15-CONTRACT-SEDGWICK CLAIMS MANAGEMENT SERVICES, INC-SIGNED.PDF
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CONTRACT SHORT TERM DISABILITY ADMINISTRATOR 230123-RFP This contract is entered into this 13th day of September, 2023 by and between Maricopa County (“County”), a political subdivision of the State of Arizona, and Sedgwick Claims Management Services, Inc., an Illinois corporation (“Contractor”) for the purchase of a single Administrative Services Only contract for the administration of a short term disability benefits plan for Maricopa County (County) employees. 1.0 CONTRACT TERM This contract is for a term of five years, beginning on the 1st of January, 2024 and ending the 31st day of December, 2028. 2.0 OPTION TO RENEW The County may, at its option and with the concurrence of the Contractor, renew the term of this contract up to a maximum of five additional year(s), (or at the County’s sole discretion, extend the contract on a month-to-month basis for a maximum of six months after expiration). The Contractor shall be notified in writing by the Office of Procurement Services of the County’s intention to renew the contract term at least 60 calendar days prior to the expiration of the original contract term. 3.0 CONTRACT COMPLETION In preparation for contract completion, the Contractor shall make all reasonable efforts for an orderly transition of its duties and responsibilities to another provider and/or to the County. This may include, but is not limited to, preparation of a transition plan and cooperation with the County or other providers in the transition. The transition includes the transfer of all records and other data in the possession, custody, or control of the Contractor that are required to be provided to the County either by the terms of this agreement or as a matter of law. The provisions of this clause shall survive the expiration or termination of this agreement. 4.0 PRICE ADJUSTMENTS Any requests for reasonable price adjustments must be submitted 60 calendar days prior to contract expiration. Requests for adjustment in cost of labor and/or materials must be supported by appropriate documentation. The reasonableness of the request will be determined by comparing the request with the Consumer Price Index or by performing a market survey. If County agrees to the adjusted price terms, County shall issue written approval of the change and provide an updated version of the contract. The new change shall not be in effect until the date stipulated on the updated version of the contract. 5.0 PAYMENTS 5.1 As consideration for performance of the duties described herein, County shall pay Contractor the sum(s) stated in Exhibit A – Pricing Sheet. 5.2 Payment shall be made upon the County’s receipt of a properly completed invoice. SERIAL 230123-RFP 5.3 INVOICES 5.3.1 The Contractor shall submit one legible copy of their detailed invoice before payment(s) will be made. Incomplete invoices will not be processed. At a minimum, the invoice must provide the following information: 5.3.1.1 Company name, address, and contact information 5.3.1.2 County bill-to name and contact information 5.3.1.3 Contract serial number 5.3.1.4 County purchase order number 5.3.1.5 Project name and/or number 5.3.1.6 Invoice number and date 5.3.1.7 Payment terms 5.3.1.8 Date of service or delivery 5.3.1.9 Quantity 5.3.1.10 Contract item number(s) 5.3.1.11 Description of purchase (product or services) 5.3.1.12 Pricing per unit of purchase 5.3.1.13 Total amount due 5.3.2 Problems regarding billing or invoicing shall be directed to the department as listed on the purchase order. 5.3.3 Payment shall only be made to the Contractor by Accounts Payable through the Maricopa County Vendor Express Payment Program. This is an electronic funds transfer (EFT) process. After contract award, the Contractor shall complete the Vendor Registration Form accessible from the County Department of Finance Vendor Registration Web Site https://www.maricopa.gov/5169/Vendor- Information. 5.3.4 Discounts offered in the contract shall be calculated based on the date a properly completed invoice is received by the County. 5.3.5 EFT payments to the routing and account numbers designated by the Contractor shall include the details on the specific invoices that the payment covers. The Contractor is required to discuss remittance delivery capabilities with their designated financial institution for access to those details. 5.4 APPLICABLE TAXES 5.4.1 It is the responsibility of the Contractor to determine any and all applicable taxes and include those taxes in their proposal. The legal liability to remit the tax is on the entity conducting business in Arizona. Tax is not a determining factor in contract award. 5.4.2 The County will look at the price or offer submitted and will not deduct, add, or alter pricing based on speculation or application of any taxes, nor will the County provide Contractor any advice or guidance regarding taxes. If you have questions regarding your tax liability, seek advice from a tax professional prior to submitting your bid. You may also find information at https://www.azdor.gov/Business.aspx. Once your bid is submitted, the offer is valid for the time specified in this solicitation, regardless of mistake or omission of tax liability. If the County finds overpayment of a project due to tax consideration that was not due, the Contractor will be liable to the County for that amount, and by contracting with the County agrees to remit any overpayments back to the County for miscalculations on taxes included in a bid price. SERIAL 230123-RFP 5.4.3 Tax Indemnification: Contractor and all subcontractors shall pay all Federal, State, and local taxes applicable to their operation and any persons employed by the Contractor. Contractor shall, and require all subcontractors to, hold Maricopa County harmless from any responsibility for taxes, damages, and interest, if applicable, contributions required under Federal and/or State and local laws and regulations, and any other costs including: transaction privilege taxes, unemployment compensation insurance, Social Security, and workers’ compensation. Contractor may be required to establish, to the satisfaction of County, that any and all fees and taxes due to a municipality or the State of Arizona for any license or transaction privilege taxes, use taxes, or similar excise taxes are currently paid (except for matters under legal protest). 6.0 AVAILABILITY OF FUNDS 6.1 The provisions of this contract relating to payment for services shall become effective when funds assigned for the purpose of compensating the Contractor as herein provided are actually available to County for disbursement. The County shall be the sole judge and authority in determining the availability of funds under this contract. County shall keep the Contractor fully informed as to the availability of funds. 6.2 If any action is taken by, any State agency, Federal department, or any other agency or instrumentality to suspend, decrease, or terminate its fiscal obligations under, or in connection with, this contract, County may amend, suspend, decrease, or terminate its obligations under, or in connection with, this contract. In the event of termination, County shall be liable for payment only for services rendered prior to the effective date of the termination, provided that such services are performed in accordance with the provisions of this contract. County shall give written notice of the effective date of any suspension, amendment, or termination under this section, at least 10 days in advance. 7.0 STRATEGIC ALLIANCE for VOLUME EXPENDITURES (SAVE) The County is a member of the SAVE cooperative purchasing group. SAVE includes the State of Arizona, many Phoenix metropolitan area municipalities, and many K-12 unified school districts. Under the SAVE Cooperative Purchasing Agreement, and with the concurrence of the successful respondent under this solicitation, a member of SAVE may access a contract resulting from a solicitation issued by the County. If contractor does not want to grant such access to a member of SAVE, state so in contractor’s bid. In the absence of a statement to the contrary, the County will assume that contractor does wish to grant access to any contract that may result from this bid. The County assumes no responsibility for any purchases by using entities. 8.0 INTERGOVERNMENTAL COOPERATIVE PURCHASING AGREEMENTS (ICPAs) County currently holds ICPAs with numerous governmental entities. These agreements allow those entities, with the approval of the Contractor, to purchase their requirements under the terms and conditions of the County contract. It is the responsibility of the non-County government entity to perform its own due diligence on the acceptability of the contract under its applicable procurement rules, processes, and procedures. Certain governmental agencies may not require an ICPA and may utilize this contract if it meets their individual requirements. Other governmental agencies may enter into a separate Statement of Work with the Contractor to meet their own requirements. The County is not a party to any uses of this contract by other governmental entities. 9.0 DUTIES 9.1 The Contractor shall perform all duties stated in Exhibit B – Scope of Work, Sections 2.1 through 2.9.3 or as otherwise directed in writing by the procurement officer. SERIAL 230123-RFP 9.2 PROGRAM OUTLINE 9.2.1 The Short Term Disability (STD) plan (Plan) is a voluntary self-funded plan offered to all benefit eligible employees. The contractor will be responsible to provide an Administrative Services Only (ASO) product. 9.2.2 Contractor shall make available program services to all County employees. 9.2.3 There is a two-week Elimination Period (14 consecutive calendar days) from the onset of the disability before employees begin to receive disability benefits unless employee becomes hospitalized or gives birth during the elimination period. If the employee is hospitalized or gives birth during the elimination period, the STD benefit will begin on the first day of employee hospitalization or birth. 9.2.4 During the Elimination Period, employees are required to use sick leave during their absence from work. If they do not have enough sick leave to cover the entire Elimination Period, they must use available vacation leave. If the employee does not have sufficient vacation leave, the employee will be unpaid. 9.2.5 Eligibility/Enrollment 9.2.5.1 All individuals eligible under Maricopa County’s group health plan. 9.2.5.2 Eligibility is determined by the County and enrollment is communicated to the contractor using an HR system (Workday) integration file. 9.2.5.3 Contractor shall accept the name and contact information for the department HR liaison for each enrolled member on the HRIS (Workday) enrollment/eligibility changes file or receive a separate excel worksheet with HR contacts by department and maintain all changes to contacts on a regular basis. 9.2.6 Coverage Effective Date 9.2.6.1 Coverage for benefit eligible employees is elected during the annual Open Enrollment process and becomes effective at the beginning of the next plan year (January 1). 9.2.6.2 Coverage for new employees electing the Plan begins on the first calendar day of the month following their date of hire. 9.2.7 Enrollment into the Short-Term Disability Plan is not allowed at the time of a qualified life event change, except for a return from active duty military leave. 9.3 CONTRACTOR REQUIREMENTS 9.3.1 Contractor shall be responsible for the following requirements: 9.3.1.1 Maintain eligibility by receiving eligibility data on a weekly basis via a HIPAA compliant file generated from the County, Workday. 9.3.1.2 Apply data received electronically from Workday to the Contractor’s enrollment/claims payment system and generate an exception report back to Workday. 9.3.1.3 Work with the County to resolve all eligibility/enrollment errors within two business days. SERIAL 230123-RFP 9.3.1.4 Accept subscriber identification number (nine digits) as defined by the County. A subscriber identification number could be either an employee identification number, social security number or an alternative identification number, as defined by the County. 9.3.1.5 Set up the account structure for eligibility and reporting by department. 9.3.1.6 Maintain and update an electronic database in order to administer claim payments, maintain complete claims history, and report to the County. 9.3.1.7 Maintain and update procedures and computer software needed to receive and process all benefit claims according to the Plan and all current and future regulations. 9.3.1.8 Provide an annual SOC 2 report no later than 30 calendar days after the anniversary date of the contract, and upon request by the County. 9.3.1.9 Provide an online and a telephonic claims filing process. 9.3.1.10 Assist the claimant in obtaining medical records if the claimant has not provided such records within two calendar days from a claims filing date. 9.3.1.11 Provide customer service via a toll-free telephone number from, at a minimum, 7:00 a.m. to 7:00 p.m. MST that is staffed with live customer service representatives to assist participants with questions regarding their claims. 9.3.1.11.1 Contractor shall provide an interpreter service, as needed, to assist non-English speaking enrollees. 9.3.1.11.2 Customer service representatives shall have the ability to view information regarding eligibility and claims 9.3.1.11.3 Customer service representatives shall be trained to explain claims denials, reason for pending claims status, and claims payment calculations. 9.3.1.12 Provide online or telephonic access to self-service capabilities where the participant can inquire about his/her claim through an Interactive Voice Response System (IVR) or secure website. 9.3.1.13 Provide a return to work program and provide program results on an annual basis. 9.3.1.14 Be able to perform/coordinate Independent Medical Exams (IMEs) when indicated or when requested by the County. 9.3.1.15 Electronically notify departmental contact persons to obtain required employer information related to a disability claim. 9.3.1.16 Handle first and second level claim appeals. 9.3.1.17 Pay claims on a weekly basis. 9.3.1.18 Assess each claim and identify those anticipated to become long-term disability claims. When such claims are identified, the contractor shall work with the Arizona State Retirement System’s (ASRS) long-term disability carrier to transition the claimant from short-term to long-term disability with minimal payment disruption. SERIAL 230123-RFP 9.3.1.19 Have a process in place to recover any overpayments, regardless of their cause. 9.3.1.20 Provide the County with online inquiry access via the contractor’s website such that the enrollment and claims payment information and standard reports can be viewed. The County prefers to be able to run ad hoc reports via the contractor’s website. 9.3.1.21 Have a continuous quality improvement program and provide a description of their quality improvement efforts on an annual basis. 9.3.1.22 Provide (at no extra cost) fully trained staff to participate during the County’s Open Enrollment Benefits Fairs or any other events hosted by Human Resources, as needed. 9.3.1.23 Produce all collateral materials in both English and Spanish. 