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SECTION 1 SECTION 1 Document Transcript

  • STATE OF MISSISSIPPI STATE AND SCHOOL EMPLOYEES HEALTH INSURANCE MANAGEMENT BOARD REQUEST FOR PROPOSAL FOR ACTUARIAL SERVICES March 13, 2008
  • TABLE OF CONTENTS SECTION 1..........................................................................................................................................1 Introduction......................................................................................................................................1 Overview and Process..................................................................................................................1 General Information.....................................................................................................................2 Scope of Services.........................................................................................................................3 SECTION 2..........................................................................................................................................5 Instructions to Proposers..................................................................................................................5 Vendors’ proposals will be evaluated in three phases: Compliance, Analysis, and Finalist. Areas within each phase are listed in order of their relative importance....................................................7 a.Compliance Phase:.........................................................................................................................7 b.Analysis Phase:..............................................................................................................................8 c.Finalist Phase:................................................................................................................................8 17.Acknowledgment of RFP Amendments................................................................................10 SECTION 3........................................................................................................................................11 Minimum Vendor Requirements....................................................................................................11 SECTION 4........................................................................................................................................12 Questionnaire..................................................................................................................................12 SECTION 5........................................................................................................................................15 Financial Exhibit............................................................................................................................15 SECTION 6........................................................................................................................................17 Statutory Requirement....................................................................................................................17 List of Vendors...............................................................................................................................18 SECTION 7........................................................................................................................................19 Statement of Compliance and Draft Contract................................................................................19 Draft Actuarial Services Contract........................................................................................................1 Draft Actuarial Services Contract........................................................................................................1 Business Associate Addendum.............................................................................................................1 Appendices: Appendix A – 2007 State and School Employees’ Health Insurance Plan Document and 2008 Amendment #1 Appendix B – Aetna Life Insurance “Your Group Plan” summary of coverage and certificate Appendix C – FY 2007 Actuarial Report i
  • STATE OF MISSISSIPPI STATE AND SCHOOL EMPLOYEES HEALTH INSURANCE MANAGEMENT BOARD REQUEST FOR PROPOSAL FOR ACTUARIAL SERVICES March 13, 2008 SECTION 1 Introduction Overview and Process The State of Mississippi State and School Employees Health Insurance Management Board (Board) is seeking an actuary to provide services to the Board relating to its management of the State and School Employees’ Life and Health Insurance Plan (Plan). The Department of Finance and Administration (DFA), provides administrative support to the Board and is coordinating this Request for Proposal (RFP). The Board desires to contract with an actuary specializing in providing actuarial services to large health plans and having prior experience directly related to the services required in this RFP. The effective date of this contract will be October 1, 2008. This contract will be for four (4) years with an option to renew for one (1) year at the Board’s discretion. This RFP is to secure the services of an actuary with the level of experience and expertise necessary to assist the Board in its management of the Plan. The purpose of this RFP is to solicit competitive proposals by defining the Board’s needs, providing vendors adequate information to develop proposals, describing the evaluation criteria on which proposals will be scored, and providing proposers with a draft contract. The selected actuary will assist the Board by providing such services as requested by the Board for which the actuary has the technical capability to render. These services will include, but not be limited to, the preparation of semi-annual actuarial analyses of the Plan, development of funding/premium recommendations, evaluation of the cost/savings of proposed benefit changes, and the provision of assistance to the Board in the development and evaluation of Return on Investment (ROI)/performance standards relating to the Board’s vendors. A more detailed listing of services is contained under the Scope of Services section in this RFP. Before the award of any contract, the proposer will be required to document to the Board that it has the necessary abilities and financial resources to provide the services specified in this RFP. The 1
  • proposer may also be required to provide additional client references, as well as related project experience detail, to satisfy the Board that the proposer has the necessary qualifications. The Board may make reasonable investigations as it deems necessary and proper to determine the ability of the proposer to perform the work, and the proposer shall furnish to the Board all information for this purpose that may be requested. The Board reserves the right to reject any proposal if the proposer fails to satisfy the Board that the proposer is properly qualified to carry out the obligations of the contract and to complete the work described in this RFP. General Information State and School Employees’ Life and Health Insurance Plan The State of Mississippi State and School Employees Health Insurance Management Board (Board) administers the State and School Employees’ Life and Health Insurance Plan (Plan). The health insurance component of the Plan is self-insured, and currently provides coverage to an estimated 190,000 Plan participants. Eligible participants include active, retired, and COBRA employees (and their enrolled dependents) of the State’s agencies, universities, community/junior colleges, school districts, and public library systems. Plan participants are primarily located within the State of Mississippi, although a small number of participants reside in other states. The Plan provides two types of health insurance coverage from which most participants may choose: Base Coverage or Select Coverage. The Base Coverage option meets the Federal Government’s criteria as a “qualifying high deductible health plan”, for the purpose of establishing a Health Savings Account (HSA). The Plan also provides a separate coverage level for Medicare- eligible retirees and their Medicare-eligible dependents. The State contributes 100% of the premium for employee-only health insurance for all enrolled active employees hired prior to January 1, 2006, regardless of which coverage option (Base or Select) the employee chooses. Active employees hired on or after January 1, 2006, may choose the 100% employer-paid Base Coverage option, or choose Select Coverage, for which they must pay a small percentage of the premium. The employee is responsible for 100% of the premium for any eligible dependents he chooses to enroll for coverage in the Plan. Retirees and COBRA participants pay 100% of their premium and their covered dependents’ premium. The Board currently contracts with Blue Cross & Blue Shield of Mississippi (BCBSMS) as the Plan’s third party medical claims administrator. The Board currently contracts with Catalyst Rx as the Plan’s pharmacy benefit manager for its prescription drug program for both retail and mail order. The Board currently contracts with CareAllies/Intracorp for utilization management, case management, and disease management services. The Board currently contracts with Mr. Wm. Lynn Townsend, FSA, MAAA for actuarial (Health and Life) services. The Board currently contracts with APS Healthcare for wellness and health promotion services. The Plan’s medical provider network is established via the Board’s contract with a direct contracting administrator, Advanced Health Systems. The Board currently contracts with Thomson/Medstat for data management services and its decision support system. For more information regarding the structure and benefits of the Plan, refer to the Plan Document in Appendix A and the FY 2007 Actuarial Report in Appendix C. 2
  • The Plan’s life insurance component currently consists of a flex-funded group term life insurance policy underwritten by Aetna Life Insurance Company. This policy currently insures nearly 90,000 active and retired employees, totaling $5.4 billion in coverage. Coverage is established for active employees as the amount equal to two times their annual salary, while retirees may choose coverage amounts of $5,000, $10,000, or $20,000. The State and enrolled employees each contribute 50% of the life insurance premium, while retirees are required to pay 100% of their life insurance premium. Refer to the Aetna Life Insurance “Your Group Plan” summary of coverage and certificate in Appendix B, the Plan Document in Appendix A, and the FY 2007 Actuarial Report in Appendix C, for more information on the life insurance coverage available under the Plan. Scope of Services The actuary is expected to provide the following services: 1. Provide actuarial analyses of the Plan. Actuarial analyses are required on a fiscal year and calendar year basis. The actuarial analyses must address items including, but not limited to, estimated claims liability including incurred but not reported claims, current and projected funding status, loss ratios by premium class, and recommended premium structure for health and life insurance programs. The Board may identify other items for inclusion in the actuarial analyses, as it deems necessary. 2. Attend all Board meetings and, as requested by the Board, attend other/special meetings. 3. As requested by the Board, provide assistance in the preparation of requests for proposals issued by the Board seeking vendors to provide services to the Plan. 4. As requested by the Board, review various reports submitted by vendors and make suggestions on the format and content of the reports, with the overall purpose of making the reports useful and meaningful to the Board. 5. As requested by the Board, analyze the cost/savings associated with proposed benefit changes, and after implementation of benefit changes, determine the cost/savings associated with the benefit change. 6. As requested by the Board, testify before the State Legislature, Legislative Budget Committee, Performance Evaluation and Expenditure Review Committee, Insurance Advisory Council, and testify or provide assistance in connection with any legal proceedings in which the Board or the State of Mississippi is a party in relation to the services provided by the actuary. 7. Assist the Board with the development and evaluation of Return on Investment (ROI)/performance standards relating to vendors’ performance of services to the Plan and the Board and assist in the evaluation of the performance of vendors. 3
