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UC Berkeley



Release Date: November 17, 2015

Last Day for Carrier Questions: November 30, 2015
Carrier Proposal Due Date: January 6, 2016

Brokered by:
Wells Fargo Insurance Services


Wells Fargo Insurance Services, on behalf of University of California, Berkeley (Berkeley),
invites interested parties to submit proposals for the purpose of making insurance coverage
available to all eligible students at Berkeley.

University of California, Berkeley:
Berkeley is one of the worlds most prestigious research universities with over 170 academic
departments and programs and has a rich history of student advocacy. There are approximately
38,000 students, including 10,000 graduate students. All eligible Berkeley students are required
to have medical insurance. Students will be automatically enrolled in Student Health Insurance
Plan (SHIP) unless they have comparable medical insurance that meets the University of
Californias waiver criteria and have completed an online waiver.
Student Health Center:
University Health Services (UHS) provides comprehensive medical, mental health and health
promotion services to all Berkeley students. In addition to treating conditions, UHS strives to
prevent health issues from occurring and to provide a safety net for students.
Students can use the medical services just as they would a regular doctor's office and urgent
care center. The facility is fully accredited, staffed by board-certified physicians, nurse
practitioners, and nurses. Students are able to use on-site laboratory, radiology and pharmacy
services and can access specialists at UHS through the specialty clinic.
A comprehensive counseling center, staffed by psychiatrists, psychologists and social workers
offers individual and group counseling, and includes a complete career counseling center.
Multidisciplinary health promotion and social services units offer programs and services for
keeping students healthy and safe, including behavior change assistance, skill-building, and
opportunities for students to get involved in shaping public health on campus.
Students must first seek non-emergency medical care at UHS. If off-campus services are
needed, UHS clinicians will make referrals for care outside of UHS. The insurance office staff
process referrals and help students find network providers. Off-campus non-emergency medical
services are not covered under Berkeley SHIP without first obtaining an authorization from UHS
(with some limited exceptions under womens health services).

Any questions regarding preparation of this proposal or submittal of information required shall
be directed to the Berkeley student health insurance broker, Wells Fargo Insurance Services
(WFIS) at the contact below.
Whitney Quan
Account Manager
Wells Fargo Insurance Services
10940 White Rock Road, 2nd Floor
Rancho Cordova, CA 95670

Phone #: (916) 589-8187

Fax #: 877-504-3136
In the absence of the above contact, for questions please contact:
Brian Judy
Managing Broker
Wells Fargo Insurance Services
10940 White Rock Road, 2nd Floor
Rancho Cordova, CA 95670
Phone #: (916) 589-8051
Fax #: (916) 877-318-5567

Response to the proposal should be submitted electronically to Brian Judy and Whitney Quan at
the email address provided above.
Submission Requirements and Timeline:
Release RFP Date
Last Day to Submit Questions to WFIS
Responses from WFIS provided by
RFP Due Date
Finalist Oral Interviews (if needed)
Carrier Award Announcement
Letter of Intent Issued

02/01/2016 02/12/2016

1. Enrollment Requirement: All eligible UC Berkeley students must have valid health
insurance as a non-academic requirement of enrollment. Students will be allowed the
opportunity to show proof of coverage through an Affordable Care Act (ACA)-compliant
insurance plan that meets the criteria outlined by the University of California. Students that
satisfy this requirement through the completion of an online insurance waiver during the
advertised waiver-period, are allowed to opt out of the Student Health Insurance Plan
(SHIP). All students who either do not submit a waiver within the allowed time frame, or who
submit a waiver that does not meet University of Californias requirements will be
automatically enrolled in SHIP, and will be required to pay the cost of the plan.
2. Insurance Plan Requirements: The insurance plan must be available to all eligible students
regardless of race, creed, sex, age, religion, country of origin, mental status, sexual
preference, gender identity, marital status, parental status, or immigration status.
3. State Requirements: The policy issued must conform to the regulations of the State of
California. Any exceptions to the specifications, as written, should be clearly indicated in
proposals submitted.
4. Additional Requirements: The insurance plan benefits should protect the University from
potential litigation. The insurance plan must comply with the requirements of Title IX of the
Education Amendments of 1972 and the Civil Rights Restoration Act of 1987, which requires
that maternity benefits be provided on the same basis as any other temporary disability.
The regulation implementing Title IX, at 334 C.F.R. and 106.40(b) (4), provides:
A recipient shall treat pregnancy, childbirth, false pregnancy, termination of
pregnancy and recovery in the same manner under the same policies as any
other temporary disability with respect to any medical or hospital benefit, service,
plan or policy which such recipient administers, operates, offers or participates in
with respect to students admitted to the recipient's educational program or


