Payment Accuracy — 98%
99.7%
99.5%
33
RFP No. 273288 — Employee Benefit Dental Plan Attachment A
19. How•are non=network and out -of -area provider claims identified'and paid?
PPO: Humana has nationwide dental network reciprocity. If members seek care from a dentist
participating in the network, benefits arepaid at the in -network level. If members seek care from a
dentist not participating in 'Humana's.network,benefits are paid at the out -of -network level.
DHMO: Out of network benefits are not available on the proposed DHMO plan. The plan covers
dental emergencies 24 hours aday, seven days a week; no.,matter.where the member. -is located. If a
member has a dental emergency, they are covered for palliative(emergency)treatment. Palliative
treatment involves only what is necessary to control unexpected pain or more -than -usual bleeding,
prevent complication related to an infection, or prevent the loss of a tooth from a traumatic injury.
Emergency dental service is intendedto relieve pain caused by an acute conditionuntil the
participating dentist can see the member. The member's emergency care=benefit does not include
procedures that are required but are not necessary for the relief of pain. For example, root canals and
crowns may be necessary treatments but are not covered under emergency care benefits. If a member
has an emergency that involves extensive accidental or traumatic injury to the teeth or mouth, or that
affects the member's ability to breathe or swallow, they should contact a medical physician.
When more than 100 miles from the nearest participating dentist, a member obtains reimbursement
for expenses for emergency care by any licensed dentist, less applicable.copayments, up to $100 per
member per year, after presenting an itemized statement of emergency services from the dental office.
Humana must be notified of the treatment within 90 days to receive reimbursement.
20. What are the Eastern Standard Time hours of operation for the claims unit?
PPO: Humana services all of the City's claims needs from its office in De Pere, Wisconsin. The
business hours are from 9 a.m. to 5 p.m., Eastern time. Customer Care specialists are available between
8 a.m. and 6 p.m., member time zone, Monday through Friday. Humana's dental interactive voice
response (IVR) system and website, HumanaDental.com, are available 24 hours a day, seven days a
week.
DHMO: Humana services all of the City's claims needs from its Chicago, Illinois office. Business
hours are from 9 a.m. to 5 p.m., Eastern time. Customer Care specialists are available to members from
8 a.m. to 6 p.m. member time zone, Monday through Friday. Humana's dental IVR system and website,
HumanaDental.com, are available 24 hours a day, seven days a week.
21. How are claims staffing levels established?
Claims are processed by hierarchal settings including but not limited to guarantees, state, and receipt
type based on expertise of claims specialist.
22. Is there a dedicated claims unit for the City?
Humana does not assign specific claims specialists to accounts. Claims are processed by hierarchal
settings including but not limited to guarantees, state, and receipt type based on expertise of claims
specialist.
34
No. 27 128x - Employee Benefit Denial flan Auachnlent A
23. How ninny bilingual customer service staff members do you have, and what languages do they
speak?
Approximately 10 percent of I-lumana's dental Customer Care specialists speak Spanish. Iicnaaana also
has a team of representatives who service Spanish calls and also subscribes to the Language Line which
supports is all languages.
24. Provide a copy of all certificates, procedures and protocol for HIPAA compliance as required to
date and for future scheduled compliance.
I-Iurnana's privacy policies and procedures are in compliance: with I-III'AA pia Vac), rules, as well as
state regulations. Measures completed to meet I-I1PAA requirements include:
• Adopting and implementing new privacy standards where applicahIe, as they relate to the privacy
of individually identifiable health information
• Creati.ng a privacy office and designated a privacy official
• . Defining the uses and disclosures for personal health information (PHI), including when
individual authorization is and is no( required.
Procedures are in place for:
• Providing -member privacy rights
▪ Providing notice to individuals o! mlormat.on practice.:
• Managing individual access to PHI
Humana provides education and training annually. based on existing or revised policies, for assc,cia(c.s
as well as temporary, part-time. and volunteer members of' the workforce who have access to personal
health information. Vendor contracts contain standard, HIPAA-compliant language for each contract
type, including self -funded and fully -insured groups. New business associates agreements have been
NV'f•r ills-d1 O ;11Yrrndledi ;If1dI 1-11)111;rn;r'c. cnnlrNr•I!rlo Crave teen ririr o.tr.•ri In
streamline H1PAA compliance efforts.
25. 1)o you maintain Performance Standards? If so, please describe.
Yes, Humana maintains performance standards. The standard dental audit measurements used by
Humana are as follows:
Timeliness
Humana guarantees that 90 percent of clean claims are processed within 10 business (14 calendar)
days and 98 percent within 30 calendar days. Cycle time is -measured from the date a clean claim is
received to the date it is processed. Clean claims are defined as not requiring any external information
from a provider, participant, employer, or any other carrier in order to complete the claim.
Financial accuracy
The financial accuracy rate is defined as the percentage of dollars paid correctly. It is calculated by
dividing the total claim dollars paid less the absolute value of overpayments and underpayments by
the total claim dollars paid. Humana commits to maintain a financial accuracy of 99 percent.
Payment accuracy
Payment accuracy is defined as the percentage of claims paid correctly. It is calculated by dividing
the total number of correctly paid claims by the total number of claims reviewed. Humana commits to
maintain a payment accuracy of 98 percent.
35
RFP No. 273288 — Employee Benefit Dental Plan
Attachment A `
Procedure accurAcy...;41, Procedural accuracy is defined as those claims processed without an overpayment, underpayment, or
procedural error. Procedural accuracy is calculated by dividingthe total number of correctly reviewed
claims by the total number of claims reviewed. (Procedural accuracy is used for internal use only.)
Humana's internal procedural accuracy standard is 95 percent.
Each is strictly monitored. Experienced quality analysts in the Quality Assurance department = which
report, to the director of dental claims — audit a random weekly sampling of claims from each plan.
Ability to Administer Requested Plan Designs/Alternatives
1. Are you able to administer the dental plan designs,as designated in this proposal?
Humana's proposed dental plans are comparable to the City's current plans. Please refer to Section V
for more information.