  • 8. At the Board’s request, work with vendors contracted with the Board to enable the provision of necessary services. 9. Maintain full and accurate records with respect to all services provided to the Board. Additionally, at the request of the Board, provide the Board all spreadsheets, assumptions, and calculations of any project authorized and funded by the Board in a format acceptable to the Board. 10. As requested by the Board, provide other such services for which the actuary has the technical capability to render. 4
  • SECTION 2 Instructions to Proposers ________________________________________________________________________ Proposals must be received at the DFA-Office of Insurance in Jackson, Mississippi, no later than 2:00 p.m. CDT, May 2, 2008. Proposals must be submitted in writing with appropriate certification signatures as indicated. Your proposal should be organized as follows: 1. Introduction 2. Minimum Vendor Requirements Confirmation (Refer to Section 3) 3. Statement of Compliance (Refer to Section 7) 4. Statutory Requirement (Refer to Section 6) 5. RFP Questionnaire/Responses (Refer to Section 4) 6. Cost Quotation (Refer to Section 5) 7. Resumes for Key Staff as requested in the Questionnaire 8. Examples of Actuarial reports as requested in the Questionnaire 9. Any Additional Information Not Specifically Requested In preparing your response to any RFP question or requests for information, you should repeat each question or requirement and then state your response. Provide complete answers and explain all issues in a concise, direct manner. If you cannot provide a direct response for some reason (e.g. your organization does not collect or furnish certain information), indicate the reason rather than providing general information that fails to answer the question. All information requested is considered important. If you have additional information you would like to provide, include it as an appendix. The information contained in your response to this RFP will be used by the Board in determining whether or not you will be selected. The proposal the Board selects will be a working document. As such, the Board will consider the proposal an integral part of any final contract and will expect that all representations made in the proposal will be honored. It is the proposer’s sole responsibility to submit information relative to the evaluation of the proposer’s proposal and the Board is under no obligation to solicit such information if it is not included with the proposer’s proposal. Failure of the proposer to submit such information may cause an adverse impact on the evaluation of the proposer’s proposal. All documentation submitted in response to this RFP and any subsequent requests for information pertaining to this RFP shall become the property of the Board and will not be returned to the proposer. FAILURE TO PROVIDE ALL REQUESTED INFORMATION MAY RESULT IN DISQUALIFICATION OF YOUR PROPOSAL. 5
  • Important Dates The Board reserves the right to adjust this schedule. 3/13/2008 RFP released by Board 4/4/2008 “Intent to Propose” and Questions Due to Board 4/18/2008 “Response to Questions” released by Board 5/2/2008 Proposals Due to Board Week of 7/14/2008 Presentations by Finalists* 7/23/2008 Vendor Selected 10/01/2008 Contract Effective Date *If deemed necessary by the Board, finalists may be required to make a presentation to the Board and staff in Jackson, Mississippi. If your organization is selected as a finalist, notification will be provided to you in advance of the scheduled presentation. Proposals must be received at the DFA-Office of Insurance in Jackson, Mississippi by 2:00 PM CDT, May 2, 2008. Any proposal received after the deadline will not be accepted. Proposals must be delivered in a sealed package and clearly labeled with the words, “Proposal - Do Not Open” prominently displayed on the outside of the package. Proposers must submit one (1) original and six (6) copies (with at least one copy to be unbound) of their proposal, along with a “soft” copy preferably in Word® format on compact disk, to the following address: Steven May Director, Planning and Analysis Department of Finance and Administration Office of Insurance 901 Woolfolk Building, Suite B 501 North West Street Jackson, MS 39201 Questions regarding the RFP and/or the proposal should be submitted in writing to Steven May at the address listed above, or by e-mail or facsimile at the address provided below: E-mail: mays@dfa.state.ms.us Facsimile No. (601) 359-6568 6
  • 1. Intent to Propose and Questions All potential proposers are requested to indicate their intention to propose by April 4, 2008. Only those vendors that submit an “Intent to Propose” by April 4, 2008 will be allowed to submit questions. Notice may be submitted via fax or e-mail (mays@dfa.state.ms.us), with questions or separately, at the proposer's discretion. Your intent to propose should indicate your organization's primary contact, direct telephone number of contact, e-mail address, and facsimile number. Responses to vendor questions received by April 4, 2008, will be made available on DFA’s website at www.dfa.state.ms.us under “Bid and RFP Notices”. It is the proposer’s sole responsibility to monitor the web site for responses to questions. 2. Duration of Proposal Within the introduction section of the proposal, it shall be stated that the proposal is valid for at least 180 days subsequent to the date of submission. The proposal shall become part of the contract in the event that the contract is awarded to your organization. 3. Corrections and Clarifications The Board reserves the right to request clarifications or corrections to proposals. Any proposal received which does not follow the "Instructions to Proposers", meet the "Minimum Vendor Qualifications" or comply with other proposal requirements of this RFP, including clarification or correction requests, may be considered to be "non-responsive" and may be rejected. 4. Withdrawal or Amendment of a Proposal A proposer may withdraw a proposal by submitting a written request for its withdrawal to the Board, signed by the proposer and mailed to the above contact. The Board shall not accept any amendments, revisions, or alterations to proposals after the due date unless formally requested in writing to, and approved by, the Board. 5. Cost of Proposal Preparation All costs incurred by the proposers in preparing and delivering their proposals, making on- site presentations, and any subsequent time and travel to meet with the Board regarding the proposal shall be borne at the proposers' expense. 6. Proposal Evaluation Vendors’ proposals will be evaluated in three phases: Compliance, Analysis, and Finalist. Areas within each phase are listed in order of their relative importance. a. Compliance Phase: In order to successfully complete the Compliance Phase, proposals must have been received by the deadline, vendors must have met the “Minimum Vendor Requirements” in Section 3, and proposals must have received a passing score relative to contract conditions and other compliance issues. In addition, vendors must have substantially adhered to the “Instructions to Proposers” in Section 2 of the RFP. Those proposals passing the Compliance Phase will be evaluated further. 7
  • b. Analysis Phase: If a proposal passes the Compliance Phase, it will be further evaluated based on the following criteria listed in order of importance: 1) Experience and Qualifications – the extent, degree, and context of the actuary’s experience and qualifications with programs of similar complexity to the Plan; 2) Pricing – the willingness to provide multiple year fee guarantees; 3) Questionnaire Responsiveness – the quality and completeness of responses to the questions and information requests in Section 4 of this RFP, including compliance with any subsequent information requests; 4) Contract Conditions – acceptance of contract conditions and terms as illustrated in Section 7 of this RFP; c. Finalist Phase: Based on the evaluation results from the Analysis Phase, selected vendors will be named as finalists and will move to the Finalist Phase of the evaluation process. The Finalist Phase may include any or all of the following: 1) References – demonstration of an acceptable level of performance, customer satisfaction, and a track record of successfully providing services for programs of similar size and complexity as the Board's Plan. 2) Presentations – at the Board’s discretion, finalists may be requested to make a presentation to the Board and DFA Staff in Jackson, Mississippi. 7. Mississippi Public Records Act/Confidentiality of Proposals Any proposal, including accompanying attachments, will be available for review by State of Mississippi personnel, the Board, members and staff of the Legislature and oversight boards. The proposal is further subject to the "Mississippi Public Records Act of 1983," codified as section 25-61-9 et seq., as amended, of the Mississippi Code Annotated and exceptions found in Section 79-23-1, as amended, of the Mississippi Code. The Board understands that you may consider some of the information required to be provided in the proposal to be proprietary. The Board requests that each page of the proposal that you consider confidential be on a different color paper than non-confidential pages and be marked in the upper right hand corner with the word "CONFIDENTIAL." The statute listed herein provides that you can request that prior to the release of any information that you will be notified by the Board of the request for the information and given sufficient time to seek protection from the appropriate court. If you do not obtain protection from the appropriate court, all information supplied whether marked confidential or not, may be released. The Board will accept no additional restrictions on the release of information contained in your proposal. 8
