hbex.coveredca.com AA Att 2... · Web viewDuring Open Enrollment Periods (approximately October...

Agreement [number] of 54Covered California/[Contractor Name]

Exhibit AA – Attachment 2Solutions Requirements Inventory

INSTRUCTIONS TO CONTRACTOR: Requirement sections from Exhibit AA and Exhibit AB are outlined below.

For each technical/system requirement: Please indicate whether Contractor includes a Commercial Off-the-Shelf Software or Software as a Service Software solution that meets the requirement by marking in the appropriate column. If your solution will consist of fully Custom Software, this Exhibit is not required. If solution fully meets requirement with no modification, please check the column “Fully Met with Existing

Software” If the solution will meet the requirement with modification:

o Indicate how closely the existing software meets the requirement by indicating the approximate percentage of the requirement that is already met by indicating a percentage between 0% and 99% in the column “Percentage of Requirement Met “Out of the Box”

o Identify the Type of Modification Required by indicating in this column one of the following:1. Modification through built-in Administrative Configuration console2. Custom Add-In required3. Additional Software Product Required4. Other

o Provide a brief Description of the Modification required Provide any additional information that may be needed or useful in the “Other Information” column

For Non-technical requirements: Some of the section requirements listed may have little or no technical solution component. For these items, Contractor is to confirm or clarify ability to meet the requirement listed.

Please be sure to address all sections applicable to Contractor’s offering. If not offering a solution for Exhibit AB, please enter “Not offered” for each requirement as applies. Sections are color coded as follows:

Exhibit AA: Individual Agent Service Center and Small Business Agent Service CenterExhibit AB: Small Business Eligibility and Enrollment and Financial Administration (Optional)



Req # Requirement Text Fully Met with

Existing Software

Requires Modification to Meet Requirement Other InformationPercentage of

Requirement Met “Out of

the Box”

Type of Modification

Required

Description of Modification

Exhibit AA: Individual Agent Service Center (IASC) and Small Business Agent Service Center (SBASC)1.2 General Scope or Tasks

Requirements outlined are designed to meet current and evolving business requirements. Covered California and Contractor agree to reasonable accommodation for some variation in stated requirements as implementation and go-live stages of work proceed. Accommodations may be driven by practical, best practice, and/or other opportunities for improved solution.

1.3.a General RequirementsAll business rules are to be per the direction and approval of Covered California.

1.3.b The Contractor shall only utilize Covered California systems as they directly relate to performing contracted duties.

1.3.c Contractor shall provide a workforce for facilitating inbound phone call and support, email support and outbound call campaign efforts.

1.3.d.i IASC staff shall be required to be trained in and have a working knowledge of the following: Health Insurance Portability and Accountability Act (HIPAA), Consolidated Omnibus Budget Reconciliation Act (COBRA), and the Patient Protection and Affordable Care Act (ACA).

1.3.d.ii Covered California Security and Privacy standards. 1.3.d.iii Standard computer programs in Windows including Word,

Excel and Outlook.




Existing Software

Requires Modification to Meet Requirement Other Information1.3.d.iv Logging customer interactions into a Covered California

provided CRM System, currently Salesforce.com, which is Covered California’s standard that will be used by the IASC.

1.3.d.v Working with custom, proprietary systems. IASC staff will be required to develop a strong proficiency working with the proprietary California Healthcare Eligibility, Enrollment, and Retention System (CalHEERS).

1.3.d.vi Delivering high quality customer service to a variety of clients via multi-channel contact including email, telephone, chat, and mobile solutions.

1.3.d.vii Researching and resolving technical issues and/or client problems as they arise with minimal direction.

1.3.d.viii Communicating verbally and in writing using modern business communications, formatting of professional written communication, reports and phone etiquette soft skills.

1.3.d.ix Establishing priorities, multi-tasking, working under pressure and deadlines, working independently with minimal supervision or in team environment.