9.4 IMPLEMENTATION 9.4.1 Contractor shall provide a qualified implementation team and shall have a comprehensive implementation plan including an implementation timeline such that benefits and services are in place by January 1, 2024. The implementation plan and timeline shall be included as Exhibit D. 9.4.2 Contractor shall put a portion of their fees at risk for completion of implementation tasks by the effective date of the contract, and as indicated in the contractor’s Service Level Agreement (SLA), attached as Exhibit E. 9.4.3 Successful implementation will be measured using the operational milestones which shall be included by the contractor in their proposed implementation plan. The implementation milestones include, but are not limited to, the following: 9.4.3.1 Setting up the account structure and corresponding subgroups 9.4.3.2 Setting up the plan design 9.4.3.3 Establishing the claims edits and/or business rules 9.4.3.4 Ensuring transaction procedures are implemented correctly 9.4.3.5 Ensuring accurate member correspondence and reporting 9.4.3.6 Setting up enrollment data (subscriber, correct plan selection, effective dates, etc.) 9.4.3.7 Setting up the enrolled employer group 9.4.3.8 Setting up benefit plans and corresponding benefit terms 9.4.3.9 Setting up integration files from the County to contractor, including testing 9.4.3.10 Correctly identifying services that need to be pre-authorized 9.4.3.11 Ensuring contractor shall be able to accurately pay claims according to the plan documents 9.4.3.12 Ensuring contractor is prepared to process remittances SERIAL 230123-RFP 9.4.3.13 Ensuring methods are in place for providing County with management reports as indicated in section 9.9 Mandatory Reporting Requirements 9.4.3.14 Ensuring County employer portal access is operational 9.4.3.15 Ensuring all employee-facing documents and materials are provided via electronic format for posting on the County’s intranet and Internet Web sites in English and Spanish. 9.4.4 A final implementation plan and implementation timeline shall be mutually agreed upon, in writing, by the contractor and the County upon award. 9.4.5 Under no circumstances shall the implementation schedule be impacted by a personnel change on the part of the contractor. 9.4.6 After the first quarter of program implementation (January 1 – March 31), Contractor shall conduct a self-audit based upon mutually agreed upon criteria for the purpose of assessing system set-up. The results from this audit shall be due by the following May 15. 9.5 ADMINISTERING THE PLAN 9.5.1 Contractor shall administer the Plan, including, but not limited to, the following action items: 9.5.1.1 Create and maintaining claims files 9.5.1.2 Evaluate claims to determine if they have been properly filed and advise claimants in meeting the requirements for additional information. 9.5.1.3 Reviewing healthcare provider documentation and confirming disability. 9.5.1.4 Compute the benefits due in accordance with the current benefit plan document. 9.5.1.5 Issue benefit payments to the claimant. 9.5.1.6 Discuss claims, where appropriate, with physicians and other healthcare providers. 9.5.1.7 Apply claims control procedures necessary for the effective administration of the Plan. 9.5.1.8 Reconcile issued and cleared checks, including prompt weekly reimbursement of any required funds in the event of an account deficit. 9.5.1.9 Prepare a monthly numerical and alphabetical register of benefit payments issued. The register should include the check number, employee name, claimant name, payee name, amount of check, the date incurred and the date paid. 9.5.1.10 Investigate claims that appear to be suspicious or fraudulent. 9.5.1.11 Prepare, print, and distribute administrative forms required for the successful operation of the Plan. SERIAL 230123-RFP 9.6 PROCESSING CLAIMS 9.6.1 Contractor shall pay claims in an accurate and timely fashion 9.6.1.1 Accurate: Contractor shall pay the correct benefit for the correct duration in 99% of claims. In the case of denials, 100% of claims must be denied for appropriate and documented reasons. Contractor shall include guarantee of such in their SLA. 9.6.1.2 Timely: Contractor shall approve or deny a claim within three business days of receipt of all necessary information. Contractor shall issue a benefit payment or notice of claim denial within two business days of claim adjudication. Contractor shall include guarantee of such in their SLA. 9.6.2 Contractor shall: 9.6.2.1 Provide return-to-work rehabilitation assistance at no charge to the employee. This includes coordination of return to work, reduced work schedule, and restrictions and limitations to existing duties. 9.6.2.2 Notify claimants of delayed claim payments that are caused by an error or omission in claim payment documentation. 9.6.2.3 Establish quality assurance standards and control mechanisms. 9.6.2.4 Print checks and corresponding explanations of benefits. 9.6.2.5 Respond within two business days following any inquiry from the County benefits personnel regarding the status or disposition of a claim. Contractor shall include guarantee of such in their SLA. 9.6.2.6 Prepare responses to participant appeals; contractor shall handle first and second level claim appeals. 9.6.2.7 Provide data required for government reporting. 9.7 FEES AND PAYMENTS 9.7.1 Contractor administrative fees as indicated in Exhibit A – Vendor Information and Pricing Sheet 9.7.2 Contractor shall use enrollment as of the 2nd calendar day of the month to invoice for any administrative fees based on monthly enrollment 9.7.3 Not-to-exceed renewal rate caps shall be due 360 days prior to the contract renewal dates for years six through ten. Final rates shall be set 180 days prior to the contract renewal date. 9.7.4 County shall self-insure claim payments and fund claim payments no more often than weekly. 9.8 COMMUNICATION WITH EMPLOYEES Contractor shall be responsible for creating and amending, as needed, the County’s summary Plan description, to be included on the County’s website, and other collateral, as needed. All communication shall be subject to County review and approval. SERIAL 230123-RFP 9.9 MANDATORY REPORTING REQUIREMENTS 9.9.1 Contractor shall provide ad hoc reporting as requested by the County at no additional cost to the County. 9.9.2 Contractor shall provide the County with a copy of the JURIS Claims Processing System SOC1 Report or equivalent on an annual basis. 9.9.3 Contractor shall provide, at a minimum, the following reports to the County in Excel or CSV format. All reports are due by the 15th calendar day following the reporting period and must be County-specific. 9.9.3.1 Claim Reports 9.9.3.1.1 Aggregate Monthly Claims Status Summary, including open/closed/pended status, amount paid, total expected benefit amount, offsets, reserve, expected duration, and disability category, by department 9.9.3.1.2 Dollars Paid Quarterly Comparison 9.9.3.1.3 Claims Incidence Quarterly Comparison 9.9.3.1.4 Distribution of Claims by Age 9.9.3.1.5 Number of claims grouped by tenure with the County 9.9.3.1.6 Distribution of claims by disability category, including comparison to industry and book-of-business averages 9.9.3.1.7 Duration comparison by disability category, including comparison to industry and book-of-business averages 9.9.3.1.8 Top ranking disabilities by incidence and cost 9.9.3.1.9 Claimant repeater report (number of claims and dollars paid, grouped by number of claims per claimant) 9.9.3.1.10 Quarterly claims turnaround time report, which shows the average time between disability onset date and claim paid date 9.9.3.1.11 Number of appeals, reasons, and outcomes each quarter 9.9.3.1.12 Number of claims received by month, by department 9.9.3.2 Financial Reports 9.9.3.2.1 Monthly paid check listing 9.9.3.2.2 Monthly outstanding checks listing 9.9.3.2.3 Monthly fund transfers and amounts, and bank reconciliation 9.9.3.2.4 Monthly claims payment and fees paid report 9.9.3.2.5 Adjustments, including voids and stop pays SERIAL 230123-RFP 9.9.3.2.6 Matrix of claims by month incurred and month paid 9.9.3.3 Service Reports 9.9.3.3.1 Results from internal audit procedures 9.9.3.3.2 Average speed of answer by Customer Service Representatives 9.9.3.3.3 Average abandonment rate of calls received by Customer Service Department 9.9.3.4 Claims and Customer Service Reports. Contractor shall maintain and operate an electronic claims and customer service call tracking and call recording systems that maintains all information regarding: 9.9.3.4.1 Customer service calls and all contacts made by a claimant 9.9.3.4.2 Dates and information about the nature of the contact 9.9.3.4.3 Claim specific information including approval, denial, and payment. 9.10 AUDITS 9.10.1 The County reserves the right to audit the contractor’s claims processing, payment, and enrollment records with reasonable notice. 9.10.2 The contractor, by submitting a proposal in response to these specifications, acknowledges the County’s right to select the auditors, and further agrees to cooperate fully with such auditors and waive all fees associated with providing access to the County’s claim records, including use of the contractor’s staff time to assist in the audit. The audits may include, but not be limited to: 9.10.2.1 Determinations of any mathematical errors in computation. 9.10.2.2 Determinations that only eligible insured’s have had claims approved. 9.10.2.3 Review of turnaround time in claim processing. 9.10.3 The audits may be conducted during the policy period and/or upon completion of the policy period and/or following submission of the final policy report by the contractor at the discretion of the County. 9.10.4 Additionally, the contractor may be requested to provide periodic eligibility lists or files to the County at no charge in order to reconcile participants’ eligibility. 9.10.5 If, at any time, the County has a reasonable belief that it is being systematically overcharged or double-billed under the contract, or that any other significant accounting irregularities exist, the County may conduct or hire an agent to conduct an audit of the Contractor’s books and records with respect to this Contract. Such audit shall be undertaken at contractor’s expense. 9.10.6 The County may correct legitimate administrative errors and is the final determinant of when such errors have occurred. The County shall be the final determinant for all eligibility issues. SERIAL 230123-RFP 9.10.7 In determining any person’s rights to benefits under the Plan, contractor shall rely upon eligibility information furnished by the County. 10.0 TERMS AND CONDITIONS 10.1 INDEMNIFICATION 10.1.1 To the fullest extent permitted by law, and to the extent that claims, damages, losses, or expenses are not covered and paid by insurance purchased by the contractor, the contractor shall defend, indemnify, and hold harmless the County (as Owner), its agents, representatives, officers, directors, officials, and employees from and against all claims, damages, losses, and expenses (including, but not limited to attorneys' fees, court costs, expert witness fees, and the costs and attorneys' fees for appellate proceedings) arising out of, or alleged to have resulted from, the negligent acts, errors, omissions, or mistakes of the contractor, a subcontractor, anyone directly or indirectly employed by them, or anyone for whose acts they may be liable relating to the performance of this contract. 10.1.2 Contractor's duty to defend, indemnify, and hold harmless the County, its agents, representatives, officers, directors, officials, and employees shall arise in connection with any claim, damage, loss, or expense that is attributable to bodily injury, sickness, disease, death, or injury to, impairment of, or destruction of tangible property, including loss of use resulting therefrom, caused by negligent acts, errors, omissions, or mistakes in the performance of this contract, but only to the extent caused by the negligent acts or omissions of the contractor, a subcontractor, anyone directly or indirectly employed by them, or anyone for whose acts they may be liable, regardless of whether or not such claim, damage, loss, or expense is caused in part by a party indemnified hereunder. 10.1.3 The amount and type of insurance coverage requirements set forth herein will in no way be construed as limiting the scope of the indemnity in this section. 10.1.4 The scope of this indemnification does not extend to the sole negligence of County. 10.2 INSURANCE 10.2.1 Contractor, at Contractor’s own expense, shall purchase and maintain, at a minimum, the herein stipulated insurance from a company or companies duly licensed by the State of Arizona and possessing an AM Best, Inc. category rating of B++. In lieu of State of Arizona licensing, the stipulated insurance may be purchased from a company or companies, which are authorized to do business in the State of Arizona, provided that said insurance companies meet the approval of County. The form of any insurance policies and forms must be acceptable to County. 10.2.2 All insurance required herein shall be maintained in full force and effect until all work or service required to be performed under the terms of the contract is satisfactorily completed and formally accepted. Failure to do so may, at the sole discretion of County, constitute a material breach of this contract. 10.2.3 In the event that the insurance required is written on a claims-made basis, Contractor warrants that any retroactive date under the policy shall precede the effective date of this contract and either continuous coverage will be maintained, or an extended discovery period will be exercised for a period of two years beginning at the time work under this contract is completed. 10.2.4 Contractor’s Commercial General Liability & Auto Liability insurance shall be primary insurance as respects County, and any insurance or self-insurance maintained by County shall not contribute to it. SERIAL 230123-RFP 10.2.5 Any failure to comply with the claim reporting provisions of the insurance policies or any breach of an insurance policy warranty shall not affect the County’s right to coverage afforded under the insurance policies. 10.2.6 The insurance policies may provide coverage that contains deductibles or self- insured retentions. Such deductible and/or self-insured retentions shall not be applicable with respect to the coverage provided to County under such policies. Contractor shall be solely responsible for the deductible and/or self-insured retention and County, at its option, may require Contractor to secure payment of such deductibles or self-insured retentions by a surety bond or an irrevocable and unconditional letter of credit. 10.2.7 The insurance policies required by this contract, except Workers’ Compensation and Errors and Omissions, shall include County, its agents, representatives, officers, directors, officials, and employees as additional insureds. 10.2.8 The policies required hereunder, except Workers’ Compensation and Errors and Omissions, shall contain a waiver of transfer of rights of recovery (subrogation) against County, its agents, representatives, officers, directors, officials, and employees for any claims arising out of Contractor’s work or service. 10.2.9 If available, the insurance policies required by this contract may be combined with Commercial Umbrella Insurance policies to meet the minimum limit requirements. If a Commercial Umbrella insurance policy is utilized to meet insurance requirements, the Certificate of Insurance shall indicate which lines the Commercial Umbrella Insurance covers. 10.2.9.1 Commercial General Liability Commercial General Liability (CGL) insurance and, if necessary, Commercial Umbrella insurance with a limit of not less than $2,000,000 for each occurrence, $4,000,000 Products/Completed Operations Aggregate, and $4,000,000 General Aggregate Limit. The policy shall include coverage for premises liability, bodily injury, broad form property damage, personal injury, products and completed operations and blanket contractual coverage, and shall not contain any provisions which would serve to limit third party action over claims. There shall be no endorsement or modifications of the CGL limiting the scope of coverage for liability arising from explosion, collapse, or underground property damage. 