  • 8. Certification of Independent Price Determination By submission of a proposal, the proposer certifies that the prices submitted in response to the RFP have been arrived at independently and without – for the purpose of restricting competition – any consultation, communication, or agreement with any other proposer or competitor relating to those prices, the intention to submit a proposal, or the methods or factors used to calculate the fees proposed. 9. Right to Consider Historical Information The Board reserves the right to consider historical information, whether gained from the proposer’s proposal, question and answer conferences, references, or any other source. 10. Right to Reject, Cancel and/or Issue another RFP The Board specifically reserves the right to reject any or all proposals received in response to this RFP, to cancel the RFP in its entirety, or to issue another RFP for the services requested. 11. Acknowledgement of RFP Amendments Should an amendment to the RFP be issued, it will be posted on DFA’s web site at www.dfa.state.ms.us under “Bid and RFP Notices”. Proposers must acknowledge receipt of any amendment to the request for proposal by signing and returning the amendment form with the proposal, by identifying the amendment number and date in the space provided for this purpose on the amendment form, or by letter. The acknowledgment must be received by DFA by the time and at the place specified for receipt of proposals. It is the proposer’s sole responsibility to monitor the web site for amendments to the RFP. 12. Representation Regarding Contingent Fees By submission of a proposal, the proposer represents that it has not retained any person or agency to solicit or secure a contract for the services described herein upon an agreement or understanding for a commission or a percentage, brokerage, or contingent fee. The Board will not pay any brokerage fees for securing or executing any of the services outlined in this RFP. Therefore, all proposed fees must be net of commissions and percentage, contingent, brokerage, service, or finder’s fees. 13. Representation Regarding Gratuities By submission of a proposal, the proposer represents that it has not violated, is not violating, and promises that it will not violate any prohibition against gratuities as set forth in Section 7-204 (Gratuities) of the Mississippi Personal Services Contract Procurement Regulations, a copy of which may be obtained by contacting the Mississippi State Personnel Board located in the Robert G. Clark Jr. Building at 301 North Lamar Street, Suite 100, Jackson, Mississippi 39201, or by accessing the website at www.spb.state.ms.us. 9
  • 14. Statement of Compliance Requirement Section 7 contains a standard contract and a Statement of Compliance. Please review this section carefully and include a Statement of Compliance signed by an officer, principal or owner of the firm with your completed proposal. PROPOSALS MUST INCLUDE A SIGNED STATEMENT OF COMPLIANCE IN ORDER TO RECEIVE CONSIDERATION. 15. Statutory Requirement In accordance with Section 25-15-9(1)(a) of the Mississippi Code, each entity that submits a proposal in response to this RFP must provide a disclosure statement detailing any services or assistance it provided during the previous fiscal year to the Board and/or DFA in the development of the State and School Employees’ Life and Health Insurance Plan. The statement must include a detailed description of the proposer’s participation in the development of the Plan, as well as any resulting compensation received from the Board and/or DFA during the previous fiscal year. If you did not provide such assistance to the Board and/or DFA, you must indicate in your disclosure statement that this provision does not apply to you. A list of persons, agents, and corporations who have contracted with or assisted the Board in preparing and developing the State of Mississippi State and School Employees’ Life and Health Insurance Plan and a copy of the statutory requirement are contained in Section 6 of this RFP. YOU MUST PROVIDE A STATEMENT WHETHER OR NOT THE PROVISION APPLIES TO YOU. FAILURE TO PROVIDE THIS DISCLOSURE STATEMENT WILL RESULT IN YOUR PROPOSAL BEING ELIMINATED FROM FURTHER CONSIDERATION. 16. Right of Negotiation Discussions and negotiations regarding price and other matters may be conducted with proposer(s) who submit proposals determined to be reasonably susceptible of being selected for award, but proposals may be accepted without such discussions. The Board reserves the rights to further clarify and/or negotiate with the “proposer evaluated best” following completion of the evaluation of proposals but prior to contract execution, if deemed necessary by the Board. The Board also reserves the right to move to the next best proposer if negotiations do not lead to a final contract with the best proposer. THE BOARD RESERVES THE RIGHT TO FURTHER CLARIFY AND/OR NEGOTIATE WITH THE PROPOSER(S) ON ANY MATTER SUBMITTED. 17. Acknowledgment of RFP Amendments Should an amendment to this RFP be issued, proposers must acknowledge receipt of the amendment by signing and returning the amendment with the proposer’s proposal, by identifying the amendment number and date in the space provided for this purpose on the amendment form or by letter. The acknowledgment must be received by the Office of Insurance by the time and at the place specified for receipt of proposals. 10
  • SECTION 3 Minimum Vendor Requirements ______________________________________________________ The following proposal requirements are mandatory. Failure to meet any of these proposal criteria will result in disqualification of the proposal submitted by your organization. Please respond by restating each vendor requirement and document how your organization meets these minimum criteria. This should be the second section of your proposal. Minimum Vendor Requirements 1. The proposing organization must have at least five (5) years experience as an organization in providing the type and scope of actuarial services to be procured through this competitive process. The determination of the length of time an entity has provided these services will be based upon the initial date the organization established a contractual relationship to provide such actuarial services. The proposing organization must provide sufficient detail to demonstrate it has significant experience in working with programs similar in size and complexity to the Plan. 2. The individual who will act as the State’s primary contact shall be at a senior actuary level and shall have at least 1) six (6) years experience of actuarial responsibilities, similar to those being requested by this RFP, in health and life insurance, of which four (4) years experience in the last ten (10) years must have been in providing actuarial services to at least one self-insured health insurance plan with at least 100,000 covered lives, 2) direct experience in funding analysis and premium rate setting for both health and life insurance, and 3) direct experience in working with fully insured health plans with “minimum premium features”, and 4) direct experience in working with life insurance programs with at least 50,000 covered lives. Additionally, this individual must have the following qualifications: 1) a Fellow of the Society of Actuaries, and 2) a Member of the American Academy of Actuaries (copies of certificates must be included in your proposal). 3. The proposing organization must be an independent entity. A pharmacy benefit manager, third party medical claims administrator, insurance company, or similar organization subject to the jurisdiction of the Mississippi Department of Insurance shall not be considered qualified. Additionally, if the majority ownership of the proposing organization is a company or similar organization referenced in this item, the proposing organization will not be considered qualified. 11
  • SECTION 4 Questionnaire 1. State the full name and home office address of your organization. Describe your organizational structure (e.g., publicly held corporation, private non-profit, partnership, etc.). If it is incorporated, include the state in which it is incorporated. List the name and occupation of the individuals serving on your organization’s board of directors, and list the name of any entity or person owning 10% or more of your organization. 2. List the name, title, mailing address, telephone number, facsimile number, and e-mail address of the contact person for this proposal. 3. How long has your organization been in business? 4. How long has your organization been providing actuarial services to health and life plans? 5. List the office that will service the Board. If it is located at a different address than the home office, provide the complete address, phone number, and facsimile number for this office. 6. Provide the name(s) of the actuary(s) to perform the work for the Board and a brief statement as to why each actuary is qualified to provide services to the Board. 7. Provide a complete resume for each actuary who will be assigned to render services to the Board, including detailed information on any special training or designations. Identify the actuary who will serve as the primary contact for the Board. 8. What was your organization’s average number of employees for calendar year 2007? 9. Does your proposal assume a joint venture with other organizations? If so, specify your role and those of the other organization(s). Which organization would be responsible for overall account management and direction? 10. The Board must have prompt and direct access throughout the contract period to the actuary(s). Address in detail how your organization will provide access of the actuary(s) to the Board. 11. Describe in detail the type work performed by the primary contact for a self-insured health plan with at least 100,000 covered lives, including dates of service. 12
  • 12. Describe in detail the type of work your organization has performed relative to flex funded life insurance programs. 13. Detail your organization’s ability to monitor regulatory and legislative developments at both the state and federal level and how will this be communicated to the Board. 14. Describe in detail your organization’s experience in comparing multiple benefit plans to determine whether the plans have the same overall actuarial value. 15. Briefly describe your organization’s experience in and knowledge of the Mississippi health care market. 16. Explain in detail your ability to provide the experience and expertise in preparing the actuarial analyses and funding recommendations required by the Plan. 17. Provide current examples of actuarial reports prepared by your organization. Include examples of reports prepared on self-insured plans with at least 100,000 covered lives. 18. State if you currently provide any services, directly or indirectly, to any of the following vendors or Board members. If so, provide a full description of services provided.  Blue Cross & Blue Shield of Mississippi  PricewaterhouseCoopers, LLP  CatalystRx  Advanced Health Systems  CareAllies/Intracorp  Thomson Medstat Systems, Inc.  Wm. Lynn Townsend, FSA, MAAA  Aetna Life Insurance Company  APS Healthcare Midwest  Board Members: Col. J. K. Stringer, Jr., Executive Director, Department of Finance and Administration; Dr. Hank Bounds, State Superintendent of Education; Liles Williams, Chairman, Workers’ Compensation Commission; Mike Chaney, Commissioner of Insurance; Dr. Thomas Meredith, Commissioner, Institutions of Higher Learning; Larry Fortenberry, President, Executive Planning Group; Christopher Burkhalter, FCAS, MAAA, Actuary, Bickerstaff, Whatley, Ryan, and Burkhalter, Inc.; Don Thompson, Director, State Personnel Board; Pat Robertson, Executive Director, Public Employees Retirement System; Dr. Eric Clark, Executive Director, State Board of Community and Junior Colleges; Senator Alan Nunnelee, Chairman, Senate Appropriations Committee; Representative Johnny Stringer, Chairman, House Appropriations Committee; Representative Walter Robinson, Jr., Chairman, House Insurance Committee; Senator Eugene Clarke, Chairman, Senate Insurance Committee. 19. List at least three current clients for whom your organization has provided services similar to those requested in this RFP. For each client, the list must specify the type work performed by your organization, the number of covered lives in the client’s group, and the 13