2. If not, please indicate the deviations.. per plan. All deviations must be indicated in your response.
Humana's proposed Custom Benefits on the Traditional Preferred 100/80/80 plan for the executives
only include: Major services and orthodontia paid at 80 percent, TMJ lifetime maximum of $750,
topical fluoride treatment (through age 19, one per calendar year), bitewing x-rays two sets per
calendar year, full mouth/panoramic x-rays once every three years, space maintainers., under
preventive services up to age 19, four cleanings per year (routine in preventive services or periodontal
as a basic service), oral surgery and denture repairs as a basic service.
Human's proposed Custom Benefits on the Traditional Preferred 100/50/50 for the non -executives
only include: $100 Individual deductible and $300 family deductible, bitewing x-rays two sets per
calendar year, full mouth/panoramic x-rays once every five years, space maintainers to age 19 paid as
a preventive service, four cleanings per year (routine in preventive services or periodontal as a basic
service), and non -surgical periodontal maintenance in basic.
Account Management Staff
1. Complete the following chart with information on the management and service team you propose
for our clients.
` `T °,,."�
r .
Moles
: �. ..
�. 1 1 x C 11
1 I I 11 A l l 1 KIIi
11 1
� 1 �,;��
1 1
After
. dui lamentation
o- , , . , n ..
Account Manager
Michelle Alvarez
Large Group
Account
Executive
30%
10%
Day to Day Liaison
Alejandra Fox
Large Group
Account Advisor
30%
10%
Implementation Coordinator
Jodi Wilson
Account
Implementation
Manager
30%
10%
Customer Service Supervisor
Marian
Castellano
Daniel Carvalho
Customer Care
Supervisor
Customer Care
As needed
As needed
36
I' IcI' No. 27 i2tts I':nlployec 13cliclii Dental Plan
Attaclurlcnt A
d a'o e
F.d�¢1Ts1'`i;2
tg"}? ufL:px:
ri:`at ! ! ' 1 I
1 I Y 11 ; ._I..,7
.
Claim Administration
Supervisor
Donna Man all
Mannaer
C:usiomcr Care
I)ircctor
('I;unls
Sul)elvisl;r -
Nei work
,
i curtinmcni
Managci
As nccctccl
\s nct:(Icll
(-•onnic S()clla
...__
Network Management,
f,iaisoa
(tiler
.lin,i Ilan
- - -
l
A� nCe(Ic(,
As nc'icicrc
2. Include the resumes of llic above proposed team members.
The City is assigned to an account executive based in 11 local Humana office. The account executive,.
Michelle Alvarez., has overall accountability and responsibility for tlae administration, retention,
strategic planning, and reporting to the City on the performance of the account. In addition to the
account executive, ii.local accoetnl.advisor, Alejandra Fox, is responsible for enrolling. The account
management team is led by a director of Account Management, Jacqueline Martino..
Michelle Alvarez, Large Group Account Executive
IA'ticilelie Ai has Peen all iaccotiiii executive Wliil Htiniaiiii•s Large Commercial (iIU1ll),
department in Miramar, Florida since 2006, managing 10 accounts with over 20,000 members in the
nul'lir rrrtrl nriv;cl" cortnrc L(-'r vr.-,1<„�e ,
providing financial reports with thoughtful analysis on the performance of their benefits programs,
and presenting solutions to meet their current and future needs.
Before j)niiv Humana, Michelle spiit several yew-s as an independent insurance igel t,he
groups and individuals achieve their insurance objectives. After graduating from Miami Dade College
with a bachelor's degree in Business Administration, Michelle began her career in the retail industry,
where she.held various management positions prior to joining the insurance industry.
Alejandra Fox, Large Group Account Advisor
Alejandra Fox joined Humana as an account advisor in April 2008. She brings with her more than 12
years of experience in the health insurance industry, with experience working for both consultants and
insurance carriers.
Alejandra's experience in Account Management includes service and -claims resolution, as well as
benefits presentation and enrollment processes. Her Humana accounts for the past year have included
large (100 to 3,000+) public and private sector clients.
Jacqueline (Jackie) Martinez-Sancho, Director of Account
Jackie Martinez has over 15 years of experience in the insurance and marketing fields. She joined
Humana in 1996 and was responsible for the servicing of the company's largest dental and vision
accounts, and for major group implementations. In 2002, Jackie was promoted by Humana to director
of Account Management for the Southeast Region and managed a team servicing over $90 Million in
annual revenue, including 13 account managers throughout Florida.
Today, Jackie's scope of responsibility includes managing a team to retain, educate and support our
public sector, hospital and labor union clients in South Florida for all product lines through Humana's
consultative approach and wellness initiatives. She is a state licensed health insurance agent and an
active member of the National Association of Health Underwriters. Jackie attained her degree of
37
RFP No. 273288 — Employee Benefit Dental Plan Attachment A
Bachelor of Business Administration in Marketing and International Business. from Florida •
International University and also earned her'Master of Business -Administration with honors in 2001
from Nova Southeastern University.
3. Is designated staff expected to maintain: measurable client satisfaction standards? If so, please
describe.
Humana believes this approach will differentiate Humana and enhance the City's'experience. The
City's client relationship team will provide you with :a consistent, clear line.of sight and focus on
bringing you the appropriate subject;matter expert support toassist you in solving your healthcare -
related business issues.
The City's client relationship team:
-• Provides consultation and guidance based on an understanding of the City's business goals,
priorities, and strategies
• Keeps the City informed about Humana's offerings that provide benefit to the City and its
employees
• Analyzes utilization and financial trends to develop a comprehensive picture for the City's
benefits plan
• Offers feedback, ideas, and options to provide the City more efficient and effective healthcare
• Proposes alternatives to address the issues driving the City's dental trend
Banking
1. What are your billing and premium payment procedures?
Timing
Humana produces premium statements for the next month's premium, which is due on the first of the
month for the entire month of coverage. If Humana does not receive the premium by the 16th of that
month, a reminder is sent. If the premium is still not received by the end of the month, coverage
terminates from the end of the month in which a payment was last received. For terminations and
coverage changes to appear on that statement, the City should submit them before the 10th of the
month.