10.2.9.2 Workers’ Compensation 10.2.9.2.1 Workers’ compensation insurance to cover obligations imposed by Federal and State statutes having jurisdiction of Contractor’s employees engaged in the performance of the work or services under this contract; and Employer’s Liability insurance of not less than $1,000,000 for each accident, $1,000,000 disease for each employee, and $1,000,000 disease policy limit. 10.2.9.2.2 Contractor, its subcontractors, and sub-subcontractors waive all rights against this contract and its agents, officers, directors, and employees for recovery of damages to the extent these damages are covered by the workers’ compensation and Employer’s Liability or Commercial Umbrella Liability insurance obtained by Contractor, its subcontractors, and its sub-subcontractors pursuant to this contract. SERIAL 230123-RFP 10.2.9.3 Errors and Omissions/Professional Liability Insurance Contractor shall maintain Professional Liability insurance which will provide coverage for any and all acts arising out of the work or services performed by the contractor under the terms of this contract, with a limit of not less than $2,000,000 per wrongful act for each claim, and $4,000,000 aggregate claims. 10.2.10 Certificates of Insurance 10.2.10.1 Prior to contract award, Contractor shall furnish the County with valid and complete Certificates of Insurance, or formal endorsements as required by the contract in the form provided by the County, issued by Contractor’s insurer(s), as evidence that policies providing the required coverage, conditions and limits required by this contract are in full force and effect. Such certificates shall identify this contract number and title. 10.2.10.2 In the event any insurance policy(ies) required by this contract is (are) written on a claims-made basis, coverage shall extend for two years past completion and acceptance of Contractor’s work or services and as evidenced by annual certificates of insurance. 10.2.10.3 If a policy does expire during the life of the Contract, a renewal certificate will be provided as soon as practicable but no later than 10 days following any insurance renewal. 10.2.10.4 Certificates of Insurance shall identify Maricopa County as the certificate holder as follows: Maricopa County c/o Risk Management 301 W Jefferson St, Suite 910 Phoenix, AZ 85003 10.2.11 Cancellation and Expiration Notice Should any of the above-described policies be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy provisions. Contractor must provide to Maricopa County, within two business days of receipt, if they receive notice of a policy that has been or will be suspended, canceled, materially changed for any reason, has expired, or will be expiring. Such notice shall be sent directly to Maricopa County Office of Procurement Services and shall be mailed, or hand delivered to 301 W. Jefferson St. Suite 700, Phoenix, AZ 85003, or emailed to the procurement officer noted in the solicitation. 10.3 FORCE MAJEURE 10.3.1 Neither party shall be liable for failure of performance, nor incur any liability to the other party on account of any loss or damage resulting from any delay or failure to perform all or any part of this contract, if such delay or failure is caused by events, occurrences, or causes beyond the reasonable control and without negligence of the parties. Such events, occurrences, or causes include, but are not limited to, acts of God/nature (including fire, flood, earthquake, storm, hurricane, or other natural disaster), war, invasion, act of foreign enemies, hostilities (whether war is declared or not), civil war, riots, rebellion, revolution, insurrection, military or usurped power or confiscation, terrorist activities, nationalization, government sanction, lockout, blockage, embargo, labor dispute, strike, and interruption or failure of electricity or telecommunication service, and pandemic. SERIAL 230123-RFP 10.3.2 Each party, as applicable, shall give the other party notice of its inability to perform and particulars in reasonable detail of the cause of the inability. Each party must use best efforts to remedy the situation and remove, as soon as practicable, the cause of its inability to perform or comply. 10.3.3 The party asserting Force Majeure as a cause for non-performance shall have the burden of proving that reasonable steps were taken to minimize delay or damages caused by foreseeable events, that all non-excused obligations were substantially fulfilled, and that the other party was timely notified of the likelihood or actual occurrence which would justify such an assertion, so that other prudent precautions could be contemplated. 10.4 ORDERING AUTHORITY Any request for purchase shall be accompanied by a valid purchase order issued by a County department or directed by a Certified Agency Procurement Aid (CAPA) with a purchase card for payment. 10.5 INTERNET ORDERING CAPABILITY It is the intent of Maricopa County to use the Internet to communicate and to place orders under this contract. 10.6 NO MINIMUM OR MAXIMUM PURCHASE OBLIGATION This contract does not guarantee any minimum or maximum purchases will be made. Orders will only be placed under this contract when the County identifies a need and proper authorization and documentation have been approved. 10.7 PURCHASE ORDERS 10.7.1 County reserves the right to cancel purchase orders within a reasonable period of time after issuance. Should a purchase order be canceled, the County agrees to reimburse the Contractor for actual and documentable costs incurred by the Contractor in response to the purchase order. The County will not reimburse the Contractor for any costs incurred after receipt of County notice of cancellation, or for lost profits, or for shipment of product prior to issuance of purchase order. 10.7.2 Contractor agrees to accept verbal notification of cancellation of purchase orders from the County procurement officer with written notification to follow. Contractor specifically acknowledges to be bound by this cancellation policy. 10.8 POST AWARD MEETING The contractor may be required to attend a post-award meeting with the department to discuss the terms and conditions of this contract. This meeting will be coordinated by the procurement officer of the contract. 10.9 SUSPENSION OF WORK The procurement officer may order the Contractor, in writing, to suspend, delay, or interrupt all or any part of the work of this contract for the period of time that the procurement officer determines appropriate for the convenience of the County. No adjustment shall be made under this clause for any suspension, delay, or interruption to the extent that performance would have been so suspended, delayed, or interrupted by any other cause, including the fault or negligence of the Contractor. No request for adjustment under this clause shall be granted unless the claim, in an amount stated, is asserted in writing as soon as practicable after the termination of the suspension, delay, or interruption, but not later than SERIAL 230123-RFP the date of final payment under the contract. 10.10 STOP WORK ORDER 10.10.1 The procurement officer may, at any time, by written order to the Contractor, require the Contractor to stop all, or any part, of the work called for by this contract for a period of 90 calendar days after the order is delivered to the Contractor, and for any further period to which the parties may agree. The order shall be specifically identified as a stop work order issued under this clause. Upon receipt of the order, the Contractor shall immediately comply with its terms and take all reasonable steps to minimize the incurrence of costs allocable to the work covered by the order during the period of work stoppage. Within a period of 90 calendar days after a stop work order is delivered to the Contractor, or within any extension of that period to which the parties shall have agreed, the procurement officer shall either: 10.10.1.1 cancel the stop work order; or 10.10.1.2 terminate the work covered by the order as provided in the Termination for Default or the Termination for Convenience clause of this contract. 10.10.1.3 The procurement officer may make an equitable adjustment in the delivery schedule and/or contract price, and the contract shall be modified, in writing, accordingly, if the Contractor demonstrates that the stop work order resulted in an increase in costs to the Contractor 10.11 TERMINATION FOR CONVENIENCE Maricopa County may terminate the resultant contract for convenience by providing 60 calendar days advance notice to the Contractor. 10.12 TERMINATION FOR DEFAULT 10.12.1 The County may, by written Notice of Default to the Contractor, terminate this contract in whole or in part if the Contractor fails to: 10.12.1.1 deliver the supplies or to perform the services within the time specified in this contract or any extension; 10.12.1.2 make progress, so as to endanger performance of this contract; or 10.12.1.3 perform any of the other provisions of this contract. 10.12.2 The County’s right to terminate this contract under these subparagraphs may be exercised if the Contractor does not cure such failure within 10 business days (or more if authorized in writing by the County) after receipt of a Notice to Cure from the procurement officer specifying the failure. 10.13 PERFORMANCE It shall be the Contractor’s responsibility to meet the proposed performance requirements. Maricopa County reserves the right to obtain services on the open market in the event the Contractor fails to perform, and any price differential will be charged against the Contractor. 10.14 ACCEPTANCE Upon completion of services, service delivery shall be deemed accepted and the warranty period shall begin when the department has deemed all service/work completed, including but not limited to, any inspection, repair, installation, design, development, deployment, operation, and initial training, (as applicable). Additionally, all documentation shall be SERIAL 230123-RFP completed prior to final acceptance. 10.15 TRAINING The contractor shall provide training services to completely train County personnel in the use of the employer website portal (if applicable) and claims process. All training shall take place on-site in the County unless otherwise negotiated with County. 10.16 WARRANTY OF SERVICES 10.16.1 The Contractor warrants that all services provided hereunder will conform to the requirements of the contract, including all descriptions, specifications, and attachments made a part of this contract. County’s acceptance of services or goods provided by the Contractor shall not relieve the Contractor from its obligations under this warranty. 10.16.2 In addition to its other remedies, County may, at the Contractor's expense, require prompt correction of any services failing to meet the Contractor's warranty herein. Services corrected by the Contractor shall be subject to all the provisions of this contract in the manner and to the same extent as services originally furnished hereunder. 10.17 INSPECTION OF SERVICES 10.17.1 The Contractor shall provide and maintain an inspection system acceptable to County covering the services under this contract. Complete records of all inspection work performed by the Contractor shall be maintained and made available to County during contract performance and for as long afterwards as the contract requires. 10.17.2 County has the right to inspect and test all services called for by the contract, to the extent practicable at all times and places during the term of the contract. County shall perform inspections and tests in a manner that will not unduly delay the work. 10.17.3 If any of the services do not conform to contract requirements, County may require the Contractor to perform the services again in conformity with contract requirements, at no cost to the County. When the defects in services cannot be corrected by re-performance, County may: 10.17.3.1 require the Contractor to take necessary action to ensure that future performance conforms to contract requirements; and 10.17.3.2 reduce the contract price to reflect the reduced value of the services performed. 10.17.4 If the Contractor fails to promptly perform the services again or to take the necessary action to ensure future performance in conformity with contract requirements, County may: 10.17.4.1 by contract or otherwise, perform the services and charge to the Contractor, through direct billing or through payment reduction, any cost incurred by County that is directly related to the performance of such service; or 10.17.4.2 terminate the contract for default. SERIAL 230123-RFP 10.18 USAGE REPORT The Contractor shall furnish the County a usage report, upon request, delineating the acquisition activity governed by the contract. The format of the report shall be approved by the County and shall disclose the quantity and dollar value of each contract item by individual unit of measure. 10.19 STATUTORY RIGHT OF CANCELLATION FOR CONFLICT OF INTEREST Notice is given that, pursuant to A.R.S. § 38-511, the County may cancel any contract without penalty or further obligation within three years after execution of the contract, if any person significantly involved in initiating, negotiating, securing, drafting, or creating the contract on behalf of the County is at any time, while the contract or any extension of the contract is in effect, an employee or agent of any other party to the contract in any capacity or consultant to any other party of the contract with respect to the subject matter of the contract. Additionally, pursuant to A.R.S. § 38-511, the County may recoup any fee or commission paid or due to any person significantly involved in initiating, negotiating, securing, drafting, or creating the contract on behalf of the County from any other party to the contract arising as the result of the contract. 10.20 OFFSET FOR DAMAGES In addition to all other remedies at Law or Equity, the County may offset from any money due to the Contractor any amounts Contractor owes to the County for damages resulting from breach or deficiencies in performance of the contract. 10.21 SUBCONTRACTING 10.21.1 The Contractor may not assign to another Contractor or subcontract to another party for performance of the terms and conditions hereof without the written consent of the County. All correspondence authorizing subcontracting must reference the bid serial number and identify the job or project. 10.21.2 The subcontractor’s rate for the job shall not exceed that of the prime Contractor’s rate, as bid in the pricing section, unless the prime Contractor is willing to absorb any higher rates. The subcontractor’s invoice shall be invoiced directly to the prime Contractor, who in turn shall pass-through the costs to the County, without mark- up. A copy of the subcontractor’s invoice must accompany the prime Contractor’s invoice. 10.22 AMENDMENTS All amendments to this contract shall be in writing and approved/signed by both parties. Maricopa County Office of Procurement Services shall be responsible for approving all amendments for Maricopa County. 10.23 ADDITIONS/DELETIONS OF REQUIREMENTS The County reserves the right to add and/or delete materials and services to a contract. If a service requirement is deleted, payment to the Contractor will be reduced proportionately to the amount of service reduced in accordance with the bid price. If additional materials or services are required from a contract, prices for such additions will be negotiated between the Contractor and the County. 10.24 RIGHTS IN DATA 10.24.1 The County shall have the use of data and reports resulting from a contract without additional cost or other restriction except as may be established by law or applicable regulation. Each party shall supply to the other party, upon request, any SERIAL 230123-RFP available information that is relevant to a contract and to the performance thereunder. 