Meeting Materials - State Employees Health Care Commission - May 21, 2021 - the State Employee ...
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State Employees
Health Care Commission
May 21, 2021
Meeting MaterialsSTATE OF KANSAS - STATE EMPLOYEES HEALTH CARE COMMISSION
AGENDA
May 21, 2021 – 2:30 PM
The public may observe the meeting by registering here:
https://register.gotowebinar.com/register/3851522576005400846
Welcome and Introductions by Secretary Burns-Wallace
1. Follow-up Items from 04/27/21 Meeting (Previously Reported to Commissioners
via email)
2. Vision Contract Recommendation — Janet Stanek, SEHP [Action Item]
3. 2022 Plan Design Modeling Session - Secretary Burns-Wallace
a. EAC Subcommittee Survey Result Memo
b. Out of Pocket Analysis Plan Years 2018-2020
c. Employer and Employee Contribution Rates
d. Segal Assumption Summary
4. Wellness Program Review Date - Secretary Burns-Wallace
a. Suggesting August 2021
Appendix
a) Plan Year 2021 Contract Expense Projections
b) Contract Report for Contracts Ending December 31, 2021
c) RFP Reference Checks (Vision)
d) EAC Survey Information
Page 2Agenda Item
#1
Page 3HCC Follow-up Q&A
April 27, 2021
Page 4Provide feedback from the Joint Committee on Rules &
Regulations hearing regarding the Elimination of the 30-day
waiting period
Official Report from the meeting noted the following:
• It is unusual for an employee health care benefits plan to make employees eligible for
coverage at the start of employment and expressed concern over the change
• No surrounding state government offers a similar day-of-employment health plan benefit
• Private industries also are facing challenges in finding employees
• The Committee requests cost figures for each of the groups covered by the SEHP, with specific
information on the numbers used and the calculations made*
*This information was provided by SEHP legal counsel ahead of the meeting
SEHP Notes:
• One committee member stated the benefit package was limited for state employees and this
could be a positive
• A follow up letter has been drafted by SEHP leadership and is being reviewed by legal counsel
prior to forwarding to Secretary Burns-Wallace for approval/signature
Page 5Share Marathon Health Performance Guarantees (1 of 5)
Kansas Department of Administration
Performance Guarantees
Exhibit 1A
Clinic utilizers = 2+ visits in contract year May 2019 - April 2020
On-Site Clinic Performance Guarantees
Measurement Service Level Target Year 1 Result Assessment Amount at Risk Refund
PerformanceStandard
Financial $ 292,230.75
Compare risk adjusted** PMPM of all clinic
Net Return on Investment of 1.0for
utilizers to non-participating group actual costs
CY2018, 1.25 for CY2019 and 1.5 for
or benchmark costs for control group. Please see N/A Participation target
CY2020+. Net ROI shortfall. N/A $ -
detailed write-up of the methodology. notmet (8.5% vs. 20%
Cost Savings for all participants using the clinic target)
(Exhibit B)
** Risk Adjustment is a statistical method thatis
commonly used in order to be able to compare ROI is null and void if less than 20%
populations with similar demographics and participation.
chronic disease risk factors.
Page 6Share Marathon Health Performance Guarantees (2 of 5)
PerformanceStandard Measurement Service Level Target Year 1 Result Assessment Amount at Risk Refund
Clinical
Percent of eligible participants that use 90% of eligible participants who 80.1% (1018 / 1271)
Personal Health Assessment survey have had at least one annual 5% of amount at risk $ 14,612 $ 14,612
theclinic complete the PHA (ADD TOTAL COMPLETING HRA)
completion rate visitwith a provider have
completed PHA
Percent of contracted eligible members
withina 30-mile radius of the Wellness Center
10% for CY2018, 15% CY2019 1.6% w 2+ visits (255/15508),
with two annual visits. 5% of amount at risk $ 14,612 $ 14,612
and 20% for CY2020+. 1319 (8.5%) had at least 1 visit
Eligible members withtwo annual visits
*Geomapping will be revisited annually.
Of clinic utilizers who smoke,
Percent of clinic utilizers, who are achieve a quit rate (smoke free 34.6% (18/52) 5% of amount at risk $ 14,612 $ -
Smoking Cessation smokers,achieve specified quit >90 days) of 3% CY2018, 4%
rates. CY2019 and 5% CY2020+.
Of clinic utilizers who are
Percent of clinic utilizers, who are overweight overweight or obese, achieve 8.3% (29/350) 5% of amount at risk $ 14,612 $ -
or obese achieve specified reduction in BMI. 5%weight reduction in 3%
Reduction in BMI Patients with BMI > 24.9. CY2018,
4% CY2019 and 5% CY2020+.
Cancer Screenings
Of clinic utilizers, achieve sex-
*Contractor will document Percent of clinic utilizers who achieve sex- and andage-appropriate breast and
“referred/declined” age- appropriate breast and colon cancer colon cancer screening referral 62.7% (541/863) 5% of amount at risk $ 14,612 $ 14,612
for members who screenings based on the specified percentages. rates in 75% CY2018, 80%
refuse screenings CY2019, 85% CY2020+
Page 7PerformanceStandard Measurement Service Level Target Year 1 Result Assessment Amount at Risk Refund
Clinic Utilizers
Clinical Goals
≥ 75% of clinic utilizers with diabetes will be
at the standard ofcare (or not applicable) for
4 out
of 5:
Annual Foot Exam, 39.4% (13/30)
Percent of clinic utilizers with
Annual Eye Exam,
diabetes will achieve the minimum 10% of amount at risk $ 29,223.08 $ 29,223
Share
Diabetes
Annual Influenza,
specified standard ofcare.
Pneumococcal at least once,
Annual Hemoglobin A1c.
Marathon
A1c≤ 7.0=10%
CY2018 12.5% CY2019, 15% 12.1% (4/33)
CY2020+.
Health Of clinic utilizers with elevated
BPs,
Performance
≥ 30% of population meets this
standard CY2018
≥ 35% of population meets this SBP 57.1% (36/63)
Guarantees
Percent of clinic utilizers with standard CY2019 5% of amount at risk $ 14,612 $
Hypertension hypertension,achieve the
≥ 40% of population meets this
specified percentages. -
standard CY2020+.
(3 of 5) Systolic BP > 140 will reduce by 12
mm/hg or normal
Diastolic BP > 90 will reduce by
DBP 63.0% (46/73)
5mm/hg or normal
≥ 75% of clinic utilizers with asthma will meet
the standard of care (or not applicable) for 4
out of
Percent of clinic utilizers with 5:
Asthma asthma will achieve the minimum Inhaled corticosteroid, 44.9% (35/78) 5% of amount at risk $ 14,612 $ 14,612
specified standard ofcare. Short acting bronchodilator,
Asthma action plan,
Flu shot,
Pneumovax.
