Table of Contents

(files on this site are in PDF and Word format)
(PDF files are controlling)

Vision Plan Services

Request For Proposals (RFP)

Section I: Introduction (amended 3-29-11)
Section II: Procurement Protocol and Process
Section III: Administrative Proposal Requirements
Section IV: Technical Proposal Requirements / Word Format (amended 3-29-11)
Section V: Cost Proposal Requirements
Section VI: Evaluation and Selection Criteria
Section VII: Draft Contract (amended 3-29-11)
Section VIII: Glossary of Terms


Appendix.A: Standard Clauses for New York State Contracts
Appendix.B: Standard Clauses for All DepartmentContracts
Appendix.C: Third Party Connection Agreement / Word Format

Exhibit I

Exhibit I.A: Proposal Submission Requirement Checklist / Word Format
Exhibit I.B: Biographical Sketch Form / Word Format
Exhibit I.C: FOIL Redaction Chart / Word Format
Exhibit I.D: MacBride Statement & Non-Collusive Bidding / Word Format
Exhibit I.E: ST-220-CA / Word Format
Exhibit I.F: Contractor Certification ST-220-TD
Exhibit I.G: EEO Obligations / Word Format
Exhibit I.H: Workforce Employment Report / Word Format
Exhibit I.I: Vendor Responsibility Questionaire / Word Format
Exhibit I.J: Notice of Bidding Intention Form / Word Format
Exhibit I.K: Offeror's Affirmation of Understanding & Agreement / Word Format
Exhibit I.L: Procurement Lobbying Policy: Restrictions on Contacts During the Procurement Process
Exhibit I.M: Compliance with Public Officers Law Requirements / Word Format
Exhibit I.N: Compliance with Americans with Disabilities Act / Word Format
Exhibit I.O: Omnibus Procurement Act Statement of Acceptance / Word Format
Exhibit I.P: Certification of Compliance Pursuant to State Finance Law / Word Format
Exhibit I.Q: Article 15-A of the Executive Law / Word Format
Exhibit I.R: Questions Template / Word Format
Exhibit I.S: Formal Offer Letter / Word Format
Exhibit I.T: Offeror Attestations Form / Word Format
Exhibit I.U: Key Subcontractors / Word Format
Exhibit I.V: Client References / Word Format
Exhibit I.W: Compliance with NYS Workers’ Compensation Law
Exhibit I.X: Department of Civil Service Information Security Policy
Exhibit I Y: Prerequisite Worksheet / Excel Format
Exhibit I Y.1: Offeror’s Participating Provider Network File

Exhibit II

Exhibit II.A: Covered Lives by Enrollee Group
Exhibit II.B: Enrollee Counts by Zipcode (amended 3-29-11)
Exhibit II.C: Summary of Benefit Eligibility by Employee Group (amended 3-29-11)
Exhibit II.D: Summary of Covered Benefits by Employee Group (amended 3-29-11)
Exhibit II.E: Monthly Paid Claims Data Report
Exhibit II.F: Distribution of Employees by Agency
Exhibit II.G: Detailed Record Layout-2010 (Page 1)
Exhibit II.G.1: Detailed Record Layout-2010 (Page 2)
Exhibit II.H: NYS Police Respirator Insert Dispenser Instructions
Exhibit II.I: Quarterly Performance Guarantee's Report (added 3-29-11)

Exhibit III

Exhibit III.A:

Participating Provider Claims – Dresswear / Excel Format

Exhibit III.A.1: Participating Provider Claims – Occupational / Excel Format
Exhibit III.B: Indemnity Utilization / Excel Format
Exhibit III.C: Dresswear Upgrade Utilization Summary / Excel Format
Exhibit III.C.1: Occupational Upgrade Utilization Summary / Excel Format
Exhibit III.D: Historical Expense Data 2007-2010
Exhibit III.E. Indemnity Reimbursement Schedule
Exhibit III.F: Medical Exception Program Utilization 2008-2010
Exhibit III.G: Listing of Plan Contact Lenses
Exhibit III.H: Laser Vision Correction Surgery 2008-2010 / Excel Format

Exhibit IV

Exhibit IV.A: Participating Provider and Laser Vision Correction Surgery Fee Schedule (amended 3-29-11)
Exhibit IV.B

Monthly Administrative Fees and Communications Fee Schedule

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