Format
The statements are billings listed by employee, including,individual coverage and applicable
premium. Premium adjustments — either credits or back billings for changes from the previous month
— appear first on the statement. For example, if coverage terminated January 31 and Humana received
and processed the termination in February, credit for February appears on the March statement. If the
City pays as billed, adjustments appear as a credit on the next statement.
Multiple entities
When a client has multiple group entities (divisions), Humana can produce separate statements for
each entity or one comprehensive statement. The comprehensive statement has the capability of
giving a subtotal by entity. When separate statements are produced for each entity, Humana provides
a summary page on each statement that indicates counts billed by coverage type.
2. What financial reporting is included?
Humana delivers the following financial reports by the 20th of each month to monitor the financial
activities conducted on behalf of the City:
38
I:l:t' N. 27.t28ti — Employee Benefit Dental Plan Attachment A
• Fund Recap Report; Displays the amounts debited and credited against the customer's hank
accounts, summarized by transaction type, and includes monthly and plan year-to-date totals.
• Bank Statement: One -page summary showing the funding account's balance at the beginning of
the month, the total amount deposited into the account during the month, the total amount
changed to the account during, the month, and the itccount's ending halance.
• 1)etailed Summary of Claim Payments: Summarizes claim payments by iucnll',er.
• Claim Adjustments Report: Sunlillarires any adjustments recovered against previously
processed claims by member,
• Shared Savings IZeport: Shows the savings generated for each claim adjudicated via I-lumana's
shared savings program as well as f-lunlana's fee for administering the program.
• Oulstancing.; Checks Report: Lists each outstanding check that has not yet cleared the
customer's checking account. It identifies each check by check nunlhcr, check type,.issue date,
and check amount.
i, What are the funding requirements (i.e., checks issued, checks cleared?)
f-Itlnlana offers a variety of banking arrangements to meet the City's needs. The arran,gcnlcnls are
cuslonlcr friendly, Cast' to understand, ancf provide choices that sleet tIle City's cash flow needs. -
Humana offers several funding options:
c ttti utu k .utkuit: Checks ale urawu on die i_rry s il•urk dccouni USirlg i iUnl:in;l encek si ei and in,:
City's funds the checks when paid at the bank. This option requires no upfront deposit. As:claims
hanking services and charges.
Daily as Issued: Checks and electronic funds transfer (EFT) can he funded on a daily basis. The
City's home Mink account is dchiti:if o ni clay 'v'i i automate(: Cleaning house (AC i ) :is checks and
EFT's are issued. Providers may he paid by check -only or check and EFT. Dependent on the option
chosen by the City, the:range of deposit is up to two days of claims.
Weekly as Issued: Checks and EFT's can be funded on a weekly basis. The. City is notified -each
Monday of checks and EFT's that were issued the previous week. On the following Wednesday, that
amount is debited from the City's home bank account. Providers may be paid by check only or.check
and EFT. Dependent on the option chosen by the City, the range of deposit is from four to six days of
claims.
The'chart below summarizes the funding options available.
f t.�'i.U$O
ID
,t d iu1 i'as t
U i 'u•
F, Y ,et x
t?- P [e yit' �..
x
a,�3'. ,aas ,
UCA.
Deposit Requirement
None
None
2 Day
Deposit
5 Day
Deposit
6 Day Deposit
Funding initiated by
Client
Humana
Client
Humana
Client
Providers paid via
Checks Only
Checks/EFT
Checks/EFT
Checks/EFT
Checks/EFT
Claims paid from
Client
Account
Humana
Account
Humana
Account
Humana
Account
Humana
Account
Funding Notification
N/A
One Day
One Day
Two Days
Two Days
Bank Reconciliation
Client
Humana
Humana
Humana
Humana
Unclaimed Property
Report
Client
Humana
Humana
Humana
Humana
39
RFP No. 273288 — Employee Benefit Dental Plan
Attachment A
f ' k 'i' ..
',.
•bM teiiiitiRm
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4 'C.'�h kS^.4
Yi »K.:. $ne/'a v
1 O
� �
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•�I '.' A
�Eedkl f $
^"i slue
�" � $$u� �.
. � �1
,
ss•'+�5 ' �.a
W ' T .'-3si{.�
Positive Pay
Optional
Yes
Yes
Yes
Yes
Client's Logo/ Signature
Optional
N/A
N/A
N/A
N/A
4. Is bank reconciliation included in your fees/premiums?
Yes, however bank reconciliation depends upon the banking option chose by the City.
5. Please give the following information for your principal banking relationship (to be used as
reference):
• Bank name
• Address
• Phone number
• Contact name and title
Bank name: PNC Bank
Address: 101 South Fifth Street, Louisville, Kentucky 40233
Phone: 502-581-2084
Contact: Patricia Robertson
Title: Vice President
40
EXHIBIT C
PROPOSED TERMS AND CON ITIONS
Employee Benefit Dental Plan
25
Humana proposal for:
City of Miami
r
Administrative Services Only
Dental claims savings
Humana's custom -designed dental claims operating system automatically applies dental logic —more than 200 edits that process
according to dental protocol —to each claim. The system decreases labor costs, saving you money.
esavfn®i
Administrative policy
svings
paying benefits only for plan provisions (alternate benefits,
frequency limits, waiting periods, and certificate restrictions)
Eligibility identifying services incurred before the effective date, by late
entrants, after termination, after reaching the plan maximum,
etc.
Duplicate procedures
Non -network dentist savings (based
on average customer selection)
Coordination of benefits and claim
adjustments
reviewing, by system, claim and history for previously
considered procedures
reimbursing only according to the usual and customary cost or
fee schedule
reducing benefits by coordinating with other carriers,
identifying pre-existing conditions and obsolete codes
submitted
5.7%
3.7%
5.7%
4.2%
5.0%
Imated total s gsfor !sofa daimssy�t!
Network savings
244 3%.'
Members can save an average of 28 percent on their out -of pocket -costs when visiting dentists who participate in our
network. (Access fees apply if you want the network linked to your dental product.)
