da.ks.govda.ks.gov/purch/...02-10-16.15.04.430exhibit_1_technical_proposal.… · web...

Exhibit 1 – Technical ProposalBid Event # EVT0004907

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SECTION IRegistration, Event Notice and Acknowledgement of Addenda

The Event Document as posted on the Division of Purchases web site and the acknowledgement of addenda posted for the bid event must be submitted as part of Section I of the Technical proposal.

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

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

To bid on events, registered bidders must be invited in SMART by the Procurement Officer BEFORE the bid closes. If invited, registered bidders will be able to receive bid event documents via e-mail. If not invited by the Procurement Officer, registered bidders will still receive notification of bid events based on their category

code registration.

Registration may be accomplished by:

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

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

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

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

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

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

mailto:[email protected]

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

mailto:[email protected]

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

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


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SIGNATURE SHEET

Item: Voluntary Insurance Plans Closing Date: 2:00 PM Central Time, March 16, 2017Agency: Kansas State Employees Health Care Commission

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

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

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

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

Legal Name of Person, Firm or Corporation

Mailing Address City & State Zip

Toll Free Telephone Local Cell: Fax

Tax Number E-Mail

Signature Date

Typed Name Title

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

Bidding Process Contact Name



E-Mail

Back-up Contact Name



E-Mail

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



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E-Mail

Vendor Contact Information

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

Primary Contact: ____________________________________________

Title: ______________________________________________________

Address: ___________________________________________________

___________________________________________________

Phone Number: ________________ Fax Number: _________________

Email Address: ______________________________________________

Alternate Contact: ___________________________________________

Title: ______________________________________________________

Address: ___________________________________________________ ___________________________________________________

Phone Number: ________________ Fax Number: _________________

Email Address: ______________________________________________


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TAX CLEARANCE

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

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

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

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

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


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

VENDOR

Contact Person for Tax Issues:

Company Name: Tax Number:

Mailing Address

City & State Zip Code


E-Mail

SUBCONTRACTOR(S)

Contact Person for Tax Issues:

Company Name: Tax Number:

Mailing Address

City & State Zip Code


E-Mail

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


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CERTIFICATION REGARDINGIMMIGRATION REFORM & CONTROL

All Contractors are expected to comply with the Immigration and Reform Control Act of 1986 (IRCA), as may be amended from time to time. This Act, with certain limitations, requires the verification of the employment status of all individuals who were hired on or after November 6, 1986, by the Contractor as well as any subcontractor or sub-subcontractor. The usual method of verification is through the Employment Verification (I-9) Form. With the submission of this bid, the Contractor hereby certifies without exception that Contractor has complied with all federal and state laws relating to immigration and reform. Any misrepresentation in this regard or any employment of persons not authorized to work in the United States constitutes a material breach and, at the State’s option, may subject the contract to termination and any applicable damages.

Contractor certifies that, should it be awarded a contract by the State, Contractor will comply with all applicable federal and state laws, standards, orders and regulations affecting a person’s participation and eligibility in any program or activity undertaken by the Contractor pursuant to this contract. Contractor further certifies that it will remain in compliance throughout the term of the contract.

At the State’s request, Contractor is expected to produce to the State any documentation or other such evidence to verify Contractor’s compliance with any provision, duty, certification, or the like under the contract.

Contractor agrees to include this Certification in contracts between itself and any subcontractors in connection with the services performed under this contract.

____________________________________________ ______________________Signature, Title of Contractor Date


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Section IIVendor Qualifications

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

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

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

Answer:2.01.2 Is your organization part of a national or regional organization? If yes, provide the corporation’s name and

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

Answer:2.01.3 List each subcontractor and/or sister corporation performing work on this contract. Include detail on type of

service the subcontractor will provide and the number of years your firm has utilized this subcontractor, and the location where the work will be done. Disclose any services under this RFP or your operations that are related to this RFP that are to be provided by workers outside of the United States.

Answer:2.01.4 Provide the name, phone number, email address and professional biography of the individuals that will be

assigned responsibility to manage or service for each of these functions for the SEHP*:

Implementation Coordinator Account Executive Account Management Eligibility Coordinator Customer Service

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

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

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

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

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

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

Title/level with problem resolution authority Problem resolution process including escalation processes Location of the office that would service this account Standard office hours


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How is account service satisfaction monitored?

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

Account Management Customer Service Claims Staff Eligibility Staff

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

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

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

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

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

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

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

your staff or outsourced. If outsourced, list who the provider of service is for each: Customer Service Claims Processing and EOB generation Certificate of Insurance production and mailing

Answer:

2.02 Experience and References2.02.1 Provide statistics regarding your Group Accident Insurance, Hospital Confinement, Cancer and Critical Illness benefits

for your entire book of business - further split as requested in the grid, below.Total Number of Employer Groups

Total Number of Enrolled Members

Total Number of Enrolled Members in Kansas

Total Number of Public Sector Groups

Total Number of Enrolled Public Sector Members

Number of Clients with 25,000+ Eligible Members

2016Group Accident InsuranceHospital ConfinementCancerCritical Illness

2017Group Accident Insurance


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Hospital ConfinementCancerCritical Illness

2.02.2 How many public sector groups did your firm service in 2016?Answer: Types of Public Sector Groups: # of Groups

Local Government Entity - Please describe each typeState GovernmentPublic UniversitiesPublic School DistrictsOther – Please describe

2.02.3 Provide your organization’s 2016 year-end membership for each of the following coverages.

Answer: 2016 Year End MembershipGroup Accident InsuranceHospital ConfinementCancerCritical Illness

2.02.4 What percentage of your 2016 total group membership renewed for the 2017 plan year?

Answer: 2017 Total Group Member Percentage Renewed

Group Accident InsuranceHospital ConfinementCancerCritical Illness

2.02.5 Provide references from three current and three former clients (within last 4 years) to whom you provided services similar to those proposed in this RFP. Public sector clients with over 25,000 covered lives are preferred. Also preferred would be former clients who have worked with the person to be assigned to this account as well as a history of providing Group Accident Insurance, Hospital Confinement, Cancer and Critical Illness benefits to public sector plans of similar size. Information should include:

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

Answer:

ACKNOWLEDGE AND ACCEPT

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

_________________________________________________Authorized Signature of Vendor


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_________________________________________________Printed Name of Signatory

_________________________________________________ Title

_________________________________________________Date


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

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

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

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

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

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


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DA – 146aState of Kansas Department of Administration DA-146a (Rev. 06-12)

CONTRACTUAL PROVISIONS ATTACHMENT

Important: This form contains mandatory contract provisions and must be attached to or incorporated in all copies of any contractual agreement. If it is attached to the vendor/contractor's standard contract form, then that form must be altered to contain the following provision: "The Provisions found in Contractual Provisions Attachment (Form DA-146a, Rev. 06-12), which is attached hereto, are hereby incorporated in this contract and made a part thereof."

