Loren Data's SAM Daily™

FBO DAILY ISSUE OF APRIL 27, 2012 FBO #3807
DOCUMENT

Q -- Request for Information. VA Dental Insurance Program - Attachment

Notice Date

4/25/2012
 

Notice Type

Attachment
 

NAICS

524114 — Direct Health and Medical Insurance Carriers
 

Contracting Office

Department of Veterans Affairs;VA Denver Acquisition & Logistics Center;(001AL-A2-4D);555 Corporate Circle;Golden CO 80401
 

ZIP Code

80401
 

Solicitation Number

VA79112I0036
 

Response Due

5/7/2012
 

Archive Date

8/5/2012
 

Point of Contact

Gabrielle Harris
 

E-Mail Address

Contract Specialist
(gabrielle.harris2@va.gov)
 

Small Business Set-Aside

N/A
 

Description

SYNOPSIS: The Department of Veterans Affairs (VA) will host one Industry Day in conjunction with one-on-one meetings in anticipation of the release of a new solicitation for VA Dental Insurance Program. THIS IS NOT A SOLICITATION FOR OFFERS AND NO CONTRACT WILL BE AWARDED FROM THIS EVENT. This announcement serves as a notice and invitation to participate in this vendor event and is issued solely for information and planning purposes. The purpose of the Industry Day is to provide general information on the anticipated solicitation and requirements and to solicit industry feedback. The Industry Day is open to all potential offerors interested in responding to the anticipated solicitation. This will be held at the location listed below. Attendance is voluntary and is not required in order to propose to future solicitations. OVERVIEW AND PURPOSE: Section 510 of the Caregivers and Veterans Omnibus Health Services Act of 2010, Pub. L. 111-163 requires that VA carry out a pilot program to assess the feasibility and advisability of providing private, premium-based dental insurance coverage to eligible Veterans and certain survivors and dependents of Veterans. VA intends to contract with qualified dental insurance carriers who will provide dental insurance and administer all aspects of the dental insurance plan. VA's role is to administer the contract with the private insurer and verify eligibility of Veterans, survivors and dependents. Please see the Draft Performance Work Statement beginning on page six for further information about VA's intended requirements. INDUSTRY DAY LOCATION, TIMES AND DATE The Industry Day will be held at the Denver Acquisition and Logistic Center in, Denver, CO on May 16, 2012. Address: 555 Corporate Circle Training Room Golden, CO 80401 The schedule for each event is as follows: Time (all times local)Topic 9:30 AM - 11:00 AM General Session - All Attendees 11:30 AM - 12:30 PMLunch (VA internal planning) 12:30 PM - 5:45 PMOne-on-One Sessions (45 minutes each for each vendor and VA) The General Session is an opportunity for all interested parties to hear about the VA Dental Insurance Program (VADIP) from the Department of Veterans Affairs. Time will be allowed in the general session for questions and answers applicable to all attendees. The "One-on-One" session for the remainder of Day 1 is an opportunity for vendors to meet one-on-one with representatives from VA to allow for direct questions and information sharing, for the purpose of market research. Each "One-on-One" session will be limited to 45 minutes and attendance of no more than 5 individuals from the vendor's organization. Vendors wishing to participate in the general session and/or a one-on-one session must register and request their one-on-one time by emailing: gabrielle.harris2@va.gov. Time will be assigned as requests are received. Please respond as soon as possible but no later than May 1, 2012 if your organization will be in attendance and requesting a one-on-one. In the registration email, please include the following information (VA will send registration confirmation to the POC listed below): Company Name Company Address POC and email address Number of Attendees Brief synopsis of services the company offers If a vendor is unable to attend any of the events but wants a copy of the presentation, please submit a request by emailing gabrielle.harris2@va.gov. One-on-One sessions are restricted to one session per vendor. Advance submission of questions and discussion topics for the One-on-One sessions is not required but is allowable. If questions and discussion topics are submitted in advance they will be kept confidential up to the time of the session. The session will not be restricted to those questions and discussion topics. WRITTEN RESPONSES: If providing a written response to the following questions, please submit not later than May 7, 2012 to: gabrielle.harris2@va.gov. 1.What is the business size and socioeconomic status of your organization? 2.What kind of geographical coverage does your organization have, i.e. regional, national? If regional how do you determine your coverage area? 3.Does your organization provide coverage in U.S. Territories (i.e. Puerto Rico, Guam, the U.S. Virgin Islands, American Samoa, and the Commonwealth of the Northern Mariana Islands). Does providing coverage in U.S. Territories present any potential issues? 