REQUEST FOR PROPOSALS LIFE & DISABILITY COVERAGE

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RFP SECTION XI: LIFE AND DISABILITY

REQUEST FOR PROPOSALS

LIFE & DISABILITY COVERAGE

RFP #: 15-32025

RFP Issue Date:

June 15, 2015

Life & Disability Proposal Due Date:

July 16, 2015

Effective Date:

January 1, 2016

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Page No.

A. Current Plan Information ... 4

B. Proposed Plan Designs ... 6

C. Fully Insured Life & Disability Questionnaire ... 7

D. Life & Disability Exhibits ... 8

E. Proposed Cost Exhibits ... 8

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QUESTIONNAIRES

Vendors MUST complete ALL of the Questionnaires applicable to the coverage(s) quoting and include them in the proposal(s).

 Fully Insured Life & Disability Questionnaire

RESPONSE EXHIBITS

Vendors MUST complete ALL of the Exhibits applicable to the coverage(s) quoting and include them in the proposal(s).

Exhibit 1: Proposal Response Form Exhibit 2: Submission Checklist Exhibit 3: Proposed Cost Exhibits Exhibit 4: Signature Page

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A. Current Plan Information

LIFE & DISABILITY – CURRENT PLANS / VENDORS / FUNDING ARRANGEMENTS

Please refer to the charts below for an overview of San Juan College’s Life and Disability plan information. San Juan College Website: www.sanjuancollege.edu

Vendor Plans Tier Structure Funding Contribution

Mutual of

Omaha Basic Life & AD&D $50,000

Fully

Insured 100% Employer Paid

Mutual of

Omaha Short Term _Disability Fully Insured 100% Employer Paid

Mutual of

Omaha Long Term _Disability Fully Insured 100% Employer Paid

Mutual of

Omaha

Supplemental Life

EE, Spouse, & Dependents

Fully

Insured 100% Employee Paid

Life Coverage:

Amount : $50,000

Guarantee Issue: $50,000

AD&D: Matches life $50,000

Benefits Terminate Upon Retirement

Eligibility: Employees working 20 hours or more are eligible.

Spouse Coverage: $10,000- Paid 100% by Employee

Dependent Child: $5000 14 days to age 19 or 23 if Full Time Student- 100% Employee Paid

Short Term Disability:

Eligibility: Employees working 20 hours or more are eligible.

Maximum Weekly Benefit: 60% of weekly salary up to $500 per week

Maximum Duration: 22 Weeks

Elimination Period: 29 days Accident & Illness

Other Sources is Income Reduction: Yes

Long Term Disability:

Eligibility: Employees working 20 hours or more are eligible.

Maximum Weekly Benefit: 40% of monthly salary up to $2000 per month

Maximum Duration: 2 yr/ Age 70

Elimination Period: 180 days

Other Sources is Income Reduction: Yes

Own Occupation: 24 months

Limitations: Mental Illness 24 months; Substance Abuse 24 months; Specified Illness No limit

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Voluntary Life:

Amount: 1X, 2X, 3X, 4X,5X your annual salary

Minimum Amount: $10,000

Maximum Amount $500,000

Guarantee Issue: The lesser of $250,000 or 5X Salary

AD&D: Matches the Supp Election

Age Banded Rates Supplemental

Rate per $1,000 of Benefit

Attained

Age

Life Only Life + AD&D < 25 $0.060 $0.080 25 - 29 $0.060 $0.080 30 - 34 $0.090 $0.110 35 - 39 $0.090 $0.110 40 - 44 $0.130 $0.150 45 - 49 $0.190 $0.210 50 - 54 $0.320 $0.340 55 - 59 $0.530 $0.550 60 - 64 $0.900 $0.920 65 - 69 $1.460 $1.480 70 - 74 $3.590 $3.610 75 - 79 $3.590 $3.610 80 - 99 $15.560 $15.580

ELIGIBILITY, EFFECTIVE DATE, CONTIBUTIONS

Eligibility: One month of continuous active work.

CENSUS

The Acknowledgment of RFP must be completed and submitted as instructed in order to receive the census. Once the Acknowledgment has been received the Census, Current Plan Information, Rates, and Claims Data will be sent to the Carrier.

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B. Proposed Plan Design Options

CONTRACT EFFECTIVE DATES

The effective date of the new Life & Disability contracts will be: January 1, 2016

PROPOSED PLAN DESIGNS

Please provide a quote for the following:

1. Fully insured, non-contributory Basic Life & AD&D Plan for San Juan College

 Assume the current plan design $50,000  Assume 100% Employer Paid

 Please provide 1 additional plan design quotes.  Please provide quotes net of commission.