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

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

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

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

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

5. Anti-Discrimination Clause: The contractor agrees: (a) to comply with the Kansas Act Against Discrimination (K.S.A. 44-1001 et seq.) and the Kansas Age Discrimination in Employment Act (K.S.A. 44-1111 et seq.) and the applicable provisions of the Americans With Disabilities Act (42 U.S.C. 12101 et seq.) (ADA) and to not discriminate against any person because of race, religion, color, sex, disability, national origin or ancestry, or age in the admission or access to, or treatment or employment in, its programs or activities; (b) to include in all solicitations or advertisements for employees, the phrase "equal opportunity employer"; (c) to comply with the reporting requirements set out at K.S.A. 44-1031 and K.S.A. 44-1116; (d) to include those provisions in every subcontract or purchase order so that they are binding upon such subcontractor or vendor; (e) that a failure to comply with the reporting requirements of (c) above or if the contractor is found guilty of any violation of such acts by the Kansas Human Rights Commission, such violation shall constitute a breach of contract and the contract may be cancelled, terminated or suspended, in whole or in part, by the contracting state agency or the Kansas Department of Administration; (f) if it is determined that the contractor has violated applicable provisions of ADA, such violation shall constitute a breach of contract and the contract may be cancelled, terminated or suspended, in whole or in part, by the contracting state agency or the Kansas Department of Administration. Contractor agrees to comply with all applicable state and federal anti-discrimination laws. The provisions of this paragraph number 5 (with the exception of those provisions relating to the ADA) are not applicable to a contractor who employs fewer than four employees during the term of such contract or whose contracts with the contracting State agency cumulatively total $5,000 or less during the fiscal year of such agency.


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

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

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

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

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

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

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

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


I have reviewed the DA146a and acknowledge that the document shall become part of the final contract. I hereby acknowledge and accept all of the provisions, requirements, and conditions stated in this document.

_________________________________________________


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Authorized Signature of Contractor


_________________________________________________Title

_________________________________________________Date


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Contract

CONTRACT TO PROVIDE A FULLY INSURED (specify type of benefit) BENEFITS PLANFOR THE KANSAS STATE EMPLOYEE HEALTH PLAN

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

WHEREAS, the HCC desires to contract with a contractor who can provide (specify type of benefit / insurance) for the Kansas State Employee Health Plan (hereinafter referred to as “SEHP”);

WHEREAS, the HCC caused to have promulgated Kansas Request for Proposal #EVT__________ for the purpose of receiving responsible and responsive bids from bidders with knowledge, experience and expertise in providing (specify type of benefit / insurance);

WHEREAS, the Contractor was selected as the successful bidder for Kansas Request for Proposal #EVT___________; and,

WHEREAS, it has been determined that it would be in the best interest of the HCC to enter into a contract with Contractor to provide (specify type of benefit / insurance) services to the SEHP;

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

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

a. Contractor’s Response to Request for Proposal #_______ including any addenda to the Request for Proposal (hereinafter referred to as “RFP”);

b. Contractor’s technical proposal; and, c. Contractor’s Response to RFP involving pricing, as set forth in Exhibit A, and submitted to the HCC in response to

the RFP.

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

3. Contract Documents:

a. This Contract consists of the following documents, incorporated herein by reference and precedence:1. The DA146a;2. The Business Associate Agreement;3. The terms stated in this Contract;4. The Addenda to the RFP, if any;5. The RFP, which includes all Exhibits and Attachments, if any; and,6. The Contractor’s Technical and Cost Proposal(s), including clarifications.

b. In the event of a conflict between or among the terms of the Contract Documents, the term in the Contract Document with the highest precedence according to the list noted in a. above will prevail. For example, the DA146a will have the highest precedence.

c. The documents identified in Section 3.a. above constitute the entire agreement between the parties and supersede all prior oral or written statements or agreements made by the parties concerning this Contract.

4. Acceptance of Contract Documents and Performance Standards: The Contract documents identified in Section 3 memorialize the expectations of the HCC as to the Contractor’s performance under this Contract. The Contractor, by presenting a bid to the RFP, accepting the award of the Contract, and signing this Contract, accepts and agrees to the terms, conditions, deliverables, deliverable options (if any), performance standards, and other requirements specified by the Contract documents identified in Section 3.


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5. Plan Requirements: As outlined within the RFP and Contract documents.

6. Deliverables: As outlined within the RFP and Contract documents.

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

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

9. Advertising: The Contractor will not use the award of this Contract as part of any news release, commercial advertising or Contractor-sponsored social media without the HCC’s prior written permission.

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

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

12. Copyrights and Ownership of Deliverables: All deliverable items produced pursuant to this Contract that are produced solely and exclusively for the HCC are the exclusive property of the HCC. The Contractor will not assert a claim of copyright or other property interest in such deliverables. Should there be a claim of infringement of copyright or patent presented as a result of or incidental to the Contractor’s performance or actions under this Contract, the Contractor shall indemnify the HCC against any and all such claims.

13. Termination Right:

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

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

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

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


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

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

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

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

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

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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

Contractor:(Name of Contractor) ______________________


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(Address of Contractor) ___________________________ ___________________________

32. Employment of Counsel and Resolution of Litigation and Legal Fees:

a. In the event of litigation involving the services under this Contract (hereinafter referred to as “Litigation”) the HCC and Contractor each:

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

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

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

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

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

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

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

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

33. Disputes : Should any dispute arise with respect to this Agreement, upon notice by either party, both agree to act immediately to resolve such dispute. The Parties agree that the existence of a dispute notwithstanding, the Parties shall continue, without delay, to carry out all of their responsibilities under the Agreement on all non-disputed work.

