SustiNet: RFP Q & A
Model Benefit Packages RFP



 Issuing Agency
State of Connecticut
Office of the Healthcare Advocate
P.O. Box 1543
Hartford, CT 06144 
Sustinet Health Plan Model Benefit Packages 
 RFP Number  MCO_0729_011
As required by the SustiNet statutes, OHA releases this request for proposals for model benefit packages. 
To learn more about the RFP and for instructions on how to submit a bid, click here.



SustiNet Model Healthcare Benefit Packages

RFP MCO_0729_011: Questions / Answers




1.  Is there an incumbent service provider?

If so, who is the current provider and what is the incumbent contract value/duration?

No. There is not an incumbent service provider for the SustiNet Health Partnership's Model Healthcare Benefit Packages.

2.  Is there a not-to-exceed value for the contract resulting from this RFP?

Yes. Currently, the not-to-exceed value for the contract resulting from RFP MCO_0729_011 is $50,000.

3.  Is the RFP MCO_0729_011 searching for a system provider for the health insurance exchange which will be established in 2014?

Currently, the RFP MCO_0729_011 is seeking a consultant or firm to develop initial comprehensive model healthcare benefit packages for the SustiNet Health Plan to be implemented by July 1, 2012.

4.  Does the scope of services include assisting OHA with issues related to the possible transition to a PPACA exchange and / or assistance with licensure?

No.  The scope of services does not include assisting OHA with exchange licensure and/or transition at this time.

5.  Does OHA contemplate engaging a separate firm for marketing to potential participants during the implementation period of the SustiNet plans?

Yes.  OHA may contract with another firm to provide a marketing strategy for the SustiNet Health Partnership for development and implementation.

6.  Does the scope of services include assistance with the PPACA grant application for consumer assistance and documentation of systematic issues?  

No.  SustiNet is not an applicant tor a PPACA consumer assistance grant.

7.  Do you expect that the SustiNet Model Healthcare Benefit Packages will be risk adjusted?  And if so, will OHA require a public rather than a proprietary system?  

Yes.  The SustiNet Model healthcare Benefit Packages will be risk adjusted.  OHA will require a public system.

8.  How would these new plans accommodate PPACA requirements for exchanges in terms of:

a. Eligibility

b. Coverage of individuals and groups

c. Benefit plan design requirements concerning actuarial value

d. Underwriting requirements regarding age differentials and geography

e. Consumer protection and education

The design of the SustiNet plan has not been completed.   During the design process, the SustiNet Board will consider whether eligibility functions could be performed through the systems currently operated by various state agencies or whether additional functionality will be obtained for the SustiNet program.  


The scope of work will include the development of premiums for individuals and families for a set of benefits that is consistent with PPACA, the SustiNet Board’s recommendations, and the large Northeast employer standard established in the SustiNet law.  Similarly, consumer protection and education functions may be included.


9.  Relating to the information that these will be self-funded plans,

a. Will a TPA be hired to administer the plans?

b. What will the risk-bearing entity be?

c. How will risk be shared among all parties?

d. What financing mechanisms will be used to fund base premium rates, cover excess risks, and account for and fund experience gains/losses?

(a)  Yes.  A Third Party Administrator (TPA) may be hired to administer the SustiNet Health Plan.


(b-d)  With regard to inquiries (b), (c), and (d), the risk bearing entity (-ies), share of risk(s), and financing mechanism(s) for funding have yet to be determined.

10.  Is OHA (or whoever is sponsoring this project) willing to provide limits on liability to the contractor chosen for this project?

Yes.  The limits of liability are stated in the sample contract provided here.   

The limits of liability are the State of Connecticut’s standard language that is not negotiable, as stated in clauses 6(a) (3), 10(f), 16(d), 34(1), 37(a)-(b)-(c)-(d), and 49 of the sample contract.




11.  Are there limits of liability associated with this work and if so, what are they?  Is this negotiable?

Yes.  The limits of liability are associated with the services provided, standard state contract language, and are not negotiable.  Please see previous answer.


The model benefit packages will enable SustiNet to estimate the total cost of services for each member who might enroll in the program.   


The state will supply data describing the cost and utilization of health care services by low income populations with known demographics.  The contractor will be required to develop a cost model that can accommodate different assumptions about key factors affecting the estimated premium costs.   The contractor should anticipate multiple scenarios and should identify the key factors that are subject to adjustment.  Examples of such items could include copayments, deductibles, co-insurance and out-of-pocket limits; chiropractic services; and tiered formularies.  The contractor should also provide the functionality to generate alternative scenarios based on adjustments to fee schedules, utilization rates and patient management services that will be required whether the contract is managed by a TPA or by an at-risk entity.  


The contractor is responsible for ensuring that the requested adjustment factors are accurately applied to the base data.


 The bidder should clearly state whether the model will be constructed and tested under the supervision of  a member of the Society of Actuaries (ASA or FSA) with public sector health care insurance expertise.

Click here for an electronic version of the Q & A which contains the sample contract.

Content Last Modified on 8/20/2010 10:20:36 AM