  • time retained as a client. One of the three must be the longest standing client; one must be the client with the largest employee population; and the third must be the client for whom the largest impact was achieved through your organization’s services. If the same client meets any of these criteria, list additional clients so that at least three unique clients are listed. For each client, include the name, title, address, email, facsimile number, and phone number of a person whom we may contact as a reference. 20. List at least three current governmental clients for whom you are providing services similar to those requested in this RFP. For each client, the list must specify the type work performed by your firm, the number of covered lives in the client’s group, and the time retained as a client. One of the three must be the longest standing client; one must be the client with the largest employee population; and the third must be the client for whom the largest impact was achieved through the organization’s services. If the same client or one mentioned in the previous question meets any of these criteria, list additional clients so that at least three more clients are listed. For each client, include the name, title, address, email, facsimile number, and phone number of a contact person whom we may contact as a reference. 21. Relative to the primary contact, identify the self-insured client having at least 100,000 covered lives and for whom the primary contact has provided actuarial services for four (4) years in the last ten (10) years. If the client is indicated in one of your previous responses, please indicate the client’s name. If not, provide the type work performed by the primary contact, the size of the client’s group, and the period retained as a client. Provide the name, title, address, email, facsimile number, and phone number of a contact person whom we may contact as a reference. 22. List all clients that have discontinued use of your services since January 1, 2007, and your understanding for their discontinued use of your services. For each client listed, include the name, title, address, email, facsimile number and phone number of a person whom we may contact as a reference. 23. Has your organization ever been involved in a lawsuit pertaining to any area covered by this RFP? If yes, provide details including dates and outcomes. 24. During the past five years, has your organization, related entities, principals, or officers ever been a party in any material criminal litigation whether directly related to this RFP or not? If so, provide details including dates and outcomes. 25. Confirm that your proposal is valid for 180 days subsequent to the date of submission. 14
  • SECTION 5 Financial Exhibit FINANCIAL PROPOSAL Please complete the following “Cost Quotation” form. Rates for each of the five years must be included. 15
  • COST QUOTATION ACTUARIAL SERVICES Our organization’s unit rates (hourly charges) to provide actuarial services to the State of Mississippi State and School Employees Health Insurance Management Board are listed below: Hourly Rates By Position: Year 1 Year 2 Year 3 Year 4 Year 5 Senior Actuary ________ ________ ________ ________ ________ Associate Actuary ________ ________ ________ ________ ________ Administrative/ Clerical ________ ________ ________ ________ ________ Other ______________ ________ ________ ________ ________ ________ 16
  • SECTION 6 Statutory Requirement You must provide a statement as to whether or not the following provision applies to you. Failure to provide this disclosure statement will result in your proposal being eliminated from further consideration. In accordance with Section 25-15-9(1)(a) of the Mississippi Code, each entity that submits a proposal in response to this RFP must provide a disclosure statement detailing any services or assistance it provided during the previous fiscal year to the Board and/or DFA in the development of the Plan. The statement must include a detailed description of the proposer’s participation in the development of the Plan, as well as any resulting compensation received from the Board and/or DFA during the previous fiscal year. If you did not provide such assistance to the Board and/or DFA, indicate in your statement that this provision does not apply to you. A copy of the statutory requirement is provided below. A list of persons, agents, and corporations who have contracted with or assisted the Board in preparing and developing the State of Mississippi State and School Employees’ Life and Health Insurance Plan is provided on the following page. STATUTORY REQUIREMENT Section 25-15-9(1)(a), Mississippi Code Ann., states: “The board may employ or contract for such consulting or actuarial services as may be necessary to formulate the plan, and to assist the board in the preparation of specifications and in the process of advertising for the bids for the plan. Such contracts shall be solicited and entered into in accordance with Section 25-15-5. The board shall keep a record of all persons, agents and corporations who contract with or assist the board in preparing and developing the plan. The board, in a timely manner, shall provide copies of this record to the members of the advisory council created in this section and those legislators, or their designees, who may attend meetings of the advisory council. The board shall provide copies of this record in the solicitation of bids for the administration or servicing of the self-insured program. Each person, agent, or corporation which, during the previous fiscal year, has assisted in the development of the plan or employed or compensated any person who assisted in the development of the plan, and which bids on the administration or servicing of the plan, shall submit to the board a statement accompanying the bid explaining in detail its participation with the development of the plan. This statement shall include the amount of compensation paid by the bidder to any such employee during the previous fiscal year. The board shall make all such information available to the members of the advisory council and those legislators, or their designees, who may attend meetings of the advisory council before any action is taken by the board on the bids submitted. The failure of any bidder to fully and accurately comply with this paragraph shall result in the rejection of any bid submitted by that bidder or the cancellation of any contract executed when the failure is discovered after the acceptance of that bid.” 17
  • Mississippi State and School Employees’ Health Insurance Plan List of Vendors In Accordance with Section 25-15-9, (1)(a), Mississippi Code Ann. Actuary: Wm. Lynn Townsend, FSA, MAAA PricewaterhouseCoopers, LLP Ann O'Connell – Principal; Donald Weber – Managing Director; Edward Patrick Cox – Managing Director; Margaret Crossin – Managing Director; Joanne Sica – Director; Lori Nipp – Director; Laura Schweitzer – Director; Tracey Giddings – Director; Jill Stockard – Director; Slate Taylor – Manager; Heather Moon – Manager; Richard Irwin – Manager; Deven Shah – Manager; Stephanie Miller – Manager; Jackie Mazoway – Manager; Kathryn Posen – Manager; Elizabeth Kaminski – Manager; Salvatore Aceto – Manager; Pamela Jones – Manager; Michael Yu-Pin Chang – Manager; Bernie Maron – Manager; Sara Yang – Manager; Sherrie Beers – Sr. Associate; Laura Thompson – Sr. Associate; Alexandra Purcell – Sr. Associate; Richard Czerwinski – Sr. Associate; Hilton Chung – Sr. Associate; Michael Hosen – Sr. Associate; Wenchao Xi – Associate; Jingmin Liu – Associate; Annette Citrone – Executive Assistant; Claudette Duncan – Executive Assistant; Sharon Smith – Executive Assistant; George Garcia – Staff Assistant; Mellony Jayroe – Staff Assistant; and Sondra Morgan – Staff Assistant. Department of Finance and Administration Employees who are assisting the Board in preparing and developing the State of Mississippi State and School Employees’ Life and Health Insurance Plan include J. K. Stringer, Jr., – Executive Director; Rita Wray – Deputy Executive Director; Office of Insurance Staff: Teresa Planch – State Insurance Administrator; Richard Self – Deputy Director; Edie Mills – Director, Benefits and Participant Services; Steven May – Director, Planning and Analysis; Carol Parker – Director of Policy Development; and Cheryl Turner – Director of Special Programs. Health Insurance Management Board Health Insurance Management Board members who are assisting in preparing and developing the State of Mississippi State and School Employees’ Life and Health Insurance Plan include J. K. Stringer, Jr., (Chairman) – Executive Director, Department of Finance and Administration; Dr. Hank Bounds – State Superintendent of Education; Liles Williams – Chairman, Workers’ Compensation Commission; Mike Chaney – Commissioner, Department of Insurance; Dr. Thomas Meredith – Commissioner, Institutions of Higher Learning; Pat Robertson – Executive Director, Public Employees’ Retirement System; Don Thompson – Director, State Personnel Board; Dr. Eric Clark – Executive Director, State Board of Community and Junior Colleges; Christopher Burkhalter, FCAS, MAAA, Bickerstaff, Whatley, Ryan and Burkhalter, Inc.; Larry Fortenberry – President, Executive Planning Group; The Honorable Alan Nunnelee – Chairman, Senate Appropriations Committee; The Honorable Johnny Stringer – Chairman, House Appropriations Committee; The Honorable Walter Robinson, Jr. – Chairman, House Insurance Committee; and The Honorable Eugene Clarke – Chairman, Senate Insurance Committee. 18
  • SECTION 7 Statement of Compliance and Draft Contract ________________________________________________________________________ This section contains a copy of the Board’s Statement of Compliance and Draft Contract for actuarial services. You must submit a signed Statement of Compliance with your proposal. If you object to any of the contract conditions or any requirements listed in this RFP, please note and explain your objection on the Statement of Compliance. 19
  • Statement of Compliance We have agreed to adhere to all conditions and requirements as set forth in the State of Mississippi Request for Proposal for Actuarial Services, dated March 13, 2008, including the draft contract contained in Section 7, except as listed below: An original signature is required below. ____________________________________ ______________________________ Signature Date ____________________________________ Typed Name ____________________________________ Title ____________________________________ Organization Please have the appropriate official sign this statement and include it as a part of your proposal. 20
  • Draft Actuarial Services Contract This Actuarial Services Contract (Contract) is made by and between the State of Mississippi State and School Employees Health Insurance Management Board (Board), acting administratively through the Department of Finance and Administration (DFA), and ________________, (Actuary) on October 1, 2008, under the following terms and conditions under which the Actuary agrees to provide services to the Board relating to the State and School Employees’ Life and Health Insurance Plan (Plan), and any other plans/programs for which the Board is or becomes responsible during the term of this Contract. 1. SCOPE OF SERVICES The Actuary agrees, at the request of the Board, to assist the Board and the staff of DFA by providing the following actuarial services: A. Provide actuarial analyses of the Plan. Actuarial analyses are required on a fiscal year and calendar year basis. The actuarial analyses must address items including, but not limited to, estimated claims liability including incurred but not reported claims, current and projected funding status, loss ratios by premium class, and recommended premium structure for health and life insurance programs. The Board may identify other items for inclusion in the actuarial analyses, as it deems necessary. B. Attend all Board meetings and, as requested by the Board, attend other/special meetings. C. As requested by the Board, provide assistance in the preparation of requests for proposals issued by the Board seeking vendors to provide services to the Plan. D. As requested by the Board, review various reports submitted by vendors and make suggestions on the format and content of the reports, with the overall purpose of making the reports useful and meaningful to the Board. E. As requested by the Board, analyze the cost/savings associated with proposed benefit changes, and after implementation of benefit changes, determine the cost/savings associated with the benefit change. F. As requested by the Board, testify before the State Legislature, Legislative Budget Committee, Performance Evaluation and Expenditure Review Committee, Insurance Advisory Council, and testify or provide assistance in connection with any legal proceedings in which the Board or the State of Mississippi is a party in relation to the services provided by the actuary. 1