34. Compliance with State and Federal Laws: Contractor shall comply with all applicable state and federal laws and regulations including, but not limited to, the State of Kansas insurance laws and regulations.

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

36. Successor to Contractor: This Contract shall be binding on any person or entity that is a successor to or a purchaser of Contractor during the term of this Contract.

37. Signatures: Signatures herein shall serve to bind the parties to this Contract. The parties represent and warrant that they have read and thoroughly understand the terms and conditions and they are represented by counsel and the terms and conditions of the RFP and Contract have been fully explained to them by counsel.

SIGNATURES OF PARTIES ON NEXT PAGE


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SIGNATURE PAGE FOR CONTRACT TO PROVIDE A FULLY INSURED (specify type of benefit) BENEFITS PLAN FOR THE KANSAS STATE EMPLOYEE HEALTH PLAN

CONTRACTOR - (Name of Contractor)

By: ____________________________ (Date)______________________

(Printed Name)

(Title)____________________________

KANSAS STATE EMPLOYEES HEALTH CARE COMMISSION

By: ____________________________ (Date)______________________

(Printed Name)

(Title)____________________________

ACKNOWLEDGE AND ACCEPTI have reviewed the Sample Contract and acknowledge that the document shall become part of the final contract. I hereby acknowledge and accept all of the provisions, requirements, and conditions stated in this section of RFP, subject to the modifications, conditions and limitations I have made in redline format above.


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_________________________________________________ Title

_________________________________________________Date


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Business Associate Agreement

BUSINESS ASSOCIATE AGREEMENT

THIS AGREEMENT is made and entered into by and between the Kansas Department of Health and Environment (hereinafter referred to as “KDHE”) and _________________________ (hereinafter referred to as “Business Associate”).

Notwithstanding Section V of this Business Associate Agreement (hereinafter referred to as “BAA”), the term of this BAA shall run concurrently with the Underlying Contract between the parties and shall have the same effective date and termination date as the Underlying Agreement.

RECITALS

The Parties to this BAA have a relationship whereby KDHE may provide the Business Associate access to Protected Health Information (hereinafter referred to as “PHI”), which may include electronic Protected Health Information, that Business Associate will use to fulfill its contractual obligations to KDHE.

KDHE and Business Associate acknowledge that each party has certain obligations under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), as amended, including those provisions of the American Recovery and Reinvestment Act of 2009 (“ARRA”), specifically the Health Information Technology for Economic and Clinical Health Act (“HITECH”), and the statutes implementing regulations to maintain the privacy and security of PHI, and the parties intend this BAA to satisfy those obligations including, without limitation, the requirements of 45 CFR 164.504(e).

KDHE, with its three divisions, self-identifies as a Hybrid Entity under HIPAA with the Division of Health Care Finance containing Covered Entity functions. Therefore, a Business Associate would not permitted to use or disclose health information in ways that KDHE could not. This protection continues as long as the data is in the hands of Business Associate. Business Associate acknowledges that for the purposes of this BAA, Business Associate is a “business associate” as that term is defined in 45 CFR § 160.103, and therefore the requirements of HIPAA apply to Business Associate in the same manner that they apply to KDHE pursuant to 42 USC § 17931(a).

NOW THEREFORE, in consideration of the mutual promises below and other good and valuable consideration the parties agree as follows:

I. DEFINITIONS

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

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

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

d) “Designated Record Set” shall mean a group of records maintained by or for KDHE that consists of the following: (a) medical records and billing records about Individuals maintained by or for a health care provider; (b) enrollment, payment, claims adjudication, and case or medical management record systems maintained by or for a health plan; or (c) records used in whole or in part, by or for KDHE to make decisions about Individuals. For these purposes, the term “record” means any item, collection, or group of information that includes PHI and is maintained, collected, used, or disseminated by or for KDHE.


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

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

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

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

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

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

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

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

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

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

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

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

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

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

II. OBLIGATIONS AND ACTIVITIES OF BUSINESS ASSOCIATE

a) Use and Disclosure . Business Associate agrees to not use or disclose PHI other than as permitted or required by this BAA or as Required by Law.

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


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

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

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

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

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

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

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

j) Reporting Disclosures to KDHE . In addition to the duty to mitigate under Section II(c), Business Associate agrees to report to KDHE any use or disclosure of the PHI not provided for by this BAA or the Privacy Rule of which it or its officers, employees, agents or subcontractors become aware, including any Security Incident of which it becomes aware, as soon as practicable but no longer than three (3) business days after the discovery of such disclosure. Notice to KDHE shall consist of notifying the KDHE Privacy Officer by phone or email of the occurrence of an unauthorized use, disclosure or security incident.

k) Notification of Breach . Business Associate shall notify Covered Entity within three (3) business days after it, or any of its employees, subcontractors, or agents, reasonably suspects that a breach of unsecured PHI as defined by 45 CFR 164.402 may have occurred, irrespective of any occurrence or non-occurrence of harm. Notice to KDHE shall consist of notifying the KDHE Privacy Officer by phone or email of the occurrence of a Breach or suspected occurrence of a Breach. Business Associate shall exercise reasonable diligence to become aware of whether a breach of unsecured PHI may have occurred and, except as stated to the contrary in this Section, shall otherwise comply with 45 CFR 164.410 in making the required notification to Covered Entity. Business Associate shall cooperate with Covered Entity in the determination as to whether a breach of unsecured PHI has occurred and whether notification to affected individuals of the breach of unsecured PHI is required by 45 CFR 164.400 et seq., including continuously providing the Covered Entity with additional information related to the suspected breach as it becomes available. In the event that Covered Entity informs Business Associate that (i) Covered Entity has determined that the affected individuals must be notified because a breach of unsecured PHI has occurred and (ii) Business Associate is in the best position to notify the affected individuals of such breach, Business Associate shall immediately provide the required notice (1) within the time frame defined by 45 CFR 164.404(b), (2) in a form and


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containing such information reasonably requested by Covered Entity, (3) containing the content specified in 45 CFR 164.404(c), and (4) using the method(s) prescribed by 45 CFR 164.404(d). In addition, in the event that Covered Entity indicates to Business Associate that Covered Entity will make the required notification, Business Associate shall promptly take all other actions reasonably requested by Covered Entity related to the obligation to provide a notification of a breach of unsecured PHI under 45 CFR 164.400 et seq. Business Associate shall indemnify and hold Covered Entity harmless from all liability, costs, expenses, claims or other damages that Covered Entity, its related corporations, or any of its or their directors, officers, agents, or employees, may sustain as a result of a Business Associate’s breach, or Business Associate’s subcontractor or agent’s breach, of its obligations under this Agreement.