4.The country will likely be divided up into five regions. The regions are defined by VA Integrated Service Networks (VISNs) grouped by geography. While VISNs will be kept intact, there will be multiple states in each region an some states could be split between regions. A map of the tentative regional breakout is included at the end of this document. Does this pose any potential issues providing coverage? 5.Do you see any potential issues with the insurance provider being completely responsible for administering the insurance plans and managing the relationship to include premium collection directly with beneficiaries? 6.Does the industry have network adequacy standards, if so what are they? 7.Does your organization have any recommendations on how to incorporate access standards across the country that aren't too detailed but are still enforceable contract standards? 8.VHA will not provide lists of eligible beneficiaries, but is exploring the use of EDI 270/271 Health Care Eligibility Benefit Inquiry and Requests to verify eligibility real time. The intended verbiage is included below, please provide any issues with this solution. The Contractor must have established (time will be allotted-60 days contemplated) a contractual relationship for transactions with the VA's EDI (Electronic Data Interchange) clearinghouse contractor (To Be Determined-TBD) prior to enrolling Veterans in VADIP, or as an alternative, use their own "value-added" contractor that has an existing relationship with the VA's EDI contractor. If VA changes the EDI clearinghouse contractor, all contracted carriers will be given ample notice and the ability to establish a working arrangement with the new clearinghouse. All EDI transactions accepted for this effort will have to go through this clearinghouse and responses will be returned through this clearinghouse. All costs associated to transactions between the contracted entity and the EDI contractor is the responsibility of the contracted entity. This solution would only provide eligibility verification and Personally Identifiable Information (PII) information has to be maintained according to approved VA standards and regulations. Normal method for receiving eligibility information on the prospective Veteran is by submission of the standard formatted 270 transaction set that results in the responding 271 standard formatted transaction set being returned with eligibility status via the EDI clearinghouse Contractor. Standard information returned by this EDI transaction is Name, Gender, SS#, Enrolled or Not Enrolled, Enrollment Date and Veteran Primary Facility. Current charges are estimated at eighteen cents (.18) for Veteran verification and twenty two cents (.22) for a CHAMPVA beneficiary. 9.At a minimum what information would your organization need to market the insurance program? 10.VA will not be able to preempt state law. Does that present any obstacles in contracting at the regional or national level? If so what are those obstacles? Please provide recommendations. 11.What are your hours for customer support? 12.Do you have any recommendations for the Schedule of Services, Contract Line Items (CLINS) structure? 13.What are the drivers for premium adjustment and can adjustments be made on an annual basis or are more frequent adjustments recommended? (This would exclude the base period of performance, rates would be set for the first period.) 14.The law mandating this program does not allow for coverage of non-beneficiary dependents. We do not intend to restrict the industry's ability to provide insurance plans outside of VA's Dental Insurance Program if the beneficiary requests coverage for non-eligible dependents, however this coverage cannot be provided under the purview of this program or through resultant contracts. Can your organization provide similar plans to non-eligible dependents? If so, will your organization provide detailed reports to VA regarding the number of non-eligible dependents who have signed up for other plans and the premium costs that they incurred for those plans? This information might be reported to Congress. 15.If awarded a contract, what period of time is necessary to ramp up and begin enrolling beneficiaries to include building a web page for the VA Dental Insurance Plan, and start receiving phone calls from beneficiaries? If willing please provide an estimated timeline with associated actions. 16.Describe, how your organization would market the program and how this differs from your typical enrollment campaign and why. 17.What do you consider the major challenges in the education/communication of the VADIP? What approaches do you propose to overcome these obstacles? 18.How do you intend to provide individualized advice and counseling? 19.Will customer service representatives (CSR)/counselors be dedicated to the VADIP Program account? If no, how will you ensure that they consistently represent the VADIP Program appropriately? 