ENTITLED: "Health Maintenance Organizations Specifications for the New York State Health Insurance Program"

Release Date: June 29, 2020

Proposal Due Date:July 27, 2020 3:00 p.m. ET

Section 3.2(1)(d) has been Amended as of 7/17/2020.

Section 3.4(1)(b)(xii) has been Amended as of 7/17/2020.

Attachment 3 has been Amended as of 7/17/2020.

Important Notice: A Restricted Period under the Procurement Lobbying Law is currently in effect for this Procurement and it will remain in effect until State Comptroller approval of the resultant Contract. During the Restricted Period for this Procurement ALL communications must be directed, in writing, solely to the Designated Contact as listed in Section 2 of these Specifications and shall be in compliance with the Procurement Lobbying Law and the NYS Department of Civil Service "Rules Governing Conduct of Competitive Procurement Process" (refer to Specifications, Section 2: Procurement Protocol and Process).

All inquiries, questions, filings and submission of comments must be directed in writing to:

NYS Department of Civil Service
Attention: Office of Financial Administration, Floor 17
Agency Building 1, Empire State Plaza
Albany, New York 12239

E-mail: DCSprocurement@cs.ny.gov

Table of Contents  

HMO Specifications

Health Maintenance Organizations Specifications for the New York State Health Insurance Program


APPENDIX A - Standard Clauses for New York State Contracts

APPENDIX B - Standard Clauses for All Department Contracts

APPENDIX C - Information Security Requirements

APPENDIX C-1 - Glossary for Appendix B and Appendix C


ATTACHMENT 1 - Offeror Affirmation of Understanding and Agreement

ATTACHMENT 2 - Procurement Lobbying Policy

ATTACHMENT 3 - Formal Offer Letter

ATTACHMENT 4 - Questions Template

ATTACHMENT 5 - NYS Department of Civil Service Debriefing Guidelines

ATTACHMENT 6 - Offeror Attestation Form

ATTACHMENT 7 - New York State Required Certifications

ATTACHMENT 8 - Non-Material Deviations Template

ATTACHMENT 9 - Subcontractors or Affiliates

ATTACHMENT 10 - Compliance with Workers Compensation Law

ATTACHMENT 11 - Freedom of Information Law - Request for Redaction Chart

ATTACHMENT 12 - New York State Subcontractors and Suppliers

ATTACHMENT 13 - JLMC Contact Members

ATTACHMENT 14 - Prescription Drug Benefit (Commercial Plan) Form

ATTACHMENT 15 - Wellness Programs/Activities Chart

ATTACHMENT 16 - Current Five Largest Employer Groups Chart

ATTACHMENT 17 - NYSHIP Enrollment Statistics by NYS County and by State

ATTACHMENT 18 - Employer Premium Contribution Rates

ATTACHMENT 19 - 2020 NYSHIP Dependent Eligibility Rider

ATTACHMENT 20 - 2019 Health Fair and Events

ATTACHMENT 21 - Medicare Enrollment Report Format and Frequency

ATTACHMENT 22 - Statement of Disability Dependent 19 Years of Age or Older Form PS-451

ATTACHMENT 23 - 2020 NYSHIP Enrollment by Group

ATTACHMENT 24 - SAMPLE Schedule of Benefits

ATTACHMENT 25 - SAMPLE Side-by-Side Comparison

ATTACHMENT 26 - Timeline of Key Events for Plan Year 2021

ATTACHMENT 27 - NYSHIP Authorization for Release of Protected Health Information

ATTACHMENT 28 - Notice of Intent

ATTACHMENT 29 - PS-457 Statement of Dependence

ATTACHMENT 30 - SAMPLE Contract and Rider Summary

ATTACHMENT 31 - HMO Rate Submission Template

ATTACHMENT 32 - Intentionally left blank

ATTACHMENT 33 - Intentionally left blank


ATTACHMENT 35 - Commercial Benefits Chart

ATTACHMENT 36 - Medicare Benefits Chart


Print HMO Specifications


Response to Questions