≥ 85% of clinic utilizers with CADwill be taking
Patients currently taking an ACE-inhibitor these two medications (or have
Coronary ArteryDisease and astatin (unless 14.3% (1/7) 5% of amount at risk $ 14,612 $ 14,612
contraindications identified)
contraindicated)
Page 8Share Marathon Health Performance Guarantees (4 of 5)
Performance Measurement Service Level Target Year 1 Result Assessment Amount at Risk Refund
Standard
Utilization
For clinic utilizers, 20% reduction 5% of amount at risk $ 14,612 $ 14,612
-10.4% (220.5 baseline to
ER Visits from prior year before program
Percent reduction in ER visits per 1,000 patients 197.7/1000 in Y1)
implementation (2017)
For clinic utilizers, 5% reduction 5% of amount at risk $ 14,612 $ -
Percent reduction in hospital admissions per -17.6% (36.3 baseline to
Hospital Admissions from prior year before program
1,000 patients 29.9/1000 in Y1)
implementation (2017)
For clinic utilizers, 20% reduction 10% of amount at risk $ 29,223 $ 29,223
Percent reduction in primary care visits per
Primary Care Visits from prior year before program Office (PCP and Specialty
person per year
implementation (2017) Combined) cost - 10.5%, service
For clinic utilizers, 20% reduction 5% of amount at risk $ 14,612 $ 14,612
Percent reduction in specialist visits per person (not unique visit) volume
Specialists Visits from prior year before program
per year decreased by -2%
implementation (2017)
Page 9Share Marathon Health Performance Guarantees (5 of 5)
Performance
Standard Measurement Service Level Target Year 1 Result Assessment Amount at Risk Refund
Operational
All contracted on-site Measured by Contractor's report of initial 'go-
clinic services shall live' readiness, reported no later than 5 100% of contracted on-site clinic
take effect/ go live business days prior to the initial 'go-live' date; services will be fully operational on Target met 10% of amount at risk $ 29,223 $ -
and be fully and SEHP's service experience during the the go live date(s) as specified in
operational on the month following the the Contract.
initial go live date(s). 'go-live' date.
Contractor must provide transmittal of relevant Contractor will provide accurate
data to any third-party vendor(s) or others as data feeds within mutually agreed Target met 5% of amount at risk $ 14,612 $ -
Transmittal ofrelevant
identified by SEHP. This standard shall be time frame(s) to be determined
data
reported to SEHP monthly and measured in after assessing the needs of SEHP
concurrence with the data feed frequencies. and its vendors.
Contractor must provide Standard Measured by SEHP's date of
Management Reports no later than 30 days receipt. Data files shall be
Create and generate following the end of the reporting period (i.e., submitted no later than 30 days Target met 5% of amount at risk $ 14,612 $ -
Standard quarterly, monthly, annually) unless discussed following the end of the reporting
ManagementReports and mutually agreed upon. Reports to be period (i.e., quarterly, monthly,
defined and mutually agreed upon at a later annually) unless discussed and
date. mutually agreed upon.
Patient Satisfaction Achieve a minimum percent of satisfaction or ≥ 90% of patients will be satisfied $ -
95.5% (784) 5% of amount at risk $ 14,612
Rates better (defined as “top two-box” satisfaction/ Or highly satisfied based on survey
Performance Guarantee penalties will not exceed 15% of total fees. $ 292,231 $ 160,727 Page 10Explain How Marathon is defining N (number of eligible patients)
in the Engagement by Department report
• The Employee count comes from the eligibility file that the SEHP
sends to Marathon on a monthly basis
• The number of enrollees on this file fluctuates
• The employees on this file are those that answered ‘yes’ to the
question about living or working in the 5-county Topeka Metropolitan
Statistical Area (MSA) in the Member Administration Portal (MAP)
that is used for new employee and annual open enrollment into the
health plan
Page 11Provide an update of the Annual Audits
The following areas are audited by an audit firm that is approved by the HCC
on an annual basis:
• Medical Claims/Process - BCBSKS (Random sample claims audit and operational review)
• Medical Claims/Process - Aetna (Random sample claims audit and operational review)
• Dental Claims/Process – Delta Dental (Random sample claims audit and
operational review)
• Dependent eligibility verification audit (To confirm the eligibility of dependents covered by
the State Employee Health Plan)
• Premium Reconciliation (Audit of State, Non State and Direct Bill employer and employee
premiums paid to the SEHP )
• Pharmacy Benefits Manager (Audit of Pricing and Fees; Reconciliation of Pricing
Guarantees; Benefit Payment Accuracy Review; Manufacturer Rebates; Pharmacy Payment
Verification; Network Pharmacy Contract Audit)
Completed audits are available on the SEHP website here.
Page 12Pharmacy Audit:
Provide pharmacy actuals for 2018-2019 calendar year
Share audit report with commission and reconcile numbers
• Segal is comparing their report to the audit numbers and the
Commission will get an update on the disparity between the two sets
of numbers at a future meeting
• 2018 and 2019 audits are complete, but payment has not yet been
received for the money owed back to the State
• These audits are posted on the SEHP website executive-summary-
final-2021-03-26.pdf (ks.gov)
Page 13Provide an analysis for the reserve language in HB2218
• The bill amends the statutory reporting requirements to include a report to the
legislature including recommendations with respect to the SEHP, along with
estimates of the cost of the program proposed by the HCC including a 5-year
(vs. 3 year) projection of the cost of the program
• The recommendations shall include a report on the current and projected
reserve balance, including as a percentage of total plan expenses
• For any reserve balance over 10% of the average plan expenses for the
immediately preceding three plan years, the HCC shall provide
recommendations for reducing reserves by minimizing increases to employee
contributions or cost sharing requirements
• The HCC shall include alternatives for cost containment and benefit coverage for
the proposed program and the 5-year projected program
• An analysis of what this report would look like today is being reviewed by Segal,
and will be reviewed at the next available HCC meeting
Page 14Proceed with the next steps for a
Diabetes Management Program RFP.
• The SEHP staff will work on an RFP for consideration/review in the
coming months.
Page 15Provide Additional research for the
Heart Health and Smoking Cessation Options
• Heart Health programs targeted at Hypertension and Hyperlipidemia
chronic conditions. Focus on monitoring condition, coaching services,
and nutrition guidance to improve metrics.
• Smoking Cessation programs targeted at Tobacco users. Focus on
campaign to improve awareness, promote usage of program and
develop measurable results from program.
Page 16Provide a summary of what is currently offered
regarding the Smoking Cessation Program
• Tobacco Cessation programs are covered by the SEHP at no cost to
members. Coverage includes generic and brand name products for
nicotine replacement/substitute and cessation programs
• Coverage for Tobacco Cessation products are provided at no cost to
members for up to 180 days per year. In addition, a member is
provided up to 3 "cessation programs" per lifetime at no cost
• Coverage for counseling services at network providers for Tobacco
Cessation are also covered at no cost to SEHP members (unlimited)
• A typical Tobacco Cessation program is 3 months; however, 6-month
programs are also included in the SEHP benefit plan at no cost
Page 17Provide a summary of the No Surprise Billing Act
Federal Level:
• On Dec. 27, 2020, the No Surprises Act was signed into law as part of the Consolidated
Appropriations Act of 2021 (H.R. 133; Division BB – Private Health Insurance and Public
Health Provisions). The No Surprises Act addresses surprise medical billing at the federal
level. Most sections of the legislation go into effect on Jan. 1, 2022.