1.3.d.x Working in a service center environment1.3.e E. General IASC inbound call/chat and e-mail

request tasks will include:

Tier 1: Inbound phone and email support I. Consumer and salesforce account supportII. Online CalHEERS application assistance III. General Covered California program eligibility information service.

Tier 2: Escalated consumer enrollment issues (Typically handled by a Lead or Supervisor):




Requires Modification to Meet Requirement Other InformationI. Manage and Resolve consumer appeals

II. Facilitate access to care requests III. Create service request tickets for CalHEERS application and account errors

1.4.a For Inbound calls/chat and email requests, IASC staff will be expected to:Perform Tier 1 and Tier 2 inbound call and e-mail request tasks as described in E.1.e. Escalated Issues such as access to care that require subject matter experts (SMEs) will be ticketed via CRM and escalated to the appropriate Covered California Service channel.

1.4.b Create and retain documentation of all inbound calls and emails within the CRM system.

1.4.c Create tickets for incoming technical support requests for online application errors and account errors within the CalHEERS support ticketing system.

1.4.d Handle all inbound calls and email with standard HIPAA compliance regulations and in accordance with applicable state and federal regulations as well as Covered California policy and procedure.

1.4.e Manage escalation of complex issues through the CRM ticketing process.

1.4.f Attend regular meetings and quality checks by vendor’s service center management and support staff with Covered California leadership or assigned Covered California staff members.

1.4.g Attend twice-weekly meetings (up to daily during open enrollment periods) with Covered California staff to review inbound phone and email stats, identify call trends and pinpoint areas for improvement.

1.5.a For Outbound Calls, IASC staff will be expected to:




Existing Software

Requires Modification to Meet Requirement Other InformationPerform outbound calls to specific groups of agents,

certified enrollment counselors, and certified enrollment entities for the purposes of gathering data and/or prompting such person to take specific actions including Covered California contract completion or maintenance.

1.5.b Create and retain documentation of all outbound calls within the CRM system.

1.5.c Develop outbound call campaign scripting in coordination with Covered California.

1.5.d Manage outbound call campaign performance based on metrics prescribed per campaign by Covered California.

1.5.e Cross-train SCRs to conduct outbound campaign calls.1.5.f Manage service center workforce to conduct outbound call

campaigns without impacting service level expectations on inbound calls.

1.5.g.1.a Contractor and Covered California agree the following outbound campaigns are included in agreement:

Perform twelve (12) outbound call campaigns per year identified as follows: Utilize power dialer and pre-recorded voice messaging capability

1. Calls to lists of 15,000 phone numbers provided by Covered California

2. Outbound Campaign management including call transfer to campaign queue or TFN, script development, recording and deployment, call dispositioning, list management for opt-outs and Do Not Call (DNC) compliance

3. Bidder will provide a fee schedule for additional call campaigns using power dialer and pre-recorded messaging campaigns for Covered California to optionally utilize beyond the twelve




Requires Modification to Meet Requirement Other Information(12) contracted campaigns

1.5.g.1.b Bidder will provide a fee schedule for additional outbound call campaigns including campaigns in which a power-dialer cannot be used which requires manual dials in conformance to TCPA regulations. Fee schedule and units are in Exhibit B, Attachment 1.

1.5.g.2 Outbound campaigns will principally be educational and/or informational and are not direct-to-consumer sales campaigns. Contractor shall bid outbound campaign efforts utilizing the same Contractor staff as designated to receive inbound calls. Should an outbound campaign effort be mutually determined to require a skill set other than that possessed by inbound call staff, Contractor and Covered California shall come to agreement on resolution.

1.6.a Hours of Operation: The Contractor shall provide the Services during Covered California’s agreed upon hours of operation. As of the date of this scope of work, the year-round business hours are:

8:00 a.m.to 6:00 p.m. Pacific Time Monday through Friday and closed on Saturday and Sunday.

1.6.b Lines are closed at 6 p.m. daily. Staff is required to service all calls in queue at the time of lines closing.