20.If possible, based on your past experience and based on the estimated population please provide your enrollment projections for the first and second enrollment years and the rationale for your projections. 21.Detail your web-based or online capabilities. Do you have all of them in place now or are they in planning? Provide examples, URLs, and references. 22.Detail your contingency plan for system overload on education and information requests from both a technology and/or staff sufficiency basis. 23.What education and advertising resources have you found to be most effective for large groups, and why? How would you propose to utilize these for the VADIP Program? 24. Do you have any recommendations that would simplify the insurance industries administrative efforts and reduce the price of premiums while still meeting the objectives of the pilot? 25.Are there portions of the Performance Work Statement that are not in-line with industry standards? Questions concerning these vendor events may be submitted to gabrielle.harris2@va.gov. ? DRAFT SECTION B.3 PERFORMANCE WORK STATEMENT 1. Overview: The Department of Veterans Affairs (VA), Health Eligibility Center (HEC), through the Denver Acquisition and Logistic Center (DALC) intends to contract with qualified dental insurance carriers to provide insurance plans to eligible VA beneficiaries and administrative services to support the program. Coverage for dental services will be provided in the United States, the District of Columbia, Puerto Rico, Guam, the U.S. Virgin Islands, American Samoa, and the Commonwealth of the Northern Mariana Islands. The Department of Veterans Affairs, Chief Business Office's (CBO) Health Eligibility Center (HEC), serves as the National Service Center for registration, enrollment and eligibility activities and serves as the business owner for administrative information systems supporting the delivery of VA health care benefits. The HEC achieves VA's Gold Standard of honoring America's veterans by providing accurate and timely health care eligibility and enrollment determinations and accurate, responsive and respectful customer service. HEC supports VA's health care delivery system by providing centralized eligibility verification and enrollment processing services. HEC determines veteran's health eligibility and facilitates the process by providing guidance to the field through training, and collaborates with CBO Policy and other administrative offices on the implementation of policy. 2. Background: Section 510 of the Caregivers and Veterans Omnibus Health Services Act of 2010, Pub. L. 111-163 (the 2010 Act) proposes that the VA shall carry out a pilot program to assess the feasibility and advisability to offer competitive, private, premium-based dental insurance to enrolled Veterans and certain survivors and dependents of Veterans. The private insurer shall be responsible for virtually all aspects of the administration of the dental insurance plan. VA's role is to administer the contract with the private insurer and verify eligibility of Veterans, survivors and dependents. 3. Objectives: The statement of objectives represents the desired outcomes of this contract. These objectives are supported by technical requirements identified throughout the Performance Work Statement (PWS). Objectives are as follows: 3.1 Carry out a pilot program to provide and administer a dental insurance plan(s) to Veterans and the Civilian Health and Medical Program of the VA (CHAMPVA) beneficiaries. 3.2 Provide desirable enrollment options and plan benefits. 3.3 Maximize number of participants through marketing efforts, customer satisfaction, and versatile services 3.4 Customer Service - provides and maintains high levels of enrollee and provider satisfaction 4. Scope of Work: The contractor will provide all personnel and resources necessary to provide the services in this Performance Work Statement (PWS). Contractors will provide and manage dental insurance plans for eligible beneficiaries, performing all administrative tasks and associated financial transactions. Eligible beneficiaries include (1) any Veteran who is enrolled under 38 U.S.C. 1705 in accordance with 38 CFR 17.36 and (2) any survivor or dependent of a Veteran who is eligible for medical care under 38 U.S.C. 1781, which includes participants in CHAMPVA under 38 CFR 17.271. Throughout the remainder of the document, eligible beneficiaries will be referred to as "eligible Veterans and CHAMPVA beneficiaries." Total enrollment in the VA healthcare system is roughly 7.4 million. Independent studies estimate participation in VADIP to be between 100,000 and 300,000, depending on the success of the marketing and outreach programs to these Veterans and beneficiaries. Truly successful marketing programs could result in higher participation. Approximately 61 percent of the eligible populations are age sixty or older. The Law mandating this program does not allow for coverage of beneficiary dependents. We do not intend to restrict the industry's ability to provide insurance plans outside of the VA Dental Insurance Program if the beneficiary requests this directly to the insurance carrier, however it cannot be provided under the purview of this program or through resultant contracts. 