10.24.2 Data, records, reports, and all other information generated for the County by a third party as the result of a contract are the property of the County and shall be provided in a format designated by the County or shall be and remain accessible to the County into perpetuity. 10.25 ACCESS TO AND RETENTION OF RECORDS FOR THE PURPOSE OF AUDIT AND/OR OTHER REVIEW 10.25.1 In accordance with Section MC1-372 of the Maricopa County Procurement Code, the Contractor agrees to retain (physical or digital copies of) all books, records, accounts, statements, reports, files, and other records and back-up documentation relevant to this contract for six years after final payment or until after the resolution of any audit questions, which could be more than six years, whichever is longest. The County, Federal or State auditors and any other persons duly authorized by the department shall have full access to and the right to examine, copy, and make use of, any and all said materials. 10.25.2 If the Contractor’s books, records, accounts, statements, reports, files, and other records and back-up documentation relevant to this contract are not sufficient to support and document that requested services were provided, the Contractor shall reimburse Maricopa County for the services not so adequately supported and documented. 10.26 AUDIT DISALLOWANCES If at any time it is determined by the County that a cost for which payment has been made is a disallowed cost, the County shall notify the Contractor in writing of the disallowance. The course of action to address the disallowance shall be at sole discretion of the County, and may include either an adjustment to future invoices, request for credit, request for a check, or a deduction from current invoices submitted by the Contractor equal to the amount of the disallowance, or to require reimbursement forthwith of the disallowed amount by the Contractor by issuing a check payable to Maricopa County. 10.27 STRICT COMPLIANCE Acceptance by County of a performance that is not in strict compliance with the terms of the contract shall not be deemed to be a waiver of strict compliance with respect to all other terms of the contract. 10.28 VALIDITY The invalidity, in whole or in part, of any provision of this contract shall not void or affect the validity of any other provision of the contract. 10.29 SEVERABILITY The removal, in whole or in part, of any provision of this contract shall not void or affect the validity of any other provision of this contract. 10.30 RELATIONSHIPS 10.30.1 In the performance of the services described herein, the Contractor shall act solely as an independent Contractor, and nothing herein or implied herein shall at any time be construed as to create the relationship of employer and employee, co- employee, partnership, principal and agent, or joint venture between the County and the Contractor. SERIAL 230123-RFP 10.30.2 The County reserves the right of final approval on proposed staff. Also, upon request by the County, the Contractor will be required to promptly remove any employees working on County projects and substitute personnel based on the discretion of the County. 10.31 NON-DISCRIMINATION Contractor agrees to comply with all provisions and requirements of Arizona Executive Order 2009-09, including flow down of all provisions and requirements to any subcontractors. Executive Order 2009-09 supersedes Executive Order 99-4 and amends Executive Order 75-5 and is hereby incorporated into this contract as if set forth in full herein. During the performance of this contract, Contractor shall not discriminate against any employee, client, or any other individual in any way because of that person’s age, race, creed, color, religion, sex, disability, or national origin. (Arizona Executive Order 2009-09 can be viewed at https://apps.azsos.gov/public_services/register/2009/46/governor.pdf) 10.32 WRITTEN CERTIFICATION PURSUANT to A.R.S. § 35-393.01 If vendor engages in for-profit activity and has 10 or more employees, and if this agreement has a value of $100,000 or more, vendor certifies it is not currently engaged in, and agrees for the duration of this agreement to not engage in, a boycott of goods or services from Israel. This certification does not apply to a boycott prohibited by 50 U.S.C. § 4842 or a regulation issued pursuant to 50 U.S.C. § 4842. 10.33 CERTIFICATION REGARDING DEBARMENT AND SUSPENSION 10.33.1 The undersigned (authorized official signing on behalf of the Contractor) certifies to the best of his or her knowledge and belief that the Contractor, its current officers, and directors: 10.33.1.1 are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from being awarded any contract or grant by any United States department or agency or any state, or local jurisdiction; 10.33.1.2 have not within a three-year period preceding this contract: 10.33.1.2.1 been convicted of fraud or any criminal offense in connection with obtaining, attempting to obtain, or as the result of performing a government entity (Federal, State or local) transaction or contract; or 10.33.1.2.2 been convicted of violation of any Federal or State antitrust statutes or conviction for embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property regarding a government entity transaction or contract; 10.33.1.3 are not presently indicted or criminally charged by a government entity (Federal, State or local) with commission of any criminal offenses in connection with obtaining, attempting to obtain, or as the result of performing a government entity public (Federal, State or local) transaction or contract; 10.33.1.4 are not presently facing any civil charges from any governmental entity regarding obtaining, attempting to obtain, or from performing any governmental entity contract or other transaction; and SERIAL 230123-RFP 10.33.1.5 have not within a three-year period preceding this contract had any public transaction (Federal, State or local) terminated for cause or default. 10.33.2 If any of the above circumstances described in the paragraph are applicable to the entity submitting a bid for this requirement, include with your bid an explanation of the matter including any final resolution. 10.33.3 The Contractor shall include, without modification, this clause in all lower tier covered transactions (i.e. transactions with subcontractors or sub-subcontractors) and in all solicitations for lower tier covered transactions related to this contract. If this clause is applicable to a subcontractor or sub-subcontractor, the Contractor shall include the information required by this clause with their bid. 10.34 VERIFICATION REGARDING COMPLIANCE WITH A.R.S. § 41-4401 AND FEDERAL IMMIGRATION LAWS AND REGULATIONS 10.34.1 By entering into the contract, the Contractor warrants compliance with the Immigration and Nationality Act (INA using E-Verify) and all other Federal immigration laws and regulations related to the immigration status of its employees and A.R.S. § 23-214(A). The Contractor shall obtain statements from its subcontractors certifying compliance and shall furnish the statements to the procurement officer upon request. These warranties shall remain in effect through the term of the contract. The Contractor and its subcontractors shall also maintain Employment Eligibility Verification forms (I-9) as required by the Immigration Reform and Control Act of 1986, as amended from time to time, for all employees performing work under the contract and verify employee compliance using the E-Verify system and shall keep a record of the verification for the duration of the employee’s employment or at least three years, whichever is longer. I-9 forms are available for download at www.uscis.gov. 10.34.2 The County retains the legal right to inspect documents of Contractor and subcontractor employees performing work under this contract to verify compliance with paragraph 10.34.1 of this section. Contractor and subcontractor shall be given reasonable notice of the County’s intent to inspect and shall make the documents available at the time and date specified. Should the County suspect or find that the Contractor or any of its subcontractors are not in compliance, the County will consider this a material breach of the contract and may pursue any and all remedies allowed by law, including, but not limited to: suspension of work, termination of the contract for default, and suspension and/or debarment of the Contractor. All costs necessary to verify compliance are the responsibility of the Contractor. 10.35 CONTRACTOR LICENSE REQUIREMENT 10.35.1 The Contractor shall procure all permits, insurance, and licenses, and pay the charges and fees necessary and incidental to the lawful conduct of his/her business, and as necessary complete any requirements, by any and all governmental or non-governmental entities as mandated to maintain compliance with and remain in good standing. The Contractor shall keep fully informed of existing and future trade or industry requirements, and Federal, State, and local laws, ordinances, and regulations which in any manner affect the fulfillment of a contract and shall comply with the same. Contractor shall immediately notify both Office of Procurement Services and the department of any and all changes concerning permits, insurance, or licenses. SERIAL 230123-RFP 10.36 INFLUENCE 10.36.1 As prescribed in MC1-1203 of the Maricopa County Procurement Code, any effort to influence an employee or agent to breach the Maricopa County Ethical Code of Conduct or any ethical conduct, may be grounds for disbarment or suspension under MC1-902. 10.36.2 An attempt to influence includes, but is not limited to: 10.36.2.1 A person offering or providing a gratuity, gift, tip, present, donation, money, entertainment or educational passes or tickets, or any type of valuable contribution or subsidy that is offered or given with the intent to influence a decision, obtain a contract, garner favorable treatment, or gain favorable consideration of any kind. 10.36.3 If a person attempts to influence any employee or agent of Maricopa County, the chief procurement officer, or his designee, reserves the right to seek any remedy provided by the Maricopa County Procurement Code, any remedy in equity or in the law, or any remedy provided by this contract. 10.37 CONFIDENTIAL INFORMATION 10.37.1 Any information obtained in the course of performing this contract may include information that is proprietary or confidential to the County. This provision establishes the Contractor’s obligation regarding such information. 10.37.2 The Contractor shall establish and maintain procedures and controls that are adequate to assure that no information contained in its records and/or obtained from the County or from others in carrying out its functions (services) under the contract shall be used by or disclosed by it, its agents, officers, or employees, except as required to efficiently perform duties under the contract. The Contractor’s procedures and controls, at a minimum, must be the same procedures and controls it uses to protect its own proprietary or confidential information. If, at any time during the duration of the contract, the County determines that the procedures and controls in place are not adequate, the Contractor shall institute any new and/or additional measures requested by the County within 15 business days of the written request to do so. 10.37.3 Any requests to the Contractor for County proprietary or confidential information shall be referred to the County for review and approval, prior to any dissemination. 10.38 PUBLIC RECORDS Under Arizona law, all offers submitted and opened are public records and must be retained by the County at the Maricopa County Office of Procurement Services. Offers shall be open to public inspection and copying after contract award and execution, except for such offers or sections thereof determined to contain proprietary or confidential information by the Office of Procurement Services. If an offeror believes that information in its offer or any resulting contract should not be released in response to a public record request, under Arizona law, the offeror shall indicate the specific information deemed confidential or proprietary and submit a statement with its offer detailing the reasons that the information should not be disclosed. Such reasons shall include the specific harm or prejudice which may arise from disclosure. The records manager of the Office of Procurement Services shall determine whether the identified information is confidential pursuant to the Maricopa County Procurement Code. SERIAL 230123-RFP 10.39 INTEGRATION This contract represents the entire and integrated agreement between the parties and supersedes all prior negotiations, proposals, communications, understandings, representations, or agreements, whether oral or written, expressed, or implied. 10.40 UNIFORM ADMINISTRATIVE REQUIREMENTS By entering into this contract, the Contractor agrees to comply with all applicable provisions of Title 2, Subtitle A, Chapter II, Part 200—UNIFORM ADMINISTRATIVE REQUIREMENTS, COST PRINCIPLES, AND AUDIT REQUIREMENTS FOR FEDERAL AWARDS contained in Title 2 C.F.R. § 200 et seq. 10.41 GOVERNING LAW This contract shall be governed by the laws of the State of Arizona. Venue for any actions or lawsuits involving this contract will be in Maricopa County Superior Court, Phoenix, Arizona. 10.42 FORCED LABOR 10.42.1 By submitting a bid for this solicitation and/or entering into a contract as a result of this solicitation, contractor agrees to comply with all applicable portions of Arizona Revised Statutes Section 35-394. Contracting; procurement; prohibition; written certification; remedy; termination; exception; definitions. 10.42.2 Contractor certifies that it does not currently, and agrees for the duration of the contract, that it will not use: 10.42.2.1 The forced labor of ethnic Uyghurs in the People’s Republic of China. 10.42.2.2 Any goods or services produced by the forced labor of ethnic Uyghurs in the People’s Republic of China. 10.42.2.3 Any contractors, subcontractors or suppliers that use the forced labor or any good or services produced by the forced labor of ethnic Uyghurs in the People’s Republic of China. 10.42.3 If contractor becomes aware during the term of the agreement that contractor is not in compliance with this paragraph, the contractor shall notify the County within five business days after becoming aware of the noncompliance. If the contractor fails to provide a written certification to the County that the contractor has remedied the noncompliance within 180 days after notifying the County of its noncompliance, then the agreement terminates, except that if the agreement termination date occurs before the end the 180 day period, the agreement terminates on the agreement termination date. 10.43 PRICES Contractor warrants that prices extended to County under this contract are no higher than those paid by any other customer for these or similar services. 