• Protects patients from receiving surprise medical bills resulting from gaps in coverage for
emergency services and certain services provided by out-of-network clinicians at in-
network facilities, including by air ambulances.
• Holds patients liable only for their in-network cost-sharing amount, while giving
providers and insurers an opportunity to negotiate reimbursement.
• Allows providers and insurers to access an independent dispute resolution process in the
event disputes arise around reimbursement. The legislation does not set a benchmark
reimbursement amount.
• Requires both providers and health providers and health plans to assist patients in
accessing health care cost information.
detailed-summary-of-no-surprises-act-advisory-1-14-21.pdf (aha.org)
Page 18Provide a summary of the No Surprise Billing Act (continued)
State of Kansas HB2325:
• Would enact the End Surprise Medical Bills Act and would prohibit a health benefit plan, health insurer, or
healthcare provider to engage in balance billing practices for services provided in hospitals, ambulatory
surgery centers, emergency rooms, and state-accredited freestanding emergency departments.
• Would also prohibit balance billing practices for services ordered by an in-network healthcare provider and
provided by an out-of-network healthcare provider or laboratory if the covered person relies on the health
plan’s provider directory and the directory was inaccurate.
• The Insurance Commissioner would enforce the Act and would be required to have rules and regulations
established by July 1, 2022.
• The bill would prohibit a health benefit plan, health insurer, or healthcare provider from issuing a covered
person a surprise medical bill.
• Under HB 2325, these groups would pay the median in-network rate under the plan or coverage, less the
covered person’s in-network cost sharing, directly to the healthcare provider.
• Remains as a bill in committee and next discussion scheduled for 5/26/21
hb2325_00_0000.pdf (kslegislature.org)
Page 19Agenda Item
#2
Page 20Vision Benefit Contract
May 21, 2021
Health Care Commission Meeting
Page 21The vision benefit is a fully insured
product that provides members
Vision with coverage for frames, lenses,
Overview contacts and eye exam coverage
for those members not enrolled in
a medical plan.
Page 22RFP Dates
November 23, 2020 December 23, 2020
February 19, 2021
Provided to the RFP was posted for public
RFP bidding closed
Commissioners for Comments bids
Page 23Bidders
Four bids were received
1. Avesis a Guardian Company
2. Metropolitan Life Insurance Company
3. Surency Vision
4. Vision Service Plan Insurance Company (VSP)
A finalist meeting was held with all four companies along with
communications to address various parts of the bid
Page 24Determine the company can administer the
dental program for a group the size of Kansas
Provider Network
Bid Services provided to the health plan
Evaluation
Customer service
Reporting
Page 25Services Included for Vision Benefit
• Network Access
• Claims processing
• Reporting
• Member Portal
• Health Plan administration Portal
• Member Communications
• ID Cards
• Benefit booklet
Page 26Monthly Premium Cost
Employee Pays 100% of the Premium
Enrollment as of Surency Current
BASIC Plan 3/1/2021 Rates Avesis MetLife/ Superior Vision Surency VSP*
Employee Only 5,762 $3.68 $2.88 $4.24 $3.68 $3.29
Employee + Spouse 1,050 $7.22 $5.84 $8.31 $7.21 $6.45
Employee + Children 1,499 $6.52 $6.32 $7.51 $6.51 $5.82
Employee + Family 1,302 $10.06 $8.68 $11.58 $10.05 $8.98
Direct Bill 646 $3.68 $2.88 $4.24 $3.68 $3.29
ENHANCED Plan
Employee Only 13,403 $7.24 $5.84 $8.19 $7.24 $6.12
Employee + Spouse 4,057 $14.30 $10.80 $16.17 $14.29 $12.09
Employee + Children 3,738 $12.90 $12.70 $14.59 $12.89 $10.91
Employee + Family 3,535 $20.00 $16.36 $22.62 $19.99 $16.91
Direct Bill 1,718 $7.24 $5.84 $8.19 $7.24 $6.12 Page 27Recommendation
• Surency Vision is the incumbent and has administered the Vision Benefit
program for the health plan for six years.
• Avesis has provided vision, dental, and hearing care benefit solutions for
more than 40 years. Avesis programs cover nearly 9,000 client groups
across the country, including more than 700 government clients. This
equates to 36% of their total insured vision members and 10% of their total
clients served. Avesis’ current group vision clients include 13 government
clients with more than 5,000 members each. They have the State of
Arizona, which has more than 200,000 members and has been an Avesis
group vision client since 2001.
• Avesis provides the member with the lower premium cost along with the
current benefit design for the members.
Page 28Recommendation (continued)
• Avesis has extensive experience building networks on demand for important client partners. The timing of
this network build is ideal, as Avesis is currently augmenting their Kansas vision provider network for a
prominent Kansas Medicaid managed-care organization and its 100,000+ enrollees.
• Avesis will continue to build out their network and Avesis offers the following performance guarantees:
• Standard: Avesis commits to recruit and contract the provider locations responsible for 85% of SEHP’s
claims in 2019 and 2020. These are the minimum number of provider locations Avesis is targeting to add
to the existing network by October 1, 2021. To deliver access to all corners of the state, Avesis will make
it a priority to recruit smaller practices in the more rural communities.
• Performance Guarantee: If the network is deficient from the above standard as of October 1, 2021,
Avesis will issue a $35,000 credit to SEHP. For each subsequent month that the network recruitment
standard is not achieved, Avesis will credit the SEHP an additional $15,000 per month—up to an
additional $90,000—for a maximum recruitment penalty of $125,000.
• The health plan has changed vendors twice over the past several years and both new vendors have built out
their networks to meet the needs of the health plan members.
• The SEHP recommends Avesis be awarded the contract for the next 3-year period beginning January 1, 2022.
Page 29Agenda Item
#3
Page 30MEMORANDUM
TO: Health Care Commission
FROM: Natalie Yoza, Employee Advisory Committee (EAC) President and Hannah Rich,
EAC Vice President
DATE: May 13, 2021
SUBJECT: EAC Recommendations for Plan Year 2022 Plan Design
At its March 12, 2021, meeting the Employee Advisory Committee (EAC) reviewed data from the 2020
EAC survey of health plan respondents to identify the following priorities for the Health Care
Commission’s (HCC) consideration when making Plan design decisions for Plan Year 2022. The EAC
unanimously voted to recommend the following priorities for consideration based on the survey data
and the extensive work of the EAC Subcommittee charged with reviewing that data.
