Table of Contents

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


2015 HMO Specifications

Section I: Introduction
Section II: Procurement Protocol and Process (Amended/Added 5/12/15)
Section III: Administrative Requirements for Submission (Amended 5/19/15)
Section IV: Program Requirements
Section V: HMO Required Submission Material / Word Verson (Amended 5/21/15)
Section VI: Draft Contract
Section VII: Glossary of Terms


Appendix A: Standard Clauses for New York State Contracts
Appendix B: Standard Clauses for All Department Contracts
Appendix C: Third Party Connection and Data Exchange Agreement / Word Version 
Appendix D: Participation by Minority Group Members and Woman With Respect to State Contracts: Requirements and Procedures
Appendix D-1: MWBE Policy Statement
Appendix D-2: MWBE Article 15-A

Exhibits I

Exhibit I.A: Proposal Submission Requirement Checklist
Exhibit I.B: This Exhibit Intentionally Left Blank
Exhibit I.C: Freedom of Information Law-Request for Redaction Chart / Word Version
Exhibit I.D: MacBride and Non-Collusive Bidding Certification / Word Version
Exhibit I.E: ST-220 CA / Word Version
Exhibit I.F: ST-220 TD
Exhibit I.G: EEO Staffing Plan (Form EEO-100) / Word Version (Amended/Added 5/12/15)
Exhibit I.H: Debriefing Guidelines / Word Version
Exhibit I.I: This Exhibit Intentionally Left Blank
Exhibit I.J: Notice of Bidding intention Form / Word Version
Exhibit I.K: Offeror’s Affirmation of Understanding and Agreement / Word Version
Exhibit I.L: Procurement Lobbying Policy
Exhibit I.M: Compliance with Public Officers Law Requirements / Word Version
Exhibit I.N: Compliance with Americans with Disabilities Act / Word Version
Exhibit I.O: MWBE Utilization Plan (Form MWBE-100) / Word Version (Amended/Added 5/12/15)
Exhibit I.P: Offerors Certification of Compliance Pursuant to State Finance Law §139-k / Word Version
Exhibit I.Q: MWBE and EEO Policy Statement / Word Version
Exhibit I.R: Questions Template / Word Version
Exhibit I.S: Formal Offer Letter / Word Version
Exhibit I.T: Offeror Attestations Form / Word Version (Amended 5/19/15)
Exhibit I.U.1: Key Subcontractors or Affiliates / Word Version
Exhibit I.U.2: NYS Supplier & Subcontractor / Word Version
Exhibit I.V: This Exhibit Intentionally Left Blank
Exhibit I.W: Compliance with NYS Workers’ Compensation Law / Word Version

Exhibits II

Exhibit II.A: Time Line of Key Events for 2016
Exhibit II.B: JLMC Contact Members
Exhibit II.C: 2016 NYSHIP Dependent Eligibility Rider
Exhibit II.D: 2015 NYSHIP Enrollment
Exhibit II.E: SAMPLE Schedule of Benefits
Exhibit II.F: SAMPLE Side-by-Side Comparison
Exhibit II.G: HMO Copayment Maximums
Exhibit II.H: Authorization for Release of PHI
Exhibit II.I: Employer Premium Contribution
Exhibit II.J: Statement of Disability
Exhibit II.J.1: Statement of Disability Instructions
Exhibit II.K: Statement of Dependence
Exhibit II.L: SAMPLE Contract and Rider Summary
Exhibit II.M: HMO Rate Submission Template
Exhibit II.M.1: HMO Rate Submission Enrollment Template
Exhibit II.M.2: HMO Rate Call Letter Template

Exhibits III

Exhibit III.A: CHOICES Guide
Exhibit III.B.1: Commercial Benefits Chart / Excel Version (Amended/Added 4/28/15)

Exhibit III.B.2:

Medicare Benefits Chart / Excel Version (Amended/Added 4/28/15)

MWBE Subcontracting CAL Insurance & Consulting Services, LLC (Added 4/27/15)
  Insurance Agents, Brokers, and Services
  Financial Consultants
  Insurance Agents
  Risk Management
  Insurance Carriers, Life, Direct

Direct Properly and Casualty Insurance Carriers

  Sullivan-Hernandez Agency, Inc. (Added 4/29/15)
  Insurance Agents, Brokers, and Services
  Insurance Agents

Insurance Brokerages

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