10.44 ORDER OF PRECEDENCE In the event of a conflict in the provisions of this contract and Contractor’s license agreement, if applicable, the terms of this contract shall prevail. SERIAL 230123-RFP 10.45 INCORPORATION OF DOCUMENTS 10.45.1 The following are to be attached to and made part of this Contract: 10.45.1.1 Exhibit A – Vendor Information and Pricing 10.45.1.2 Exhibit B – Scope of Work 10.45.1.3 Exhibit C – Confirmation of Compliance 10.45.1.4 Exhibit D – Implementation Plan and Timeline 10.45.1.5 Exhibit E – Service Level Agreement 10.45.1.6 Exhibit F – Sedgwick Response to Negotiation Questions 10.46 NOTICES All notices given pursuant to the terms of this contract shall be addressed to: For County: Maricopa County Office of Procurement Services 301 W. Jefferson St. Suite 700 Phoenix, Arizona 85003-1647 For Contractor: Sedgwick 8125 Sedgwick Way Memphis, TN 38125 10.47 INQUIRIES 10.47.1 Administrative telephone/email inquiries shall be addressed to: ELIZABETH KUTTNER, PROCUREMENT OFFICER TELEPHONE: (602) 506-0099 elizabeth.kuttner@maricopa.gov 10.47.2 Inquiries may be submitted by telephone but must be followed up in writing. No oral communication is binding on Maricopa County. SERIAL 230123-RFP IN WITNESS WHEREOF, this contract is executed on the date set forth above. SEDGWICK CLAIMS MANAGEMENT SERVICES, INC. dba SEDGEWICK AUTHORIZED SIGNATURE PRINTED NAME AND TITLE ADDRESS _______________________________________ DATE MARICOPA COUNTY CHAIRMAN, BOARD OF SUPERVISORS DATE ATTESTED: CLERK OF THE BOARD DATE APPROVED AS TO FORM: DEPUTY COUNTY ATTORNEY DATE DATE Michael Shook; Senior Vice President 8125 Sedgwick Way, Memphis, TN 38125 August 16, 2023 SERIAL 230123-RFP EXHIBIT A – VENDOR INFORMATION AND PRICING COMPANY NAME: Sedgwick Claims Management Services, Inc. DOING BUSINESS AS (dba): Sedgwick MAILING ADDRESS: 8125 Sedgwick Wy, Memphis TN 38125 REMIT TO ADDRESS: PO Box 207834, Dallas TX 75320-7834 TELEPHONE NUMBER: 602-506-1010 FAX NUMBER: N/A WWW ADDRESS: www.sedgwick.com REPRESENTATIVE NAME: Christina Moreno REPRESENTATIVE TELEPHONE NUMBER: 6268486068 REPRESENTATIVE EMAIL ADDRESS christina.moreno@sedgwick.com YES NO REBATE WILL ALLOW OTHER GOVERNMENTAL ENTITIES TO PURCHASE FROM THIS CONTRACT: WILL ACCEPT PROCUREMENT CARD FOR PAYMENT: PAYMENT TERMS: RESPONDENT IS REQUIRED TO PICK ONE OF THE FOLLOWING. PAYMENT TERMS WILL BE CONSIDERED IN DETERMINING LOW BID. FAILURE TO CHOOSE PAYMENT TERMS WILL RESULT IN A DEFAULT TO NET 30 DAYS. NET 30 DAYS 1.0 PRICING: 1.1 Short Term Disability Administration: Rates Rate Guarantee Year 1 (1/1/2024 - 12/31/2024) Year 2 (1/1/2025 - 12/31/2025) Year 3 (1/1/2026 - 12/31/2026) Year 4 (1/1/2027 - 12/31/2027) Year 5 (1/1/2028 - 12/31/2028) ASO 1.1.1 Monthly Retainer Fee $692.00 $692.00 $692.00 $692.00 $692.00 1.1.2 Initial Adjudication Per Claim $232.00 $232.00 $232.00 $232.00 $232.00 (APPLIES TO DENIALS ONLY) 1.1.3 Charge Per Approved Claim $433.00 $433.00 $433.00 $433.00 $433.00 (INCLUDES ADJUDICATION AND ALL PROCESSING FEES) SERIAL 230123-RFP 1.1.4 Charge for drafting and maintaining Plan document $6,074.00 $6,074.00 $6,074.00 $6,074.00 $6,074.00 1.1.5 Other: (Describe) Year 6 (1/1/2029 - 12/31/2029) Year 7 (1/1/2030 - 12/31/2030) Year 8 (1/1/2031 - 12/31/2031) Year 9 (1/1/2032 - 12/31/2032) Year 10 (1/1/2033 - 12/31/2033) ASO 1.1.1 Monthly Retainer Fee $713.00 $713.00 $713.00 $713.00 $713.00 1.1.2 Initial Adjudication Per Claim $239.00 $239.00 $239.00 $239.00 $239.00 (APPLIES TO DENIALS ONLY) 1.1.3 Charge Per Approved Claim $446.00 $446.00 $446.00 $446.00 $446.00 (INCLUDES ADJUDICATION AND ALL PROCESSING FEES) 1.1.4 Charge for drafting and maintaining Plan document $6,256.00 $6,256.00 $6,256.00 $6,256.00 $6,256.00 1.1.5 Other: (Describe) SERIAL 230123-RFP EXHIBIT B – SCOPE OF WORK Executive Summary Approach The County has been a valued partner since 2001, and we see this proposal as an opportunity to continue a strong, strategic commitment to support and strengthen STD program administration. Our expertise, stability and program outcomes are a firm foundation for this proposal, but our focus is on the future and continuing to strengthen and evolve our partnership. We will continue to be proactive in how we communicate with the County and will leverage technology, data and additional resources to provide added value to the program. Caring counts® At Sedgwick, caring counts. Every year, 31,000 colleagues in 80 countries around the world embrace this mission as they handle more than 10.1 million new claims, with responsibility for claim payments totaling more than $30.8 billion. As evidenced by our average annual rollover rate of 98%, we are fortunate to partner with clients that continue to choose Sedgwick and grow with us over the long term. Sedgwick is working to drive a culture of caring. Our caring counts philosophy empowers our claims representatives to offer compassionate, personalized care for the County and your employees. We maximize opportunities to communicate with empathy and urgency. This advocacy-based approach helps build rapport with employees, reducing the chance of litigation and resulting in better overall outcomes. Taking care of people and organizations — from public to private employers — is at the heart of everything we do. The consumer experience Our proprietary technology is fully aligned with our caring counts philosophy. We deliver real-time web and mobile access through our self-service portal, mySedgwick, which is designed to provide a superior user experience. mySedgwick provides many benefits to employees navigating the absence process. From the opening dashboard, the tool provides a calendar detailing absences, relevant notifications and an activity stream of claim progress milestones. Claims are hyperlinked to additional information, including payment status, recent activity, important notifications and the communication center, where employees may send a note to the disability representative. Employees can also report new absences, securely upload documents or images, view/complete medical authorization and medical history release forms and much more. mySedgwick also enables greater functionality for the County’s departmental contacts who require consolidated data to search for an employee, absence type, date range and other details. This information is defined by a County- provided hierarchy, and authorized users view different levels of access based on their roles. Our client-facing web portal, viaOne, also provides full visibility into claims to the County’s disability management team. viaOne gives the County the ability to check the real-time status of claims and see an overall, at-a-glance view of your claims program for analyzing metric and County data. Each dashboard or graphical report offers the ability to drill down to the individual claim level, and user-defined threshold functionality on each dashboard provides customizable alerts when a key performance indicator (KPI) is exceeded. Data analytics and stewardship Sedgwick is the industry leader in intelligent use of data. Beyond the facts and merits of each claim, we understand the numbers. Sedgwick has invested in a team of analysts who work with our colleagues and clients to help them take the data and translate it into meaningful reports and statistics that ultimately empower smarter decisions for our clients. Our data analysts can tell the historical story of the County’s program and help paint the picture of where the program is headed. The use of our extensive dataset derived from our clients’ programs is a true differentiator for Sedgwick. We will leverage this intelligence on the County’s program in a variety of ways: SERIAL 230123-RFP • Program scorecarding — Our overall approach to managing customer programs includes continuous use of program data to drive progress and improvements. Stewardship is a constant process at Sedgwick as we use our results on a routine basis to identify areas of opportunity and action needed. • Peer benchmarking — Sedgwick’s peer group benchmarking helps clients understand how their results compare to those of similar organizations. Our ability to customize this by specific groups within an industry allows clients to understand how the nuances of their program drive results. Presented as part of our routine stewardship meetings, the value of peer benchmarking includes the ability to learn from the best programs in the country and apply new practices based on what is working for others. • Stewardship — Sedgwick believes in the importance of regular stewardship meetings, reviewing statistical information on results with the goal of continuous improvement. Sedgwick will continue to provide a detailed analysis that includes all pertinent performance metrics as well as periodic review against industry trends that may impact the County’s program and information regarding the effectiveness of specific programs on the overall County loss information. Your client services representative, Christina Moreno, will work with the County to determine the appropriate metrics to report on an annual basis. Qualifications Sedgwick is uniquely qualified to render the services set forth in the County’s RFP since Sedgwick has provided ASO STD for the County since 2001. In view of our current partnership, we can seamlessly start a new contract with the County, bringing a keen understanding of your processes, culture and philosophy regarding claims management and outcomes. We are proud to note that our monitoring of Sedgwick’s key performance standards on the County’s STD program shows that Sedgwick can deliver a strong claims program that provides security for your employees in their time of need. The same dedication to excellence will be delivered for the County going forward. Experience Sedgwick is honored to serve more than 560 public entity clients. Several of our client partners are public entity pools and associations that comprise anywhere from five to 1,500 entities, allowing Sedgwick to serve a total of more than 6,800 individual public entities nationwide. Our services for public entity clients include professional, general and auto liability; workforce absence, including disability, leave of absence and ADA; and workers’ compensation claims administration. Our commitment Sedgwick brings a combination of innovation, experience and flexibility that cannot be found anywhere else in the industry. We apply resources to our programs in a way that enables our colleagues to do the right thing for our clients every day. Our programs are designed around respect for each client’s needs. We do a better job of listening to our customers, identifying and analyzing the gap between the current program and ultimate program vision and then translating that vision into reality. Throughout our partnership with the County, our focus has been on the success of your program and continuing to deliver a value-added claims administration program that is unique to the County. Our goal is to continue our successful partnership with the County, delivering superior service and optimal outcomes and leveraging a solid framework of shared knowledge and experience to continually evolve the program and drive excellent results. Our proposal illustrates our understanding of the County’s program, our plan to deliver best-in-class customer service, our focus on continuous program improvement, and our deep understanding of the fiduciary responsibility Sedgwick has to the County and its taxpayers. We value our partnership with the County, and we remain committed to meeting and exceeding your expectations now and in the future. 5.6.1.1.2 Respondent’s proposal should outline any additional services and their costs and whether the Respondent deems them necessary or complementary to the Existing Group Short-Term Disability Plan Description. Sedgwick has carefully reviewed the Existing Group STD Plan Description and will continue to meet the plan design as written with the staff and program resources we currently have in place for the program. SERIAL 230123-RFP 5.6.1.1.3 Respondent’s proposal shall also include: 5.6.1.1.3.1 SLA shall, provided by the respondent as Exhibit E, shall include performance guarantees including, but not limited to implementation timeline/benchmarks, response time to member telephone inquiries, abandonment rate, member appeals, claims payment accuracy and timeliness, member satisfaction, and delivery of management reports. The SLA will be negotiated as part of the final contract. Sedgwick is always willing to work with the County to design and remain accountable for meaningful performance standards that have an impact on your program. We have found that the most effective performance agreements are derived from partnered preparation with our clients. With a focus on definable content, valid sample size, simplicity of scoring and relevancy of the result, we work with our clients to create an agreement that serves less to enforce and more to promote desired results and continuous improvement. All performance guarantees take effect 90 days after go-live. 5.6.1.1.3.2 The implementation plan and timeline, as described in section 9.4 Implementation, shall be provided as Exhibit D. Plan should include a description of the methods, benchmarks, and timeline-of-communication that respondent will use with the County during implementation phase the contract. 5.6.1.1.3.3 Proof of experience providing STD benefits to a minimum of five private or public organizations. Sedgwick provides STD benefits to more than 232 STD clients, including Maricopa County. We currently provide disability services to the following public and private organizations: • Ascension • County of Los Angeles • General Electric • Southern California Edison • Verizon 5.6.1.1.3.4 Proof of a minimum of five years of experience servicing organizations in Arizona with a minimum of 5,000 employees, as well as working with multiple businesses within an organization. Sedgwick was founded as a regional third-party administrator (TPA) in 1969. From 1983 through 2013, based on the success of our initial role as a workers’ compensation claims administrator, we expanded our risk management solutions to include managed care, multiline liability, first- and third-party property, short- and long-term disability, FMLA, ADAAA, paid family leave and leave of absence administration. Today, Sedgwick is the leader in disability/leave management services for clients seeking a customized solution. Of Sedgwick’s 232 STD clients, approximately 180 have a minimum of 5,000 employees as well as work with multiple businesses within their organizations. Our client size ranges from less than 1,000 to 1.5 million covered lives, with the average number of covered lives being 14,400. In Arizona, we serve two public entity workforce absence clients, Maricopa County and Yuma Regional Medical Center. 5.6.1.1.3.5 Most recent three years of audited annual reports. Reports must demonstrate that the respondent has been financially solvent for the past three calendar years. Sedgwick has included audited annual reports for 2020, 2021 and 2022. We consider our financials proprietary and confidential and not subject to the Freedom of Information Act (FOIA). 5.6.1.1.3.6 Samples of Reports, as indicated in section 9.9 Mandatory Reporting Requirements, including samples of Claim Reports, Financial Reports, Service Reports, and Claims and Customer Service Reports. SERIAL 230123-RFP Sedgwick has the ability to produce reports for virtually all data elements that we manage. Reporting can consist of graphs and trending reports on CSV or interface files that may be transmitted electronically to the County’s RMIS, HR or other systems. Sedgwick provides a variety of standard disability reports, which can be generated for any level of the County on a regular basis. Samples of the following reports are embedded below: • Disability status report — shows all open and closed claims since the prior report • Program report — gives a monthly or quarterly high-level snapshot of the program on key metrics, including: o Volumes o Durations o Payments o Diagnostic groups o Denial reasons There are no additional fees for standard reports. 