5. Marketing: VA, will market VADIP through existing communication channels (internally-facing and externally-facing websites), as well as through print media (posters and brochures). VA will also publish press releases and present plan information at Veteran Service Organization meetings. The contractor, in connection with VA will be responsible for notifying all eligible persons of their right to voluntarily enroll in VADIP. The contractor shall be responsible for continued marketing efforts. The Contractor will capitalize the "V" in Veteran, per VA communication standards. The contractor shall submit an annual education (or marketing) plan to inform and educate VA beneficiaries and network providers on all aspects of the VADIP. The plan at a minimum must include the contractor's approach and marketing techniques identified and accepted in its original proposal. The VA Program Office will review the plan and provide concurrence or feedback for recommended changes. The Contractor shall not utilize any beneficiary Protected Health Information (PHI) or personally identifiable information (including enrollees' addresses and phone numbers) for any purpose other than enrollment and/or administration of dental benefits. However, the Contractor is permitted to market and enroll family members in a non-VADIP plan. It must be clear the VA does not endorse or include family member's enrollment and plan as part of VADIP. 6. Eligibility, Enrollment and Disenrollment: 6.1 Enrollment: The participating insurer will manage the enrollment process, notify all eligible persons to include providing instruction on its enrollment process to beneficiaries The contractor will verify the beneficiaries eligibility through VA prior to informing potential beneficiary of their eligibility or ineligibility for the program or beginning the enrollment process. The initial period of enrollment will be for a period of 12 calendar months, followed by month-to-month enrollment as long as the insured remains eligible for coverage and chooses to continue enrollment, so long as VADIP continues to authorize the insurance plan. The participating insurer will agree to continue to provide coverage to an insured that ceases to be eligible for at least 30 calendar days after eligibility ceased. The insured must pay any premiums due during this 30 day period. This 30 day coverage does not apply to an insured who is disenrolled under any of the scenarios outlined in the disenrollment section below. 6.2 Eligibility Verification: Through VA and Contractor marketing efforts, Veterans will be contacting the Contractor by phone, web or other means of communication. The Contractor will start the enrollment process by querying for eligibility status through approved means once the potential Veteran or CHAMPVA beneficiary contacts the Contractor Call Center. The eligibility verification process will be determined at a later date. 6.3 Disenrollment: Insured beneficiaries may be involuntarily disenrolled at any time for failure to make premium payments. Insured beneficiaries will be voluntarily disenrolled, and will not be required to continue to pay any copayments or premiums, under the following circumstances: a. For any reason, during the first 30 days that the beneficiary is covered by the plan, if no dental services or benefits were used by the insured b. If the insured relocates to an area outside the jurisdiction of the plan that prevents the use of the benefits under the plan. c. If the insured asserts that he or she is prevented by serious medical condition from being able to obtain benefits under the plan, or that he or she would suffer severe financial hardship by continuing in VADIP. d. For any reason during the month to month coverage period, after the initial 12 month enrollment period. 6.4 Requests for Disenrollment: All insured requests for disenrollment will be submitted to the insurer for determination of whether the insured qualifies for disenrollment. Requests for disenrollment due to financial hardship or serious medical condition must include submission of written documentation that verifies the existence of a serious medical condition or financial hardship. The written documentation submitted to the insurer must show that circumstances leading to a serious medical condition or financial hardship originated after the effective date coverage began, and will prevent the insured from maintaining the insurance benefits. 7. Plan Requirements: At a minimum the following dental services are required to in each plan included in the package of services. 