Plus, no hidden charges
One administrative fee encompasses Humana's services for self -funded groups so you''re not surprised by separate
charges for materials and processing that can significantly increase your cost from the proposal. Our administrative
fee covers:
• Transfer of claims and eligibility data • Electronic summary plan description
• Toll -free access to contact center • Web -based services
• Underwriting and actuarial assistance • HIPAA compliance
- Establish rates (active, retirees, COBRA) • Proactive claims processing including:
- Develop claim cost projections (paid, incurred) - Automated pretreatment review
• Benefit design consulting - Coordination of benefits
• Enrollment materials - Fraud detection
• ID cards • Utilization/code review
• Automated information line • Completing Schedule A of Federal Tax Form 5500
• Group implementation meetings - Financial management reporting
• Implementation schedule
42
Humana proposal for:
City of Miami
44 til0a0:1a
Administrative Services Only
Service standards
We know it takes excellent service to keep employers and members happy, and we deliver.
Humana agrees to meet the following service standards:
Performance Definition
Claims turnaround
Financial accuracy
Payment accuracy
90% of clean claims' processed within
10 business days (14 calendar days)
and 98% within 30 calendar days
Dollars paid correctly
Claims paid correctly
Service standard 2010 results
90% in 10 business 95.5%
days (14 calendar days) and
98% in 30 calendar days 99.5%
99% or higher 99.6%
98% or higher 99.5%
Telephone response
Call abandon
Percentage of member calls answered within
20 seconds
80% in 20 seconds
Percentage of member callers who hung up <_ 3%
before reaching an associate
81.5%
1.3%
1 Clean claims are defined as not requiring any "external" information from a provider, participant, employer, or any
other carrier in order to complete the claim.
Network guarantees
If you elect dental PPO network access, we guarantee the savings for members using the network will be more than
your network access fee. If not, we will refund the difference between the paid access fee and claims savings to
groups with at least 75 percent of the members in our service area (access standard is two dentists within 10 miles).
43
Humana proposal for:
City of Miami
Administrative Services Only
Effective date: 01/01/2012
Administration fees
Base fee
Commissions
PPO access fee
Total administration fee (per subscriber per month)
Total estimated monthly fee
Year 1
$2.92
$0.00
$0.30
$3.22
$386.40
Year 2
$2.92
$0.00
$0.30
$3.22
$386.40
Year 3
$2.92
$0.00
$0.30
$3.22
$386.40
TWA
Base fee
Commissions
PPO access fee
Total administration fee (per subscriber per month)
Total estimated monthly fee
Estimatec
claims costs
Year 1
$2.92
$0.00
$0.30
$3.22
$3,162.04
Year 2
$2.92
$0.00
$0.30
$3.22
$3,162.04
Year 3
$2.92
$0.00
$0.30
$3.22
$3,162.04
Traditional Preferred 100/80/80 for the executives
Estimated counts
Estimated claims cost
Monthly claims cost
Annual claims cost
49
$26.66
$1,306.34
$15,676.08
0
$0.00
$0.00
$0.00
0
$0.00
$0.00
$0.00
71
$81.48
$5,785.08
$69,420.96
Estimated counts
Estimated claims cost
Monthly claims cost
Annual claims cost
Traditional Preferred 100/80/50 MAF for Non Executives
401
$20.48
$8,212.48
$98,549.75
62
$42.16
$2,613.92
$31,367.04
110
$41.79
$4,596.90
$55,162.80
409
$74.55
$30,490.95
$365,891.40
The fee includes administration of the Traditional Preferred plans only. The estimated claim costs are based on the
current PPO dental plan design. The employer must contribute toward the cost of the dental plans.
44
Humana proposal for:
City of Miami
Mmigistratty_e;Servi sOn1y
Dental plan terms and conditions
Fee Assumptions:
> Fees are guaranteed for three (3) years from 01/01/2012 through 12/31/2014.
> ASO setup fees are waived for a maximum of two (2) dental products.
> COBRA administration is not included.
Estimated Claims Cost Assumptions:
Benefits are comparable to the group's current dental plan(s).
> Group will use the HumanaDental PPO network.
Enrollment:
> Group must have minimum enrollment of 1000 subscribers and a member -to -subscriber ratio of not more
than 2.8.
> If enrollment decreases to fewer than 1000 subscribers as of 09/30/2013, we reserve the right to adjust fees
effective 01/01/2014.
Plan Design:
Benefits are based on the current plan(s) and are subject to a detailed review of the current plan design(s).
To ensure quality, HumanaDental requires a 40-day notice before the effective date to complete all facets of
the implementation and quality -assurance testing. Tasks during this time include internal and external
meetings to discuss plan design; receiving and loading eligibility; building the plan specific benefits; and
creating, printing and mailing ID cards.
> Fees include an electronic Summary Plan Description (SPD). Printed copies are available for an additional
cost.
> Claims will not apply to aggregate coverage.
> HumanaDental does not hold fiduciary responsibility.
Billing:
With our standard billing cycle, premiums are due by the first of the month for which coverage is to be
provided. Grace period is 60 days.
> Bank funding options available are: Custom, Weekly as Issued, and Daily as Issued. A funding deposit is
required for Weekly as Issued and will be required on the Daily as Issued if the group remits the daily
payment. Custom banking requirements may be subject to additional expenses.
> HumanaDental will not process run-in.
The fee includes administration of the Traditional Preferred plans only. The estimated claim costs are based on the
current PPO dental plan design. The employer must contribute toward the cost of the dental plans.
45
Humana proposal for:
City of Miami
xg
Fully Insured
Effective date: 01/01/2012
Dental plan highlights and rates
Proposed plan 1: Custom Traditional Preferred 100/80/80-For Executives only
Employer Sponsored Dual Choice
anhighlights;
Preventive services coinsurance
Basic services coinsurance %
Major services coinsurance
Individual Deductible
Family Deductible
Waive deductible on preventive
Annual maximum
Extended annual max
Estimated counts
Proposed rates
Estimated monthly premium
Estimated annual premium
100
80
80
50
150
Yes
1500
Yes
Endodontics/Periodontics
Composite fillings for molars
Implants
Orthodontia
Orthodontia coinsurance %
Orthodontia lifetime maximum
Complex surgical extractions
Irtel
5
49
$31.87
$1,561.63
$18,739.56
Basic
Not Selected
Not Selected
Child
80
1500
Major
71
$97.40
$6,915.40
$82,984.80
MAF (U&C): If a member visits a participating network dentist, the member will not receive a bill for charges more than
the negotiated fee schedule. If a member sees an out -of -network dentist, the coinsurance level will apply to the maximum
allowable fee. To ensure you do not receive additional charges, visit a participating PPO network dentist.