As part of the survey, active State employees were asked to rate their satisfaction with seven Plan
features—premium, out-of-pocket maximum, deductible, cost to access primary care providers, cost to
access specialists, cost of an ER visit, and the HSA/HRA feature (except for Plan A participants that do
not have the HSA/HRA options). Active State employees were also asked to report the importance of
the same seven features when selecting a health plan. Comparing the response data from these two
questions comprises the primary supporting data for the EAC’s recommendations. Response data from
these questions is provided as an appendix to this memo.
1. Reduction of out-of-pocket maximum (OOP maximum)
a. The OOP maximum was ranked lowest in satisfaction of Plan features with a combined
52 percent of respondents either dissatisfied or very dissatisfied. It was also rated the
third most important feature to members with 98.8 percent of respondents choosing
either very important or somewhat important. This led the EAC to consider it a prime
target for Plan adjustments.
b. Per State Employee Health Plan (SEHP) records, only two to four percent of members
annually have medical costs high enough to reach the OOP maximum. However, it is
our observation that the possibility of a major medical event causing a member to owe
the full OOP maximum causes significant anxiety among members.
Page 31c. In addition to answering the survey questions, survey respondents were invited to
provide open-ended feedback. Responses from Plan C members repeatedly expressed a
desire for Plan C to return to the previous OOP maximum equal to the deductible, or in
other words, a 0% coinsurance.
d. RECOMMENDATION: Due to the high proportion of dissatisfaction in this feature and
the potential to significantly reduce member anxiety with a lower potential cost to
members than adjusting other features, the EAC recommends lowering the OOP
maximum be considered the top priority during Plan adjustments.
2. Reduction of Plan deductible
a. The second highest level of employee dissatisfaction reported on the survey was with
the deductible with a combined 43 percent of respondents dissatisfied or very
dissatisfied. It was ranked the second most important feature—just ahead of OOP
maximum. The difference in importance between these two features was a margin of
less than 1%, indicating similar member feelings for both.
b. Of all survey respondents, 55.6 percent are enrolled in Plans C or N. These Plans are
qualified high-deductible healthcare plans (HDHP), which have federally regulated
minimum individual and family deductibles.
c. Fewer than three percent of all survey respondents are enrolled in Plans J or Q, the low-
deductible plan offerings.
d. RECOMMENDATION: Due to the high proportion of both dissatisfaction and relative
importance of this feature among survey respondents, as well as recognition of federal
regulations governing HDHP deductibles, the EAC recommends lowering of the
individual and family deductibles be considered a priority for Plans A, C, and N.
3. Reduction or maintenance of semi-monthly premiums
a. Semi-monthly premiums were ranked second highest in satisfaction for Plan features
with a combined 76.2 percent of respondents either satisfied or very satisfied. However,
it was also ranked highest in relative importance by respondents, with 99.3 percent of
respondents choosing either very important or somewhat important.
b. Historically, when projecting annual claims and contribution figures, the SEHP actuarial
model assumes a four percent annual increase to employee and employer contributions.
However, in both 2020 and 2021 Plan years, HCC was able to hold employee premiums
steady or reduce premiums for some coverage types. This is, of course, the most popular
option among Plan members, but we do recognize that decreases to the OOP maximum
or deductibles may necessitate an increase in premiums.
c. RECOMMENDATION: As decreases to OOP maximum and deductible occur, the EAC
understands that increases to cost-sharing may need to occur elsewhere. Although a
decrease to OOP maximum, deductible, and premiums would be happily welcomed by
Plan members, the survey response data indicates that a modest increase in premiums
would be accepted by Plan members in exchange for lower cost-share in other Plan
features. If an increase in premiums is required, it should be noted that State employees
will not be receiving a Cost of Living Adjustment (COLA) this year. Ensuring the Plan
is affordable for all members and their families continues to be a high priority, so
minimal increases are preferred.
Page 32Out Of Pocket Analysis 2018 to 2020
2020 2019 2018
Total Member Individual % of Total Member Total Member Individual % of Total Total Member Individual Members % of Total
Only Count Members who Only Count Only Count Members who Member Only Count for who reached the Member
Enrolled on reached the OOP Enrolled on reached the OOP Only Enrolled on OOP Max. Only Count
Dec. 1, 2020 Max. De. 1 2019 Max. Count Dec. 1, 2018
Plan A 28,562 1,024 3.6% Plan A 30,947 1,289 4.2% Plan A 35,896 1,401 3.9%
Plan C 36,278 1,146 3.2% Plan C 35,320 1,746 4.9% Plan C 36,314 1,724 4.7%
Plan J 1,455 37 2.5% Plan J 1,471 33 2.2% Plan J 1,299 16 1.2%
Plan N 6,581 188 2.9% Plan N 6,459 174 2.7% Plan N 5,081 129 2.5%
Plan Q 1,075 41 3.8% Plan Q 917 23 2.5% Plan Q 558 13 2.3%
Total 73,951 2,345 3.2% Total 75,114 3,265 4.3% Total 79,148 3,283 4.1%
2020 2019 2018
Member +1 or Member +1 or more % of Total Member Member +1 or Member +1 or % of Total Member +1 or Member +1 or more % of Total
more Coverage who +1 Count more more Coverage Member more Contracts Coverage who Member +1
Contracts as reached the Family Contracts as who reached the +1 Count as of Dec. 1, reached the Family Count
of Dec. 1, 2020 OOP Max. of Dec. 1, Family OOP Max. 2018 OOP Max.