5.6.1.2 Qualifications – This section shall describe the respondent’s ability and experience related to the programs and services proposed. All project personnel, as applicable, shall be listed, including a description of assignments and responsibilities, a resume of professional experience, an estimate of the time each would devote to this program, and other pertinent information. Sedgwick has been providing STD ASO claims administration program for the County since 2001, so we possess unique, in-depth knowledge of the County’s program and culture and greatly value our partnership. Disability experience Sedgwick is the leader in disability/leave management services for clients seeking a customized solution. Over the past 10 years, Sedgwick has been selected as the partner of choice for over 185 organizations to administer their disability and/or absence management programs, including nearly 59% of the Fortune 500 companies. In addition to our more than 7,500 colleagues who manage claims for our clients and 850 clinical resources in our organization (with approximately 100 of them supporting our absence management clients), we have also developed national practice groups for both our disability and absence management products. These practice groups ensure consistency within our organization and compliance with legal and regulatory requirements while also keeping our clients and colleagues abreast of changes and best practices within the industry. Sedgwick’s approach to customer service is to form a partnership with our clients, providing the consultation and flexibility required for mutual success. We maintain a clear focus on achieving the best outcomes for the County by continuing to provide a quality system defined by the County’s needs, analytical capabilities to identify cost drivers and program management services designed to ensure excellence. Together, we will continue to provide the County with an optimal STD ASO program. Leveraging our proven processes with most of the major long-term disability (LTD) carriers, we will also continue to coordinate a smooth transition of your STD claims to your LTD carrier. Our position as a leader in disability/leave management services results from our commitment to providing our clients and their employees with unparalleled customer service, focusing on outcomes and dealing effectively with the dynamic nature of the disability, leave and integrated disability management (IDM) marketplace. A few key highlights of our offering include: • Customized, dedicated solutions delivered by more than 31,000 colleagues in 80 countries around the globe • More than 10.1 million workers’ compensation/disability/absence claims handled annually • More than 500 disability/absence clients SERIAL 230123-RFP • Largest administrative services only (ASO) provider of integrated disability and absence management services Project personnel Sedgwick will continue to staff the County’s program with the following key positions: • Client services representative • Operations manager • Absence management team lead • Disability representative Name and job title Description of responsibilities Estimated % of time d d h Vice President, Client Services Executive sponsor 2% Operations Manager Staff development and training 1% Team Lead Supervision, staff coaching, denial and complex claim review 10% Client Services Representative Program management 5% Senior Disability Representative STD claims administration 25% Senior Disability Representative STD claims administration 75% Senior Disability Representative STD claims administration 80% Workforce Absence Management Operations Manager The Absence Management Operations Manager with Sedgwick is responsible for disability, statutory plan, and leave of absence administration for multiple Sedgwick clients. Workforce Absence Management Team Lead The Absence Management Team Lead for Sedgwick is responsible for the supervision of disability representatives and technical staff for clients, monitoring colleagues' workload, providing training and monitoring individual claim activities. They provide technical/jurisdictional direction to disability representatives on claims adjudication and to maintain oversight on claims activity within the teams, including frequent diaries on complex or high exposure claims. Sr. Disability Representative The Senior Disability Representative for Sedgwick manages claims for the County. They are responsible for complex disability cases. These types of claims are where case management and claim determinations are based on complex medical documentation and the applicable disability plan interpretation, including determining benefits due and making timely payments/approvals and adjustments, medically managing disability claims; coordinating investigative efforts, thoroughly reviewing contested claims, negotiating RTW with or without job accommodations and evaluating and arranging appropriate referral of claims to outside vendors. Sr. Disability Representative The Senior Disability Representative for Sedgwick manages claims for the County and is responsible for complex disability cases. These types of claims are where case management and claim determinations are based on complex medical documentation and the applicable disability plan interpretation, including determining benefits due and making timely payments/approvals and adjustments, medically managing disability claims; coordinating investigative efforts, thoroughly reviewing contested claims, negotiating Return To Work (RTW) with or without job accommodations and evaluating and arranging appropriate referral of claims to outside vendors. SERIAL 230123-RFP Sr. Disability Representative The Senior Disability Representative for Sedgwick is responsible for complex disability claims. These types of claims are where case management and claim determinations are based on complex medical documentation and the applicable disability plan interpretation, including determining benefits due and making timely payments/approvals and adjustments, medically managing disability claims; coordinating investigative efforts, thoroughly reviewing contested claims, negotiating RTW with or without job accommodations and evaluating and arranging appropriate referral of claims to outside vendors. Client Services Representative The client services representative for Sedgwick is the primary client contact for eight designated accounts. Responsibilities include working directly with insurance brokers, internal finance and legal teams. This position prepares and distributes stewardship and ad hoc reports; and arranges client meetings to identify and resolve issues that impact consistency and customer satisfaction and establishes plans for service improvement. Vice President, Client Services The vice president of client services is responsible for managing a team of client service managers who handle complex and sophisticated self-funded disability and leave of absence programs for public and private employers. They successfully maintain good client and client broker relationships while managing program procedures and processes in order to ensure a high level of claimant satisfaction and client retention. Sedgewick’s Response to the Scope of Work 2.0 SCOPE OF WORK 2.1 PROGRAM OUTLINE 2.1.1 The Short Term Disability (STD) plan (Plan) is a voluntary self-funded plan offered to all benefit eligible employees. The contractor will be responsible to provide an Administrative Services Only (ASO) product. 2.1.2 Contractor shall make available program services to all County employees. 2.1.3 The County has an employee population in excess of 13,000 of which approximately 12,500 are benefit eligible. The participation enrollment in the Plan as of February 2023 is: Benefit Level Enrollment 40% Benefit Level 1,779 50% Benefit Level 2,449 60% Benefit Level 4,267 Total 8,495 2.1.4 There is a two-week Elimination Period (14 consecutive calendar days) from the onset of the disability before employees begin to receive disability benefits unless employee becomes hospitalized or gives birth during the elimination period. If the employee is hospitalized or gives birth during the elimination period, the STD benefit will begin on the first day of employee hospitalization or birth. 2.1.5 During the Elimination Period, employees are required to use sick leave during their absence from work. If they do not have enough sick leave to cover the entire Elimination Period, they must use available vacation leave. If the employee does not have sufficient vacation leave, the employee will be unpaid. SERIAL 230123-RFP 2.1.6 Eligibility/Enrollment 2.6.1.1 All individuals eligible under Maricopa County’s group health plan. 2.6.1.2 Eligibility is determined by the County and enrollment is communicated to the contractor using an HR system (Workday) integration file. 2.6.1.3 Contractor shall accept the name and contact information for the department HR liaison for each enrolled member on the HRIS (Workday) enrollment/eligibility changes file or receive a separate excel worksheet with HR contacts by department and maintain all changes to contacts on a regular basis. 2.1.7 Coverage Effective Date 2.1.7.1 Coverage for benefit eligible employees is elected during the annual Open Enrollment process and becomes effective at the beginning of the next plan year (January 1). 2.1.7.2 Coverage for new employees electing the Plan begins on the first calendar day of the month following their date of hire. 2.1.8 Enrollment into the Short-Term Disability Plan is not allowed at the time of a qualified life event change, except for a return from active duty military leave. 2.2 MANDATORY CONTRACTOR’S QUALIFICATION 2.2.1 Contractor shall be licensed to provide short-term disability ASO contracts within the State of Arizona. Confirmed. Sedgwick has been providing the County with STD ASO services in the State of Arizona since 2001 2.2.2 Contractor shall serve at least five private or public organizations and have a minimum of five years of experience servicing organizations in Arizona with a minimum of 5,000 employees. Confirmed. 2.2.3 Contractor shall have experience meeting the demands and needs of over 5,000 employees as well as working with multiple businesses within an organization. Confirmed. 2.3 CONFIRMATION OF CONTRACTOR REQUIREMENTS 2.3.1 Contractor shall be responsible for the contractor requirements as indicated in Exhibit C: Confirmation of Compliance with Contractor Requirements and shall provide confirmation of such on Exhibit C. Confirmed. 2.4 IMPLEMENTATION 2.4.1 Contractor shall provide a qualified implementation team and shall have a comprehensive implementation plan including an implementation timeline such that benefits and services are in place by January 1, 2024. Contractor’s proposed implementation plan and timeline shall be provided with proposal as Attachment F. As the current administrator of the County’s disability program, Sedgwick proposes to continue handling your program without interruption. For your reference, and as an example of our change management experience, depth of transition support resources and attention to project detail, Sedgwick has included a sample implementation plan as Attachment F. 2.4.2 Contractor shall put a portion of their fees at risk for completion of implementation tasks by the effective date of the contract, and as indicated in the contractor’s Service Level Agreement (SLA), provided to the County with respondent’s proposal as Attachment G (contract Exhibit E). SERIAL 230123-RFP 2.4.3 Successful implementation will be measured using the operational milestones which shall be included by the contractor in their proposed implementation plan. The implementation milestones include, but are not limited to, the following: 2.4.3.1 Setting up the account structure and corresponding subgroups 2.4.3.2 Setting up the plan design 2.4.3.3 Establishing the claims edits and/or business rules 2.4.3.4 Ensuring transaction procedures are implemented correctly 2.4.3.5 Ensuring accurate member correspondence and reporting 2.4.3.6 Setting up enrollment data (subscriber, correct plan selection, effective dates, etc.) 2.4.3.7 Setting up the enrolled employer group 2.4.3.8 Setting up benefit plans and corresponding benefit terms 2.4.3.9 Setting up integration files from the County to contractor, including testing 2.4.3.10 Correctly identifying services that need to be pre-authorized 2.4.3.11 Establishing the claims edits and business rules 2.4.3.12 Ensuring contractor shall be able to accurately pay claims according to the plan documents 2.4.3.13 Ensuring contractor is prepared to process remittances 2.4.3.14 Ensuring methods are in place for providing County with management reports as indicated in section 9.9 Mandatory Reporting Requirements 2.4.3.15 Ensuring County employer portal access is operational 2.4.3.16 Ensuring all employee-facing documents and materials are provided via electronic format for posting on the County’s intranet and Internet Web sites in English and Spanish. Sedgwick’s client services representative, Christina Moreno, will determine any program enhancements, service delivery requirement changes or service expansion needs beyond services as currently indicated in the contract and engage Sedgwick’s dedicated implementation team if necessary. 2.4.4 A final implementation plan and implementation timeline shall be mutually agreed upon, in writing, by the contractor and the County upon award. For any change management need, we have available and ready to engage and deploy for the County a multidisciplinary team with extensive project management experience. Our implementation and transition management expertise is unmatched in our industry. 2.4.5 Under no circumstances shall the implementation schedule be impacted by a personnel change on the part of the contractor. As the County’s business partner, Sedgwick does not foresee the need for any complex or prolonged implementation activities. All program components provided by Sedgwick are in place and fully operational, including our service team. 2.4.6 After the first quarter of program implementation (January 1 – March 31), Contractor shall conduct a self-audit based upon mutually agreed upon criteria for the purpose of assessing any new system set-up or any new services. The results from this audit shall be due by the following May 15. 2.5 ADMINISTERING THE PLAN. In addition to the contractor requirements identified above Exhibit C: Confirmation of Compliance with Contractor and referenced in section 9.3 CONTRACTOR REQUIREMENTS, contractor shall be responsible for the following requirements: 2.5.1 Creating and maintaining claims files. Sedgwick will continue to comply with this requirement. All claims data is retained electronically in Sedgwick’s claims management system for the life of the claim. We may image and incorporate hard copy documents received during claim management into the online claim records as appropriate. SERIAL 230123-RFP Presently, we only retain a small amount of information in hard copy, such as x-rays, photos and other types of evidence that do not lend themselves to imaging. Certain types of legal documents are also retained in hard copy format and are returned to their respective offices for storage. 2.5.2 Evaluating claims to determine if they have been properly filed and advising claimants in meeting the requirements for additional information. Sedgwick will continue to comply with this requirement. After triage and assignment to an appropriate disability representative, the initial three-point contact is used to gain and clarify information about the claim, including the nature and degree of injury, and to set expectations about the process. 