Contract will be awarded to the company who best demonstrates the following:

A history of providing coverage in the student health insurance marketplace

Financial solvency and stability
Reasonable and justifiable premium costs
Favorable target loss ratio, including itemized retention costs
Large network provider access in Berkeley and the Bay Area, including indication of innetwork participation of current frequently used Berkeley providers as well as a strong
national network
Ability to quote the benefit designs requested in this RFP, or structure of comparable
benefits. If alternate plan structure is submitted, please provide complete details on plan
design (benefits, exclusions, etc.)
Detailed claims reporting capabilities

Dedicated account team with student insurance experience

Student insurance customer service unit with West Coast operational hours mirroring the
UCB Tang Centers hours and service structure designed to student needs.
Indication of ability to offer a fully developed, functional, and customer-friendly online
waiver system
An AM Best rating of at least AAbility to offer a pricing agreement, commitment, or strategy that supports long-term rate
stability and predictability

At the Universitys discretion, carrier finalists may be requested to attend the campus for oral
presentations and interviews. Berkeley reserves the right to award the contract without oral

Berkeley SHIP has been a fully-insured program since the 2013-14 plan year. The insurance
carrier from 2013-14 through the present year has been Aetna Student Health. The program is
comprised of an undergraduate and graduate population. While both student groups share the
same plan design, schedule of benefits, and exclusions, they are priced separately to reflect
differences in the average age and utilization of each prospective population. Berkley has an
eligible student population of 38,000 students, of which approximately 22,000 enroll on the plan
under a hard-waiver mandatory requirement. For Fall of 2015, there are approximately 14,000
undergraduate hard-waivers and 8,000 graduate hard-waiver enrollees in SHIP. Berkeley is
anticipated to have a slight enrollment bump for future years as the university increases the
sizes of incoming student classes (expected enrollment increases of 500-900 students per year
over the next 5 years).

While Berkeley did not offer a voluntary dependent plan for the 2015-2016 plan year,
such a plan was offered in 2014-2015. As part of this RFP, Berkeley is requesting an
optional dependent plan be priced for the 2016-17 plan year. Dependent enrollment will
be offered on a voluntary basis and may be rated independently of the student rates
(subject to rate filing compliance).
Eligible dependents included (1) their lawful spouse, (2) the person identified as a
domestic partner in the Declaration of Domestic Partnership which is completed and
signed by the covered student and (3) any dependent child under 26 years of age In
2014-2015. There were about 225 dependents on the voluntary plan. Plan metallic tier
was at the gold level. The cost of this plan was paid in advance by the member for the
entire plan period. Regardless of a voluntary dependent plan, the student plan shall
include provisions for insuring newly born children.

Continuing Students
Voluntary available to graduate students on filing fee and undergrad students in concurrent
enrollment. There were 124 voluntary students enrolled in the plan for 2013/14, 127 voluntary
students for 2014/15 and currently 25 filing students enrolled in the plan for 2015-16.