2019
Plan A 6,056 54 0.9% Plan A 6,704 76 1.1% Plan A 8,516 90 1.1%
Plan C 9,411 251 2.7% Plan C 9,128 334 3.7% Plan C 9,670 333 3.4%
Plan J 394 6 1.5% Plan J 397 5 1.3% Plan J 299 3 1.0%
Plan N 1,591 29 1.8% Plan N 1,578 30 1.9% Plan N 1,265 12 0.9%
Plan Q 251 3 1.2% Plan Q 223 2 0.9% Plan Q 114 0 0.0%
Total 17,703 343 1.9% Total 18,030 447 2.5% Total 19,864 438 2.2%
2020 2019 2018
Total Member Individual % of Total Member Total Member Individual % of Total Total Member Individual Members % of Total
Only Count for Members who Only Count Only Count Members who Member Only Count for who reached the Member
anyone reached the OOP for anyone reached the OOP Only anyone OOP Max. Only Count
enrolled Max. enrolled Max. Count enrolled during
Plan A 38,799 999 2.6% Plan A 50,981 1,289 2.5% Plan A 61,325 1,401 2.3%
Plan C 42,695 1,083 2.5% Plan C 51,370 1,746 3.4% Plan C 54,373 1,724 3.2%
Plan J 1,560 37 2.4% Plan J 1,964 33 1.7% Plan J 1,534 16 1.0%
Plan N 6,716 186 2.8% Plan N 8,226 174 2.1% Plan N 6,559 129 2.0%
Plan Q 1,128 40 3.5% Plan Q 1,192 23 1.9% Plan Q 744 13 1.7%
Total 90,898 2,345 2.6% Total 113,733 3,265 2.9% Total 124,535 3,283 2.6%
Page 33Plan N
Plan A Plan C Plan J Plan Q
Employee Category
ER EE ER EE ER EE ER EE ER EE
$611.28 $79.80 $611.28 $70.40 $611.28 $105.12 $611.28 $46.50 $611.28 $52.70
Employee Only
(88%) (12%) (90%) (10%) (85%) (15%) (93%) (7%) (92%) (8%)
$895.66 $484.22 $895.66 $252.42 $895.66 $313.02 $895.66 $172.04 $895.66 $193.00
Employee + Spouse
(65%) (35%) (78%) (22%) (74%) (26%) (84%) (16%) (83%) (17%)
$895.66 $253.12 $895.66 $130.04 $895.66 $194.54 $895.66 $87.84 $895.66 $97.82
Employee + Children
(78%) (12%) (87%) (13%) (82%) (18%) (91%) (9%) (90%) (10%)
$895.66 $847.76 $895.66 $425.16 $895.66 $536.30 $895.66 $306.46 $895.66 $365.00
Employee + Family
(51%) (49%) (68%) (32%) (63%) (37%) (75%) (25%) (71%) (29%)
Dental Vision
Basic Enhanced
Employee Category
ER EE ER EE ER EE
$22.64 $12.94 $0.00 $3.68 $0.00 $7.24
Employee Only
(64%) (36%) (0%) (100%) (0%) (100%)
$37.96 $31.62 $0.00 $7.22 $0.00 $14.30
Employee + Spouse
(55%) (45%) (0%) (100%) (0%) (100%)
$37.96 $27.88 $0.00 $6.52 $0.00 $12.90
Employee + Children
(58%) (42%) (0%) (100%) (0%) (100%)
$37.96 $46.62 $0.00 $10.06 $0.00 $20.00
Employee + Family
(45%) (55%) (0%) (100%) (0%) (100%)
Page 34Kansas State Employees Health Care Commission
Data Through March 2021
Assumption Summary
Trend Assumptions 2020 2021 2022 2023 2024
Interest Rate on Fund Balance 0.05% 0.05% 0.05% 0.05% 0.05%
Admin/Contract Fee Trend/Vision Trend 2.0% 2.0% 2.0% 2.0% 2.0%
Medical claim trend rate 5.5% 5.5% 5.5% 5.5% 5.5%
Prescription drug claim trend rate 8.5% 8.5% 8.5% 8.5% 8.5%
Dental claim trend rate 3.0% 3.0% 3.0% 3.0% 3.0%
Medicare Advantage trend rate 6.0% 6.0% 6.0% 6.0% 6.0%
Funding Rate Assumptions
Medical
Employer % Change (eff. July 1) TRUE TRUE TRUE
Employee 4.5% 3.0% 4.6% 4.6% 4.6%
Employee + Spouse 4.5% 3.0% 4.6% 4.6% 4.6%
Employee + Child(ren) 4.5% 3.0% 4.6% 4.6% 4.6%
Employee + Family 4.5% 3.0% 4.6% 4.6% 4.6%
Employee % Change (fee. Jan 1)
Employee 0.0% 0.0% 4.6% 4.6% 4.6%
Employee + Spouse -6.0% -2.0% 4.6% 4.6% 4.6%
Employee + Child(ren) 0.0% 0.0% 4.6% 4.6% 4.6%
Employee + Family -6.0% -2.0% 4.6% 4.6% 4.6%
Non-Medicare Retiree Contrib % Change (eff. Jan 1)
Employee -6.0% -2.0% 4.6% 4.6% 4.6%
Employee + Spouse -6.0% -2.0% 4.6% 4.6% 4.6%
Employee + Child(ren) -6.0% -2.0% 4.6% 4.6% 4.6%
Employee + Family -6.0% -2.0% 4.6% 4.6% 4.6%
Dental
Employer % increase (eff. July 1) 3.2% 3.3% 3.3% 3.3% 3.3%
Employee tier contribution % (eff. Jan 1) 3.2% 3.3% 3.3% 3.3% 3.3%
Dependent tier contribution % (eff. Jan 1) 3.2% 3.3% 3.3% 3.3% 3.3%
Wellness Assumptions
Earned HSA/HRA Contribution ($500/$1,000) 65% 50% 50% 50% 50%
Wellness Contribution Credit $40 per month 50% 65% 50% 50% 50%
Reserve Targets
IBNR Claim Reserve (% of claims) 7.5% 7.5% 7.5% 7.5% 7.5%
Claim Fluctuation Reserve (% of claims) 5.5% 5.5% 5.5% 5.5% 5.5%
Page 35Agenda Item
#4
Page 36APPENDIX – a
Page 37SEHP CONTRACTS - PY 2021 PROJECTION
Open
Contract HCC Decision
Original Contract Contract End Enrollment PY 2021 Cost
Contract Type Vendor Type Contract Description Extension Needed by
Term Date Time Projection
Term Date
Sensitive
Medical Plan
Medical Plan BCBS of KS Medical Plan Administrator Medical Plan - ASO 2021-2023 12/31/2023 June 2023 Y $ 11,463,103
Medical Plan BCBS of KS Medicare Supplement Insurance Fully Insured Plans 2019-2021 12/31/2021 August 2021 Y $ 2,300,000
Medical Plan Aetna Medical Plan Administrator Medical Plan - ASO 2021-2023 12/31/2023 June 2023 Y $ 1,277,155
Medical Plan Aetna Advantage Medicare Advantage Insurance Fully Insured Plans 2019-2021 12/31/2021 August 2021 Y $ 1,750,000
Dental Plan
Dental Plan Delta Dental Plan of KS Dental Plan Administrator Dental Plan 2019-2021 12/31/2021 April 2021 Y $ 618,579
Vision Insurance
Vision Insurance Surency Voluntary Vision Insurance Fully Insured Plans 2019-2021 12/31/2021 April 2021 Y $ 4,080,000
Prescription Drug
Prescription Drug CVS Caremark Prescription Drug Benefits Pharmacy Benefit Management (PBM) Services 2020-2022 12/31/2022 June 2022 Y $ 7,317,005
Prescription Drug SilverScript Medicare Part D Drug Plan Part D Pharmacy Coverage - Fully Insured 2021-2023 12/31/2023 August 2023 Y $ 3,586,222
Lab Services
Preferred Provider Network for Lab
Preferred Lab Services Quest Diagnostics Lab services 2021-2023 12/31/2023 April 2023 Y $ 1,845,000
Services
Preferred Provider Network for Lab
Preferred Lab Services Stormont-Vail Lab services 2021-2023 12/31/2023 April 2023 Y $ 651,244
Services
The University of Kansas Health Preferred Provider Network for Lab
Preferred Lab Services Lab services 2021-2023 12/31/2023 April 2023 Y $ 250,000
System Services
Voluntary Benefits
Provides Voluntary Accident, Critical Illness and Hospital
Voluntary Benefits Hartford Insurance Co. Voluntary Benefit Insurance 2021-2023 12/21/2023 February 2023 Y $ 3,778,173
Indemnity Insurance
Long Term Care