III. PERMITTED USES AND DISCLOSURES BY BUSINESS ASSOCIATE

a) General Use and Disclosure Provisions . Except as otherwise limited in this Agreement, Business Associate may use or disclose PHI on behalf of, or to provide services to, Covered Entity for the purposes set forth in III(b), if such use or disclosure of PHI would not violate the Privacy Rule if done by Covered Entity.

b) Specific Use and Disclosure Provisions .

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

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

Business Associate may disclose PHI in its possession for the proper management and administration of Business Associate, provided that disclosures are Required By Law.

Business Associate may only de-identify PHI in its possession obtained from Covered Entity with Covered Entity’s prior written consent, in accordance with all de-identification requirements of the Privacy Rule.

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

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

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

IV. OBLIGATIONS OF COVERED ENTITY

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

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


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

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

V. TERMINATION

a) Term. The term of this Agreement shall run concurrently with the Underlying Contract with Covered Entity and shall terminate upon termination of the Underlying Contract and when all of the PHI provided by Covered Entity to Business Associate, or created or received by Business Associate on behalf of Covered Entity, is destroyed or returned to Covered Entity, or, if it is infeasible to return or destroy the PHI, protections are extended to such information, in accordance with the termination provisions of Section (V)(c)(2).

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

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

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

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

c) Effect of Termination.

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

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

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

VI. MISCELLANEOUS

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


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

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

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

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

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

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

Business Associate:

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

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

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

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

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

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

In the event that a federal or state law, statute, regulation, regulatory interpretation or court/agency determination materially affects this Agreement, as is solely determined by Covered Entity, the parties agree to negotiate in good faith any necessary or appropriate revisions to this Agreement. If the parties are unable to reach an agreement concerning such revisions within the earlier of sixty (60) days after the date of notice seeking negotiations or the effective date of the change in law or regulation, or if the change in law or regulation is effective immediately, the Covered Entity, in its sole discretion, may unilaterally amend this Agreement to comply with the change in law upon written notice to Business Associate.

VII. OBLIGATIONS OF BUSINESS ASSOCIATE PURSUANT TO HITECH

a) Access to PHI in an Electronic Format . If Business Associate uses or maintains PHI in an Electronic Health Record, Business Associate must provide access to such information in an electronic format if so requested by an Individual. Any fee that Business Associate may charge for such electronic copy shall not be greater than Business Associate’s labor costs


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in responding to the request. If an Individual makes a direct request to Business Associate for access to a copy of PHI, Business Associate will promptly inform the Covered Entity in writing of such request.

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

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

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

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

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

VIII. ADDITIONAL OBLIGATIONS OF BUSINESS ASSOCIATE

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

IX. ENFORCEMENT

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

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

On behalf of:

KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT

By: _______________________________________ Date: ________________________ Susan Mosier, MD Secretary, KDHE

BUSINESS ASSOCIATE - (Name of Contractor)

By: _______________________________ Date: ______________________

(Printed Name)____________________

(Title)____________________________


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I have reviewed the Sample BAA and acknowledge that the document shall become part of the final contract. I hereby acknowledge and accept all of the provisions, requirements, and conditions stated in this section of RFP, subject to the modifications, conditions and limitations I have made in redline format above.



_________________________________________________ Title

_________________________________________________


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Section IVPurpose of Project, Background and Scope of Work

PURPOSE OF PROJECT

This RFP will open negotiations with vendors to offer the following voluntary benefits – Group Accident Insurance, Hospital Confinement, Critical Illness and cancer insurance is optional if covered under the critical illness plan for state employees. Voluntary health plan offerings will be paid entirely by the employees. The SEHP is looking to partner with one vendor to offer all of the voluntary plans. The SEHP we only accept proposals directly from the carrier. Third-party broker/consultants representing the carrier will not be considered and will be disqualified.

This RFP is seeking a contract with the State of Kansas for a three year contact to offer voluntary health benefits with the option of renewal if mutually agreed upon by the parties. Multiple year rate guarantees or fee caps are preferred. Such guarantees or caps should be clearly outlined in your proposal. The SEHP is requesting a minimum 3-year guarantee. Longer fee guarantee periods would be preferred.

The SEHP is seeking to partner with a vendor who demonstrate flexibility, knowledge and plan offerings that will supplement the current SEHP offerings. Because the SEHP is a large public employer group, with multiple agencies and payroll systems, the selected Vendor must demonstrate flexibility and ability to administer plan offerings with little to no involvement of SEHP staff.

Voluntary plan offerings cannot duplicate any plan offering currently available to SEHP members through the State of Kansas (Medical, Dental, Prescription Drug, Vision, LTC, LTD, Life). All plan offerings must be available to all active state employees. The State currently has approximately 48,000 full or part time employees. Medical underwriting is allowed where appropriate. All pricing for voluntary insurance offerings should be included in the Cost Proposal Exhibit 2B. As a reminder the SEHP does not pay agent commissions or finders fees on the products it procures.

BACKGROUND

The Kansas State Employees Health Care Commission (HCC) provides for the purchase and administration of a comprehensive health benefit program for State of Kansas employees and retirees who have elected to participate in the State Employee Health Plan (SEHP).