Limitations, exclusions, waiting periods, and frequency or age limitations may apply. Do not cancel current group
coverage until you receive written approval from Humana. Please verify the rates and selected plan(s) before
implementation to ensure a smooth transition.
46
Humana proposal for:
City of Miami
Fully Insured
Effective date: 01/01/2012
Dental plan highlights and rates
Proposed plan 2: Custom Traditional Preferred 100/80/50-For non -executives only
Voluntary Dual Choice
P,lamhlghlllgh'
Preventive services coinsurance %
Basic services coinsurance %
Major services coinsurance
Individual Deductible
Family Deductible
Waive deductible on preventive
Annual maximum
Extended annual max
100
80
50
100
300
Not Selected
1000
Yes
Endodontics/Periodontics
Composite fillings for molars
Implants
Orthodontia
Orthodontia coinsurance %
Orthodontia lifetime maximum
Complex surgical extractions
Major
Not Selected
Not Selected
Child
50
1500
Major
Estimated counts
Proposed rates
Estimated monthly premium
Estimated annual premium
401
$24.47
$9,812.47
$117,749.64
EESP
62
$50.40
$3,124.80
$37,497.60
EECH`r
110
$49.96
$5,495.60
$65,947.20
409
$89.11
$36,445.99
$437,351.90
MAF (U&C): If a member visits a participating network dentist, the member will not receive a bill for charges more than
the negotiated fee schedule. If a member sees an out -of -network dentist, the coinsurance level will apply to the maximum
allowable fee. To ensure you do not receive additional charges, visit a participating PPO network dentist.
Limitations, exclusions, waiting periods, and frequency or age limitations may apply. Do not cancel current group
coverage until you receive written approval from Humana. Please verify the rates and selected plan(s) before
implementation to ensure a smooth transition.
47
Humana proposal for:
City of Miami
TAW StkAttigt
Fully Insured
Effective date: 01/01/2012
Dental plan highlights and rates'
Proposed plan 3: FL DHMO/PREPAID HS195 ADULT/CHILD ORTHO
Employer Sponsored Dual Choice
Estimated counts
Proposed rates
Estimated monthly premium
Estimated annual premium
154
$13.36
$2,057.44
$24,689.28
341
$39.16
$13,353.56
$160,242.72
Limitations, exclusions, waiting periods, and frequency or age limitations may apply. Do not cancel current group
coverage until you receive written approval from Humana. Please verify the rates and selected plan(s) before
implementation to ensure a smooth transition.
48
Humana proposal for:
City of Miami
Fully Insured
Effective date: 01/01/2012
Dental plan highlights and rates
Proposed plan 4: FL DHMO/PREPAID HS205 ADULT/CHILD ORTHO
Employer Sponsored Dual Choice
Estimated counts
Proposed rates
Estimated monthly premium
Estimated annual premium
154
$12.13
$1,868.02
$22,416.24
341
$35.53
$12,115.73
$145,388.75
Limitations, exclusions, waiting periods, and frequency or age limitations may apply. Do not cancel current group
coverage until you receive written approval from Humana. Please verify the rates and selected plan(s) before
implementation to ensure a smooth transition.
Custom Benefits on the Traditional Preferred 100/80/80 plan include: Major services and orthodontia paid at 80%, TMJ
lifetime maximum of $750, topical fluoride treatment (through age 19, one per calendar year), bitewing x-rays 2 sets per
calendar year, full mouth/panoramic x-rays once every three years, space maintainers under preventive services up to
age 19, four cleanings per year (routine in preventive services or periodontal as a basic service), oral surgery and denture
repairs as a basic service.
Custom Benefits on the Traditional Preferred 100/50/50 plan include: $100 Individual deductible and $300 family
deductible, bitewing x-rays 2 sets per calendar year, full mouth/panoramic x-rays once every five years, space
maintainers to age 19 paid as a preventive service, four cleanings per year (routine in preventive services or periodontal
as a basic service), and non -surgical periodontal maintenance in basic.
49
Humana proposal for:
City of Miami
Fully Insured
Dental plan terms and conditions
Rate Assumptions:
> The effective date is no later than 01/01/2012.
Rates are guaranteed for three (3) years from 01/01/2012 through 12/31/2014. If the average enrollment
from 01/01/2012 through 09/30/2012 changes by +/-10% from the quoted enrollment of 2092 subscribers,
HumanaDental reserves the right to adjust rates effective 01/01/2013.
Rates are based on SIC code 9111, situs state FL.
> Plan assumes an employer/employee relationship exists between all parties.
These rates include a replacement commission schedule of a level 0%.
Enrollment:
> Rates are based on 3243 eligible employees.
> For employer -sponsored dental plans, the group must have 100% participation if the employer contributes
100% of the premium, or a minimum of 75% of all eligible employees if the employer contributes less than
100% of the premium.
> If enrollment changes by +/-10 percent from the quoting enrollment of 1597 subscribers / 4000 members,
underwriting reserves the right to re-evaluate rates.
> On Employer Sponsored plans, no waiting periods will apply for initial or timely add-ons for PPO/TRP and
DHMO plans.
Rates include an annual open enrollment at renewal time. Open enrollment allows employees to enroll as
timely applicants during open enrollment. Standard waiting periods apply.
Plan Design:
> Proposal is contingent on Humana being the only dental plan(s) offered.
> This plan is based on Humana's dental standard certificate language and includes custom benefits. To
ensure quality, Humana requires a 40-day notice before the effective date to complete at facets of
implementation and quality -assurance testing. Tasks during this time include internal and external meetings
to discuss plan design, receiving and loading eligibility, building plan -specific benefits; and creating, printing
and mailing ID cards.
Billing:
> With our standard billing cycle, premiums are due by the first of the month for which coverage is to be
provided. Grace period is 60 days.
> Humana may adjust rates because of changes in plan design, legislation, or regulations that affect benefits
payable, eligible, or contractual provisions.