7.1 Diagnostic services Clinical oral examinations. Radiographs and diagnostic imaging Tests and laboratory examinations 7.2 Preventive services Dental prophylaxis Topical fluoride treatment (office procedure) Sealants Space maintenance 7.3 Restorative services Amalgam restorations Resin-based composite restorations 7.4 Endodontic services Pulp capping Pulpotomy and pulpectomy Root canal therapy Apexification and recalcification procedures Apicoectomy and periradicular services 7.5 Periodontic services Surgical services Periodontal services 7.6 Oral surgery Extractions Surgical extractions Alveoloplasty Biopsy 7.7 Other Services Palliative (emergency) treatment of dental pain Therapeutic drug injection Other drugs and/or medications Treatment of postsurgical complications Crowns Bridges Dentures 7.8 Alternative benefit provision: Plans must offer an alternate benefit provision when more than one dental procedure could provide suitable treatment based on common dental standards. The alternate benefit provision, for benefits beyond the least expensive professionally accepted standard of care, will require that the patient pays the difference between the covered benefit and the more expensive treatment option. 7.9 Benefit Plan Designs (to be completed by offeror(s) with proposal submission and incorporated into contract(s) as a result of the RFP and evaluation process). 7.9 General Policies: All covered dental services are subject to the following general policies: Services must be necessary and meet accepted standards of dental practice. Services determined to be unnecessary or which do not meet accepted standards of practice are not billable to the patient by a participating dentist unless the dentist notifies the patient of their liability prior to treatment and the patient chooses to receive the treatment. Participating dentists shall document such notification in their records. An appeal is not available when the services are determined to be unnecessary or do not meet accepted standards of dental practice unless the dentist notifies the patient of his/her liability prior to treatment and the patient makes the decision to receive the treatment. This is because such services are not billable to the patient, and there would be no amount in dispute to consider at appeal. Procedures must be reported using the American Dental Association's (ADA) current dental procedure codes and terminology (CDT). Covered services will include only those which have an associated CDT code. Adjunctive services are not covered under this contract. Services, including evaluations, which are routinely performed in conjunction with or as part of another service, are considered integral. Participating dentists may not bill members for services denied if they are considered integral to another service. Charges for the completion of claim forms and submission of required information for determination of benefits are not payable to participating dentists by either the contractor or the enrollee. 8. Network Requirements: The Contractor must provide a stable, high-quality network or networks of general dental care participating providers that are available to all enrolled Veterans and CHAMPVA beneficiaries. The network must include appropriate specialty care providers such as oral surgeons and endodontists. 8.2 VA requires nationwide coverage which could be comprised of national options, regional options, or a combination thereof. 8.3 The Contractor must provide a robust network of dental providers in order to ensure adequate access to Veterans. The network must provide enrollees with provider selection within a reasonable distance from their homes, and must ensure that enrollees are able to obtain an appointment within a reasonable amount time. Reasonable is defined as beneficiaries traveling a distance that is not extreme or excessive in terms of travel time where dental services are readily available in the community based on a reasonable person's expectation. The contractor must provide and maintain adequate networks for the delivery of dental services. Network adequacy is based on proposed and accepted distances to general and specialty dentists in urban, rural, and highly rural areas. Network adequacy must be based on the percentage of available access to general dentistry care within the proposed and accepted mileage. 8.4 Allowed charges for out-of-network providers will be 100 percent of the usual, customary, and reasonable charges for the area (50th percentile charged in the region according to the Fair Health Data). For geographic areas that do have enough dental providers to meet the contracts minimum access standards, there is no requirement for the carrier to offer an out of network benefit, except in the case of emergency care, or in exceptional cases where no network provider is available to provide a covered service. 8.5 All preferred providers must accept the patient cost sharing as payment in full at the point of service. 