CITY OF MOBILE, ALABAMA REQUEST FOR PROPOSAL DEPENDENT ELIGIBILITY AUDIT & TOBACCO CERTIFICATION
STATEMENT OF PURPOSE The City of Mobile offers a group health plan to employees and retirees in a self-funded arrangement administered by Blue Cross and Blue Shield of Alabama (BCBS). In addition to the City of Mobile, the Mobile Public Library, Mobile Museum and Emergency Management participate in the plans for their employees and retirees. All entities are located in Mobile, Alabama. The City will conduct a dependent eligibility audit in March of 2016 with a suggested completion date by April 30th but this is negotiable. The audit will include: 1. Dependent eligibility audit with documentation of dependent eligibility. 2. Tobacco certification attestation for the employee and spouse if covered by the health plan (the employee may attest for both). 3. EEO-4 survey to assist with determining preferred racial status. 4. Spouse employment & other employer sponsored group health plan survey. The audit may be conducted in one-on-one meetings or electronically using a survey form and mail/electronic filing of evidence. The employee/retiree must submit acceptable evidence to verify covered dependent eligibility (see example attached). Pricing should state which method will be used. INSTRUCTIONS FOR RESPONSE The following sets out the procedure for this request for proposal. Date RFP to be released: Date RFP response due: Interview representative in Mobile: Date contract to be effective: Audit Start Date (Suggested - To be determined): Audit Completion Date (Suggested - To be determined):
12/15/2016 01/05/2016 01/14/2016 03/01/2016 03/01/2016 04/30/2016
Actual time to be negotiated and may take 90 days to complete.
The deadline for receipt of proposals is Tuesday, January 5, 2016 by 3 pm. The City will require two (2) complete copies of the proposal and one electronic copy. Proposals are to be submitted to: Leslie Rey, Director City of Mobile Human Resources 4th Floor South Tower Mobile Government Plaza 205 Government Street Mobile, AL 36602 [email protected]
Inquiries concerning the proposal must be submitted only by email to [email protected]
ELIGIBILITY Type Active Other Agency Retiree* Totals
Single 711 57 133 901
Family 1,381 62 256 1,699
Dependents 3,270 117 379 3,766
Total Members 5,362 236 768 6,366
* Retirees may reduce based on Medicare Advantage Plan.
State company name and all contact information including the name, phone and email for the individual to be contacted for additional information regarding your proposal.
Provide an executive summary of your organization, management team competencies and background.
Provide specific background information on the individual to be the account executive in charge of this audit including experience, length of employment and education.
Provide reference information for two audits conducted within the last 24 months for contact.
Do you offer any other services besides dependent eligibility audits, if so, please briefly list those services?
Provide a detailed description of the audit process including: a. b. c. d. e. f. g.
Provide a timeline for the audit and communications program. Describe the amnesty program and time period if recommended. Will the City have a designated toll free number? Sample introduction communication and documents to be used in the audit process. Method of confirming receipt of eligibility documentation. If one-on-one, number of meetings recommended in Mobile and the number of auditors. Human resource personnel training to assist with the audit: information and responsibilities of the City’s human resources department.
Explain your eligibility appeal process.
Explain how and when the City should terminate coverage as a result of the audit findings.
Include a copy of your professional service contract.
Provide a brief description of your confidentiality procedures and safeguards.
Explain how and why your audit will reduce the City’s cost.
FINANCIAL The City prefers an all-inclusive flat fee for the audit services (spouse employment survey priced separate). Your proposal should include all services involved with the audit. If you have services which can be added or are priced separately please clearly state all fees. a. State any restrictions or limitations concerning the proposed rate. b. Detail any additional extra contractual costs/expenses associated with this contract. c. Ongoing services after the audit to maintain dependent eligibility priced separate. CERTIFICATION I acknowledge in behalf of the firm providing this proposal that this Request for Proposal was carefully reviewed and all terms, conditions and requirements contained therein are expressed in this proposal unless otherwise stated. This proposal is certified by – Company Name: Print Authorized Individual’s Name: Signature: Title:
Date: Email Address:
City of Mobile Health & Dental Plan City of Mobile Retiree-Only Health Plan REQUIRED DOCUMENTATION FOR ELIGIBLE DEPENDENTS Evidence of dependent eligibility must be submitted with your application for coverage and when requested by the Human Resources Department. The Plan may conduct an audit to verify dependent eligibility. Failure to timely provide required documentation will prevent the start of coverage or result in a retroactive termination of coverage in which case the member will be held liable for benefits paid by the Plan. Legal spouse: Marriage Certificate AND one of the following documents to show current marriage:
Most recent federal income tax return as filed with the IRS listing the spouse Current mortgage statement, loan or lease agreement listing both member and spouse Current property tax documents listing both member and spouse Vehicle registration currently in effect listing both member and spouse Current credit card or bank account statement listing both member and spouse Current utility bill listing member and spouse
Common law spouse: Each of the following:
Questionnaire and affidavit provided by Human Resources Department Most recent federal income tax return as filed with the IRS listing the spouse One of the documents listed in the spouse category above as proof of current marriage
Maximum Dependent Child Age:
Employee Group – Retiree Group –
Age 26 Age 19
Biological child: Birth certificate issued by a state, county or vital records office Stepchild: Each of the following:
Marriage certificate between member and spouse Birth certificate of stepchild issued by state, county or vital records office showing spouse as parent Affidavit form provided by the Human Resources Department
Adopted child: One of the following documents:
Certificate of adoption or Court Order granting legal custody during a probationary period prior to adoption International adoption papers from country of adoption Birth certificate issued by state, county or vital records office naming the adoptive parents
Child over whom you have legal guardian or legal custody status: One of the following documents:
Placement authorization signed by a judge Final court order signed by a judge
Disabled child over age 26 who is not married and became disabled prior to age 19 while covered by the City of Mobile Health & Dental Plan: Each of the following:
Acceptable proof of dependent child status Social Security Disability Entitlement Certificate Proof of continuous coverage for disabled child as the dependent of member since the disability commenced
Employee dependent child coverage may continue through the last day of the child’s 26th birthday. Retiree dependent child coverage terminates on the last day of the child’s 19th birthday.
All dependents must have a Social Security number to be eligible for coverage. Pursuant to recent federal health care reform, a child under the age of 26 can be married and there are no conditions of residency, student status, or financial dependency.