2. Fully insured, non-contributory Short and Long Term Disability Plan for San Juan College

 Assume the current plan design  Assume 100% Employer Paid

 Please provide 1 additional plan design quotes (with shorter elimination period on STD).  Please provide quotes net of commission.

3. Fully insured, Voluntary Life & AD&D Plan for San Juan College

 Assume this is in addition to the Basic Life Plan  Assume 100% Employee Paid

 Please provide quotes net of commission.

Life & Disability Plans – Notes:

1. Respondents may respond to all or some of the plan designs/coverages contained in the RFP. All

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C. Fully Insured Life & Disability Questionnaire

FIRM/ORGANIZATION

1. How many trained examiners do you employ at the site _{where claims will be paid?} ▪ What is their average length of experience? . ▪ What is the volume of claims paid per day per

examiner?

▪ What is your average annual turnover? __________% 2.. Show the number of employer groups you service, at your

claims office, in each of the size categories below: ▪ 250 – 500 EEs

▪ 1,000 – 5,000 EEs ▪ 5,000 + EEs

3. Will you agree to have retention increase at general CPI or some other factor, independent of Life & Disability trend?

4 Will experience be based on actual paid claims (rather _{than incurred or estimated incurred?)} Yes No

5

Is your quote fully pooled/experience rated or have you

proposed both? Pooled Experience Rated

Blended Both ▪ If blended, specify percentage attributed to group's

experience. _________ %

6

For the first year and each renewal year, what periods of time will be used as the basis for determining renewal recommendations? Specify weightings to be applied to applicable periods.

7 Confirm that any adjustment of reserves will be _{suppported by/aligned with current triangulation studies.}

8 In the event the account produces a deficit in any one year, will your company seek, in any way, to recoup the

deficit? Yes No

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D. LIFE & DISABILITY EXHIBITS

VENDORS MUST COMPLETE ALL REQUESTED EXHIBITS IN THIS SECTION.

PROPOSAL RESPONSE FORM

Complete Exhibit 1.

SUBMISSION CHECKLIST

Complete Exhibit 2

E. PROPOSED COST EXHIBITS

Complete the Proposed Cost Exhibit – Exhibit 3. (3a, 3b, 3c, 3d)

F. SIGNATURE PAGE

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LIFE & DISABILITY RFP SECTION XI

EXHIBIT 1

LIFE& DISABILITY RFP Proposal

Response Form

VENDORS MUST COMPLETE THIS SECTION.

Please check (X) the boxes for the coverages / services included in your proposal. Proposal Includes Quotes for the Following Fully Insured Plans

 Offerings based on Existing Plans

 Up to one (1) additional plan designs

Company Name / Title Date

NOTE: Your typed name and date above will be considered a valid signature for this RFP.

Contact information for questions related to your proposal. To whom should questions related to your proposal be directed?

Name / Title Email Address Phone Number

Pl

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LIFE & DISABILITY RFP SECTION XI EXHIBIT 2

Life & Disability Submission Checklist

This Submission Checklist is a summary of the forms and materials required as part of your proposal. You are urged to thoroughly read the entire RFP and complete the checklist to ensure compliance with the submission requirements. APPLICABLE TO ALL LINES OF COVERAGE Refer to Proposal Organization RFP Section III.A.1

Consideration RFP Section Reference Check if

Included 1. Acknowledgement of RFP Form RFP Section I‐V, and Appendix A 2. Included signed Letter of Transmittal RFP Section III. A 2 3. Included signed Campaign Disclosure Form RFP Section I‐V. and Appendix C 4. Provided all required materials As requested throughout RFP Sections I‐V 5. Completed Minimum Requirements RFP Section VI 6. Completed General Questionnaire RFP Section VII APPLICABLE TO MEDICAL RFP (SECTION VIII)

Consideration RFP Section Reference Check if

Included 1. Completed and signed Proposal Response Form LIFE & DISBILITY RFP, Exhibit 1 2. Completed and signed Submission Checklist (this document) LIFE & DISABILITYRFP, Exhibit 2 3. Reviewed and completed all Questionnaires as outlined in the Table of Contents LIFE & DISABILITY RFP, Questionnaires 4. Completed All Medical Response Exhibits as outlined in the Table of Contents LIFE & DISBILITY RFP, Response Exhibits 1 ‐ 4 5. Reviewed and signed all Addenda Addenda as released 6. Formal proposal, including all items indicated above and all requested information. As requested in RFP Sections I‐V, and Section XI 7. Proposal copies submitted and distributed as requested. RFP Section II, B 5 8. LIFE & DISABILITY Proposal submitted by deadline: 12:00 Noon M.D.T. on July 16, 2015. As requested in RFP Section II, A 9. CD of “Reporting Samples” RFP Section II, B 5 ______________________________________________ _________________________ Company Date ______________________________________________ Name / Title

