Health Maintenance Organizations (HMO) Specifications
for the New York State Health Insurance Program
Specifications
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 ServiceAttention: 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
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
Attachments
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