Long Term Care ACSIA Voluntary Long Term Care Insurance Fully Insured LTC Plan 2016-2018 2019-2021 12/31/2021 February 2021 $ 300,000
Health Savings Account (HSA) & Health Reimbursement Accounts (HRA)
HSA: $185,000
Health Savings Accounts Provides third-party administration for the State of Kansas
HSA & HRA NueSynergy 2019-2021 12/31/2021 April 2021 Y
HSA & HRA
Health Reimbursement Accounts HRA: $57,600
Flexible Spending Accounts
Cafeteria Plan/Flexible Spending Provides third-party administration for the State of Kansas
Flexible Spending Accounts NueSynergy 2020-2022 12/31/2022 February 2022 Y $ 190,000
Accounts Flexible Spending Accounts
COBRA Administration
COBRA Administration TASC COBRA admin. Provides COBRA administration and billing services 2019-2021 12/31/2021 February 2021 Y $ 110,000
Actuarial and Consulting Services
Provides consulting and actuarial services to the SEHP and
Actuarial and Consulting Services Segal Consulting and Actuarial Services 2016-2018 2019-2021 12/31/2021 June 2021 $ 300,000
HCC
Transparency Tool
Online Drug Transparency Tool, Text & Telephonic Customer
Transparency Tool Rx Savings Solutions Pharmacy Transparency Tools 2021-2023 12/31/2023 February 2023 $ 1,600,000
Support Services
Audit Services
Audit Sagebrush SEHP Audit Provides audit services of SEHP vendors and services 2021-2023 12/31/2023 June 2023 $ 225,500
Data Administration
2015-2016
Year-round enrollment and health plan changes for State
Data Administration iTEDIUM ITS Web Hosting Enrollment 2011-2014 2017-2019 12/31/2022 April 2022 Y $ 250,000
Employees, Non State Employees and Direct Bill Members
2020-2022
User licenses, user training, and data extract and analysis for
Data Administration Gain Data Warehouse 2017-2022 12/31/2022 KDHE Contract $ 359,000
SEHB
Employee Assistance Program
Service include no cost counseling up to 8 sessions, telephonic
EAP ComPsych Employee Assistance Program support for legal, financial and family support and online 2020-2022 12/31/2022 April 2022 Y $ 3,750,000
resource center
Onsite Medical Center
Provides medical are, lab services and immunizations, mental
Onsite Medical Center Marathon Health Onsite employee health center health & coaching services for employees and their covered 2018-2021 12/31/2021 June 2021 $ 2,400,000
dependents on the SEHP
Wellness
Furnishes health risk appraisals, health screening, health
Wellness Cerner Wellness HealthQuest Wellness Program coaching, disease management, and other related services to 2019-2022 6/30/2022 February 2022 Y $ 2,400,000
the 88,000 covered lives of the SEHB recipients
Wellness Holmes Murphy -NS412 Naturally Slim Weight Loss Provides a weight loss program 2017-2019 2020-2022 12/31/2022 February 2022 Y $ 2,300,000
CBIZ Benefits & Insurance Services,
Wellness Wellness Consultant Planning and implementation of SEHP HealthQuest programs 2015-2018 2019-2021 12/31/2021 June 2021 $ 20,400
Inc.
Memorandum of Understanding
Flu Immunization KDHE On-site Flu Shot Clinics On-site flu shot immunizations 2020 12/31/2020 Feb 2021 $ 150,000
Page 38APPENDIX – b
Page 39Contracts Ending In 2021
Provide to the HCC
for Comments Prior Projected Public Actual Public Posting Public Posting Bid
Open HCC Projected
to Posting with Posting Bid Date by Date Provided by the End Date Provided Single or Contract
Enrollment Decision length of
Contract Name Description Expiration Date Comments back two the Office of Office of by the Office of multi-vendor Awarded
Time Needed by the
weeks after the Procurement and Procurement and Procurement and award by HCC
Sensitive Date contract
Documents are Contracts Contracts Contracts
Provided
Long term care (LTC) is the assistance a person
may need with the basic activities of daily living –
eating, bathing, dressing, transferring, toileting,
and continence. It can also include supervision
Voluntary Group Long needed to protect a person’s health and safety. Third Week of Single Vendor Contract
LTC consists mainly of personal care rather than December 31, 2021 October 28, 2020 November 20, 2020 December 17, 2020 No Feb-21 3 years
Term Care November Award Extended
medical care, which is typically covered by a
health plan. Long Term Care Insurance provides
payment toward LTC services and nursing
home confinement.
The Consolidated Omnibus Budget
Reconciliation Act (COBRA). Provides the
employee the right to choose to continue group
health benefits for limited periods of time under Single Vendor
COBRA Administration December 31, 2021 October 28, 2020 First week of December November 24, 2020 January 5, 2021 Yes Feb-21 3 years Yes
certain circumstances such as voluntary or Award
involuntary job loss, reduction in the hours
worked, transition between jobs, death, divorce,
and other life events.
Provides thenetwork and dental claims Week of December 7, Single Vendor
December 31,2021 November 23, 2020 December 23, 2020 February 18, 2021 Yes Apr-21 3 years Yes
processing for the health plan 2020 Award
Dental ASO Contract
Vision insurance covers eye exams,
eyeglasses, lens and contact lens. It is a
Week of December 7, Single Vendor
fully insured product with the vendor December 31,2021 November 23, 2020 December 23, 2020 February 19, 2021 Yes May-21 3 years
2020 Award
providing the network and coverage for
Vision Insurance eligible claims.
The health plan actuary deals with the
measurement and management of risk and
uncertainty. Some items they provide: Highly
forecast trends, premium rates, plan design, Dependent
Single Vendor
Actuarial Consulting budget to actual reporting, RFP evaluation, December 31, 2021 February 2021 Early March 2021 March 9, 2021 April 15, 2021 on 2022 Jun-21 3 years
Award
trend reports, prescription drug Program Actuarial
regarding pricing and rate setting, work
calculation of GASB 43/45 liabilities and
other GASB requirements
Provides the administration services for the
Single Vendor
HSA/HRA Account Health Savings Account and Health December 31, 2021 December 17, 2020 Third Week of January January 20, 2021 March 2, 2021 Yes Apr-21 3 years
Award
Administration Reimbursement Account.
