REQUEST FOR PROPOSALS
For the State of Wisconsin Group Insurance Board
Group Health Insurance Administration Services Only Contract
#ETE0003


Revision History
11/07/12 WPS Contract Documents Posted
 
01/28/05 Vendor Questions Answer Set # 5 Posted
 
01/26/05 Vendor Questions, Links to Full File Compare files and Answer Set # 4 Posted. Steve Grob will continue to be the Departmental contact until further notice. Continue to copy Arlene Larson with any e-mails sent.
 
01/18/05 Vendor Questions and Answers Set # 3 Posted
 
01/11/05 Departmental contact from 1-12-05 through 1-21-05 is Steve Grob. He can be reached at steve.grob@etf.state.wi.us or (608) 266-3099. If you e-mail Steve, please copy Arlene.
 
  Vendor Questions and Answers Set # 2 Posted
 
  Exhibit O, updated to include #11. Posted, titled "Local Experience for Stop Loss".
 
  Exhibit S. Sample Reports. We invite innovations in reports, however we are supplying examples of current reports for your information. When personal health information was supplied, those areas have been whited out.
 
01/07/05 Vendor Questions and Answers Set # 1 Posted
 
  Correction to Section 2.9, date of potential vendor conference on 1/18/2005 posted
 
  Clarification of 5.17.2.3. in last box of grid to read "State of Wisconsin Top Facility Providers"
 
  Correction of 5.17.5.2.3.1. to remove Pharmacies column
 
  Exhibit O, updated to include #9. Posted, titled "Census for group relevant to RFP". This includes LAHP subscribers.
 
  Exhibit O, updated to include #10. Posted, titled "LAHP Experience".
 
12/21/04 Exhibit O. updated to include #8. Posted, titled "Out of state subscribers by zip code. Also lists out-of-country subscribers."
 
Contract
WPS Contract (DOA-3049) Standard Plan 2011
WPS HIPAA Election 2011
WPS Professional Administrative Services Agreement 2011
WPS Health Benefit Plan 2011

Revision History Section 5.0 - Technical Specifications Section 6.0 - Terms and Conditions Section 7.0 - Cost Proposal Attachment 1 - Program Description Attachment 2 - Cost Proposal Forms Attachment 3 - Designation of Confidential and Proprietary Information Attachment 4 - Reference Sheet Attachment 5 - Vendor Information

List Of Exhibits
 
A.   Current Contract
     Professional Administrative Services Agreement
     Health Benefit Plan
     Amendment for Underwriting Summary
     Underwriting Agreement Details
     Amendment Summary 1/1/2005
     Amendment Article VII 1/1/2005
     Amendment Article VIII 1/1/2005
B.  ET-1136 Guidelines
     Table of Contents
     Guidelines
     Addendums
     Addendum 1 - State (Note various tabs)
     State Contract
     Local Contracts
     Uniform Benefits
C.  ET-2112 Standard Plan Certificate
     Amendment
D.  ET-4113 Medicare Plus $1,000,000 Certificate
     Amendment (Prints as booklet, note page numbers on bottom.)
E.  ET-2107 It's Your Choice Book for State Employees
F.  ET-4112 Group Health Insurance Brochure
G.  ET-2131 Wisconsin Public Employees Standard Plan/SMP Certificate
     Amendment
H.  ET-2160 Wisconsin Public Employees Standard PPP Certificate
I.  ET-2161 Wisconsin Public Employees Deductible Standard Plan Certificate
J.  ET-2162 Wisconsin Public Employees Deductible Standard PPP Certificate
K.  ET-2163 Wisconsin Public Employees Deductible SMP Certificate
L.  ET-2128 It's Your Choice Book for Wisconsin Public Employees and Annuitants
M.  ET-2330 Local Annuitant Health Plan (LAHP) Application
N.  ET-2156 LAHP Brochure
O.  Wisconsin Subscriber Counts, Prior Claims History and Utilization Facts
P.  ET-1407 Employer Contact List for Participating Public Employers
Q.  ET-1118 Employer Administration Manual
   Chapter 1 - Preface
   Chapter 2 - Health Care Plans
   Chapter 3 - Eligibility/Coverage
   Chapter 4 - Enrollment
   Chapter 5 - Monthly Reporting
   Chapter 6 - Automated Monthly Reporting
   Chapter 7 - Rates and Refunds
   Chapter 8 - Continuation-Conversion
   Chapter 9 - Accumulated Sick Leave Conversion Credits
   Chapter 10 - Retirement, Disability or Long-Term Disability Insurance
   Chapter 11 - Rehired Annuitants
   Chapter 12 - Employee Death
   Chapter 13 - Claims and Coordination of Benefits
   Chapter 14 - Complaints
R.  Summary Chart of ASO & Insured Products
 
S.  Sample Reports. We invite innovations in reports, however we are supplying examples of current reports for your information. When personal health information was supplied, those areas have been whited out.
   General Reports
   Utilization Report
 
Additional Information:
 
Vendor Questions and Answers Set #1
 
Vendor Questions and Answers Set #2
 
Vendor Questions and Answers Set #3
 
Vendor Questions and Answers Set #4
  Full File Compare (FFC) Health Plan Extract File Design Document
  Full File Compare (FFC) Health Plan Extract File Design Appendix A
  Full File Compare (FFC) Health Plan Extract File Design Appendix B
 
Vendor Questions and Answers Set #5