Voluntary plans were offered for the first time to all active State employees by the Health Care Commission (HCC) in 2016 under a one year agreement through a purchasing coalition. Enrolled members will have the right to maintain their current policies with the current vendor and will not be required to transition to the vendor selected through this RFP. There are approximately 48,000 state employees (full and part time) who could be offered the voluntary plan offerings. This number includes employees who are not currently considered benefits eligible for the medical program but could elect a voluntary plan. Voluntary plans have been and are currently offered at some of the State universities and possibly some state agencies under arrangements that are outside of the HCC and SEHP control. We have no information about these plans or the arrangements under which they are offered.

The selected vendor will be expected to work in partnership with the other health plan vendors chosen by the HCC. All SEHP Vendors are deemed partners and are expected to respect the other plan offerings and to provide accurate benefit information about the SEHP health plan to enhance member understanding. As part of this process, the selected voluntary vendor will need to be educated on the SEHP health plans and be able to provide members with accurate unbiased education on their SEHP benefits and not just on the voluntary plans. Disparaging other SEHP vendors or other SEHP plan offers will not be tolerated.

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

Waiting Periods: A thirty (30) day waiting period for the SEHP became effective August 1, 2010, for newly hired employees.

Plan Year: The Plan Year is the calendar year.

Contributions: For active State of Kansas employees, payroll deductions are taken semimonthly.

Open Enrollment: Open enrollment for active employees is conducted October 1 through October 31 each year and consists of a series of statewide employee meetings conducted by SEHP staff, agency personnel officers and representatives from the Vendors

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providing services, and other contracting parties. Enrollment elections are made online in the Membership Administrative Portal (MAP). In addition, webinars are offered for those SEHP members who cannot attend a meeting.

Services Requirements: In this section the SEHP is outlining the services being requested in this RFP. You do not need to accept each item. You do need to highlight in Redline any item or service which you will not be able to provide and exceptions to the requested services.

4.1 General Requirements4.1.01 Vendor shall be responsible for insuring and/or administering all approved voluntary health plan offerings in

accordance with all applicable state and federal laws.

4.1.02 Vendor will provide all administrative services necessary for the plan offerings.4.1.03 Vendor shall be responsible for compliance with the privacy and security provisions of the Health Insurance

Portability and Accountability Act (HIPAA) and shall comply with other HIPAA provisions and regulations applicable to the SEHP, including all terms of the applicable Business Associate Agreement (hereinafter referred to as the “BAA”), as well as applicable terms of the Financial Services Modernization Act of 1999, the HITECH Act of 2009, and any other federal or State law pertaining to the protection of personally identifiable information. The Vendor shall accept full responsibility for providing adequate supervision and training its agents and employees to ensure compliance with the Act.

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

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

4.1.06 Vendor must comply with encryption standards specified in applicable state and Federal policy and law, including State of Kansas ITEC, HIPAA, HITECH, FISMA, NIST, and FIPS standards for the storage and transmission of confidential or restricted data. http://oits.ks.gov/kito/itec/itec-policies

4.1.07 Vendor agrees that quoted premium rates will remain valid for at least the first 36-month period of the contract.

4.1.08 Vendor confirms there will be no minimum participation requirement.

4.1.09 Benefits under any voluntary plan offering must be available on a statewide basis. Preference is for a nationwide offering.

4.1.10Complete administrative and support services for the SEHP including:Printing and mailing

Certificates of coverage must be provided to all enrolled members within 30 days of enrollment. All costs must be included in the premium rates and are not billable to the SEHP.

During the course of this contract, if the Vendor’s name is changed for any reason or if other relevant information changes, is incomplete or contains errors, the Vendor must issue revised certificates of coverage to all members at the Vendor’s expense.

Other required notices

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

4.1.12 Act in an advisory capacity to the Employee Advisory Committee upon request.

4.1.13 Design communication materials, as mutually agreed by the parties, to inform and educate plan participants. Prepare and file regulatory documentation necessary to fulfill reporting and disclosure requirements.

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4.1.14 Vendor must have a minimum of five years continuous experience providing services comparable in scope and complexity to those specified in this RFP.

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

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

4.1.17 Vendor shall warrant that all persons assigned by it to the performance of this contract shall be employees of the Vendor (or specified Subcontractor) and shall be fully qualified to perform the work required. Contractor shall include a similar provision in any contract with any Subcontractor selected to perform work under this contract.

4.1.18 Contractor shall commit to providing, during the length of the contract, written notice to the SEHP in advance of any major computer system conversion or other technology changes that may affect the delivery of services to the SEHP. This does not apply to any program fixes, modifications and enhancements.

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

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

4.1.21 In the event that the SEHP terminates this contract and moves to another vendor, the vendor is expected to cooperate in the transition process.

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

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

4.2.02 The Account Executive or a designated back up will respond to all SEHP inquiries within one business day.

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

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

4.2.05Each Vendor shall, at no cost to the SEHP, have a representative available to attend planning meetings, Health Care Commission meetings, Employee Advisory Committee meetings or other meetings as requested through and approved by the SEHP.

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

4.2.07 Vendors will establish and maintain secure communication protocols to facilitate program operations with SEHP.

4.2.08 Vendor will work with SEHP to develop meaningful reports, making modifications to report structures and contents as necessary to meet the needs of SEHP.

4.2.09 No reports regarding this program may be published without the express written consent of the SEHP and the HCC.


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

include promptness, courtesy and accuracy of responses. Customer service representatives (CSRs) should be able to handle questions and concerns regarding claim submission, benefit design, etc. Customer service should be able to troubleshoot any system issues and make appropriate referrals to others within the company to resolve any member issues. CSRs should be willing to initiate call-backs to customers when appropriate. Customer services needs to take ownership of Vendor’s decisions and respond to members’ concerns. Customer service is not to refer members to the SEHP or agency human resources offices to resolve issues.

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

4.3.03 Customer service will need to be staffed and ready to take calls one month prior to the start of the contract benefit year. Such staffing and all operational costs associated with operating the customer service center is the responsibility of the Vendor.

4.3.04 If the Vendor elects to close due to inclement weather, natural disaster, other business reason, or phone lines are unavailable, the Vendor will notify the Senior Manager of Health Plan Operations in a timely manner and provide the reason for the closure or disruption and estimated time to restore service or function.