1.6.c During Open Enrollment Periods (approximately October 1—January 31), at the request of Covered California, contractor shall also be prepared to operate the service center for extended hours for up to eight (8) days during the Open Enrollment Period. Extended hours will typically be requested on or around traditional “deadline” dates during Open Enrollment such as December 15 (the deadline for January 1 coverage), January 15 (the deadline for February 1 coverage), or the last day of the Open Enrollment period. Extended hours may include weekend




Existing Software

Requires Modification to Meet Requirement Other Informationdays and/or extended hours up to midnight. The eight (8)

instances of extended hours or weekend dates for Open Enrollment shall be included in the base pricing. Covered California may request additional hours at a mutually agreed-upon price.

1.6.d The individual exchange annual Open Enrollment Period will be October 1 through the last day of January of each year (dates may vary based on state regulations). However, these dates are subject to regulatory change. Covered California will provide Contractor with one hundred twenty (120) days’ notice and budget approval of a change in the individual market annual Open Enrollment Period, if applicable.

1.6.e Any changes to the dates and hours of operation shall be mutually agreed upon with acceptable advanced notice by both parties.

1.6.f The Contractor shall allow access to on-site operations by Covered California’s Project Management Team and/or their approved representative(s) during normal business hours of operation for scheduled and unscheduled visits.

1.6.g The Contractor shall designate a single person (e.g., Individual Agent Service Center director) to whom all project communications may be addressed and who has the authority to act on all aspects of the contract for services. This person will be responsible for the overall project and will be the contact for all invoice issues.

1.6.h Contractor will strictly follow protocols, use of job aids, task guides and training materials for all work performed to support Covered California. In addition, quality evaluation monitoring procedures will be in place to ensure SCR staff are delivering services in accordance with approved protocols. Supervisors will monitor staff performance against documented processes and




Existing

Requires Modification to Meet Requirement Other Informationprocedures to maintain a high expectation for Customer

Service.1.7 Surge.

The Contractor is required to assist in the automatic transfer and automatic routing of calls to Covered California’s Service Center to handle surges of volume during the annual individual Open Enrollment Period. When necessary, the Contractor shall deploy changes in its call center technologies which may include IVR changes, phone or network changes, or development of web or batch services to connect to Covered California systems in order to accommodate this surge strategy.

Surge will be triggered when the longest call in the IASC queue reaches 360 seconds. All calls that select or have selected Individual Application Assistance will be sent to the Covered California surge staff until the longest call in queue is less than 360 seconds. When the longest call in queue falls to a number lower than 360 seconds, calls will no longer surge.

1.8.a Technology. Voice and Data technology must provide the following:Multi-Channel contact functionality which includes:1. Voice2. Email3. Chat4. Mobile (including Text)5. Social Media

1.8.b Inbound and outbound contact integration. This includes:1. Campaign management and measures2. Ability to transfer to IVR or recorded message connections made via outbound calling and campaign




Requires Modification to Meet Requirement Other Informationefforts.

1.8.c Ability to establish an Application Programming Interface (API) with Covered California CRM (currently Salesforce.com).

1.8.d Computer Telephony Integration (CTI). CTI to CRM real time synchronization.

1.8.e Multiple (Blended) Sales Dialer functionality including:1. Predictive Dialer2. Progressive Dialer 3. Power Dialer 4. Preview Dialer 5. Capability to switch between the Dialers types based on the business needs 6. Compliance with the following:a. Telephone Consumer Protection Act (TCPA)b. DNC (Do Not Call) List

1.8.f Contractor Internet access shall be made available for each SCR workstation to access required applications and websites.

1.8.g Covered California shall provide all staff performing work under this scope of work a Covered California email address, and the Contractor shall ensure that staff and SCRs maintain Covered California email credentials.

1.8.h Contractor shall at its own expense maintain and provide existing workstations and obtain and deploy replacement/additional SCR workstations.

1.8.i Automatic Call Distribution (ACD) Applications. Contractor shall at its own expense utilize its ACD applications to receive and route Covered California calls within the Contractor’s environment.1. Contractor’s solution shall support the ability to




Requires Modification to Meet Requirement Other Informationroute multiple channel types to appropriately skilled SCRs.