  • G. Assist the Board with the development and evaluation of Return on Investment (ROI)/performance standards relating to vendors’ performance of services to the Plan and the Board and assist in the evaluation of the performance of vendors. H. At the Board’s request, work with vendors contracted with the Board to enable the provision of necessary services. I. Maintain full and accurate records with respect to all services provided to the Board. Additionally, at the request of the Board, provide the Board all spreadsheets, assumptions, and calculations of any project authorized and funded by the Board in a format acceptable to the Board. J. As requested by the Board, provide other such services for which the actuary has the technical capability to render. It is mutually understood and agreed by both parties that this is not an exclusive actuarial contract. The Board is free to contract with other professionals to perform similar and like services as those contained in this Contract. Payment for work performed by the Actuary shall not be affected by this provision. 2. CONTRACT TERM A. The effective date of this Contract will be October 1, 2008. This Contract’s term will be for four (4) years with an option to renew for one (1) year at the Board’s discretion. By March 31, 2012, the Board will notify the Actuary, in writing, of the Board’s intent as to renewal of the Contract for one (1) additional year. B. This Contract may be terminated by either party, with or without cause, upon at least thirty (30) days prior written notice of intent to terminate. C. All records and information provided by the Board or through its third party contractors to the Actuary are the sole property of the Board and shall be returned to the Board within thirty (30) days of the termination date of this Contract. The Actuary shall be entitled to retain and utilize data that have been captured, computed, or stored in the Actuary’s databases to the extent that such data cannot be identified or linked to the Board, Plan, or an individual Plan Participant. D. Upon termination of this Contract, the Actuary shall fully cooperate with the Board and the new Actuary during the transition of the Plan to the new Actuary. Upon request of the Board, the Actuary shall provide all information maintained by the Actuary in relation to the Plan in a time frame specified by the Board. Information provided shall be in a format designated by the Board. The Actuary shall provide such explanation of the information provided as to facilitate a smooth transition. 2
  • 3. CONSIDERATION The Board agrees to compensate the Actuary for services approved by the Board and performed by the Actuary under the terms of this Contract as follows: A. The unit rates listed in Attachment A, “Cost Quotation”, of this Contract shall constitute the entire compensation due to the Actuary for services and all of the Actuary’s obligations hereunder regardless of the difficulty, materials, or equipment required. The unit rates include, but are not limited to, all applicable taxes, fees, general office expense, overhead, profit, and all other direct and indirect costs, incurred or to be incurred, by the Actuary. No additional compensation will be provided by the Board for any expense, cost, or fee not specifically authorized by this Contract, or by written authorization from the Board. B. The unit rates listed in Attachment A, “Cost Quotation”, of this Contract are firm for the duration of this Contract and are not subject to escalation for any reason, unless this Contract is duly amended. C. Compensation to the Actuary for travel, meals and/or lodging shall be allowed subject to the following criteria: 1. In order to be compensable by the Board, travel expenses must be reasonable and necessary for the fulfillment of the project and contractual obligations; 2. Air travel reimbursement will be limited to “Coach” or “Tourist” class rates, and must be supported by a copy of an original invoice; 3. Meals and lodging expenses will be reimbursed in the amount of actual costs, subject to the maximum per diem as defined in the Federal Register. A copy of all hotel receipts must be provided. A copy of meal receipts is not necessary; 4. Taxi fares, reasonable rental car expenses, and airport parking expenses will be reimbursed in the amount of actual costs, and must be supported by a copy of an original receipt/invoice; 5. Personal automobile mileage and related costs are not compensable expenses; and 6. Time spent in “travel status” is not compensable. Unit rates in Attachment A, “Cost Quotation”, of this Contract are to be charged for actual hours worked only and shall not include travel time. D. Fees for actuarial services provided by the Actuary shall be billable to the Board in arrears on a monthly basis. The Board will not provide any prepayments or initial deposits in advance of services being rendered. Only those services agreed to by 3
  • Contract will be considered for reimbursement/compensation by the Board. Payment for any and all services provided by the Actuary to the Board shall be made only after said services have been duly performed and properly invoiced. The Board shall submit all invoices, in a form acceptable to the Board will all of the necessary supporting documentation, prior to any payment of allowable costs. Such invoices will include, at a minimum, the name and title of each individual providing services, a description of the service(s) provided, the quantity or number of units billed (as applicable), the compensation rate, the time period in which the services were provided, total compensation requested for each individual service being billed, and the total amount due the Actuary for the period invoiced. E. The payment of an invoice by the Board shall not prejudice the Board’s right to object to or question any invoice or matter in relation thereto. Such payment by the Board shall neither be construed as acceptance of any part of the work or service provided nor as an approval of any costs invoiced therein. Actuary’s invoice or payment shall be subject to reduction for amounts included in any invoice or payment theretofore made which are determined by the Board, on the basis of audits, not to constitute allowable costs. Any payment shall be reduced for overpayment, or increased for underpayment on subsequent invoices. F. The Board reserves the right to deduct from amounts which are or shall become due and payable to the Actuary under this Contract between the parties any amounts which are or shall become due and payable to the Board by the Actuary. Notwithstanding anything to the contrary herein, any reduction of payments to Actuary shall be made only with the prior agreement of both parties. In addition, in the event of termination of this Contract for any reason, Actuary shall be paid for services rendered and allowable expenses incurred up to the effective date of termination. G. The Board agrees to make payment in accordance with Mississippi law on “Timely Payments for Purchases by Public Bodies”, Section 31-7-301, et seq. of the 1972 Mississippi Code Annotated, as amended, which generally provides for payment of undisputed amounts within forty-five (45) days of receipt of the invoice. Payments using the Statewide Automated Accounting System (SAAS) shall be made and remittance information provided electronically as directed by the State. These payments shall be deposited into the bank account of the Actuary’s choice. The Board may, at its sole discretion, require the Actuary to submit invoices and supporting documentation electronically at any time during the term of this Contract. The Actuary understands and agrees that the Board is exempt from the payment of taxes. All payments shall be in the United States currency. No payment, including final payment, shall be construed as acceptance of defective or incomplete work, and the Actuary shall remain responsible and liable for full performance. 4. AVAILABILITY OF FUNDS 4
  • It is expressly understood and agreed that the obligation of the Board to proceed under this Contract is conditioned upon the appropriation of funds by the Mississippi State Legislature and the receipt of State and/or federal funds. If the funds anticipated for the continuing fulfillment of this Contract are, at anytime, not forthcoming or insufficient, either through the failure of the federal government to provide funds or of the State of Mississippi to appropriate funds, or the discontinuance or material alteration of the program under which such funds were provided, or if funds are not otherwise available to the State, the Board shall have the right upon ten (10) working days written notice to the Actuary, to terminate this Contract without damage, penalty, cost, or expenses to the Board of any kind whatsoever. The effective date of termination shall be as specified in the notice of termination. 5. ACCESS TO RECORDS The Actuary agrees that the Board or any of its duly authorized representatives, at any time during the term of this Contract, shall have access to and the right to audit and examine any pertinent books, documents, papers, and records of the Actuary related to the Actuary’s charges and performance under this Contract. The Actuary shall retain such records for a period of six (6) years after final payment under this Contract, unless the Board authorizes in writing their earlier disposition. The Actuary agrees to refund to the Board any overpayment disclosed by any such audit. However, if any litigation, claim, negotiation, audit, or other action involving the records has been started before the expiration of the six (6) year period, the records shall be retained until completion of the action and resolution of all issues that arise from it. Information generated by the Actuary may be subject to the Public Records Law of the State of Mississippi. Unless otherwise required by law, the Board will not disseminate, sell, or license any proprietary information to others without the Actuary’s prior written approval. The Actuary recognizes that it may have access to certain confidential and proprietary information pertaining to the business of the Board. The Actuary agrees that it will not, at any time, directly or indirectly disclose such confidential or proprietary information to any other person or organization for any purpose except as may be required by law, or as reasonably relates to the services being provided by the Actuary pursuant to this Contract, without the express, written approval of the Board. 6. STANDARDS OF CARE/REMEDIES The Actuary will exercise reasonable care and due diligence consistent with standards in the industry in the performance of its obligations under this Contract. Each party shall have available to it all remedies at law or equity. 7. APPLICABLE LAW/VENUE This Contract shall be governed by and construed in accordance with the laws of the State of Mississippi, excluding its conflicts of laws provisions. The Actuary shall comply with applicable 5