Intercollegiate Athletes
Berkeley has a population of approximately 850 intercollegiate student athletes eligible to enroll
in SHIP. Of these, 725 are intercollegiate division 1 NCAA athletes. Coverage for intercollegiate
related sports injuries has not been included on Berkeley SHIP historically. Your proposal
should address if intercollegiate sports-related injuries will be covered going forward based on
Department of Insurance requirements. If intercollegiate athletic coverage is excluded, the
University would like an optional quote to include this coverage. This price should be listed as a
separate rate that would be paid by athletes only not all students enrolled on SHIP.
It is expected that club and intermural sports coverage will be included under the standard SHIP


Students are required to use the services of University Health Services (UHS) first prior to
seeing an off-campus provider. UHS referrals are required for all non-emergency services
received outside of UHS, with some exceptions for womens health services. Berkeley staff do
have the authority to grant retroactive referrals as necessary though this is not an advertised
UHS Hours of Operation:
During the regular school year, Tang Center hours for most offices are 8am-5pm, MondayFriday.
Urgent Care hours: Monday-Tuesday, 8am-7pm; Wednesday-Friday, 8am-6pm; Saturday,
9am-5pm (last check-in at 4:30pm); Sunday 12-4pm.
o UHS expanded the Urgent Care hours to include evenings and Sundays effective
9/1/15 in an effort to reduce ER visits.
Pharmacy, Radiology, and Laboratory hours: Monday-Tuesday, 8am-7pm; WednesdayFriday, 8am-6pm; Saturday, 9am-12:30pm & 1-5pm; Sunday 12-4pm.
o UHS expanded the Pharmacy, Radiology, and Laboratory hours to include
evenings and Sundays to compliment the Urgent Care hours effective 9/1/15.
Counseling and Psychological Services hours: Monday-Wednesday, 8am-5:30pm;
Thursday, 9am-5:30pm; Friday, 8am-5pm.
o UHS is anticipated to increase mental health services in Spring 2016.


Services offered by Berkeleys University Health Services (AKA the Tang Center) are:
Medical Services

Advice line
Urgent Care clinic
Primary Care clinics
Travel Counseling and vaccination services
After-hours assistance

By referral
Specialty clinics (e.g., orthopedics, dermatology, allergy, etc.)
Physical therapy
Support services
Clinical laboratory
Appointment scheduling
Medical records

Counseling and Psychological Services

Individual counseling and psychiatry appointments (including Tang Center and satellite locations)
Groups and workshops
Consultation and outreach services
Career testing and library
Community referrals
After-hours assistance

Social Services

Individual counseling and nutrition appointments (e.g., unplanned pregnancy, serious illness or
accident, sexual assault or other violence, harassment or stalking, problematic alcohol/drug use)
Case management
Consultation and training

Health Promotion

Academic health courses

Individual appointments
Workshops, activities and events
Peer education, internship and volunteer opportunities
Consultation and training
Other outreach (e.g., awareness weeks, campaigns, social media, etc.)


Tang Information Center

Student Health Insurance Office
Communications and social media
Technology, including Tang patient portal


The Carrier must provide rates NET of all school administrative and broker fees, but inclusive of
all state and federal taxes and fees.


Dental and vision coverage is administered on a HWM basis and is bundled with the medical
plan. Your proposal may include (but is not required to include) a proposal for dental and vision
coverage as well. Dental and vision plan options will be considered independently from the
SHIP medical plan and will not result in the rejection of a qualified medical proposal. The
University reserves the right to award different contracts to different bidders. Your pricing may
be included independently from or in combination with your medical pricing, however your
medical pricing must also be presented independently. Berkeley currently contracts with VSP
and MetLife for vision and dental coverage.
Wells Fargo Insurance Services will be providing broker services only for Berkeley no plan
administration services. Carrier may be responsible for:
1. Enrollment
2. Invoicing and premium processing
3. Online waiver services
4. Brochure, highlight sheet, and other promotion material development and printing
5. Reporting
6. Customer service for students