8.6 All provider contracts must indicate that the provider cannot bill the patient for covered services provided during a period for which premiums have been paid for other than stated patient cost sharing. Alternately, an offeror may provide proof of reinsurance to protect Veterans and CHAMPVA beneficiaries in the event of plan insolvency. 8.8 Prior to the payment of any claim for dental services, the Contractor shall ensure that the provider has complied with the licensure requirements established by the state in which the services were rendered. Claims for services rendered by providers who do not meet applicable licensure requirements shall be denied. 9. Administration: The Contractor shall provide Veterans and CHAMPVA beneficiaries a full suite of integrated benefit and financial tools that can provide individualized help in selecting the right type of benefits and level of coverage for each unique circumstance. 9.1 Information Technology: The Contractor shall provide Veterans and CHAMPVA beneficiaries' information with which to compare available dental plans and select the plan which best meets his or her needs. The contractor will establish a website for the VADIP to allow public access to check for eligibility and to compare available plans to facilitate a decision by eligible participants on selecting a dental plan. Minimum features shall include: A tool that will allow an individual accessing the site self-determine if they would be eligible for benefits. (Business rules will be provided by VHA.) A dynamic side-by-side comparison table of features (coverage, copays, deductibles, exclusions, inclusions, special notes and premiums as a minimum). Estimates of dental service needs and corresponding region-specific costs for those services at a general and specific basis, depending on the level of detail the user wishes to provide. Online application process that allows potential eligible's to apply online with application forwarded to selected insurance carrier upon completion. Contact information page for insurance carriers, VHA, and call center. Clear guidance shall be provided on which number to dial based on caller needs. Vendor shall maintain web site/application/tool hosting and content management updates in cooperation with VHA representatives. 9.2 Customer Service: The Contractor shall operate a customer service program to provide customer support through telephonic, facsimile, written and electronic means. The Contractor shall provide long distance telephone access at no cost to call for general information, enrollment assistance, help in locating a provider, status of claims, or other VADIP related questions or issues. The Contractor's customer service center shall be available to answer enrollee inquiries, in accordance with contract standards, from 8:00 a.m. to 8:00 p.m., Eastern Time, Monday through Friday (except Federal holidays). The Contractor's customer service center shall be able to communicate with non-English speaking beneficiaries and/or providers, including at a minimum, Spanish. The Contractor shall respond to negative customer feedback and meet the contractual standards for performance. The Contractor shall provide responses to written correspondence received either via hardcopy or electronic media within thirty calendar days of receipt. In addition, the contractor may be expected to respond to emails and other correspondence from beneficiaries. The contractor shall staff and train a call center to provide service to potential and enrolled VADIP participants. The call center shall be responsible for managing the following call types as a minimum: Responding to general calls about the VADIP program Assisting in determining eligibility Providing guidance in selection of appropriate plans based on callers situation/need Directing callers to appropriate providers for enrollment, questions about specific coverage, and billing issues. Directing callers to other VA business areas based on caller needs. 9.3 Premiums: VADIP premiums are determined by each contracted insurance provider annually, in consultation with VA. Premiums will vary based on geographic location of the enrollee (his or her residence address). VADIP plans may have up to five rating regions. During enrollment, a Veteran or CHAMPVA beneficiary can enroll in a regional plan only if he or she lives in a ZIP code serviced by the plan. If the enrollee moves during the plan year, there may be a change in premium due to a change in the rating region or a change in the plan because the enrollee no longer lives in a regional plan's service area. 9.4 Claims Processing: The Contractor shall process dental care claims to completion (payment or denial) in an accurate manner, within the timeframe established by each state's insurance policy/regulations or, if not defined at state level, within 30 days of receipt from provider. Non-network provider claims filed by the enrollee shall be paid to the enrollee in U.S. Dollars. The Contractor shall retain all claims that contain sufficient information to allow processing and all claims for which missing information may be developed from in-house sources, including Contractor-operated or maintained electronic, paper, or film files. 