  • federal, state, and local laws and regulations. Venue for any action shall be in the First Judicial District, Hinds County, Mississippi. 8. SEVERABILITY If any part of this Agreement is declared to be invalid or unenforceable, such invalidity or unenforceability shall not affect any other provision of the Agreement that can be given effect without the invalid or unenforceable provision, and to this end, the provisions hereof are severable. In such event, the parties shall amend the Agreement as necessary to reflect the original intent of the parties and to bring any invalid or unenforceable provisions in compliance with applicable law. 9. ASSIGNMENT The Actuary shall not assign or subcontract, in whole or in part, its rights, or obligations under this Contract without prior written consent of the Board. Any attempted assignment without said consent shall be void and of no effect. 10. COMPLIANCE WITH LAWS The Actuary understands that the State of Mississippi is an equal opportunity employer and therefore maintains a policy which prohibits unlawful discrimination based on race, color, creed, sex, age, national origin, physical handicap, disability, or any other consideration made unlawful by federal, State, or local laws. All such discrimination is unlawful and the Actuary agrees during the term of this Contract that the Actuary will strictly adhere to this policy in its employment practices and provision of services. The Actuary shall comply with, and all activities under this Contract shall be subject to, all applicable federal, State of Mississippi, and local laws and regulations, as now existing and as may be amended or modified. 11. INDEPENDENT CONTRACTOR The Actuary shall perform all services as an independent contractor and shall at no time act as an agent for the State. No act performed or representation made, whether oral or written, by the Actuary with respect to third parties shall be binding to the Board. 12. MODIFICATION / AMENDMENTS / RENEGOTIATION This Contract may be modified, altered, or changed only by written agreement signed by the parties hereto. The parties agree to renegotiate this Contract if federal and/or State revisions of any applicable laws or regulations make significant changes in this Contract necessary. 13. REPRESENTATION REGARDING CONTINGENT FEES The Actuary represents that it has not retained a person to solicit or secure a State contract upon an agreement or understanding for a commission, percentage, brokerage, or contingent fee. The Board will not pay any commissions and/or any brokerage, percentage, finder’s service, or contingent fees for securing or executing any of the services outlined in this Contract. 6
  • 14. REPRESENTATION REGARDING GRATUITIES The Actuary represents that it has not violated, is not violating, and promises that it will not violate any prohibition against gratuities set forth in Section 7-204 (Gratuities) of the Mississippi Personal Service Contract Procurement Regulations. 15. TERMINATION FOR CONVENIENCE A. Termination. The Board may, when the interests of the State so require, terminate this Contract in whole or in part for the convenience of the State. The Board shall give written notification of the termination to the Actuary specifying the part of the Contract terminated and when termination becomes effective. B. Actuary’s Obligations. The Actuary shall incur no further obligations in connection with the terminated work and on the date set in the notice of termination, the Actuary will stop work to the extent specified. The Actuary shall also terminate outstanding orders and subcontracts as they relate to the terminated work. The Actuary shall settle the liabilities and claims arising out of the termination of subcontractors and orders connected with the terminated work. The Board may direct the Actuary to assign the Actuary’s right, title and interest under terminated orders or subcontracts to the State. The Actuary must still complete the work not terminated by the notice of termination and may incur obligations as are necessary to do so. 16. TERMINATION FOR DEFAULT A. Default. If the Actuary refuses or fails to perform any of the provisions of this Contract with such diligence as will ensure its completion within the time specified within this Contract, or any extension thereof; otherwise fails to timely satisfy the Contract provisions, or commits any other substantial breach of Contract, the Board may notify the Actuary in writing of the delay or nonperformance, and if not cured in ten days or any longer time specified in writing by the Board, the Board may terminate the Actuary’s right to proceed with this Contract or such part of this Contract as to which there has been delay or failure to properly perform. In the event of termination in whole or in part, the Board may procure similar supplies or services in a manner and upon the terms deemed appropriate by the Board. The Actuary shall continue performance of the Contract to the extent it is not terminated. B. Actuary’s Duties. Notwithstanding termination of this Contract and subject to any directions from the Board, the Actuary shall take timely, reasonable, and necessary actions to protect and preserve property in the possession of the Actuary in which the State has an interest. C. Compensation. Payment for completed services delivered and accepted by the State shall be at the Contract price. The Board may withhold from amounts due the 7
  • Actuary such sums as the Board deems to be necessary to protect the Board against loss because of outstanding lien holders. D. Excuse for Nonperformance or Delayed Performance. Except with respect to defaults of subcontractors, the Actuary shall not be in default by reason of any failure in performance of this Contract in accordance with its terms (including any failure by the Actuary to make progress in the prosecution of the work hereunder which endangers performance) if the Actuary has notified the Board within 15 days after the cause of the delay and the failure arises out of causes such as: acts of God; acts of the public enemy; acts of the State and any other governmental entity in its sovereign or contractual capacity; fires; floods; epidemics; quarantine restrictions; strikes or other labor disputes; freight embargoes; or unusually severe weather or other causes beyond the Actuary’s reasonable control. If the failure to perform is caused by the failure of a subcontractor to perform or make progress, and if such failure arises out of causes similar to those set forth above, the Actuary shall not be deemed to be in default, unless the services to be furnished by the subcontractor were reasonably obtained from other sources in sufficient time to permit the Actuary to meet the Contract requirements. If any failure to perform was occasioned by any one or more of the excusable clauses, and that, but for the excusable cause, the Actuary’s progress and performance would have met the terms of the Contract, the delivery schedule shall be revised accordingly, subject to the rights of the State under the clause of this Contract entitled “Termination for Convenience”. E. Erroneous Termination for Default. If, after notice of termination of the Actuary’s right to proceed under the provisions of this clause, it is determined for any reason that the Contract was not in default under the provisions of this clause, or that the delay was excusable under the provisions of this clause, or that the delay was excusable under the provisions of Paragraph (D) of this clause, the rights and obligations of the parties shall be the same as if the notice of termination had been issued pursuant to the clause of this Contract entitled “Termination for Convenience”. F. Additional Rights and Remedies. The rights and remedies provided under this clause are in addition to any other rights and remedies provided by law or under this Contract. 17. STOP WORK ORDER A. Order to Stop Work. The Board may by written order to the Actuary at any time, and without notice to any surety, require the Actuary to stop all or any part of the work called for by this Contract. This order shall be for a specified period not exceeding 90 days after the order is delivered to the Actuary, unless the parties agree to any further period. Any such order shall be identified specifically as a stop work order issued pursuant to this clause. Upon receipt of such an order, the Actuary shall forthwith comply with its terms and take all reasonable steps to minimize the occurrence of costs allocable to work covered by the order during the period of work stoppage. Before the stop work order expires, or within any further period to which the parties shall have agreed, the Board shall either: 8
  • 1. cancel the stop work order; or 2. terminate the work covered by such order as provided in the “Termination for Default” clause or the “Termination for Convenience” clause of this Contract. B. Cancellation or Expiration of the Order. If a stop work order issued under this clause is canceled at any time during the period specified in the order, or if the period of the order or any extension thereof expires, the Actuary shall have the right to resume work. An appropriate adjustment shall be made in the delivery schedule or the Actuary price, or both, and the Contract shall be modified in writing accordingly, if: 1. the stop work order results in an increase in the time required for, or in the Actuary’s cost properly allocable to, the performance of any part of this Contract; and 2. the Actuary asserts a claim for such an adjustment within 30 days after the end of the period of work stoppage; provided that, if the Board decides that the facts justify such action, any such claim asserted may be received and acted upon at any time prior to final payment under this Contract. C. Termination of Stopped Work. If a stop work order is not canceled and the work covered by such order is terminated for default or convenience, the reasonable costs resulting from the stop work order shall be allowed by adjustment or otherwise. D. Adjustment of Price. Any adjustment in Contract price made pursuant to this clause shall be determined in accordance with the “Modification / Amendments / Renegotiation” clause of this Contract. 18. ORAL STATEMENTS No oral statement of any person shall modify or otherwise affect the terms, conditions, or specifications stated in this Contract. All modifications to this Contract must be made in writing by the Board. 19. OWNERSHIP OF DOCUMENTS AND WORK PAPERS The Board shall own all documents, files, reports, work papers and working documentation, electronic or otherwise, created in connection with the project which is the subject of this Contract, except for the Actuary’s internal administrative and quality assurance files and internal project correspondence. The Actuary shall deliver such documents and work papers to the Board upon termination or completion of this Contract. The foregoing notwithstanding, the Actuary shall be entitled to retain a set of such work papers for its files. The Actuary shall be entitled to use such work papers only after receiving written permission from the Board and subject to any copyright protections. 9