In your RFP response, please include the question and your response in the same order
as listed below.
Carrier Information
1. Provide the full name of your insurance company and where you are headquartered.
2. Provide years of operation in the student health insurance market and include the total
number of insured students in CA and nationwide, as well as the total number of schools
who have a student health insurance plan with your company.
3. Provide company financial statements or other documents that speak to the financial
health of your organization.
4. Provide your companys AM Best Report for the past three years (including current).
5. Indicate whether your company has a dedicated Account Manager and an Account
Management team for each school account. Include name, location, experience, length
of service with your company, whether the Account Manager has experience working
with similar schools as Berkeley, and how many accounts he/she is currently handling.
6. Provide 5 university client references at least 3 should be current clients with student
health insurance programs

Claims Administration
7. Provide the name and location of your claims administrator. If your claims administrator
is a separate vendor, provide a brief history on the vendor and their experience in the
student insurance market.
8. Provide operating hours and time zone of your claims administration unit.
9. Provide detailed information on your claims handling process: Is the claims
administration department dedicated to processing only student insurance claims? Is
the claims department able to receive electronic billing from non-contracted pharmacies
and health centers? What is your claims processing turn-around time and accuracy
10. Describe your claims submission process and capability (electronic, claim form, etc.).
11. Do you have online claims viewing capability for on-campus staff for any campus-billed
12. Do you have an electronic referral system?
13. Do you have an online member service site (i.e., access to personal benefit info., search
engine of in-network providers, claims, print ID cards, etc.)?
14. Ability to interface with UHS electronic medical system (Point & Click) and medical
claims clearinghouse.
Waiver System
15. Indicate whether you have a fully vetted online waiver system. Can it handle multiple
choice as well as yes or no question formats? Do you have the capability to audit the
waiver to determine if waiver criteria have been met?
16. Please describe the IT support available to assist with any waiver system issues.
17. Are you able to give access to the Berkeley staff to change waiver status or enter appeal
details? Can your waiver system automatically generate emails to students to inform
them of their waiver status upon submission? Can you also generate emails when a
change of status is entered? Please indicate if the system has the ability to generate
and send an email explaining why the waiver was denied, along with why a waiver
appeal is being denied.
18. Please indicate that the waiver system can track by both annual plan year and by
semester (e.g. Fall Semester of 8/15/2016 to 12/31/16 and Spring Semester of 1/1/2017
and 7/31/2017 Please note, in 2017-2018 and on, Fall will start 8/1 at the start of the
month instead of mid-month).

Customer Care
19. Indicate whether you have a separate student insurance dedicated customer care unit
(CCU), number of customer care representatives, their location, operating hours, and
time zone.
20. Are you able to provide a CCU Call report specific to Berkeley should one be requested?
21. Indicate whether your CCU calls are being monitored and/or recorded. Also, indicate
whether your CCU has direct contact with the Account Manager and the Account
Management team for any escalated issues, questions, or clarification.
22. Describe how you access information on each individual caller (i.e., by student ID#,
name, medical ID#, etc.).

Claim Reports
23. Confirm that you will provide monthly standard reports and ad-hoc claims reports in a
timely manner as requested. Provide examples of report templates you currently
24. Do you have the ability to provide an electronic data feed of claim information to the
broker (i.e., a raw data file)?
25. Are you able to track claims by the effective and termination dates of each policy year
(i.e., 8/15/16 7/31/17)?
26. Can you track claims utilization data by enrollment group (e.g. undergraduate, graduate,
international, domestic, voluntary, etc.)?

27. Indicate whether you are able to receive eligibility files in a separated values file. If not,
list the file formats you are able to receive.
28. What is your eligibility load/processing turn-around time? What is the pharmacy
eligibility load/processing time if different from medical?
29. Do you have an eligibility confirmation and discrepancy report?
30. What systems do you have in place to protect the Insureds Protected Health Information

31. Provide the name of your provider network.
32. Provide the name of your pharmacy network.


33. Provide a list of In-Network pharmacies, medical and mental health providers, hospitals,
and facilities within a 10-mile radius of campus.
34. Provide a total number of network providers and total number of network pharmacies
throughout the United States.
35. Please indicate ability to customize provider network to meet Berkeley needs as
requested by Berkeley.

