RFP Intake & Data Collection
Name two essential data elements required in an initial RFP intake.
What is
1. legal name,
2. address,
3. SIC code,
4. current terms
3. census,
4. claims data,
5. SBCs.
Define Medical Loss Ratio (MLR).
What is claims spend divided by premiums paid
On our level funded panel, what is the only "stack" element/vendor with flexibility?
What is network selection is flexible (other stack vendors like PBM & TPA are fixed.)
Name a group demographic you would consider when choosing which carriers to market to.
what is 1. funding type
2. participation
3. state
4. number of lives
5. industry
What is 1. Requested funding type,
2. due date,
3. carriers marketed,
4. stack specifications.
On a fully insured case, if either of the 2 required renewals have an increase that exceeds __%, the RFP is auto-declined (DTQ).
What is a 25% increase
How is Participation Rate calculated?
What is (# of Enrolled Employees) ÷ (# of Eligible Employees).
What is a benefit of implementing a CPH cost management program?
What is 1. Lowering claims spend,
2. improving member health outcomes by targeting high-cost conditions and procedures.
Name the carrier that we give priority to when marketing a captive if the case has claims data.
What is ISLS
Name the standard timeline for carriers to facilitate a medical review after receiving the necessary data to firm.
What is typically 4 business days.
How is Estimated Gross Written Premium calculated on fully insured or level funded cases
What is 30% of current or renewal premium
Name two valid reasons for waiving coverage.
What is 1. covered under spouse's plan,
2. parent's plan,
3. Medicare,
4. individual coverage.
What vendor is required on every CPH captive opportunity?
What is Innovu?
Name a function of the CPH Carrier Matrix other than evaluating a carrier’s suitability.
what is 1. "UW tools" (EGWP calc, participation calc, Spec deductible calc, MLR calc)
2. auto DTQ reference
3. naming convention & captive request reference
4. weekly facilitator & monthly presentation calendar
5. channel rules of engagement
6. carrier issue & CRM/CQ log
How are the carrier quotes organized in the market analysis?
What is ranked by competitiveness (lowest to highest cost).
Name three situations that cause an automatic DTQ of an RFP.
what is
1. a FI Renewal increase >25%,
2. no confirmation to complete IHQs,
3. prospect from a General Agency without direct access,
4. currently in a PEO,
5. age-banded rates,
6. HMO participation >40%.
At what percentage of variance in enrollment does a census require clarification?
What is 10% variance
What is 60 days?
Describe the steps taken when carriers fail to respond by the COE due date.
What is 1. follow up on the COE due data
2. if no response within 2 business days, close out the carrier’s opportunity.
How soon after sending the initial market analysis should we follow up with the BA if we haven't received feedback?
What is one week after the initial delivery.
Explain the procedural hierarchy of Benefit Advisor status the team follows in the event of a duplicate submission of an RFP.
What is
1. PDRS + BOR,
2. PDRS,
3. BOR,
4. first-in submission
Name 2 group demographics that are used to identify ideal captive prospects.
What is
1. an "expert" level BA who is bought in to our Captive mission and has completed a "conceptual stage" meeting
2. a group running at or below 70% MLR
3. with at least 18 months of data
4. a participation rate of at least 75%
5. at least $100K in Estimated Gross Written Premium (EGWP).
Name 2 of our cost management programs and what they address.
What is
1. Leap Health (Infusion Nursing, Rx Redirection, Rx Dispensing)
2. Upswing Health (MSK Solution)
3. Private Health Management (Complex Case Management)
Name a criterion you would consider when deciding which CPH Fixed stack to propose.
What is 1. BA vendor preference
2. current TPA/ Network
3. local of plan participants (regional versus national)
Name 2 items you would call out to the BA when sending the initial market analsys.
What is 1. Highlight the competitiveness
2. Proposed stacks
3. firm or illustrative of each quote (If illustrative, what is needed to firm each quote)
4. Any important notes from the underwriters
5. Any carriers that are outstanding
6. If a CPH stack was proposed, confirm with the BA if they would like to elect any of the bolt-ons for the elected TPA