2. The system shall have the capability to provide the estimated wait time to caller.3. The system shall have the capability measure adherence to a required Service Levels.

1.8.j Interactive Voice Response (IVR): The Contractor’s IVR shall:1. Be tailored for the types of customers serviced by the IASC and designed to maximize opportunities for customer service self-service. Types of customers include:a. Agent Supportb. Certified Enroller Supportc. Consumer Support2. Be accessible via touch tones, voice, and/or natural language input.3. Allow direct access to an IASC SCR for alternate languages

1.8.k IVR Call Follow: The IVR call flow and menus shall be proposed by Contractor and approved by Covered California in post award design sessions.

1.8.l Auto answer: The contractor systems shall auto answer and play a greeting message to all calls prior to the second ring and route to an agent appropriately. If no available representatives the ACD should either play music or play pre-recorded messages

1.8.m Call prioritization: Priority can be set based on type of call or caller. Surge calls have the highest priority. Other call or caller priorities may be defined by Covered California.

1.8.n Courtesy call back. The ACD system shall offer the option to receive a courtesy call back instead of waiting on the phone and in queue for an agent. The Courtesy Call back function shall not change the time a customer must wait to be connected to an agent but rather enable the caller to




Requires Modification to Meet Requirement Other Informationhang up and not be required to remain in queue.

1.8.o Contractor shall make changes to the ACD menu and prompts within a timeframe mutually agreeable to the parties by written request from Covered California. All efforts shall be made to implement urgent changes as quickly as possible.

1.8.p Contractor shall provide complete testing of the ACD call-routing process to ensure all functionality meets Covered California’s criteria.

1.9.a Technology Integration The Contractor should securely connect to CalHEERS, Salesforce.com CRM, and other Covered California Cloud applications using the internet.

1.9.b The Contractor may be required to have the capability to access and integrate with the following Covered California Service Center solution.1. Cisco Contact center Solution 11.5 or newer version.2. Cisco Reporting tool (CUIC) 11.5 or newer version.

1.10.a Key Performance Indicators. This section sets forth the performance metric(s) (“Performance Metric(s)”) which will be measured periodically, but not less frequently than once monthly.

Definitions and Targets:1.10.a.1 Answer within Standard or “Service Level” (SL)

a. Definition: 80% of all Calls Offered answered within a 30-second wait timeb. Calculation: Service Level = [Number of calls answered within 30 seconds/Number of calls offered] *100c. SL is measured both on a monthly average and daily frequency




Requires Modification to Meet Requirement Other Information

Important Note: Covered California requires cost alternatives for the following Answer within Standard requirements.• 30 Seconds (to be included in “Base” bid submission)• 60 Seconds increased by 30 second increments up to 360 seconds.

Accommodation for these alternatives are made in Exhibit B, Attachment 1 – Pricing Worksheet.

1.10.a.2 Abandonment Ratea. Definition: No more than 5% of all Calls to the IVR may be abandoned (disconnected by caller) before it is answered by an SCR b. Calculation: Abandonment Rate % = [Number of Calls to the IVR – Number of Calls Handled]/Number of Calls to the IVR]*100

1.10.a.3 Average Handle Timea. Definition: Average is in range of 18-23 minutes during peak months (October through December) and range of 12-19 minutes in all other months. b. Calculation: Add total talk time + total hold time + total after-call tasks, and then divide by the number of total calls.c. Contractor and Covered California agree to review this measure annually or as otherwise mutually agreed.