36. Please provide the definition of a dependent that will be used in your policy filing for
Berkeley (please reference desired definition on page 5).
37. Confirm that carrier will reimburse all UHS claims including pharmacy at UHS billed rates
less any applicable co-payments or co-insurance. Plan deductible does not apply to
services within UHS.
38. Confirm the plan designs offered will meet all California mandated filing requirements, as
well national Affordable Care Act standards, including qualifying as Minimum Essential
Health benefits.
39. Confirm the plan designs offered will meet all J-1 and F-1 visa health insurance
40. Please provide information on IT services and support to resolve any issues with claims
processing, online waiver system, websites, or enrollment/eligibility processing.
41. Please indicate ability to provide after-hours nursing line to plan members. Please
indicate who staffs this and for what hours. What reporting capabilities does the nurse
line have and how frequent is reporting?
42. Please indicate ability to print and produce brochures and other plan materials as
requested by Berkeley. Please also indicate ability to provide promotional goods for
outreach events and ability to be physically present at outreach events at the starts of
each semester and as requested otherwise.

Pricing - Confidential
43. Provide an itemization of ACA and state premium taxes included in the rate as a percent
of premium.
44. Identify your proposed target medical loss ratio provide inclusive and exclusive of
taxes listed above.


45. Provide an itemized breakdown of the retention as a percentage of premium, (i.e.,

premium tax, ACA taxes, claims administration, marketing, profit, other expenses).
46. Indicate medical inflation and student health center inflation rates used for 2016-17.
47. Berkeley desires to enter into a long-term partnership with the selected carriers.
Propose any rate guarantee or pricing strategy intended to provide Berkeley with a
stable and predictable price structure in the next five years.



NOTE: This section is to be completed by the Insurance Company with proposed rates.

The University would prefer a fully-insured program but is willing to consider self-funded
arrangements under the right circumstances.
Coverage should include:
1. Evacuation and Medical Repatriation coverage matching existing services.
2. 24/7 nurse advice line advice line should be able to provide reporting back to the SHC,
preferably on a daily schedule.
3. Effective the 2015/16 academic plan year, the California DOI is requiring all student health
insurance plans to cover intercollegiate sports related injuries. If your interpretation is
different, please price the plan accordingly and note the plan excludes intercollegiate sports
related injuries.
4. UC Berkeleys plan has historically been an excess only policy. Please specify how your
policy will be filed in California.
5. International care should be paid at the out of network rate as reimbursement only.

Please provide the following plan options:

1. Current 2015-16 plan of benefits (Platinum plan)
Note: If plan modification is required to maintain platinum designation under the 2016-17
actuarial value calculator, please provide recommended benefit changes to maintain metal
tier compliance.
2. Optional plan of benefits (Gold plan)
Carriers are given discretion on best benefit mixture to achieve gold-level plan, noting
increases to plan co-pays and deductible should be kept modest.
UCB is open to the following optional benefit changes to student plans. Please note adding
a deductible to services received at the Tang Center will not be considered.
OOPM not to exceed $5,000, preference closer to $4,000.
Deductible not to exceed $1,000 preference closer to $500.
In-network coinsurance no lower than 80%.
Open to increases in office visit copays and urgent care copays outside of Tang only, but
prefer to keep these modest.
Add fourth tier pharmacy copay for specialty drugs.
Reduce out of network coinsurance to 50%.

3. Dependent pricing option

The University wishes to explore offering a voluntary plan for dependents. The dependent
plan option may be selected independent of the student plan option. The University wishes
to evaluate multiple metal-tier plans for dependents

Price voluntary dependents for both undergraduate and graduate students.


