A Report on the Actuarial, Marketing, and Legal Analyses of the CLASS Program. Requirements and Requested Information

10/14/2011

To accomplish our mission, we are gathering information on three sets of activities: enrollment, premium administration, and program management. In addition, if an RFP is offered in the future, we may include an additional option for claims. In each of the below sections, we describe our anticipated requirements and the requested information for a response to this RFI. The requested information will help us better clarify requirements in the future.

Provide and Administer an Enrollment System

Requirements

  1. Provide and manage a registration/enrollment process for employers and individuals.
  2. Provide and administer a web-based enrollment system.
  3. Interact with external databases during the enrollment process to confirm eligibility status, and on a periodic basis thereafter to update individual enrollee earnings information.
  4. Interface with participating employers to facilitate/perform enrollments.
  5. Provide online tools to assist individuals with decision-making, including a premium calculator.
  6. Manage a free-look/opt-out process where enrollees have a certain number of days to cancel a new enrollment with return of any premiums paid.
  7. Process changes to existing enrollments.
  8. Maintain accounting of enrollments, including tracking of individual enrollee vesting and earnings requirement statuses.
  9. Provide web-based enrollee self-service functionality, to include the ability to view account information (including vesting/earning requirement statuses and claims information) and change demographic information and premium payment methods.
  10. Manage disenrollment processes.
  11. Manage reenrollment processes.
  12. Integrate with the premium administration system and with a future claims system, which may be included as an additional option in a future RFP.

Requested Information

  1. What is your experience performing large-scale enrollment of individuals and employer-based groups via a web-based enrollment system and phone-based customer service representatives?
    1. Describe the size, complexity, staffing levels and infrastructure requirements of past efforts.
    2. Did your approach and methods for enrolling individuals differ from your approach and methods for enrolling employer-based groups?
    3. What strategies have you found to be most effective in guiding the user experience during enrollment?
  2. Discuss your approaches for interfacing with employers, brokers, benefit consultants and third-party administrators to conduct enrollments.
  3. What is necessary to process enrollment files and/or eligibility files received from employers?
    1. Can you provide insights/thoughts into how group enrollments could take place without receipt of an eligibility file from an employer?
    2. Employees automatically enrolled through their employer will have the option to waive participation. Discuss your experiences with such a process.
  4. Discuss possible approaches for interactions with external databases, including government databases, to verify information (e.g., earnings/self-employment income) required to complete an enrollment in real time.
  5. Discuss your experience in developing decision support tools for insurance benefits. What methods and tools have you found most useful?
  6. Discuss your experiences in integrating an enrollment system with a claims system, which may be included as an additional option in a future RFP.

Provide and Administer a Premium Administration System

Requirements

  1. Calculate premium amounts due per enrollee based on premium tables and business rules provided by HHS.
  2. Collect premiums via employer payroll systems, including transmission of bill files, payment files, and reconciliation files.
  3. Collect premiums directly from individuals through direct bill, automatic bank withdrawal, credit/debit card, and online electronic funds transfer options.
  4. Remit premiums collected to the government as directed by HHS.
  5. Manage premium payment changes, such as in payroll location, payment method, or amount.
  6. Identify and resolve processing and premium payment errors.
  7. Maintain accounting of premiums due, collected and remitted, protecting the integrity of premiums from receipt through remittance; while held by contractor prior to remittance, funds must be accounted for separately from any other contractor funds.
  8. Resolve instances in which requested deductions were not remitted.
  9. Follow business rules established by HHS for premium payment lapses.
  10. Perform enrollment and premium reconciliations.
  11. Integrate the premium administration system with the enrollment system with the future claims system, which may be included as an additional option in a future RFP.

Requested Information

  1. We are interested in receiving information about your premium administration processes, including payroll deduction interfaces with employers or their benefits administrators or payroll providers.
    1. What is your experience with providing these services on a large scale?
    2. Discuss the number and size of the clients you provide these services for.
    3. Discuss the amount of time it typically takes you to set up payroll deduction with an employer and then start to receive payments.
    4. Does that time differ significantly by employer size or whether the employer handles its own payroll?
    5. In your experience, are payroll deductions generally reliable and accurate? Discuss the processes you follow when you do not receive an expected payment from an employer.
    6. Do you typically require standard file formats or customize per employers’ formats?
    7. What are the critical interactions with employers/payroll administrators/benefits brokers and their varying systems that you believe must be considered?
    8. Do you have an automated billing reconciliation process?
  2. The system will need to collect premiums from individuals by methods other than payroll deduction.
    1. What are your experiences with other payment methods?
    2. Which methods are the most popular and produce the most consistently accurate results? Which are the most cost-effective?
  3. As CLASS enrollments will be portable, enrollees may change payroll deduction locations several times and go in and out of pay status during the course of their enrollment.
    1. What insights can you provide into ways to manage that scenario?
    2. Discuss how you manage changes to premium payment methods and amounts, e.g. from payroll deduction to automatic bank withdrawal or from a biweekly payment cycle to a monthly payment cycle, and the necessary adjustments to premium to ensure full payment.
    3. Discuss how you identify and resolve processing errors.
  4. Please discuss your approach to missed premiums (via payroll deduction and on an individual basis), partial premiums received, insufficient funds, grace periods, communication to enrollees/employers who owe back premiums, and debt collection methods.

Program Management Activities

Requirements

  1. Account Management and Customer Service
    1. Provide and administer self-service and managed service functionality for enrollee and employer accounts, including role-based access to the system.
    2. Allow users to upload and house documents in their accounts.
    3. Manage and reply to public inquiries received by phone, mail, and email.
    4. Provide, staff, and operate a phone-based customer service center with highly-qualified personnel to provide program information, perform enrollments, and assist enrollees with account management problems and questions.
  2. Document Management and Reports
    1. Automatically generate necessary forms and correspondence such as:
    2. Welcome letters
    3. Opt-out confirmation notification
    4. Change in status notification
    5. Generate standard or custom reports pulling from any of the collected data.
    6. Log and track marketing material or other information requested.
  3. 3. Systems and Processes
    1. Provide and administer systems and processes that meet the criteria and rules described in Appendix A: Applicable IT Policies and Standards.
    2. Provide and administer systems and processes that appropriately account for:
      1. Authenticating and ensuring data integrity and confidentiality
      2. Data Redundancy and recovery
      3. Protecting personally identifiable information (PII)
      4. System reliability
    3. Provide and administer systems and processes that are:
      1. Scalable to account for disproportionate system usage
      2. Able to link to external (non-CLASS) systems for eligibility verification
      3. Simple and easy to use for end-users
    4. Provide and administer storage capacity large enough to retain all enrollee and former enrollee records for decades.

Requested Information

  1. Account Management and Customer Service
    1. Discuss how you manage user access to the system.
    2. Discuss how you manage and reply to public inquiries. How do you ensure that the responses are timely?
    3. Discuss your ability to provide, staff, and operate a phone-based customer service center.
  2. Document Management and Reports
    1. Discuss your ability to generate standard reports and ad hoc reports using any of the collected data elements for deeper data analysis. Discuss how your system accomplishes these reporting needs.
  3. 3. Systems and Processes
    1. Discuss how you manage your system so that it is user-friendly but offers the necessary data integrity provisions and protects PII.
    2. Discuss how your system is scalable for extremely high-usage times.
    3. Discuss your experiences and expertise in meeting the federal system requirements outlined in Appendix A.
    4. Discuss what steps you would take to link up your systems with other systems ensuring secure but efficient data transfers for verification purposes.
    5. Discuss how your system accommodates the large capacity required to hold the records for decades.

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