Pricing includes dependent age to 26.
For insuring or offering entity, please see applicable sales or marketing literature.
50
FLORIDA
City of Miami
Calendar -year deductible
(excludes orthodontia services)
Individual Family
$100 $300
Annual maximum
(excludes orthodontia services)
$1, 000
After youreach the annual maximum amount, you will
receive 30 percent coinsurance on preventive, basic, and
major services for the rest of the plan year. (Implants and
orthodontia excluded.)
Preventive services
• Oral examinations
• X-rays
• Cleanings
• Topical fluoride treatment
(through age 14, one per calendar year)
• Sealants (through age 14)
100% after deductible
Basic services
• Space maintainers (through age 14)
• Emergency care for pain relief
• Basic oral surgery services - basic
extractions of erupted tooth or root
• Fillings (amalgam, composite for
anterior teeth)
• Appliances for children (through age 14)
• Prefabricated stainless steel crowns
80% after deductible
Major services
• Crowns
• Inlays and onlays
• Bridgework
• Dentures
• Denture relines and rebases
• Denture repair and adjustments
• Complex surgical extractions - surgical
removal of erupted tooth, impacted
tooth, and tooth roots
• Periodontics
• Endodontics (root canal)
50% after deductible
Orthodontia
Child orthodontia covers children through age 18. Plan
pays 50 percent (no deductible) of the covered
orthodontia services, up to: $1,500 lifetime orthodontia
maximum.
Non -participating dentists can bill you for charges above the amount covered by your HumanaDental
plan. To ensure you do not receive additional charges, visit a participating PPO Network dentist.
1-800-233-4013 • HMnana.com
Waiting periods
Employer -sponsored funding: 10+ enrolled employees
Enrollment t
,�aiY^W'M1n YdL ^AT' t"s�
reventive Basic
Orthodontia
Initial enrollment and timely add -on No
No
No
No
Late applicant
No
12 months
12 months 12 months
1-800-233-4013 • H6'nana.com
Questions?
Simply call 1-800-233-4013 to speak with a friendly,
knowledgeable Customer Care specialist, or visit Humana.com.
Feel good about choosing
a HumanaDental plan
Make regular dental visits a priority
Regular cleanings can help manage problems
throughout the body such as heart disease,
diabetes, and stroke.* Your HumanaDental PPO
plan focuses on prevention and early diagnosis,
providing four exams and cleanings every calendar
year: two regular and two periodontal.
* www.perio.org
Go to MyDentallQ.com
Take a health risk assessment that immediately
rates your dental health knowledge. You'll receive
a personalized action plan with health tips. You
can print a copy of your scorecard to discuss with
your dentist at your next visit.
Tips to ensure a healthy mouth
• Use a soft -bristled toothbrush
• Choose toothpaste with fluoride
• Brush for at least two minutes twice a day
• Floss daily
• Watch for signs of periodontal disease such as
red, swollen, or tender gums
• Visit a dentist regularly for exams and cleanings
Did you know that 74 percent of adult Americans believe
an unattractive smile could hurt a person's chances for
career success?* HumanaDental helps you feel good about
your dental health so you can smile confidently.
* American Academy of Cosmetic Dentistry
Use your HumanaDental benefits
Find a dentist
With HumanaDental' s PPO plan, you can see any
dentist. You save an average of 28 percent when
you visit a dentist in HumanaDental' s PPO
Network. To find a dentist in HumanaDental' s PPO
Network, log on to Humana.com or call
1-800-233-4013.
Know what your plan covers
The other side of this page provides a summary of
HumanaDental benefits. Your plan certificate
describes in detail your HumanaDental benefits.
You can find it on MyHumana, your personal page
at Humana.com or call 1-800-233-4013.
See your dentist
Your HumanaDental identification card contains all
the information your dentist needs to submit your
claims. Be sure to share it with the office staff
when you arrive for your appointment. If you
don't have your card, you can print proof of
coverage at Humana.com.
Learn what your plan paid
After HumanaDental processes your dental claim,
you will receive an explanation of benefits or
claims receipt. It provides detailed information on
covered dental services, amounts paid, plus any
amount you may owe your dentist. You can also
check the status of your claim on MyHumana at
Humana.com or by calling 1-800-233-4013.
HUMANA.
Specialty Benefits
Insured or administered by HumanaDental Insurance Company
This is not a complete disclosure of plan qualifications and limitations. Your broker will provide you
with specific limitations and exclusions as contained in the Regulatory and Technical Information Guide.
Please review this information before applying for coverage. The amount of benefits provided depends
upon the plan selected. Premiums will vary according to the selection made.
Plan summary created on: 10/25/11 10:06 Policy Number: FL-70090-HD 3®8 et.al.
FLORIDA
City of Miami
Calendar -year deductible
Individual Family
(excludes orthodontia services) $50 $150
Annual maximum
(excludes orthodontia services)
$1,500
After you reach the annual maximum amount, you will
receive 30 percent coinsurance on preventive, basic, and
major services for the rest of the plan year. (Implants and
orthodontia excluded.)
Preventive services
• Oral examinations
• X-rays
• Cleanings
• Topical fluoride treatment
(through age 14, one per calendar year)
• Sealants (through age 14)
100% after deductible
Basic services
• Space maintainers (through age 14)
• Emergency care for pain relief
• Basic oral surgery services - basic
extractions of erupted tooth or root
• Fillings (amalgam, composite for
anterior teeth)
• Appliances for children (through age 14)
• Prefabricated stainless steel crowns
• Periodontics
• Endodontics (root canal)
80% after deductible
Major services
• Crowns
• Inlays and onlays
• Bridgework
• Dentures
• Denture relines and rebases
• Denture repair and adjustments
• Complex surgical extractions - surgical
removal of erupted tooth, impacted
tooth, and tooth roots
80% after deductible
Orthodontia
Child orthodontia covers children through age 18. Plan
pays 80 percent (no deductible) of the covered
orthodontia services, up to: $1,500 lifetime orthodontia
maximum.
Non -participating dentists can bill you for charges above the amount covered by your HumanaDental
plan. To ensure you do not receive additional charges, visit a participating PPO Network dentist.