1.10.a.4 SCR Call Quality Assurance Score a. Definition: Maintain a 90% monthly SCR Call Quality Assurance Score average site-wide using the approved quality assurance process as defined in this




Requires Modification to Meet Requirement Other Informationscope of work

b. Monthly individual SCR QA score will be based on 1 call scored per SCR per week

1.10.a.5 Email Response Timea. Definition: 85% of electronic and written inquiries shall be responded to within 1 business dayb. Calculation: Response time is calculated based upon total hours elapsed between the “open” date stamp in CRM and the “closed” date stamp in the same CRMc. Auto-responses cannot be considered a reply to meet the desired service leveld. Monthly average service level is site-wide and based upon total monthly inbound email interaction in the CRM

1.10.a.6 Customer satisfaction survey a. Contractor and Covered California agree to a customer satisfaction survey measure. This measure will be a transactional post-call survey focused on the interaction with the SCR. It is further mutually agreed to establish a minimum measure for the first year post go-live with modification of measures to be performed after baseline period of six months.

1.10.a.7 First Call Resolution: a. Contractor and Covered California agree to measure first call resolution. It is further mutually agreed to establish measures to be met after baseline period of 120 days post go live.

2.2 General RequirementsRequirements outlined are designed to meet current and evolving business requirements. Covered California and Contractor agree to reasonable accommodation for some




Existing Software

Requires Modification to Meet Requirement Other Informationvariation in stated requirements as implementation and

go-live stages of work proceed. Accommodations may be driven by practical, best practice, and/or other opportunities for improved solution.

2.2.a All business rules are to be per the direction and approval of Covered California.

2.2.b The Contractor shall only utilize CCSB systems as they directly relate performing contracted duties.

2.2.c Contractor shall utilize Covered California Enrollment and Financial management solution as the system of record for all transactions. This includes, but is not limited to, all reconciliations, group and member transactions, and data transmissions.

2.2.d Contractor shall utilize Covered California Customer Relationship Management (CRM) solution.

2.2.e CCSB will develop all Policy Guidance and Notices in accordance with applicable Federal and State law, rules and regulations to assist Contractor in carrying out is duties pursuant to this agreement.

2.2.f Contractor shall immediately notify CCSB via email or phone of any issues that pose a serious risk to CCSB operations, system performance, or its service center. Contractor shall provide CCSB with a proposed resolution for any identified issues.

2.2.g Contractor shall provide eligibility and enrollment guidance to consumers, which include employers, employees, Agents, and General Agents in accordance with CCSB Eligibility and Enrollment Regulation and policies.

2.2.h Provide consumer support for CCSB that is an employee choice model across multiple health and dental carriers and across multiple metal levels.




Existing Software

Requires Modification to Meet Requirement Other Information2.2.i Staff shall have increasingly deep knowledge of the

following:1. Generally accepted Health Care Eligibility and Billing procedures as well as Health Insurance Portability and Accountability Act (HIPAA), Consolidated Omnibus Budget Reconciliation Act (COBRA), California-COBRA, Multiple Employer Welfare Arrangement (MEWA) and Employee Retirement Income Security Act (ERISA) legislation, and Patient Protection and Affordable Care Act (ACA);2. Standard computer training in Windows, Word, Excel and Outlook 3. Experience logging customer interaction into a CRM System4. Ability to develop a strong proficiency working with CCSB’s Enrollment and Financial Systems.5. Ability to deliver quality customer service to a variety of clients via telephone, email, and chat.6. Ability to research and resolve technical issues and/or client problems as they arise with minimal direction.7. Written and oral communication skills to include modern business communications, formatting of professional written communication, reports and phone etiquette soft skills.8. Skills to establish priorities, multi-task, work under pressure and deadlines, work independently with minimal supervision or in team environment.

2.3.a Small Business Service Center (SBSC) Team:SBSC staff duties and responsibilities which include:General Tasks1. Tier 1: Inbound phone and email support. Consumer and service channel account support including:




Requires Modification to Meet Requirement Other Informationa. Online CCSB application assistance

b. General CCSB program eligibility and financial information service. 2. Tier 2: escalated consumer enrollment issues: a. Facilitate employer/employee appealsb. Facilitate employee access to care requests c. Create service request tickets for CCSB application and account errors3. Callers. Callers may include but are not limited to:a. Certified Agentsb. General Agentsc. Employer Group representatives d. Enrolled members

2.4.a Inbound calls and emailPerform Tier 1 and Tier 2 call services for inbound calls and email where Tier 1 is general phone support (as described in general tasks) and Tier 2 is a call that requires Lead or Supervisor support. Escalated Issues such as access to care that require subject matter experts (SMEs) will be ticketed via CRM and escalated to the appropriate Covered California Service channel.