4.3.05 Provide Open Enrollment Support and staffing during September and October, for Personnel Officer Training (6-10 different sessions) and for every Open Enrollment meeting. OE meetings are held each year, during the last two full week of September through the third week of October.

4.3.06 If requested by the member, the vendor shall provide education on the SEHP benefits. Vendor shall represent the benefits in a true and fair manner and shall not disparage the benefit offerings of the SEHP. Vendor employees engage in meeting with and advising SEHP members shall comply with relevant Kansas licensing requirements and have adequate Error and Omission coverage enforce.

4.3.07 Certificates of Insurance and other governing documents must be maintained online. Certificates for each plan must be made available to eligible participants of the SEHP upon request, regardless of enrollment status. Vendor may provide electronic copies of the benefit description to members as long as members have the option to receive a paper document if requested.

4.3.08 Vendor shall not use names, home addresses, or any other information obtained about participants of this plan for the purpose of offering for sale any property or services which are not directly related to services negotiated in this RFP without the express written consent of the SEHP.

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

4.4 Claim Administration4.4.01 Vendor shall have procedures for submission and payment of claims. Vendor shall, at its own expense, provide paper

claim forms to members when necessary. Paper claim forms will meet all national standards.

4.4.02 Vendor is responsible for the processing and administration of all claims incurred while the coverage is in effect. Vendor shall compute and verify the amount of benefits available for claims payment.

4.4.03 Make payment of approved claims or amounts due, as appropriate.

4.5 Billing Invoices and Payment4.5.01 Vendor agrees to submit electronic invoices for member premiums on the Vendor’s letterhead to the parties

designated by the SEHP. Invoices should contain the name and contact information to whom the SEHP can ask


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questions regarding the bill and detail regarding the membership for which SEHP is being billed. A detailed report of membership may be required to support the invoice.

Bills and any supporting documents should be sent in electronic format to the designated SEHP staff.4.5.04 The SEHP does not pay finder’s fees, agent commissions, service fees, or other fee arrangements to any person or

organization.

4.6 Eligibility4.6.01 Vendor agrees to exchange data with SEHP using SEHP’s secure FTPP server (passive mode FTP/SSL, RFC 4217).

Vendor shall pick up eligibility files from the SEHP’s FTP site. Details available on request. The Vendor shall work quickly and efficiently to resolve all eligibility issues with the SEHP staff. The Vendor must acknowledge via phone call, each eligibility issue within one business.

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

4.6.03 The Vendor must be able to retrieve the change only eligibility files from the SEHP secure FTP site daily. Files will be placed on the FTPP site by 10:00 AM Central Time daily unless Vendor is otherwise notified of a schedule change. Vendor must notify SEHP administrative staff within twenty-four (24) hours if information on the file received is incomplete or unreadable. Vendor will provide eligibility load reports to the SEHP Membership staff in a timely manner.

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

4.7 Reporting4.7.01 Vendor shall provide SEHP such aggregate data as needed to respond to requests from the SEHP or required for

research or legal reasons.

4.8 Right to Audit: As a public entity, the SEHP is subject to legislative requested audits in addition to the standard fiduciary audits done by the Plan. As noted in the DA- 146a No provision of this contract shall be construed as limiting the Legislative Division of Post Audit from having access to information pursuant to K.S.A. 46-1101 et seq. Therefore, limitations on the Plans right to audit will not be accepted.4.8.01 Vendor must agree to allow the SEHP or legislative auditors the right to audit all programs and any other information

relevant to this account. Vendor agrees to reasonably cooperate in having any such audit conducted and to provide all data necessary for the audit.

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

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


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

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

4.9 Website4.9.01 Vendor must provide to the SEHP an integrated website that allows for secure sign-on to all aspects of the Vendors

services (benefits, claims submission and tracking, customer service, etc.)

4.9.02 The website structure, pages and content shall be available one month prior to the start of the enrollment period for review and usability testing. In the event of downtime, a notice should be posted on the website to notify users.

4.9.03Vendor shall provide plan information that the member can access as needed, as well as claim payment information.

4.9.04Website shall be ADA compliant with 508 and WC3 standards.


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



_________________________________________________ Title

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SECTION VQuestions

Please do not repeat your answers. If you have described a program/service or other content and it applies to multiple questions, simply refer us to the prior description.

5.1 Implementation and Transition 5.1.01 Provide a proposed implementation plan that includes both a project overview and details on specific tasks,

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

Testing of eligibility files and eligibility logic Date to begin receiving eligibility files Process for pass-through of payroll deductions Plan documents/certificates of coverage Develop Open Enrollment materials for approval by the SEHP

Answer:5.1.02 If the implementation coordinator and on-going account manager will be two different people, describe how they

work together during the initial implementation process and the procedures for transfer of responsibility. Also, how long will the implementation coordinator be involved with the SEHP account after the implementation is complete.

Answer:5.1.03 Confirm that, if selected as a finalist, the implementation coordinator and designated account management team

will be present for the Finalist Interview.Answer:5.1.04 Are you willing to provide a one-time implementation allowance to fund, as approved by SEHP, implementation

support, such as readiness assessments, communication plans, outside printing costs, etc., for all four voluntary benefit coverages? What dollar amount are you willing to provide?

Answer:5.1.05 Confirm that all SEHP members participating in a voluntary benefits plan will receive a certificate of coverage

within 30 days following enrollment.Answer:

5.2 Customer Service 5.2.01 Where will the customer service unit be located and what are the hours of operation?Answer:5.2.02 How is performance monitored?Answer:5.2.03 Describe how you will communicate to the members. Please attach sample communication materials you have

produced for your clients. Are customized communications available? Any fees associated with communication materials must be delineated in your cost proposal.

Answer:5.2.04 Do your rates include the full cost of communications, including the production and distribution of promotional

materials? If so, what type of communications will be provided (i.e. posters, fliers, Open Enrollment materials, etc.)?Answer:5.2.05 Confirm that SEHP will be able to review and approve all communication materials (including letters, brochures,

electronic, website, etc) prior to being sent to members.Answer:5.2.06 What are your normal customer service hours? The State requires minimum Customer Service access of 8:00am to

5:00pm Central Time, Monday through Friday. Will you be able to meet this minimum? Are expanded hours available, if so, what are they? If there would be additional fees for expanded customer service hours, delineate these fees in your cost proposal.