1-800-233-4013 • HWnana.com
Waiting periods
Employer -sponsored funding: 10+ enrolled employees
�� x3x�f � t x„��'L;.�r n �� f� ��;' rr'"h?'
Enrollment type
Initial enrollment and timely add -on
preventive y
No
No
No
No
hodontia.
Late applicant
No
12 months
12 months 12 months
1-800-233-4013 • Hlrnana.com
EXHIBIT D
INSURANCE REQUIREMENTS
I. Commercial General Liability
A. Limits of Liability
Bodily Injury and Property Damage Liability
Each Occurrence $1,000,000
General Aggregate Limit $ 2,000,000
Personal and Adv. Injury $ 1,000,000
Products/Completed Operations $ 1,000,000
B. Endorsements Required
City of Miami included as an Additional Insured
II. Business Automobile Liability
A. Limits of Liability
Bodily Injury and Property Damage Liability
Combined Single Limit
Owned/Scheduled Autos
Including Hired, Borrowed or Non -Owned Autos
Any One Accident $ 1,000,000
B. Endorsements Required
City of Miami included as an Additional Insured
III. Worker's Compensation
Limits of Liability
Statutory -State of Florida
Waiver of Subrogation
IV. Employer's Liability
A. Limits of Liability
$100,000 for bodily injury caused by an accident, each accident
$100,000 for bodily injury caused by disease, each employee
$500,000 for bodily injury caused by disease, policy limit
V. Professional Liability/Errors and Omissions Coverage
Employee Benefit Dental Plan
26
Combined Single Limit
Each Claim $1,000,000
General Aggregate Limit $1,000,000
Deductible- not to exceed 10%
The above policies shall provide the City of Miami with written notice of cancellation or
material change from the insurer not less than (30) days prior to any such cancellation or
material change.
Companies authorized to do business in the State of Florida, with the following qualifications,
shall issue all insurance policies required above:
The company must be rated no less than "A" as to management, and no less than "Class V" as to
Financial Strength, by the latest edition of Best's Insurance Guide, published by A.M. Best
Company, Oldwick, New Jersey, or its equivalent. All policies and /or certificates of insurance are
subject to review and verification by Risk Management prior to insurance approval.
Employee Benefit Dental Plan
27
EXHIBIT E
COMPENSATION
CITY OF MIAMI
DENTAL
EFFECTIVE January 1, 2012
Employer Sponsored
Executives
Custom TRP 100/80/80 MAF Humana Humana Humana . Humana
Current Current Original Original Updated Updated
Rates Premium Rates Premium Rates Premium
EE 40 $ 39.78 $ 1,591 $31.87 $1,275 $ 34.39 $ 1,376
EE+SP 0 $0.00 $0 $
EE+CH 0 $0.00 $0 $
Family 79 $ 121.58 $ 9,605 $97.40 $7,695 $ 105.11 $ 8,304
Monthly 119 $ 11,196 $8,969 $ 9,679
Annualized $ 134,352 $107,633 $ 116,151
Voluntary
Non Executives
TRP 100/50/80 MAF Humana Humana Humana Humana
Current Current Original Original Updated Updated
Rates Premium Rates Premium Rates Premium
EE 481 $ 30.55 $ 14,695 $24.77 $11,914 $ 26.41 $ 12,703
EE+SP 153 $ 62.91 $ 9,625 $50.40 $7,711 $ 54.39 $ 8,322
EE+CH 96 $ 62.36 $ 5,987 $49.96 $4,796 $ 53.91 $ 5,175
Family 144 $ 111.24 $ 16,019 $89.11 $12,832 $ 96.17 $ 13,848
Monthly 874 $ 46,325 $37,254 $ 40,049
Annualized $ 555,899 $447,043 $ 480,585
Voluntary
Non Executives
DHMO HS 205 Humana Humana , Humana Humana
Current Current Original Original Updated Updated
Rates Premium Rates Premium Rates Premium
EE 771 $ 12.18 $ 9,391 $12.13 $9,352 $ 12.18 $ 9,391
EE+SP 0 0.00 $0
EE+CH 0 0.00 $0
Family 1013 $ 30.52 $ 30,917 $35.53 $35,992 $ 30.52 $ 30,917
Monthly $ 40,308 $45,344 $ 40,308
Annualized $ 483,690 $544,129 $ 483,690
Grand Total $ 1,173,942 $1,098,805 $ 1,080,427
Employee Benefit Dental Plan
28
EXHIBIT F
CORPORATE RESOLUTIONS
AND EVIDENCE OF QUALIFICATION TO DO BUSINESS IN FLORIDA
(To be provided upon document execution)
Employee Benefit Dental Plan
29
City of Miami
Attn: Johnny Martinez, City Manager
444 S.W. 2nd Ave., 10th Floor
Miami, FL 33130
Mr: Martinez:
November 14, 2011
RE: Recommendation of the Evaluation Committee
for RFP 273288 - Employee Benefit Dental Plan
As Chairperson of the Evaluation Committee ("Committee") for the above services for the City of.
Miami, it is my responsibility to offer the findings and recommendation of the. Committee for your
consideration and approval.
The City issued RFP #273288 for the provision of Employee Group Benefit Dental Plan. A total
of nine (9) Proposals were received, of which one (1) was deemed non -responsive due to lack
of timely response. Per Section .3.1.2, of RFP #273288, it was the City's intent to solicit
proposals for Part I Dental HMO, and Part. II Dental PPO either on a fully insured or a self
insured basis. The City reserved the right to award Part I and Part II services either jointly or
separately to a Successful Provider, whichever is in the best interest of the City. The Evaluation
Committee ("Committee"), appointed by the City Manager, was comprised of the following
individuals:
1. Frank Giallorenzo, Assistant Director of Human Resources, City of Coral Gables
2. Richard Kaufman, Vice President, Aon-Hewitt
3. Jay. Light, Group Benefits Manager, City of Miami — Risk Management
4. Gisela Rodriguez (Alternate), Administrative Assistant II, City of Miami— Risk
Management
The Evaluation/Selection Committee ranked the firms as follows:
Services:
Highest Ranked Firm(s):
Second Highest
Third Highest
Ranked Firm(s)
Ranked Firm(s)
PART I: Dental HMO
Humana, Inc.
