HMO Specifications

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
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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