Answer:5.2.07 Do Customer Service representatives have online access to real-time claim processing information?Answer:5.2.08 What is the policy and procedure for ‘escalated’ calls – those referred to a supervisor or manager?Answer:


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5.2.09 What is the average time to answer the telephone? What is the average time a person waits in queue to speak to a representative?

Answer:5.2.10 Do you use an automated phone system? If yes, does the menu or options include talking to a ‘real person’ or

CSR? Is there an option to leave a message for a call back when a customer service representative is available?Answer:5.2.11 Confirm that TTD/Y services and multi-language communication phone line support is available for members.Answer:5.2.12 Describe your ability to provide to monitor customer service call. Is quality monitoring done on live calls? Recorded

calls? If recorded calls, is a sampling done on a weekly basis. Please describe your organization’s system capabilities for reviewing calls related to member complaints.

Answer:

5.3 Claims Administration If claims will be administered by more than one service provider for different lines of business, please specify and respond to these questions for all areas or lines of business. 5.3.01 Describe your company’s performance standards with respect to:

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

Please indicate your actual performance during the 2016 calendar year in attaining these standards.Answer:5.3.02 Submit a sample of your claim form(s) and benefit payment statement that would accompany an issued

check. Would you be willing to customize the information contained in these forms?Answer:5.3.03 Explain in detail the claim filing process required for each product. Specify any supporting documentation

required to accompany the claim form. If the answer differs by product – Group Accident Insurance, Hospital Confinement, Cancer, and Critical Illness – please specify.

Answer:5.3.04 Describe the claim adjudication process, from receipt of claim submission to claim payment. If the answer

differs by product – Group Accident Insurance, Hospital Confinement, Cancer, and Critical Illness – please specify.

Answer:

5.4 Eligibility/Membership Processing 5.4.01 Are you able to administer electronic eligibility transfers? Confirm your ability to pick up eligibility files from

the SEHP secure FTP site?Answer:5.4.02 Can your system process eligibility files with multiple transaction rows for one participant?Answer:5.4.03 Please list the eligible participants (e.g.: employees, spouses, dependent child(ren), etc.). If the answer

differs by product – Group Accident Insurance, Hospital Confinement, Cancer, and Critical Illness – please specify.

Answer:5.4.04 Is there an age limit for employees enrolling? If yes, indicate the age limit. If the answer differs by product –

Group Accident Insurance, Hospital Confinement, Cancer, and Critical Illness – please specify.Answer:5.4.05 If there is no age limit for employees enrolling, what is the age limit for dependents, including adult children?

If the answer differs by product – Group Accident Insurance, Hospital Confinement, Cancer, and Critical Illness – please specify.

Answer:5.4.06 Describe any linkage requirements (i.e. must the employee enroll for the spouse, parent, etc., to enroll)? If

the answer differs by product – Group Accident Insurance, Hospital Confinement, Cancer, and Critical Illness – please specify.

Answer:

5.5 Voluntary Insurance Offerings:


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Voluntary insurance offerings cannot duplicate any insurance plan offerings (Medical, Dental, Prescription Drug, Vision, LTC, LTD, Life) currently available to SEHP members from the State of Kansas.

5.5.01 Describe each of the voluntary health plan(s) requested in this RFP – Group Accident Insurance, Hospital Confinement, Critical Illness and Cancer. Identify who underwrites the plan(s) and if they are licensed in the State of Kansas.

Answer:5.5.02 Describe how you propose to market these products. Provide sample materials.Answer:5.5.03 Have your insurance products and marketing materials been approved for use by the Kansas Insurance

Department (KID)? Provide date approved by KID. Provide copies of each proposed insurance plan you offer.Answer:5.5.04 Describe the enrollment process. Is there a limited enrollment period or can member’s enroll at any time? Will

your company require an eligibility file from the SEHP? If so, will you agree to pick up the file from the SEHP FTP site?

Answer:5.5.05 For each of the plans you propose to offer to State employees, identify what happens if the member leaves

employment with the State. What is the process to transition to a direct bill arrangement?Answer:

5.6 Group Accident Insurance5.6.01 Are benefits written on your company’s paper, or offered through an arrangement with another carrier?Answer:5.6.02 Confirm that benefit plans will be offered on a group basis.Answer:5.6.03 Is coverage portable? If yes, is coverage portable at the same rates?Answer:5.6.04 Do you offer a waiver of premium provision? Please describe.

5.6.05 Please describe the procedures used to process applications and health statementsAnswer:5.6.06 What is the eligibility age range?Answer:5.6.07 What indemnity levels are available to employees? What indemnity levels are available to spouses?

Answer:5.6.08 Does your plan include benefit reduction or termination at a specified obtained age? If yes, provide details.

Answer:5.6.09 Describe any pre-existing condition exclusions in your policy.

Answer:5.6.10 Describe benefit limitations and/or parameters for condition/event recurrence, multiple conditions, etc.

Answer:5.6.11 Is coverage available to employees and spouses on a Guaranteed Issue (GI) basis? If yes, what are the

minimum/maximum GI amounts available?

Answer:5.6.12 Please describe any other underwriting variations. Are there any medical conditions that would result in

automatic rejection of coverage if underwriting is required? If yes, please explain.

Answer:5.6.13 Do you own and operate your enrollers and/or call center, or do you outsource these functions? If

outsourced, to whom do you typically outsource?

Answer:


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5.7 Hospital Confinement5.7.01 Are benefits written on your company’s paper, or offered through an arrangement with another carrier?Answer:5.7.02 Confirm that benefit plans will be offered on a group basis.Answer:5.7.03 Is coverage portable? If yes, is coverage portable at the same rates?Answer:5.7.04 Do you offer a waiver of premium provision? Please describe.











Answer:

5.8 Critical Illness5.8.01 Are benefits written on your company’s paper, or offered through an arrangement with another carrier?Answer:5.8.02 Confirm that benefit plans will be offered on a group basis.Answer:5.8.03 Is coverage portable? If yes, is coverage portable at the same rates?Answer:5.8.04 Do you offer a waiver of premium provision? Please describe.


