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Possible Questions to Include in a Vision RFP

These will cover everything from opthalmic materials to reasons why providers have disenrolled from their network.

January 8, 2002
Related Topics: Benefit Design and Communication, Health and Wellness, Compensation
Reprints

The following items are not intended as an RFP model but are presented as a broad list of questions and requests that might be included in an RFP. Not every question need be included and others that are omitted might be regarded as important to certain groups or for special circumstances.

Organizational/Financial

  • Discuss the history and ownership of your company.

  • Provide names, titles and detailed background information for the principal owners, officers and shareholders of your corporation.

  • Describe your company's organizational structure and provide an organizational chart.

  • Describe your company's current affiliations and any recent or upcoming changes in ownership.

  • Provide detailed information on persons who will have overall responsibility and day-to-day responsibility for this account.

  • Provide a copy of your most recent liability insurance certificate.

  • Furnish a copy of your audited financial statements for the last two years.

  • Provide an administrative fee history for the past five years.

  • Provide a list of your current accounts including the name and phone number of a contact person for your ten most major accounts.

  • Disclose your company's history of litigation and the history of any lawsuits.

  • What is the total number of employees in your organization?

Administration

  • Prepare a flowchart demonstrating the processes involved from the time a member decides to use the benefit, until the time they receive their eyewear.

  • Describe the computer hardware, software and other systems used in the administration of your vision plan.

  • How do providers access eligibility information?

  • Describe your procedures for processing claims submitted by providers and members.

  • Submit copies of all forms used by members and providers for obtaining services and submitting claims.

  • Indicate your performance standards for claims processing, provider and member payments, average call response time and call abandonment rates.

  • Describe your procedures for members to file grievances and explain how grievances are resolved.

  • Describe your member inquiry unit and how it operates.

  • What are your hours for handling member inquiries, requests for benefits and grievances?

  • Describe your member service phone system.

  • Provide copies of member communications you have helped to prepare for other clients.

  • Explain how the costs of material preparation, mailing and promotions are to be borne for plan implementation.

  • Provide a copy of your standard contract.

  • Provide copies of all forms used in the administration of your vision plan.

  • Can you accept eligibility information electronically and/or by magnetic tape?

  • Discuss your ability to provide data in electronic tape format.

  • Describe your standard reports and provide copies.

  • What is your normal time frame for providing reports?

  • Are you able to provide customized reports and are there additional fees for producing them?

Provider Panel

  • Submit a list of your provider network for our geographical area.

  • What is the proportion of ophthalmologists, optometrists and retail optical establishments in your network?

  • If additional providers are needed, can they be enrolled? If "yes," please explain.

  • Submit a copy of your provider agreement.

  • Explain your organization's philosophy in forming a provider network, e.g., selection process, criteria, numbers, distribution.

  • Does your provider credentialing process meet NCQA standards?

  • Describe your provider credentialing and recredentialing process and submit all relevant forms.

  • What materials are collected from providers to verify their application responses?

  • Do providers pay to be in your network?

  • Are any administrative fees charged to your providers or withheld from their payments?

  • Describe any standards you have for geographic access and appointment availability for care.

  • Submit copies of three provider directories you have prepared for clients.

  • How many providers have you added and how many have disenrolled in the past 12 months?

  • What are the primary reasons providers have disenrolled from your network?

  • Explain how network providers are reimbursed.

  • Can a member obtain an examination from one provider and eyeglasses from another?

  • Must members obtain their services from network providers?

  • Do your providers receive a provider manual? If so, submit a copy.

  • What percentage of members of your current clients use panel providers as compared to indemnity?

Ophthalmic Materials

  • List the lens types and features that are covered and those that are not covered under your standard benefit plan.

  • Are noncovered lens items available to members at fixed surcharge fees? If so, provide the fee schedule.

  • What is the frame selection that is available to members under your standard benefit plan?

  • Is the same plan frame selection available to members at all panel offices?

  • What percentage of the plan lenses and frames are made in America?

  • Explain where the materials provided in your plan are fabricated.

  • Do the provider offices profit from the sale of eyeglasses and contact lenses? Explain.

Quality Assurance

  • What standards have you established for eye examinations?

  • What standards have you established for provider facilities?

  • Do you have standards for ophthalmic materials and eyeglass fabrication? If so, explain.

  • Explain any review processes you have for monitoring the care provided by panel providers and submit copies of forms used.

  • How often are provider site visits conducted and by whom?

  • Describe your method of assuring that materials provided in your program meet quality standards and submit copies of forms used.

  • Do you routinely survey beneficiaries to determine satisfaction with services provided? Explain your program in this regard and submit copies of forms used.

  • If you routinely survey beneficiaries, supply statistical results for the past two years.

  • Provide whatever proof you can to substantiate claims of providing high quality services and materials and conducting an effective quality assurance program. (Note: All managed care organizations claim high quality and effective quality assurance, so some proof is needed to separate the "claimers" from the "doers.")

Costs

  • What is the overall per claim administrative fee?

  • Illustrate the fee-for-service cost to the plan and member for providing and administering a standard benefit of examination and single vision eyeglasses.

  • What are the costs for bifocals, trifocals, frames, dispensing, lenses, and so on?

  • Which lenses and lens features are included in your standard benefit, which are available for the entered price, and which are not available? This includes oversized lenses, tinted, gradients, anti-scratch coating, and more.

  • Provide projected utilization of the benefit for the first two years of the program and the projected cost based upon your fee-for-service charges. Include benefit and administrative costs.

Reprinted with permission from "Managed Vision Benefits" by Jesse Rosenthal and Mort Soroka, Copyright 1998, International Foundation of Employee Benefit Plans, Brookfield, Wisconsin. All rights reserved.

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