2.5.3 Reviewing healthcare provider documentation and confirming disability Sedgwick will continue to comply with this requirement. Our disability representatives use the Official Disability Guidelines (ODG) to assist them in determining the proper disability duration. ODG provides an evidence-based summary (midrange, at-risk) and best practice (based on the severity of the claim, type of treatment and type of job) guidelines forecasting expected disability duration for every reportable condition. The disability representative compares the guidelines to the expected length of disability recommended by the employee’s physician. If there is a discrepancy, the claims manager will call the physician to negotiate an earlier return to work or discuss why the employee needs additional time away from work. If the duration of absence exceeds disability guidelines after speaking with the provider and evaluating any adjustment factors, the disability representative refers the claim to a clinical claims manager who may recommend a physician advisor (PA) review to help determine the length of disability. If additional clarification is still required, an independent medical exam or functional capacity evaluation may be conducted. The disability representative evaluates the medical documentation, information gathered from the employee, eligibility data supplied by the client and the definition of disability outlined in the County’s plan document to determine if the employee’s condition meets benefit criteria. The assigned disability representative has overall responsibility for the claim and will make claim determinations based on County plan documents, client service instructions and the medical and vocational facts of the claim. The disability representative has clinical specialists available to them for consultation for complex medical reviews. 2.5.4 Computing the benefits due in accordance with the current benefit plan document Sedgwick will continue to comply with this requirement. Benefit calculations are automatically generated based on an employee’s benefit plan(s). Sedgwick has worked with the County to ensure we obtain all information regarding benefit plan requirements, pay schedules and pay cycles. With that information, we continue to program your unique benefit plan information and benefit calculations into the claims administration system for automated employee benefit plan processing. Our automation or recurrent payments with system-generated adjustments facilitate the accuracy of payment. Periodic diarized team lead reviews of all claims and quality audits are other ways we monitor and maintain a high level of financial accuracy. 2.5.5 Issuing benefits payments to the claimant. Sedgwick will continue to comply with this requirement. We offer paper check and EFT/direct deposit options for STD claim payments. 2.5.6 Discussing claims, where appropriate, with physicians and other healthcare providers. Sedgwick will continue to comply with this requirement. The disability representative compares the guidelines to the expected length of disability recommended by the employee’s physician. If there is a discrepancy, the claims manager will call the physician to negotiate an earlier return to work or discuss why the employee needs additional time away from work. If the duration of absence exceeds disability guidelines after speaking with the provider and evaluating any adjustment factors, the disability representative refers the claim to a clinical claims manager who may recommend a physician advisor (PA) review to help determine the length of disability. If additional clarification is still required, an SERIAL 230123-RFP independent medical exam or functional capacity evaluation may be conducted. 2.5.7 Applying claims control procedures necessary for the effective administration of the Plan. Sedgwick will continue to comply with this requirement. 2.5.8 Reconciling issued and cleared checks, including prompt weekly reimbursement of any required funds in the event of an account deficit. Sedgwick will continue to comply with this requirement. 2.5.9 Preparing a monthly numerical and alphabetical register of benefits payments issued. The register should include the check number, employee name, claimant name, payee name, amount of check, the date incurred and the date paid. Sedgwick will continue to comply with this requirement. 2.5.10 Investigating claims that appear to be suspicious or fraudulent. Sedgwick will continue to comply with this requirement. We recognize that the identification, investigation and pursuit of suspicious claims or fraudulent elements of claims are an integral part of our responsibility as a TPA. We have a formalized special investigation unit (SIU) designed to support fraud mitigation if the need arises. Sedgwick created the SIU to support employers and claim teams using state-of-the-art detection techniques, varied interventions for identified fraud and consultative advice on pursuing fraud individually. Sedgwick designed the fraud prevention program around these key elements: identification through analytics, focused investigations, expert analysis, vendor management, quality assurance and impact and ROI reporting. We are happy to further discuss the use of our SIU. 2.5.11 Preparing, printing, and distributing administrative forms required for the successful operation of the Plan. Sedgwick will continue to comply with this requirement. 2.6 PROCESSING CLAIMS 2.6.1 Contractor shall pay claims in an accurate and timely fashion 2.6.1.1 Accurate: Contractor shall pay the correct benefit for the correct duration in 99% of claims. In the case of denials, 100% of claims must be denied for appropriate and documented reasons. Contractor shall include guarantee of such in their SLA. See EXHIBIT E-Service Level Agreement (SLA) We will continue to work with the County to receive custom, incoming reports and interfaces to update claimant HR data and/or claim details that can be used by the operations team. This will include payment information to ensure accurate calculations of disability benefits. We treat all employees fairly and all claim denials will be fully supported by the facts of the claim. The team lead and disability representative will review the claim file to ensure JURIS notes are properly documented and that a complete investigation and evaluation were conducted. 2.6.1.2 Timely: Contractor shall approve or deny a claim within two (as per the SLA) business days of receipt of all necessary information. Contractor shall issue a benefit payment or notice of claim denial within two business days of claim adjudication. Contractor shall include guarantee of such in their SLA. Sedgwick agrees to comply with this requirement. For STD claims, we allow 20 calendar days for the employee to submit medical documentation from the date of disability or the date the claim is reported to Sedgwick, whichever is later. If medical information is not received in that time frame, the claim is denied the next business day. If medical information is received within that time frame, the initial claim decision is made within two business days of receipt of completed information, but no later than the first business day after calendar day 20. SERIAL 230123-RFP 2.6.2 Contractor shall: 2.6.2.1 Provide return-to-work rehabilitation assistance at no charge to the employee. Sedgwick will continue to coordinate RTW assistance at no charge to the employee. 2.6.2.2 Notify claimants of delayed claim payments that are caused by an error or omission in claim payment documentation. Sedgwick will continue to comply with this requirement. 2.6.2.3 Establish quality assurance standards and control mechanisms. Sedgwick will continue to comply with this requirement. Sedgwick uses a total performance management system to ensure that disability representatives are following our service expectations and the customized client service instructions. In general, disability representative scorecards include timeliness of decisions, the accuracy of approvals/denials and ongoing benefit determinations. A random sample audit is conducted monthly in each office. The minimum level of achievement on each scorecard measure is 90% and the expectation is that they reach a score of 90%. These audits, along with performance metrics established by client contract, measure overall timeliness of decisions and claimant communications, administrative accuracy and payment accuracy at the team level. We develop insights that allow client services and operations to develop best practices and targeted action plans in order to exceed the County’s expectations. We accomplish all the above through the use of three major surveys, which collect client satisfaction data at various touch points: • Employee satisfaction survey: Sent after initial claim approval and claim closure to employees who have opted in for email or text • Client satisfaction survey: Distributed biannually to day-to-day client contacts who have frequent communication with our claims management staff 2.6.2.4 Print checks and corresponding explanations of benefits. Sedgwick will continue to comply with this requirement. 2.6.2.5 Respond within two business days following any inquiry from the County benefits personnel regarding the status or disposition of a claim. Contractor shall include guarantee of such in their SLA. Sedgwick will agree to comply with this requirement. Return call requests and any email or message center inquiries will be returned within one business day of receipt. Sedgwick’s best practice is to keep the County’s internal resources informed during the claim process by communicating at specific touchpoints, including at intake and eligibility; approval; denial; and exhaust decisions. Through viaOne, the County will have the ability to view case status in real-time, accessing all activity, including disability representative notes, diaries and payment history, as well as the ability to monitor the progress and activity for individual leaves. 2.6.2.6 Prepare responses to participant appeals; contractor shall handle first and second level claim appeals. Sedgwick handles first-level appeals as a part of our core integrated disability services and can administer the County’s second-level appeals as an optional service for an additional fee. We agree to administer claims and appeals in accordance with the County and statutory requirements. Sedgwick will agree to defend the County in litigation arising from the fault or misconduct of Sedgwick. 2.6.2.7 Provide data required for government reporting. Sedgwick will continue to comply with this requirement. SERIAL 230123-RFP 2.7 FEES AND PAYMENTS 2.7.1 Contractor administrative fees shall be proposed using Attachment D - Pricing Sheet Sedgwick will comply with this requirement. 2.7.2 Contractor shall use enrollment as of the 2nd calendar day of the month to invoice for any administrative fees based on monthly enrollment Sedgwick will comply with this requirement. 2.7.3 Not-to-exceed renewal rate caps shall be due 360 days prior to the contract renewal dates for years six through ten. Final rates shall be set 180 days prior to the contract renewal date. Sedgwick will comply with this requirement. 2.7.4 County shall self-insure claim payments and fund claim payments no more often than weekly. Sedgwick will continue to comply with this requirement. 2.8 COMMUNICATION WITH EMPLOYEES Contractor shall be responsible for creating and amending as needed, the County’s summary Plan description, to be included on the County’s website, and other collateral, as needed. All communication shall be subject to County review and approval. Sedgwick will continue to comply with this requirement. 2.9 MANDATORY REPORTING REQUIREMENT 2.9.1 Contractor shall provide ad hoc reporting as requested by the County at no additional cost to the County. Sedgwick will continue to comply with this requirement. Through our web-based tool, mySedgwick, the County’s HR/benefits staff will have access to a real-time dashboard that reflects all employees on leave or disability. For more global reporting needs, Sedgwick uses data analysts to ensure all reporting requirements are accurate and meet the needs of our clients. This includes ad hoc and regularly scheduled reports for no additional fee. 2.9.2 Contractor shall provide the County with a copy of the JURIS Claims Processing System SOC1 Report or equivalent on an annual basis. Sedgwick will continue to comply with this requirement. 2.9.3 Contractor shall provide, at a minimum, the following reports to the County in Excel or CSV format. All reports are due by the 15th calendar day following the reporting period and must be County-specific. 2.9.3.1 Claim Reports 2.9.3.1.1 Aggregate Monthly Claims Status Summary, including open/closed/pended status, amount paid, total expected benefit amount, offsets, reserve, expected duration, and disability category, by department 2.9.3.1.2 Dollars Paid Quarterly Comparison 2.9.3.1.3 Claims Incidence Quarterly Comparison 2.9.3.1.4 Distribution of Claims by Age 2.9.3.1.5 Number of claims grouped by tenure with the County 2.9.3.1.6 Distribution of claims by disability category, including comparison to industry and book-of-business averages 2.9.3.1.7 Duration comparison by disability category, including comparison to industry and book-of-business averages SERIAL 230123-RFP 2.9.3.1.8 Top ranking disabilities by incidence and cost 2.9.3.1.9 Claimant repeater report (number of claims and dollars paid, grouped by number of claims per claimant) 2.9.3.1.10 Quarterly claims turnaround time report, which shows the average time between disability onset date and claim paid date 2.9.3.1.11 Number of appeals, reasons, and outcomes each quarter 2.9.3.1.12 Number of claims received by month, by department Sedgwick will continue to comply with these reporting requirements. 2.9.3.2 Financial Reports 2.9.3.2.1 Monthly paid check listing 2.9.3.2.2 Monthly outstanding checks listing 2.9.3.2.3 Monthly fund transfers and amounts, and bank reconciliation 2.9.3.2.4 Monthly claims payment and fees paid report 2.9.3.2.5 Adjustments, including voids and stop pays 2.9.3.2.6 Matrix of claims by month incurred and month paid Sedgwick will continue to comply with these reporting requirements. 2.9.3.3 Service Reports 2.9.3.3.1 Results from internal audit procedures 2.9.3.3.2 Average speed of answer by Customer Service Representatives 2.9.3.3.3 Average abandonment rate of calls received by Customer Service Department Sedgwick will continue to comply with these reporting requirements. 2.9.3.4 Claims and Customer Service Reports. Contractor shall maintain and operate an electronic claims and customer service call tracking and call recording systems that maintains all information regarding: 2.9.3.4.1 Customer service calls and all contacts made by a claimant 2.9.3.4.2 Dates and information about the nature of the contact 2.9.3.4.3 Claim specific information including approval, denial, and payment. Sedgwick maintains and operates an electronic claims and customer service call tracking and call recording system that will continue to maintain all contacts made by the claimant, dates and nature of the contact and claim specific information including approval, denial and payment. Sedgwick records all inbound and outgoing calls to our national contact center operations. We review these recordings for internal quality control and colleague training/development. Access to these recordings is not typically provided to clients, although the client service director can retrieve recordings for claim appeals and complaints at the County’s request. We retain all call recordings for 90 days; however, longer retention is available for an additional cost. We have designed our system to facilitate an efficient, effective claim process, and allow our disability representatives to focus on claims management by automating many administrative tasks. Once a claim has been initiated, all relevant data associated with the claim is stored in the system and keyed to the claim record. The data includes claim notes, copies of all correspondence, demographic data, historic case and employee data, etc. AUDITS 2.9.4 The County reserves the right to audit the contractor’s claims processing, payment, and enrollment records with reasonable notice. Sedgwick will continue to comply with this requirement. We welcome independent audits as directed by SERIAL 230123-RFP the County; however, all costs associated with a third-party audit for the independent review team are the responsibility of the County. Sedgwick will provide on-site or electronic access to requested file information without limitations on the number of files reviewed, type of files reviewed and/or staff interviews associated with the operational review. Sedgwick would like the opportunity to review and comment on the results prior to publishing the final findings. 