  • 20. INDEMNIFICATION To the fullest extent allowed by law, the Actuary shall indemnify, defend, save and hold harmless, protect, and exonerate the State of Mississippi (State), its Commissioners, Board Members, officers, employees, agents, and representatives from and against all claims, demands, liabilities, suits, actions, damages, losses, and costs of every kind and nature whatsoever, including, without limitation, court costs, investigative fees and expenses, and attorneys’ fees, arising out of or caused by the Actuary and/or its partners, principals, agents, employees, and/or Subcontractors in the performance of or failure to perform this agreement. In the State’s sole discretion, the Actuary may be allowed to control the defense of any such claim, suit, etc. In the event the Actuary defends said claim, suit, etc., the Actuary shall use legal counsel acceptable to the State; the Actuary shall be solely responsible for all costs and/or expenses associated with such defense, and the State shall be entitled to participate in said defense. The Actuary shall not settle any claim, suit, etc. without the State’s concurrence, which the State shall not unreasonably withhold. 21. INSURANCE The Actuary shall maintain, throughout the term of this Contract, at its own expense, professional and comprehensive general liability insurance. Such policy of insurance shall provide a minimum coverage in the amount of One Million Dollars ($1,000,000) per occurrence, Three Million Dollars ($3,000,000) annual aggregate through an insurance company licensed by the Mississippi Department of Insurance. The Actuary shall annually provide the Board a current Certificate of Insurance. 22. THIRD PARTY ACTION NOTIFICATION The Actuary shall give the Board prompt notice in writing of any action or suit filed, and prompt notice of any claim made against the Actuary by any entity that may result in litigation related in any way to this Contract. 23. CONTRACTOR PERSONNEL The Board shall, throughout the life of the contract, have the right of reasonable rejection and approval of staff or Subcontractors assigned to the work by the Actuary. If the Board reasonably rejects staff or Subcontractors, the Actuary must provide replacement staff or Subcontractors satisfactory to the Board in a timely manner and at no additional cost to the Board. The day-to-day supervision and control of the Actuary’s employees and Subcontractors is the sole responsibility of the Actuary. 24. RECOVERY OF MONEY Whenever, under the contract, any sum of money shall be recoverable from or payable by the Actuary to the Board, the same amount may be deducted from any sum due to the Actuary under the contract or under any other contract between the Actuary and the Board. The rights of the Board are in addition and without prejudice to any other right the Board may have to claim the amount of any loss or damage suffered by the Board on account of the acts or omissions of the Actuary. 10
  • 25. NOTICE All notices required or permitted to be given under this Contract must be in writing and personally delivered or sent by certified United States mail postage prepaid, return receipt requested, to the party to whom the notice should be given at the addresses set forth below. Notice shall be deemed given when actually received or when refused. The parties agree to promptly notify each other in writing of any change of address. The addresses to which notices are initially to be sent are as follows: (a) If to the Board: Executive Director Department of Finance and Administration Post Office Box 267 Jackson, Mississippi 39205 Facsimile No: (601) 359-2405 With a copy of any notice to: State Insurance Administrator Office of Insurance Department of Finance and Administration Post Office Box 24208 Jackson, Mississippi 39225-4208 Facsimile No: (601) 359-6568 (b) If to Actuary: 26. INCORPORATION OF DOCUMENTS The State’s Request for Proposal (RFP) entitled “State of Mississippi Request for Proposal for Actuarial Services”, dated March 13, 2008, the Business Associate Addendum, and the Actuary’s response to the Request for Proposal are attached hereto as Exhibit B and made a part hereof as if fully copied in words and figures herein. The terms of the Actuarial Services Standard Contract shall control in the event there is a conflict between the terms of the Contract, Request for Proposal, or Actuary’s Response to Request for Proposal. State and School Employees ______________________________________ Health Insurance Management Board 11
  • BY: ________________________________ BY: __________________________________ TITLE: _____________________________ TITLE: _______________________________ DATE: _____________________________ DATE:________________________________ 12
  • Draft Actuarial Services Contract Business Associate Addendum This Business Associate Addendum (Addendum) supplements and is made part of the Actuarial Services Contract (Contract) entered into by and between (Insert Vendor Name), (Business Associate) and the State and School Employees Health Insurance Management Board (Board) and shall apply to the Business Associate’s services provided pursuant to the Contract relating to the State and School Employee’s Life and Health Insurance Plan (Covered Entity). Whereas, the Board and Business Associate have entered into the Contract, and whereas the parties are entering into this Addendum to satisfy certain standards and requirements of the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191 (HIPAA) and regulations promulgated thereunder by the U.S. Department of Health and Human Services (HIPAA Regulations) and other applicable laws; Whereas, the Covered Entity wishes to disclose certain information (Information) to Business Associate pursuant to the terms of the Contract, some of which may constitute Protected Health Information (PHI); Whereas, the Covered Entity desires and directs Business Associate to share PHI with other Business Associates of Covered Entity; Therefore, in consideration of mutual promises below and exchange of information pursuant to this Addendum, the parties agree as follows: 1. Definitions. Terms used, but not otherwise defined, in this Addendum or the Contract shall have the same meaning as those terms in the Standards for Privacy of Individually Identifiable Information (the Privacy Rule) and the Security Standards under the Health and Insurance Portability and Accountability Act of 1996 (HIPAA). In the event of an inconsistency between the provisions of this Addendum and mandatory provisions of the Privacy Rule and or the Security Standards, as amended, the Privacy Rule and/or the Security Standards shall control. Where provisions of this Addendum are different than those mandated in the Privacy Rule and/or the Security Standards, but are nonetheless permitted by the Privacy Rule and/or the Security Standards, the provisions of this Addendum shall control. a. Business Associate. “Business Associate” shall have the meaning given to such term under the HIPAA Regulations, including, but not limited to, 45 CFR Section 160.103, of which meaning (Insert Vendor Name), meets. 1
  • b. Covered Entity. “Covered Entity” shall have the same meaning given to such term under the HIPAA Regulations, including, but not limited to, 45 CFR Section 160.103, of which meaning the State and School Employees’ Health Insurance Plan meets. c. Electronic Media. “Electronic Media” shall have the meaning set forth in 45 in CFR § 160.103, which is: i. Electronic storage media including memory devices in computers (hard drives) and any removable/transportable digital memory medium, such as magnetic tape or disk, optical disk, or digital memory card; or ii. Transmission media used to exchange information already in electronic storage media. Transmission media include, for example, the internet (wide-open), extranet (using internet technology to link a business with information accessible only to collaborating parties), leased lines, dial-up lines, private networks, and the physical movement of removable/transportable electronic storage media. Certain transmissions, including of paper, via facsimile, and of voice, via telephone, are not considered to be transmissions via electronic media because the information being exchanged did not exist in electronic form before the transmission. d. Electronic Protected Health Care Information or (EPHI). “Electronic Protected Health Care Information or (EPHI)” has the meaning in 45 CFR § 160.103, and is defined as that as that received from, or created or received on behalf of Covered Entity. e. Individual. “Individual" shall have the same meaning as the term “individual" in 45 CFR § 164.501 and shall include a person who qualifies as a personal representative in accordance with 45 § CFR 164.502(g). f. Privacy Rule. “Privacy Rule" shall mean the Standards for Privacy of Individually Identifiable Health Information at 45 § CFR part 160 and part 164, subparts A and E. g. Protected Health Information or (PHI). “PHI” shall have the same meaning as the term “protected health information" in 45 CFR 164.501, limited to the information created or received by Business Associate from or on behalf of Covered Entity. h. Required By Law. “Required By Law” shall have the same meaning as the defined term “required by law” in 45 § CFR 164.501, except the term “covered entity” therein shall be replaced with “business associate” or “person,” as applicable. 2
  • i. Security Incident. “Security Incident” has the meaning in 45 CFR § 164.304, which is: the attempted or successful unauthorized access, use, disclosure, modification, or destruction of information or interference with system operations in an information system. j. Security Standards. “Security Standards” shall mean the Security Standards under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) codified at 45 CFR Parts 160 and 164 (Security Rule) 2. Obligations and Activities of Business Associate. a. Use and Disclosure of Protected Health Information. Business Associate may use and/or disclose Covered Entity’s PHI received by Business Associate pursuant to this Addendum, the Contract, or as required by law, or as permitted under 45 CFR § 164.512, subject to the provisions set forth in this Addendum. Business Associate may use PHI in its possession for its proper management and administration or to fulfill any of its legal responsibilities. Covered Entity specifically requests that Business Associate disclose PHI to other Business Associates of Covered Entity for Health Care Operations of the Covered Entity. Covered Entity shall provide a list of the affected Business Associates and will request specific disclosures in written format. If any affected Business Associate is no longer under a business associate agreement with Covered Entity, Covered Entity shall promptly inform Business Associate of such change. b. Safeguards Against Misuse of Information. Business Associate shall use appropriate safeguards to prevent the use or disclosure of Covered Entity’s PHI in any manner other than as required by this Addendum, the Contract, or as required by law. Business Associate shall maintain a comprehensive written information privacy and security program that includes administrative, technical, and physical safeguards appropriate to the size and complexity of the Business Associate’s operations and the nature and scope of its activities. c. Reporting of Disclosures. Business Associate shall report to Covered Entity any use or disclosure of Covered Entity’s PHI in violation of this Addendum, the Contract, or as required by law of which the Business Associate is aware, and agrees to mitigate, to the extent practicable, any harmful effect that is known to Business Associate of a use or disclosure of Covered Entity’s PHI by Business Associate in violation of this Addendum. d. Business Associate’s Agents. Business Associate shall ensure that any agents, including subcontractors, to whom it provides PHI received from (or created or received by Business Associate on behalf of) Covered Entity agree to be bound to by the same restrictions and conditions on the use or disclosure of PHI as apply to Business Associate with respect to such PHI. 3
