Department of Employee Trust Funds (ETF)

Responses to DRAFT RFP ETG0003 Administrative Services for the State of Wisconsin Health Benefit Program


The Wisconsin Department of Employee Trust Funds (ETF) on behalf of the Wisconsin Group Insurance Board (Board) is seeking input from interested parties on a draft request for proposals for an upcoming Request for Proposals (RFP) ETG0003 for Administrative Services for the State of Wisconsin Health Benefit Program. The purpose of this RFI is to solicit comment and input from potential bidders in the form of an official response.

Please see the instructions on responding to this RFI within the ETF0055 RFI for DRAFT RFP ETG0003 document linked below.

Responses to this RFI will be reviewed and may be used to further develop, change, alter or delete specifications, terms or conditions within the RFP. Providing a response to this RFI is not a prerequisite to submitting a proposal should ETF offer such an opportunity in the future. The contents of responses to this RFI will not be considered in the review or evaluation of future bids or proposals.

This RFI is issued solely for information and planning purposes, and does not constitute a solicitation. Responses to the RFI will not be returned. Responses to this RFI are not an offer and cannot be accepted by ETF to form a binding contract. ETF is not liable for any cost incurred by the vendor in responding to this RFI.

This RFI is authorized under Chapter 40 of the Wisconsin State Statutes.

Any news releases or release of broadcast e-mails pertaining to this RFI shall not be made without the prior written approval of the State of Wisconsin or ETF.

The deadline for receipt of a response for this RFI is Friday, June 24, 2016 at 5:00 p.m. CDT. Late submissions will not be accepted. Questions may be submitted as indicated in the RFI via email to

RFI# RFI Title
ETF0055 Request for Information (RFI): Responses to DRAFT RFP ETG0003


Revision History

July 22, 2016     

ETF0055 RFI Response to Vendors Dated July 22 2016
June 13, 2016 Request for Information release date


Request for Information Documents

ETF0055 Designation of Confidential and Proprietary Information
ETF0055 Non-Disclosure Agreement (NDA)

DRAFT RFP ETG003 Documents

Exhibit 1 - Pro Forma State of Wisconsin Contract
Exhibit 2 - Standard Terms and Conditions (DOA-3054)
Exhibit 3 - Supplemental Standard Terms and Conditions for Procurement for Services (DOA-3681)
Exhibit 4 - Department Terms and Conditions
Exhibit 5 - Wisconsin Group Health Insurance Regional Coverage Map

Appendix 1 - 834 Companion Guide
Appendix 2 - Pharmacy Data Specifications
Appendix 3 - Wellness Data Specifications
Appendix 4 - Claims Data Specifications
Appendix 5 - Provider Data Specifications
Appendix 6 - Disease Management Guidelines
Appendix 7 - State Employer Group Roster (ET-1404)
Appendix 8 - Local Employer Group Roster (ET-1407)
Appendix 9 - Health Insurance Fact Sheet (ET-8902)
Appendix 10 - Financial and Utilization Data
Appendix 11 - Quality of Care Metrics

FORM A - Proposal Checklist (Available at the release of the RFP)
FORM B - Mandatory Proposer Qualifications (Available at the release of the RFP)
FORM C - Subcontractor Information (Available at the release of the RFP)
FORM D - Proposer Verification of Data Submission to Board Actuary (Available at the release of the RFP)
FORM E - ETG0003 Designation of Confidential and Proprietary Information
FORM F - ETG0003 Non-Disclosure Agreement (NDA)
FORM G - DOA-3261 Request for Proposal
FORM H - DOA-3477 Vendor Information
FORM I - DOA-3478 Vendor References

Attachment A - Regional Bid Designation
Attachment B - Network Access
Attachment C - Repricing Layout
Attachment D - Repricing - Service Category
Attachment E - Repricing - Providers
Attachment F - Repricing - Contract Types
Attachment G - Contract Improvements
Attachment H - Market Pricing
Attachment I - ASO Fees
Attachment J - Capitation
Attachment K - Self Insured Projection
Attachment L - Actuarial Certification