Provide Platinum, Gold, and Silver plan and pricing options for dependents (plan design
subject to carrier discretion, but should be in line with criteria outlined above regarding
benefit preferences).

4. Continuation pricing option

- Continuation plan is offered to students who leave UCB and were enrolled in the student
health insurance the term prior to their departure. Students may enroll in a single term of
continuation coverage once per academic career. This coverage is offered to students
only, dependents are not eligible to enroll.
- Continuation rates should coincide with other voluntary students (Filing Fee for
graduates and Concurrently Enrolled for undergraduates).
5. Intercollegiate Athletics
- Please indicate if your proposal includes coverage for intercollegiate athletics.
- If it does not, please price out a supplemental athletic benefit available for purchase by
intercollegiate athletes enrolled in SHIP.

Historical Plan Changes

14/15 Plan Changes:
1) Incorporate all preferred care copays, Rx drug copays, and pharmacy coinsurance as
applicable to meeting the plan annual out-of-pocket max
2) Adjust student plan preferred care out-of-pocket max from $3,000 per policy year to
$3,200 per policy year
3) Adjust student plan non-preferred care out-of-pocket max from $6,000 per policy year to
$6,500 per policy year
4) Add coverage for routine eye exam for children
5) Add coverage for eye glasses/lenses for children
6) Add coverage for pediatric dental care
7) Remove 26 visit limitation for weight management
15/16 Plan Changes:
1) Change Deductible to #400 (combined for Preferred and Non-Preferred Care)
2) Remove Dependent plan
3) Remove Continuation plan


The University would like to consider two pricing strategies based on the undergraduate
and graduate student populations. Proposals must include pricing for both scenarios to
be considered.
1. Existing pricing split provide rates based on a single percentage increase applied to
both. 2015-16 student rates
2. Independent pricing split provide rates based on each groups historical plan

STUDENT RATES, list the rate and the percentage increase/decrease to the current rates for
each program
Option 1 (Based on existing undergrad and grad split)
A. Students only - no dependent coverage, no continuation coverage.





Platinum Tier
Gold Tier

Required benefit changes:

Option 1 (Based on existing undergrad and grad split)

B. Students with dependents and continuation coverage.





Platinum Tier
2+ Children
Gold Tier
2+ Children
Silver Tier
2+ Children

Required benefit changes:


Option 2 (Based on independent grad/undergrad utilization)

A. Students only - no dependent coverage, no continuation coverage.





Platinum Tier
Gold Tier

Required benefit changes:

Option 2 (Based on independent grad/undergrad utilization)
B. Students with dependents and continuation coverage.





Platinum Tier
2+ Children
Gold Tier
2+ Children
Silver Tier
2+ Children

Required benefit changes:


Optional Benefit Enhancements, list the percentage increase to the current rates for each
program to add each additional benefit.






Transgender benefits
**Medical abortions at
Tang Center

*Additional Transgender benefits:

Male to Female (MTF) top surgery
Tracheal shave
**Medical abortions at Tang Center: Coverage of early pregnancy termination, at estimated
gestational age of 9 or less weeks (medical abortion), covered at 100% waiving the annual
deductible and co-insurance.

Sample Response:
Option 1 (Based on existing undergrad and grad split)
A. Students only - no dependent coverage, no continuation coverage.



$x,xxx 10%


$x,xxx 8%

Platinum Tier
$x,xxx 11%
Gold Tier
$x,xxx 9%



$x,xxx 14%

$x,xxx 8%

$x,xxx 10%

$x,xxx 11%

Required benefit changes:

o Reduce OOPM to $3,000 for in network providers
o OON coinsurance reduced to 50%
o Fourth tier pharmacy copay of $XX added
o Increase deductible to $500
o Increase OOPM to $4,000 for in network providers



OON coinsurance reduced to 50%

Fourth tier pharmacy copay of $XX added

Transgender benefits
**Medical abortions at
Tang Center