Provides coverage for the copays and the
coinsurance related to Medicare-covered
Medicare Supplement hospital, skilled nursing facility, home health Single Vendor
December 31, 2021 April 30, 2021 Third week of May TBD TBD Yes Sep-21 3 years
Insurance care, ambulance, durable medical Award
equipment, and doctor charges under
Medicare Parts A and B
Page 40Contracts Ending In 2021
Provide to the HCC
for Comments Prior Projected Public Actual Public Posting Public Posting Bid
Open HCC Projected
to Posting with Posting Bid Date by Date Provided by the End Date Provided Single or Contract
Enrollment Decision length of
Contract Name Description Expiration Date Comments back two the Office of Office of by the Office of multi-vendor Awarded
Time Needed by the
weeks after the Procurement and Procurement and Procurement and award by HCC
Sensitive Date contract
Documents are Contracts Contracts Contracts
Provided
Medicare Advantage plans sometimes
referred to as Medicare Part C or MA plans
Medicare Advantage Single Vendor
provide all of the Medicare Part A (Hospital December 31, 2021 3rd week of May Early June 2021 TBD TBD Yes Sep-21 3 years
Plans Award
Ins), and Part B (Medical Ins) and members
can select a Part D (Prescription Drug) plan
Provides primary care medical services to
Single Vendor
anyone enrolled in the health plan over the December 31, 2021 TBD TBD TBD TBD No Jul-21 3 years
Award
Onsite Clinic age of 2
Provides consulting to work directly with the
SEHP on all aspects of the wellness and EAP
program. Provide the SEHP staff with updates Single Vendor
Wellness Consulting December 31, 2021 TBD TBD TBD TBD No Feb-21 3 years
on changes in the market that may affect the Award
compliance of or features of the wellness and
EAP program.
Page 41APPENDIX – c
Avesis
Page 42Page 43
Page 44
APPENDIX – c
Met Life Superior Vision
Page 45Former Client Reference Check
RFP EVT 7764 for Vision Insurance
Reference for MetLife Superior Vision
1. How long did you work with vendor for vision insurance? January 2009 through December
2016. Are there specific features of the vision insurance that were popular with your
employees? Members liked the nationwide provider network and thought the Superior
website was informative/useful.
2. Were there any issues with the vendor's performance? Not that I can recall. If so what
type of issues did you encounter? Is there anything you would have done differently? No.
3. Did you experience issues related to the vendor processing eligibility files? Not that I can
recall. Were eligibility changes processed timely? Yes.
4. Did the vendor respond timely to employee or staff questions or issues? Yes. What did
you hear from your employees about the vendor’s service? Members found the customer
service team to be friendly, professional and knowledgeable about the Charter plan.
5. Did you encounter any issues with their technology, administration, or communication of
the benefits? Not that I can recall
6. What do you like most about working with the vendor? The account team was helpful
and responsive. Were there any areas that you experienced challenges? Not that I can
recall.
7. On a scale of 1 to 10 with 10 being excellent service, how would you rate the vendor’s
performance? Please explain the reason for the rating. I would give them a 9. I don’t recall
experiencing any large-scale challenges or issues and members seemed satisfied overall.
Completed by: Michelle Pallardy
Company: Charter Communications
Date: April 16, 2021
Page 46Page 47
Reference Check
RFP EVT 7764 for Vision Insurance
Reference for MetLife Superior Vision
1. How long have you worked with Vendor for vision insurance? Are there specific features
of the vision insurance that have been popular with your employees?
We have worked with Superior Vison for 3 ½ years. We chose them for the expanded
network.
2. Have you experienced any issues with the vendor's performance? If so what type of issues did
you encounter? Is there anything you would do differently if you had to do it again?
We have not experiences any issues with their performance. The contracting process took
some time. We might better define our contract requirements in the future.
3. Have you experienced issues related to eligibility files? Do they process plan changes
timely?
We have not had any issues with the eligibility file. We use Workday, which has not been
an issue for Superior. We had a few plan design changes for 9/1/2020. There were no
issues with the changes.
4. Does the vendor respond timely to employee or staff questions or issues? What have you
heard from your employees about the vendor’s service?
Superior has responded to any issues quickly. However, I have not heard of very many
issues since inception. Employees are happy with the expanded network.
5. Have you encountered any issues with technology, administration, or communication of
the benefits?
We have not.
6. What do you like most about the company? Are there any areas that you have
experienced challenges in working with the vendor?
We appreciate their responsiveness. When we were looking at plan design changes last
year, they were very quick in letting us know the cost, so we could present the different
premiums to the committee and make an informed decision on which changes to
implement. They also have provided good reporting on where our employees are using
their benefit, which helped us decide the best changes to make.
7. On a scale of 1 to 10 with 10 being excellent service, how would you rate the vendor’s
performance? Please explain the reason for the rating.
I would give them a 9 with the only issue being the more than 6 months it took to complete
the initial contract.
Completed by: Sheri Meyer, Associate Director
Company: Texas A&M University System
Date: April 15, 2021
Page 48Former Client Reference Check
RFP EVT 7764 for Vision Insurance
Reference for MetLife Superior Vision
1. How long did you work with vendor for vision insurance? Are there specific features of the
vision insurance that were popular with your employees?
Worked with Superior Vision for Vison plan for 19 years. Employees liked the claims
processing and the vision network.
2. Were there any issues with the vendor's performance? If so what type of issues did you
encounter? Is there anything you would have done differently?
No issues with Superior Vision performance, very good working relationship.
3. Did you experience issues related to the vendor processing eligibility files? Were eligibility
changes processed timely?
No issues with Superior Vison files, processed timely.
4. Did the vendor respond timely to employee or staff questions or issues? What did you
hear from your employees about the vendor’s service?
Superior Vision responded timely, we heard great things about Superior Vision and the
network from employees.
5. Did you encounter any issues with their technology, administration, or communication of
the benefits?
No issue with Superior Vision.
6. What do you like most about working with the vendor? Were there any areas that you
experienced challenges?
Superior Vision very professional, easy to work with, no issues working with them.
7. On a scale of 1 to 10 with 10 being excellent service, how would you rate the vendor’s
performance? Please explain the reason for the rating.
Superior Vision a 10, great customer service, worked well with our enrollment platform
and the payroll centers, claims processed timely.
Completed by: Robert Kelley
Company: Office of State HR
Date: 4-13-2021
Page 49Reference Check
RFP EVT 7764 for Vision Insurance
Reference for MetLife Superior Vision
1. How long have you worked with Vendor for vision insurance? Are there specific features
of the vision insurance that have been popular with your employees?
We became a customer of Superior Vision on January 1, 2018. The ease of the plan and
the provider network has been well received by our employees.
2. Have you experienced any issues with the vendor's performance? If so what type of issues did
you encounter? Is there anything you would do differently if you had to do it again?
We have not experienced any issues with the vendor’s performance. They are great to
work with and are always very responsive. They are proactive in providing wellness related
resources and keep us abreast of any internal changes within their organization. We would
not do anything differently and would certainly choose Superior Vision as our vision vendor
again.
3. Have you experienced issues related to eligibility files? Do they process plan changes
timely?
There have been no issues related to eligibility files. Plan changes are processed weekly
via an electronic integration file. There has been no feedback from plan participants
regarding eligibility, nor enrollment issues.
4. Does the vendor respond timely to employee or staff questions or issues? What have you
heard from your employees about the vendor’s service?
I cannot recall a situation where we have received feedback from an employee regarding
service or customer service for this vendor. No news is good news!
5. Have you encountered any issues with technology, administration, or communication of
the benefits?