Answer:


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5.8.08 Does your plan include benefit reduction or termination at a specified obtained age? If yes, provide details.









Answer:

5.9 Cancer5.9.01 Are benefits written on your company’s paper, or offered through an arrangement with another carrier?Answer:5.9.02 Confirm that benefit plans will be offered on a group basis.Answer:5.9.03 Is coverage portable? If yes, is coverage portable at the same rates?Answer:5.9.04 Do you offer a waiver of premium provision? Please describe.











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Answer:

5.10 Web Access 5.10.01 Describe in detail your internet capabilities and member portal:

Member inquiry capabilities Security/privacy issues Description of benefits Online claim submission and status

Answer:5.10.02 Has your website been tested for ADA compliance with 508 and W4C standards? If not, will your website be

compliant by 1/1/18?Answer:5.10.03 Do you have the capability and willingness to create a personalized web experience (content and

transactions), at no additional cost, for the State of Kansas?Answer:5.10.04 Can members send questions and inquiries to Customer Service via secure web or internet?Answer:5.10.05 Can members access online, their own and/or their covered dependents claim submission and benefit

payment histories? For what period of time are these histories available?Answer:

5.11 HIPAA Section (These questions must be answered by all Vendors.)5.11.01 Please confirm your compliance with HIPAA privacy and security rules for data transferred to outside

parties. If you cannot confirm, please explain below.Answer:5.11.02 Have you had any data or security breaches of PHI in the last 3 years? What have you done to mitigate the

impact of any data breaches on your members?Answer:5.11.03 Have you been investigated by a state or federal agency for issues involving HIPAA?

Answer:

5.12 Systems Backup and Disaster Recovery 5.12.01 Describe your disaster recovery plan.Answer:


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

________________________________________________________Authorized Signature

________________________________________________________Printed Name of Signatory

________________________________________________________Title


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________________________________________________________Date


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SECTION VI PERFORMANCE STANDARDS, GUARANTEES, LIQUIDATED DAMAGES

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

Damages assessments are linked to performance of system implementation or operational responsibilities. For all self-reported metrics, the vendor should provide backup documentation along with performance report response for documentation. Where an assessment is defined as an ‘up to “$X” amount, the dollar value shall be set at the discretion of the SEHP. Written notification of each failure to meet a performance requirement that is measured by the SEHP shall be given to the Vendor prior to assessing liquidated damages. The Vendor shall have five (5) business days from the date of receipt of written notification of a failure to perform to specifications to cure the failure. However, additional days can be approved by the SEHP Contract Manager if deemed necessary. If the failure is not resolved within this warning/cure period, liquidated damages may be imposed retroactively to the date of failure to perform. Late reports will incur additional liquidated damages to the SEHP. Liquidated damage amounts will double for each five (5) business days that a report is delayed. The imposition of liquidated damages is not in lieu of any other remedy available to the SEHP.

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

PERFORMANCE GUARANTEES: The following requirements are areas where the Vendor will guarantee performance for each plan offered. Measurement will be based on the SEHP account rather than the contractor’s Book of Business unless otherwise noted. Failure to meet the required standards will result in the liquidated damages. Prompt resolution of problems or issues is expected but will not reduce or eliminate any liquidated damages imposed due to failure to meet the performance standards outlined below. Liquidated Damages may be enforced by reducing the premiums, fees, claims or any other amount owed to the Vendor by the SEHP.

Vendor will be held harmless if the reason for the late reports or other missed deadlines is due to the SEHP not providing the necessary data or other required information in a timely manner. In such case, a new due date for the report or other required performance will be mutually agreed upon by both parties.

If the Vendor fails to pay once notified by the SEHP of an amount owed due to Liquidated Damages, the Liquidated Damages may be enforced by reducing the administrative fees or other amounts owed to the Vendor.

Service Performance Standards Liquidated DamagesAccount Management

6.1 Service to State Employee Health Plan Staff:(a) One hundred (100) percent of calls returned by account service

representative by 5:00 p.m. on the next business day.(b) One hundred (100) percent of issues received by phone call or

email resolved within three (3) business days of receipt.

$150 per incident

$150 per incident

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

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


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Service Performance Standards Liquidated Damages6.3 Money Owed to the State of Kansas:Money owed to the State of Kansas shall be paid within thirty (30) calendar days from notification of Liquidated damages or monies owed. Vendor has thirty (30) calendar days to document any dispute of amounts owed. Amounts owed that are not received within thirty (30) calendar days will be subject to liquidated damages of $25 per day until paid. After thirty (30) days, SEHP may collect owed funds by deducting the amounts from the administrative fees or other payments made to the Vendor.

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

6.4 Plan Materials:All plan documents and member communications must be submitted to the SEHP prior to distribution to members.

$500 per incident

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

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

6.6 Legislative Requests: Vendor will provide support to the HCC and SEHP staff in responding to information requests made by the Legislature. Responses to Legislative Requests are due to the SEHP staff within two business days of the request.

$200 per incident

6.7 Implementation:Membership file testing protocols completed one month prior to any Open Enrollment period for the plan as necessary.

$500 per month

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

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

$100 per incident

6.9 InterVendor Cooperation:Vendors are expected to cooperate with one another to ensure the smooth functioning of the SEHP. Vendor shall represent the benefits of the SEHP in a true and factual manner. Any misrepresentation of SEHP benefits and coverage or disparaging of the SEHP Vendor or plan shall be consider a violation of the InterVendor Cooperation required under this RFP.

This provision shall not preclude the member from filing and receiving benefit from the Vendor’s Errors and Omissions coverage if appropriate.

$1,000 per incident

Please comment on whether or not your organization will be able to report the performance standards in the requested format. If development or programming will be required in order to respond in the desired format, please indicate by what date the desired format would become available.

Reporting Due Dates: Quarterly reports are due fifteen (15) business days after the end of the quarter to be reported.


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

________________________________________________________Authorized Signature of Vendor

________________________________________________________Printed Name of Signatory

________________________________________________________Title

________________________________________________________Date