Solstice Benefits, Inc.
Delta Dental
Insurance Co.
PART II: Dental PPO
Humana, Inc.
Delta Dental
Insurance Co.
Solstice Benefits, Inc.
Pursuant to Section 3.1. of the RFP, where the City reserves the right to award Part I and Part II
services to a Successful Proposer, whichever is in the best interest of the City, the Evaluation
Committee recommends that the City enter into negotiations with Humana, Inc., the highest
ranked firm for both Part I and Part II. However, if negotiations with Humana, Inc. should fail,
the City should then enter into negotiations with the second highest ranked firms, Solstice
Benefits, Inc. for Part I, and with Delta Dental Insurance Co., for Part II. If negotiations should
fail with the second highest ranked firms, the City should then enter into negotiations with Delta
Dental insurance Co., for Part I, and with Solstice Benefits, Inc. for Part 1l. If negotiations
should fail with the third highest ranked firms, it is the Selection Committee's recommendation
that the City reissue the RFP.
City of Miami
Page 2
November 14, 2011
Upon successful contract negotiations, the recommendation from the City Manager to the City
Commission seeking permission to authorize and execute the professional services agreement
will be presented at the next available meeting.
Your signature below represents your approval of the Committee's recommendation.
APPROVED:
ny Martinez City•Ma- ger
DATE: t(p- t I
Sincerely,
y' -
Richard Kaufman, Vice President
Aon Hewitt
RFP NO.273288
EMPLOYEE BENEFIT DENTAL PLAN
SUMMARY EVALUATION SHEET
•
Evaluators
Proposers
� --- ��_.��•t;��.�r=
Jay Light
Richard KaufmanGiallorenzo
Frank
Total
Ranking
Points
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_
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Y
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_ -
'>.- � :
fir.--. :.� '.
.-ch.K&.:7�'.�'.Y..siaa�a. z, ;w,_;t:, .i
-W
Aetna
SO
..-r`.
)43
-
/ ! C
6
Always Care! Florida Dental Benefits
�0
1n
6.0
17
7
Assurant Employee Benefits (Union Security Insurance Co.)
lc
-70
c
of 6
,1'
Delta Dental Insurance Co.
6 :c.
Ma
'16
1-ac
For Dearborn Life (No DHMO plan proposed)
n/a
n/a
n/a
; n/a
n/a
Humana, Inc. (CompBenefits.Co.)
9C)
8K
0
1-6-�
I
Metlife (SafeGuard Health Hans, Inc_
(S
"it ,
Solstice'Benefits, Inc.
. ai_.�6
rC
) � I
- -_ -;i�.V.� -
l
fla��j:'���-' _r_•s - a.,-�.ci^��T1=7=:c•�csrr --.;�:t, C•a.,oc:
'.4 r " .. .sue ' ,- 1 . r:.;._,. _
>< ?i�.:.:_r ficsf*'• P�O `d7: �k:'�"'h=.
- «.• -
..c: c,8
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°'-S Y.�T.�,'�"1;"�'."�'
-
• :i3= ,NS�c:-+�'-'
�tG$s��:=�..t•_a. �K1,�j�7���y«:,�`'::''`��-'-'�
-
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'�7
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3y,4,�.�'v" ."a••im-
«af.�-....-....�.s��,'S ^ �: �» .,...a...'�t:.uca� �''•
Aetna
fA 4
4-2t1-
.�.�-
b S
- i
�"D
Always Dare/ Florida Dental Benefits
lib
“ ' -
17 c
1-76-
Assurant Employee Benefits (Union Security Insurance Co.)'4'6
0
Delta Dental Insurance Co_
'Lifer
NS
WO
.--.06`
9Fot
Dearborn
p�l�9
.c
t`
Si.
Humana, Inc. (CompBenefits Co-) • -
9 0�
��
MetIife (SafeGuard Health Plans, Inc.
• 6S'
86
RI
v,.s.
Solstice Benefits,. Inc_
=r
PO
93
i-
• 3
HUMANA.
Dental Plan Highlights
Dental PPO
Matched current benefits as closely as possible, with the following enhancements:
• Largest DPPO network of dentists in South Florida and across the state
• 2 additional regular cleanings allowed per calendar year, for a total of 4
• All covered employees and family members can now get 2 sets of bitewing X-rays per calendar
year
• Members who reach their calendar year maximumcan have additional services covered at 30%
coinsurance
• No waiting period for initial enrollment or new hires
Dental HMO
Benefits are comparable to current. Some enhancements include:
• Largest DHMO network of dentists in South Florida and across the state
• Referrals from general dentists to see specialists are no longer required
• Material and laboratory fees are capped at $200 per crown
• No waiting period for initial enrollment or new hires
To Find a Network Provider
• Go to www.humanadental.com
• Click on "Find a Dentist"
• Under Search by "Coverage & Network", select either DHMO or DPPO and enter your zip code
• . Select Your Network, either HS205 DHMO/Prepaid Network or PPO/Traditional Preferred
• Search by address or by state and county
• Search by dentist specialty or by dentist name
• You can also call Humana's Customer Service at (800) 342-5209 for DHMO or (800) 233-4013 for
DPPO for assistance in finding a dentist
To Refer a Dentist
If your dentist is not in Humana's network:
• Go to www.humanadental:com
• Under Tools & Resources, select "Refer a dentist"
• Fill out the requested information and submit
• Humana will contact your dentist and invite him/her to join
2012 HUMANA DENTAL RATES
IN -Weekly
EXECUTIVE DPPO RATES
CURRENT HUMANA
RATES RATES
Employee Only
Family
$18.36 $15.87
$56.11 $48.51
VOLUNTARY NON -EXECUTIVES DPPO
CURRENT HUMANA
RATES RATES
Employee Only $14.10 $12.19
Employee + Spouse $29.04 $25.10
Employee + Child(ren) $28.78 $24.88
Family $51.34 $44.39
VOLUNTARY NON -EXECUTIVES DHMO
Employee Only
CURRENT HUMANA
RATES RATES
$5.62 $5.62
Family $14.09 $14.09