Employees have the capability to access their coverage details, print ID cards, submit
claims, etc, directly on the website. The Benefits Department also has access to employee
data and billing on the website. We have not encountered any issues.
6. What do you like most about the company? Are there any areas that you have
experienced challenges in working with the vendor?
The ease of administration, minimal questions and lack of negative feedback from
employees makes our jobs easier and confirms that this vendor is a great partner for Old
Dominion and our employees.
7. On a scale of 1 to 10 with 10 being excellent service, how would you rate the vendor’s
performance? Please explain the reason for the rating.
Based on responses above I would rate this vendor a 10!
Page 50Completed by: Beverly Boyd
Company: Old Dominion Freight Line
Date: April 13, 20201
Page 51APPENDIX – c
Surency
Page 52Page 53
Reference Check
RFP EVT 7764 for Vision Insurance
Reference for Surency
1. How long have you worked with Vendor for vision insurance? Are there specific
features of the vision insurance that have been popular with your employees?
At least since 2016 when I joined the team
2. Have you experienced any issues with the vendor's performance? If so what type of issues
did you encounter? Is there anything you would do differently if you had to do it again?
No, we have not had any account manager or employee experience related to Surency’s
performance. Our benefits team and employees are satisfied with our relationship and
programs with Surency.
3. Have you experienced issues related to eligibility files? Do they process plan changes
timely?
None.
4. Does the vendor respond timely to employee or staff questions or issues? What have you
heard from your employees about the vendor’s service?
We never hear from employees regarding complaints or issues with Surency. We are
happy with the customer service they provide to our employees and staff. We also receive
very timely updates as a benefits team. We have worked with the same account
management team for many years. The consistency in their team is very helpful as they
know our company and plans very well.
5. Have you encountered any issues with technology, administration, or communication of
the benefits?
None.
6. What do you like most about the company? Are there any areas that you have
experienced challenges in working with the vendor?
Our employees utilize vision benefits very frequently (high usage). Surency delivers on
their programs and customer services, which makes our jobs in benefits much easier.
Great employee experience with Surency.
7. On a scale of 1 to 10 with 10 being excellent service, how would you rate the vendor’s
performance? Please explain the reason for the rating.
10 – Our employees are very happy with Surency. They have a great network, great plans
to choose from, and great customer service to both our employee and Benefits team.
Page 54Completed by: Jackie Kuisle
Company: Hallmark Cards
Date: 4.14.2021
Page 55Former Client Reference Check
RFP EVT 7764 for Vision Insurance
Reference for Surency
1. How long did you work with the vendor for vision insurance? 1/2015-12/2018 Are there
specific features of the vision insurance that were popular with your employees?
Nationwide network of providers.
2. Were there any issues with the vendor's performance? If so what type of issues did you
encounter? Is there anything you would have done differently? After some minor initial
growing pains we had no issues with the vendors performance.
3. Did you experience issues related to the vendor processing eligibility files? Were eligibility
changes processed timely? No issues except it was a very manual process but every
change was made promptly and on time.
4. Did the vendor respond timely to employee or staff questions or issues? What did you
hear from your employees about the vendor’s service? Yes. Most of our employee issues
were around denials for services. This was usually an issue with employee not reading
the plan document.
5. Did you encounter any issues with their technology, administration, or communication of
the benefits? None that I can remember.
6. What do you like most about working with the vendor? Were there any areas that you
experienced challenges? I miss working with Surency. They were always very responsive
and quick to help resolve any issues that may have come up.
7. On a scale of 1 to 10 with 10 being excellent service, how would you rate the vendor’s
performance? Please explain the reason for the rating. 10 – no complaints. Claims were
filed quickly and accurately and any issues were quickly resolved.
Completed by: Richard Grantham
Company: Ash Grove Cement Co.
Date: 4/13/2021
Page 56Page 57
APPENDIX – c
VSP
Page 58Reference Check
RFP EVT 7764 for Vision Insurance
Reference for VSP
1. How long have you worked with the vendor for vision insurance? Are there specific
features of the vision insurance that have been popular with your employees? The Oregon
Educators Benefit Board (OEBB) has been partners with VSP for about four years. The
Public Employees’ Benefit Board (PEBB) and VSP for 19 years. Members really
appreciate the broad network and excellent customer service. They are also a fan of
SunCare.
2. Have you experienced any issues with the vendor's performance? If so what type of issues did
you encounter? Is there anything you would do differently if you had to do it again? VSP
has been an excellent partner. The only issue we’ve had is at the beginning of a plan year
as members change plans. There is sometimes a minor delay in making the changes.
3. Have you experienced issues related to eligibility files? Do they process plan changes
timely? The only issue we’ve had is described in Q2.
4. Does the vendor respond timely to employee or staff questions or issues? What have you
heard from your employees about the vendor’s service? VSP provides excellent customer
service to both staff and members, often going above and beyond. They are persistent in
ensuring issues are fully resolved.
5. Have you encountered any issues with technology, administration, or communication of
the benefits? We have not encountered any issues.
6. What do you like most about the company? Are there any areas that you have
experienced challenges in working with the vendor? VSP provides excellent customer
service and has a broad network with good vision benefits.
7. On a scale of 1 to 10 with 10 being excellent service, how would you rate the vendor’s
performance? Please explain the reason for the rating. VSP is an excellent partner. The
plan year change file updates are the only area for improvement. We’d assess them an 8
or 9.
Completed by:
Company:
Date:
Page 59Former Client Reference Check
RFP EVT 7764 for Vision Insurance
Reference for VSP
1. How long did you work with vendor for vision insurance? Are there specific features of the
vision insurance that were popular with your employees?
Missouri Consolidated Health Care Plan (MCHCP) had a contract with VSP from
1997 – 2013.
MCHCP designated the plan design features and employees rather than VSP.
They enjoyed the basic -vs- premium plan design as well as the
Coordination of Benefit with the medical plan to pay for a refraction
therefore eliminating additional OOP costs
2. Were there any issues with the vendor's performance? If so what type of issues did you
encounter? Is there anything you would have done differently?
There were no performance issues.
3. Did you experience issues related to the vendor processing eligibility files? Were eligibility
changes processed timely?
There were no performance issues. Eligibility files were processed timely.
4. Did the vendor respond timely to employee or staff questions or issues? What did you
hear from your employees about the vendor’s service?
VSP received consistently high marks on account responsiveness. Members were
generally very satisfied with the vision plan offered with high uptake.
5. Did you encounter any issues with their technology, administration, or communication of
the benefits?
No issues encountered.
6. What do you like most about working with the vendor? Were there any areas that you
experienced challenges?
VSP was an excellent partner and consistently brought new opportunities for our
consideration. They handled our separation with great professionalism.
7. On a scale of 1 to 10 with 10 being excellent service, how would you rate the vendor’s
performance? Please explain the reason for the rating.
9. The account team was responsive and attentive to client and member concerns.
They continued to keep MCHCP updated on trends and changes to best
practices.
Completed by: Judith Muck, Executive Director
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