  • Business Associate represents that in the event of a disclosure of PHI to any third party, the information disclosed shall be no more than the minimum necessary for the intended purpose. e. Nondisclosure. Business Associate shall not use or further disclose Covered Entity’s PHI otherwise than as permitted or required by this Addendum, the Contract, or as required by law. f. Availability of Information to Covered Entity and Provision of Access and Accountings. Business Associate shall make available to Covered Entity such information as Covered Entity may require to fulfill Covered Entity’s obligations to provide access to, provide a copy of, and account for disclosures with respect to PHI pursuant to HIPAA and the HIPAA Regulations, including, but not limited to, 45 CFR Sections 164.524 and 164.528. Business Associate agrees to provide access, at the request of Covered Entity, and in the time and manner designated by Covered Entity, to Protected Health Information to Covered Entity or, as directed by Covered Entity, to an Individual in order to meet the requirements under 45 CFR 164.524. As requested by Covered entity, Business Associate shall produce an accounting of disclosures to an Individual in accordance with 45 CFR § 164.528. [45 CFR § 164.504(e)(2)(E) and (G)] g. Amendment of PHI. Business Associate shall make Covered Entity’s PHI available to Covered Entity as Covered Entity may require to fulfill Covered Entity’s obligations to amend PHI pursuant to HIPAA and the HIPAA Regulations, including, but not limited to, 45 CFR Section 164.526 and Business Associate shall, as directed by Covered Entity, incorporate any amendments to Covered Entity’s PHI into copies of such PHI maintained by Business Associate. Business Associate agrees to make any amendment(s) to Protected Health Information that the Covered Entity directs or agrees to pursuant to 45 CFR 164.526 at the request of Covered Entity or an Individual, and in the time and manner designated by Covered Entity. [45 CFR § 164.504(e)(2)(F)] h. Internal Practices. Business Associate agrees to make its internal practices, policies, procedures, books, and records relating to the use and disclosure of PHI received from Covered Entity (or created or received by Business Associate on behalf of Covered Entity) available to the Secretary of the U.S. Department of Health and Human Services for inspection and copying for purposes of the determining Covered Entity's compliance with HIPAA and the HIPAA Regulations. i. Notification of Breach. During the term of this Addendum, Business Associate shall notify Covered Entity within twenty-four (24) hours of any suspected or actual breach of security, intrusion or unauthorized use or disclosure of PHI and/or any actual or suspected use or disclosure of data in violation of any applicable federal or state laws or regulations. Business 4
  • Associate shall take (i) prompt corrective action to cure any such deficiencies and (ii) any action pertaining to such unauthorized disclosure required by applicable federal and state laws and regulations. j. Safeguard of EPHI. The Business Associate will implement administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of the Electronic Protected Health Information that it creates, receives, maintains, or transmits on behalf of the Covered Entity. k. Subcontractors. The Business Associate will ensure that any agent, including a subcontractor, to whom it provides PHI agrees to implement reasonable and appropriate safeguards to protect it. l. Notification. The Business Associate will, beginning on {Insert Date of Contract}, report to the Covered Entity through the Department of Finance and Administration, Office of Insurance any Security Incident of which it becomes aware, in the following time and manner; i. any actual, successful Security Incident will be reported to Covered Entity in writing, within five (5) business days of the date on which Business Associate becomes aware of such actual successful Security Incident; and ii. any attempted, unsuccessful Security Incident, of which Business Associate becomes aware, will be reported to Covered Entity in writing, on a reasonable basis, at the written request of Covered Entity. If the Security Rule is amended to remove the requirement to report unsuccessful attempts at unauthorized access, this subsection (ii) shall no longer apply as of the effective date of the amendment of the Security Rule. m. Data Aggregation. Business Associate may use PHI in its possession to provide data aggregation services relating to the health care operations of Covered Entity, as provided for in 45 CFR §164.501. n. De-identification of PHI. Business Associate may de-identify any and all PHI, provided that the de-identification conforms to the requirements of 45 CFR §164.514(b), and further provided that Business Associate maintains the documentation required by 45 CFR §164.514(b), which may be in the form of a written assurance from Business Associate. Pursuant to 45 CFR §164.502(d), de-identified information does not constitute PHI and is not subject to the terms of the Addendum. 5
  • 3. Obligations of Covered Entity a. Covered Entity Representatives. Covered Entity shall designate, in writing to Business Associate, individuals to be regarded as Covered Entity’s representatives, so that in reliance upon such designation Business Associate is authorized to make disclosures of PHI to such individuals or to their designee(s). b. Voluntary Restrictions on Use or Disclosure of PHI. If Covered Entity agrees to voluntary restrictions on use or disclosure, as provided for in 45 CFR §164.522, of PHI received or created by Business Associate regarding an Individual, Covered Entity agrees to pay PBM the actual costs incurred by PBM in accommodating such voluntary restrictions. c. Limitation on Requests. Covered Entity shall not request or require that Business Associate make any use or alteration of PHI that would violate HIPAA or HIPAA Regulations if done by Covered Entity. 4. Audits, Inspection, and Enforcement. Upon reasonable notice, upon a reasonable determination by Covered Entity that Business Associate has breached this Addendum, Covered Entity may inspect the facilities, systems, books and records of Business Associate to monitor compliance with this Addendum. Business Associate shall promptly remedy any violation of any term of this Addendum and shall certify the same to Covered Entity in writing. The fact that Covered Entity inspects, or fails to inspect, or has the right to inspect, Business Associate’s facilities, systems and procedures does not relieve Business Associate of its responsibility to comply with this Addendum, nor does Covered Entity’s (i) failure to detect or (ii) detection, but failure to notify Business Associate or require Business Associate’s remediation of any unsatisfactory practices constitute acceptance of such practice or a waiver of Covered Entity’s enforcement rights under this Addendum. 5. Termination. a. Material Breach. A breach by Business Associate of any provision of this Addendum, as determined by Covered Entity, shall constitute a material breach of the Addendum and shall provide grounds for immediate termination of the Addendum and the Contract by Covered Entity pursuant to Section 4.b. of this Addendum. [45 CFR § 164.504(e)(3)] b. Reasonable Steps to Cure Breach. If Covered Entity knows of a pattern of activity or practice of Business Associate that constitutes a material breach or violation of the Business Associate’s obligations under the provisions of this Addendum or another arrangement and does not terminate this Addendum and the Contract pursuant to Section 4(a), then Covered Entity shall take reasonable steps to cure such breach or end such violation, as 6
  • applicable. If Covered Entity’s efforts to cure such breach or end such violation are unsuccessful, Covered Entity shall either (i) terminate this Addendum and the Contract, if feasible or (ii) if termination of this Addendum and the Contract is not feasible, Covered Entity shall report Business Associate’s breach or violation to the Secretary of the Department of Health and Human Services. [45 CFR § 164.504(e)(1)(ii)] c. Judicial or Administrative Proceedings. Either party may terminate this Addendum, effective immediately, if (i) the other party is named as a defendant in a criminal proceeding for a violation of HIPAA or (ii) a finding or stipulation that the other party has violated any standard or requirement of HIPAA or other security or privacy laws is made in any administrative or civil proceeding in which the party has been joined. d. Effect of Termination. Upon termination of this Addendum and the Contract for any reason, Business Associate shall return or destroy all PHI received from Covered Entity (or created or received by Business Associate on behalf of Covered Entity) that Business Associate still maintains in any form, and shall retain no copies of such PHI or, if return or destruction is not feasible, it shall continue to extend the protections of this Addendum to such information, and limit further use of such PHI to those purposes that make the return or destruction of such PHI infeasible. [45 CFR § 164.504(e)(2)(I)] 6. Disclaimer. Covered Entity makes no warranty or representation that compliance by Business Associate with this Addendum, HIPAA or the HIPAA Regulations will be adequate or satisfactory for Business Associate’s own purposes or that any information in Business Associate’s possession or control, or transmitted or received by Business Associate, is or will be secure from unauthorized use or disclosure. Business Associate is solely responsible for all decisions made by Business Associate regarding the safeguarding of PHI. 7. Amendment. Amendment to Comply with Law. The parties acknowledge that state and federal laws relating to electronic data security and privacy are rapidly evolving and that amendment of this Addendum may be required to provide for procedures to ensure compliance with such developments. The parties specifically agree to take such action as is necessary to implement the standards and requirements of HIPAA, the HIPAA Regulations and other applicable laws relating to the security or confidentiality of PHI. The parties understand and agree that Covered Entity must receive satisfactory written assurance from Business Associate that Business Associate will adequately safeguard all PHI that it receives or creates pursuant to this Addendum. Upon Covered Entity’s request, Business Associate agrees to 7
  • promptly enter into negotiations with Covered Entity concerning the terms of an amendment to this Addendum embodying written assurances consistent with the standards and requirements of HIPAA, the HIPAA Regulations or other applicable laws. Covered Entity may terminate this Addendum upon 30 days written notice in the event (i) Business Associate does not promptly enter into negotiations to amend this Addendum when requested by Covered Entity pursuant to this Section or (ii) Business Associate does not enter into an amendment to this Addendum providing assurances regarding the safeguarding of PHI that Covered Entity, in its sole discretion, deems sufficient to satisfy the standards and requirements of HIPAA and the HIPAA Regulations. 8. Assistance in Litigation or Administrative Proceedings. Business Associate shall make itself, and any subcontractors, employees or agents assisting Business Associate in the performance of its obligations under this Addendum, available to Covered Entity, at no cost to Covered Entity, to testify as witnesses, or otherwise, in the event of litigation or administrative proceedings being commenced against Covered Entity, its directors, officers or employees based upon claimed violation of HIPAA, the HIPAA Regulations or other laws relating to security and privacy, except where Business Associate or its subcontractor, employee or agent is a named adverse party. 9. No Third Party Beneficiaries. Nothing express or implied in this Addendum is intended to confer, nor shall anything herein confer, upon any person other than Covered Entity, Business Associate and their respective successors or assigns, any rights, remedies, obligations or liabilities whatsoever. 10. Effect on Addendum. Except as specifically required to implement the purposes of this Addendum, or to the extent inconsistent with this Addendum, all other terms of the Contract shall remain in force and effect. 11. Interpretation. This Addendum shall be interpreted as broadly as necessary to implement and comply with HIPAA, HIPAA Regulations and applicable state laws. The parties agree that any ambiguity in this Addendum shall be resolved in favor of a meaning that complies and is consistent with HIPAA and the HIPAA Regulations. The parties hereto agree to duly execute this Addendum as of the Addendum Effective Date. 8
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