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LIFE DISABILITY SECTION XI EXHIBIT 3

BASIC LIFE PLAN PROPOSAL

PROPOSED PROPOSED PROPOSED PROPOSED

Eligibility Class 1: Class 2: Life / AD&D Benefit Class 1: Class 2: Maximum Amount Class 1: Class 2: Guarantee Issue Seat Belt Benefit (AD&D) Airbag Benefit (AD&D) Waiver of Premium Benefit Reduction At Age 65: At Age 70: At Age 75: Volume of Insurance Life Rate per $1,000 AD&D Rate per $1,000 Total Monthly Premium $0.00 $0.00 $0.00 $0.00 Total Annual Premium $0.00 $0.00 $0.00 $0.00 Renewal Date January 1, 2016

PROPOSED COST EXHIBITS

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LIFE DISABILITY SECTION XI EXHIBIT 3a

VOLUNTARY LIFE PLAN PROPOSAL

Life Amount Increments Employees: Spouse: Child(ren) 14 days‐6 months: Child(ren) over 6 months: Maximum Life Amounts Employees: Spouse: Child(ren) 14 days‐6 months: Child(ren) over 6 months: Guarantee Issue Amounts Employees: Spouse: Child(ren):

Rate per $1,000 Rate per $1,000 Rate per $1,000 Rate per $1,000

Employee Spouse Employee Spouse Employee Spouse Employee Spouse

< 20: 20 ‐ 24: 25 ‐ 29: 30 ‐ 34: 35 ‐ 39: 40 ‐ 44: 45 ‐ 49: 50 ‐ 54: 55 ‐ 59: 60 ‐ 64: 65 ‐ 69: 70 ‐ 74: Child(ren) per Unit January 1, 2016 Age of Insured

PROPOSED COST EXHIBITS

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LIFE DISABILITY SECTION XI EXHIBIT 3b

SHORT TERM DISBILITY PLAN PROPOSAL

Eligibility Benefits Begin Accident: Illness: Percentage of Earnings Maximum Weekly Benefit Minimum Weekly Benefit Benefit Duration Period Occupational Coverage Covered Benefit Rate per $10 Total Monthly Premium $0.00 $0.00 $0.00 $0.00 Total Annual Premium $0.00 $0.00 $0.00 $0.00 Renewal Date January 1, 2016

PROPOSED COST EXHIBITS

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LIFE DISABILITY SECTION XI EXHIBIT 3c

LONG TERM DISBILITY PLAN PROPOSAL

Eligibility Class 1: Class 2: Elimination Period Class 1: Class 2: Percentage of Earnings Class 1: Class 2: Maximum Monthly Benefit Class 1: Class 2: Minimum Monthly Benefit Definition of Disability "Own Occ" Class 1: Class 2: Benefit Duration Period Earnings Test (Own Occ/Any Occ) Return to Work Incentive Survivor Benefit Mental/Nervous Limitation Special Conditions Limitation Employee Assistance Program Pre‐Existing Limitation Covered Monthly Payroll Rate per $100 Total Monthly Premium $0.00 $0.00 $0.00 $0.00 Total Annual Premium $0.00 $0.00 $0.00 $0.00 January 1, 2016

PROPOSED COST EXHIBITS

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LIFE & DISABILITY RFP SECTION XI EXHIBIT 4

LIFE & DISABILITY SIGNATURE PAGE

VENDORS MUST COMPLETE THIS SECTION.

All deviations from the specifications and other standards included in the RFP MUST be specifically outlined and defined in this section of the RFP. An Officer of your organization must sign this Signature Page. In the absence of any identified deviations, your organization will be bound to all of the terms and conditions outlined in the RFP. We certify that our proposal complies with the contents of this Request for Proposal, unless noted in the following list of exceptions.

1. 2. 3. 4. 5. 6. Company Name: ___________________________ Name: ___________________________ Title: ___________________________ Phone Number: ___________________________ E-mail Address: ___________________________ Signature: ___________________________ Date: ___________________________

NOTE: In the case of an electronic proposal submission, your typed name and date above, will be considered a valid signature for this RFP.

REQUEST FOR PROPOSALS LIFE & DISABILITY COVERAGE

RFP SECTION XI: LIFE AND DISABILITY