9.5 Dental Explanation of Benefits (DEOB): An industry standard Dental Explanation of Benefits (DEOB) is expected to be provided to each beneficiary and provider. Information provided in the DEOB is expected to follow Federal HIPAA and privacy standards. 9.6 Appeals: Denials of voluntary disenrollment; when the participating insurer denies a request for voluntary disenrollment, the participating insurer will issue a written decision and notify the insured of the basis for the denial and how to appeal. The participating insurer will establish the form of such appeals whether orally, in writing, or both. The decision and notification of appellate rights will be issued to the insured no later than 30 days after the request for voluntary disenrollment is received by the participating insurer. The appeal will be decided and issued in writing to the insured no later than 30 days after it is received by the participating insurer. All other appeals: Procedures for appeals of any issue other than a denial of a request for voluntary disenrollment will be established by, and be the responsibility of, the participating insurer. An enrollee has the right to appeal to the VA the Contractor's determination that a disenrollment request does not qualify under the preceding paragraphs. The enrollee may appeal that determination by submitting a written request to the Contracting Officer's Technical Representative (COTR). 10. Reporting Requirements and Deliverables The Contractor will furnish reports that VA determines to be necessary in order to assess the success of the VA Dental Insurance Plan. Unless otherwise specified, Contractors shall electronically submit all deliverables (contract plans, reports, etc.) to the COTR in a format approved by the Government to include Microsoft Office Excel, Word, PDF, or other specified format. These reports need to be received by VA on the 15th of each month, following the reporting month (e.g., summary July data is due August 15). The reports will include, at a minimum: Enrollment reports - number of new enrollees per month (total and breakdown by plan), number of disenrollment's per month (total and breakdown by plan), YTD number of enrollees (total and breakdown by plan), YTD number of disenrollments (total and breakdown by plan) Utilization reports - monthly utilization (percent of total enrollees actively using the insurance benefit, total and breakdown by plan), average YTD utilization (total and breakdown by plan.) Network/access reports - listing of network providers to include additions/deletions, current enrollees to network provider ratio. Claims reports - monthly total claims, average monthly claim amount, average monthly time to pay, YTD total claims, average YTD claim amount, average YTD time to pay. Customer service reports - monthly customer complaints, phone metrics (monthly calls received, average length of call [by call type], average hold times, abandonment rate, average speed of answer), correspondence metrics (monthly number pieces received, average days to respond), email metrics (monthly number of emails received, average days to respond.) 10.6 Reporting Requirements: The Contractor is required to provide the following reports. The Contractor will permit VA and the Government Accountability Office (GAO) to examine its records to the extent necessary for VA and GAO to carry out their functions and responsibilities. Quarterly Reports: a.Number of participants oBy plan option oBy region oBy state/US territory/Philippines b.Average premium paid oBy region oBy state c.Breakout of dollars spent on marketing d.Number of calls received oGeneral program inquiries oActual enrollment calls e.Number who elected to participate o# who added on a family plan (assuming this is a viable option) o# new enrollments o# reenrollments f.Number of disenrollments g.Number of applications received and denied due to ineligibility (not within the eligible population) h.Number of delinquent participants o30 days - 89 days o90+ days oDisenrolled Annual Reports: a. Twelve Month Feedback Report: what are positives and negatives of the program, what are we doing well and what could we improve upon. b. Non-VADIP eligible dependents enrollee report (if contractor elects to extend a program separate from VADIP to non-VADIP eligible dependents). This information would be useful in reporting back to Congress on the success or limitations of this pilot program oType of plan oNumber of enrollees oAge and gender. END DRAFT PERFORMANCE WORK STATEMENT ? Potential Geographic Regions
 

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File Name: VA791-12-I-0036 VA791-12-I-0036_1.doc (https://www.vendorportal.ecms.va.gov/FBODocumentServer/DocumentServer.aspx?DocumentId=328229&FileName=VA791-12-I-0036-001.doc)

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