2.9.5 The contractor, by submitting a proposal in response to these specifications, acknowledges the County’s right to select the auditors, and further agrees to cooperate fully with such auditors and waive all fees associated with providing access to the County’s claim records, including use of the contractor’s staff time to assist in the audit. The audits may include, but not be limited to: 2.1.1.1 Determinations of any mathematical errors in computation. 2.1.1.2 Determinations that only eligible insured’s have had claims approved. 2.1.1.3 Review of turnaround time in claim processing. Sedgwick will continue to comply with this requirement. 2.9.6 The audits may be conducted during the policy period and/or upon completion of the policy period and/or following submission of the final policy report by the contractor at the discretion of the County. Sedgwick will continue to comply with this requirement. 2.9.7 Additionally, the contractor may be requested to provide periodic eligibility lists or files to the County at no charge in order to reconcile participants’ eligibility. Sedgwick will continue to comply with this requirement. 2.9.8 If, at any time, the County has a reasonable belief that it is being systematically overcharged or double-billed under the contract, or that any other significant accounting irregularities exist, the County may conduct or hire an agent to conduct an audit of the Contractor’s books and records with respect to this Contract. Such audit shall be undertaken at contractor’s expense. Sedgwick is willing to work with the County on a reasonable solution to ensure that billing is accurate and timely. 2.9.9 The County may correct legitimate administrative errors and is the final determinant of when such errors have occurred. The County shall be the final determinant for all eligibility issues. Sedgwick will continue to comply with this requirement. 2.9.10 In determining any person’s rights to benefits under the Plan, contractor shall rely upon eligibility information furnished by the County. Sedgwick will continue to comply with this requirement. Pricing Narrative Sedgwick has uploaded the completed Attachment D Pricing Sheet to the bid submission site. In addition, we have provided Sedgwick’s pricing narrative below. Maricopa County – ASO STD and FMLA Administration Pricing Information Assumptions and pricing The rates are guaranteed for five years1 unless the parameters noted below are exceeded. This proposal is based on servicing the program from our West Hills, California, service center. SERIAL 230123-RFP Servic Annual new Per Claim Estimated annual STD administration 448 $433 $193,984 Denials 75 $232 $17,461 Monthly retainer fee 12 $692 $8,304 Printing benefit documents - $6,074 $0 If takeover services for existing claims are required, there is a one-time fee of $95 per open STD claim and $25 per active FMLA claim. We reserve the right to renegotiate the fees if: • There is a material change in the plan of benefits or by legislative or regulatory action • There is a material change, positive or negative, in the eligible employee population • Claim volume (incidence rate and/or open claim rate) changes by more than 10% incrementally by line of coverage, positive or negative. Performance guarantees related to volume during this period will be waived NOTE 1. Rates are guaranteed for five years as per Exhibit F – Sedgewick Response to Negotiation Questions, Answer to Question #1 SERIAL 230123-RFP EXHIBIT C – CONFIRMATION OF COMPLIANCE WITH CONTRACTOR REQUIREMENTS Maricopa County Solicitation 230123-RFP Short Term Disability Administrator Respondent Name: Sedgwick Claims Management Services, Inc. Contractor shall be responsible for the contractor requirements indicated, and shall confirm acceptance of such below. Contractor Requirement Yes If applicable, explain request for non- or partial-compliance Maintain eligibility by receiving eligibility data on a weekly basis via a HIPAA compliant file generated from the County, Workday. Yes Apply data received electronically from Workday to the Contractor’s enrollment/claims payment system and generate an exception report back to Workday. Yes Work with the County to resolve all eligibility/enrollment errors within two business days. Yes Accept subscriber identification number (nine digits) as defined by the County. A subscriber identification number could be either an employee identification number, social security number or an alternative identification number, as defined by the County. Yes Set up the account structure for eligibility and reporting by department. This must include the ability to accept the name and contact information for the department HR liaison for each enrolled member on the HRIS (Workday) enrollment/eligibility changes file or a separate excel worksheet with HR contacts by department and maintain all changes on a regular basis. Yes Maintain and update an electronic database in order to administer claim payments, maintain complete claims history, and report to the County. Maintain and update procedures and computer software needed to receive and process all benefit claims according to the Plan and all current and future regulations. Yes Provide an annual SOC 2 report no later than 30 calendar days after the anniversary date of the contract, and upon request by the County. Yes SERIAL 230123-RFP Provide an online and a telephonic claims filing process. Yes Assist the claimant in obtaining medical records if the claimant has not provided such records within two calendar days from a claims filing date. Yes Provide customer service via a toll-free telephone number from, at a minimum, 7:00 a.m. to 7:00 p.m. MST that is staffed with live customer service representatives to assist participants with questions regarding their claims. Yes a. Contractor shall provide an interpreter service, as needed, to assist non-English speaking enrollees. Yes b. Customer service representatives shall have the ability to view information regarding eligibility and claims. Yes c. Customer service representatives shall be trained to explain claims denials, reason for pending claims status, and claims payment calculations. Yes Provide online or telephonic access to self-service capabilities where the participant can inquire about his/her claim through an Interactive Voice Response System (IVR) or secure website. Yes Provide a return to work program and provide program results on an annual basis. Yes Be able to perform/coordinate Independent Medical Exams (IMEs) when indicated or when requested by the County. Yes Electronically notify departmental contact persons to obtain required employer information related to a disability claim. Yes Handle first and second level claim appeals. Yes Pay claims on a daily basis. Yes Assess each claim and identify those anticipated to become long- term disability claims. When such claims are identified, the contractor shall work with the Arizona State Retirement System’s (ASRS) long-term disability carrier to transition the claimant from short-term to long-term disability with minimal payment disruption. Yes Have a process in place to recover any overpayments, regardless of their cause. Yes SERIAL 230123-RFP Provide the County with online inquiry access via the contractor’s website such that the enrollment and claims payment information and standard reports can be viewed. The County prefers to be able to run ad hoc reports via the contractor’s website. Yes Have a continuous quality improvement program and provide a description of their quality improvement efforts on an annual basis. Yes Provide (at no extra cost) fully trained staff to participate during the County’s Open Enrollment Benefits Fairs or any other events hosted by Human Resources, as needed. Yes Produce all collateral materials in both English and Spanish. Yes SERIAL 230123-RFP EXHIBIT D – IMPLEMENTATION PLAN AND TIMELINE Maricopa County - Implementation Plan Section Action Items Complete Y/N Estimated Completion Date Comment 9.4.3.1 Setting up the account structure and corresponding subgroups Y 9.4.3.2 Setting up the plan design Y 9.4.3.3 Establishing the claims edits and/or business rules Y 9.4.3.4 Ensuring transaction procedures are implemented correctly Y 9.4.3.5 Ensuring accurate member correspondence and reporting Y 9.4.3.6 Setting up enrollment data (subscriber, correct plan selection, effective dates, etc.) Y 9.4.3.7 Setting up the enrollment employer group Y 9.4.3.8 Setting up benefit plans and corresponding benefit terms Y 9.4.3.9 Setting up integration files from the County to contractor including testing Y 9.4.3.10 Correctly identifying services that need to be pre-authorized Y 9.4.3.12 Ensuring contractor shall be able to accurately pay claims according to the plan documents Y 9.4.3.13 Ensuring contractor is prepared to process remittances Y 9.4.3.14 Ensuring methods are in place for providing County with management reports as indicate in Section 9.9 Mandatory Reporting Requirements Y 9.4.3.15 Ensuring County employer portal access is operational Y Sedgwick employer portal (viaOne View) is currently operational and can be accessed by key Maricopa employees. There are currently no Maricopa users with access, and we would need to be advised of which users to allow. 9.4.3.16 Ensuring all employee-facing documents and materials are provided via electronic format for posting on the County's intranet and internet Web sites in English and Spanish. N TBD Maricopa to advise of the specific employee-facing documents required to be posted on the County's intranet and internet Web sites. SERIAL 230123-RFP EXHIBIT E – SERVICE LEVEL AGREEMENT All “Percentage at Risk” realized shall be based upon administrative fees paid in the applicable quarter. Sedgwick’s total Percentage at Risk shall be equal to 20% of the administrative fees, with a maximum pay-out of Percentage at Risk of 5% of the administrative fees for the applicable quarter. Sedgwick Customer Service Customer Service Response - Quarterly All calls must be answered within an average of 30 seconds after reaching the Customer Service Queue (does not include abandoned calls). 85% Percentage at Risk 1% Customer Service Abandon Rate - Quarterly Measure the number of calls where the caller hangs up before receiving an answer once in the Customer Service Queue. 3% Percentage at Risk 1% Claim Timeliness STD Timely Initial Decision Timeliness – Quarterly A measure of the time to make an initial claim decision is within two business days of receipt of medical information. If medical information is not provided to support a claim, an employee is allowed to provide medical information to support a claim for up to 21 calendar days after an initial claim is received. If medical information is not provided by day 21, Sedgwick will make a denial decision. If medical information is provided to support a claim, Sedgwick will make the decision within 2 days from the greater of the benefit start date or the employee medical information report date. 98% Percentage at Risk 3% Claim Accuracy Claim Accuracy - Quarterly or Semi-Annual or Annual A measure aimed at ensuring appropriate case and claims management and accuracy for STD. Contractor shall pay the correct benefit for the correct duration in 99% of claims. 99% Percentage at Risk 2% A measure aimed at ensuring accurate claims management for STD denial decisions. 100% of denied claims must be denied for appropriate and documented reasons 100% Percentage at Risk 2% SERIAL 230123-RFP Contractor R i Timeliness of Responses A measure aimed at ensuring responsiveness to Benefits team emails sent to a Sedgwick’s Operations email box exclusive to the County. Email inquiries from County benefits team will be responded to within one business day (24 hours). 99% Percentage at Risk 2% Return call responsiveness is a measure aimed at ensuring responsiveness to Benefits team calls to Sedgwick. Phone calls from County benefits team will be returned within one business day 98% Percentage at Risk 2% Corresponding with the Correct County HR The right HR person will be contacted 100% of the time using the most recent list provided by the County Benefits team whether provided manually or automated through Workday. (County will work with Sedgwick to modify the existing eligibility file to include real time updates to the HR liaison on the file) 99% Percentage at Risk 2% Data Accuracy of Enrollment/Eligibility Data Import Accuracy of the data after Sedgwick has imported and loaded the data provided by the County data to Sedgwick. 99% Percentage at Risk 2% Timeliness Enrollment/Eligibility Data Import Timeliness of the import of enrollment/eligibility data HR eligibility file will be imported within one business day of receipt of the file. Sedgwick will notify the County of issues with loading the file within one business day of identifying an issue with the file load. 99% Percentage at Risk 3% SERIAL 230123-RFP EXHIBIT F – SEDGWICK RESPONSE TO NEGOTIATION QUESTIONS Negotiation questions for Sedgwick The solicitation was written as a five year Sedgwick has included a 3-year guarantee in their bid. This is an initial five-year contract. 1. Is Sedgwick willing to guarantee for five years with the option for up to five years of renewal? Sedgwick is willing to guarantee rates offered in the RFP for five years, with an option to extend for five years with a rate increase of 3% in year six and guaranteed for the remainder. 2. Is Sedgwick able to guarantee for three years with an option for up to seven years of renewal? Sedgwick is willing to guarantee rates offered in the RFP for three years, with an option to extend for seven years with a rate increase of 3% in year four and guaranteed for the remainder. Sedgwick stated, “We will continue to work with the County to receive custom, incoming reports and interfaces to update claimant HR data and/or claim details that can be used by the operations team. This will include payment information to ensure accurate calculations of disability benefits.” 3. If the County is unable to set up an electronic file, would Sedgwick be able to continue to process updates manually? We do currently receive an HR file, but it is deficient of specific contact records. We can continue to update if the County is unable to support. 4. Sedgwick has stated, “For STD claims, we allow 20 calendar days for the employee to submit medical documentation from the date of disability or the date the claim is reported to Sedgwick, whichever is later. If medical information is not received in that time frame, the claim is denied the next business day. If medical information is received within that time frame, the initial claim decision is made within two business days of receipt of completed information, but no later than the first business day after calendar day 20.” Please confirm once medical information is received, the claim decision is made within two business days of receipt of completed information. Confirmed. Sedgwick will review supporting documentation within two business days of receipt and will make a determination on the same date of review if sufficient information has been received. If supporting documentation is not received, the claim will be denied on the 21st calendar day from receipt of claim. 5. Sedgwick stated, “Sedgwick handles first-level appeals as a part of our core integrated disability services and can administer the County’s second-level appeals as an optional service for an additional fee.” Sedgwick is currently handling second-level appeals on the existing contract with the County. Can Sedgwick continue to administer first and second-level appeals? Yes, Sedgwick can continue to administer first and second-level appeals.