2.4.b The solution shall provide for receiving inbound calls and email from employers, employees, agents, general agents, CCSB staff and others as applicable in accordance with the regulations, policies and procedures established by Covered California.

2.4.c The solution shall accommodate a variety of call types. Call types include but are not limited to:1. Application creation2. Application maintenance3. Password reset4. Application status




Requires Modification to Meet Requirement Other Information5. Additions of employees

6. Deletion of employees7. Changes in status of or information regarding employer group or employees8. Questions regarding renewals9. Premium payment status

2.4.d Create and retain documentation of all inbound calls and emails within the CRM system.

2.4.e Service Tickets for incoming technical support requests for online application errors and account errors

2.4.f Handle all inbound calls and email with standard HIPPA, PII, and PHI compliance regulations and in accordance to applicable state and federal regulations as well as Covered California policy and procedure.

2.4.g Manage escalation of complex issues through the CRM ticketing process.

2.4.h Schedule regular meetings and quality checks by vendor’s service center management and support staff with CCSB leadership or assigned CCSB staff members.

2.4.i Schedule weekly or daily meetings with CCSB staff to review inbound phone and email stats, identify call trends and pinpoint areas for improvement.

2.5.a Outbound Calls and EmailsDeveloping outbound call campaign scripting in coordination with CCSB

2.5.b Managing outbound call campaign performance based on metrics prescribed per campaign by CCSB

2.5.c Training dual-skilled service center representatives to participate outbound call campaigns

2.5.d Managing service center workforce to conduct outbound call campaigns outside of peak inbound support call intervals

2.6.a Hours of Operation




Existing Software

Requires Modification to Meet Requirement Other InformationThe Contractor shall provide the Services during Covered

California’s agreed upon hours of operation. As of the date of this scope of work, the year-round business hours are:

2.6.b 8:00 a.m. to 5:00 p.m. Pacific Time Monday through Friday and closed on Saturday and Sunday.

2.6.c Any changes to the dates and hours of operation shall be mutually agreed upon with acceptable advanced notice by the parties

2.7 Technology. Voice and Data technology must be capable of supporting SCR access to Covered California cloud-based systems.

2.7.a Contractor solution shall have ability to establish an API with Covered California CRM (currently Salesforce.com)

2.7.b Contractor Internet access shall be made available for each SCR workstation to access work-related websites.

2.7.c Covered California shall provide all staff performing work under this scope of work a Covered California email address, and the Contractor shall ensure that staff and SCRs maintain the Covered California email credentials and meet Covered California policies.

2.7.d Contractor shall at its own expense maintain and provide existing workstations and obtain and deploy replacement/additional SCR workstations.

2.7.e Automatic Call Distribution (ACD) Applications. Contractor shall at its own expense utilize its ACD applications to receive and route Covered California calls within the Contractor’s environment.1. ACD: Solution shall support unlimited skills-based routing. Specifically, this includes the ability to route multiple interaction types, including phone calls and in the future, if so desired, and customer chat requests or email requests. SCRs shall be assigned based on priority,




Existing Software

Requires Modification to Meet Requirement Other Informationproficiency and preference. The system shall match the

requirements of the incoming interaction to an SCR with the appropriate skills. 2. The system shall predict the estimated wait time and use this information to make skills-based routing decisions. This includes considering multiple backup skills and overflow destinations. Customer Interaction Center’s ACD shall be configured to distribute interactions to SCRs based on:a. Estimated wait timeb. Estimated position in queuec. Total SCRsd. Number of available SCRse. Number of SCRs on callf. Number of SCRs in After Call Work (ACW)g. Longest time an SCR has been availableh. Number of calls waiting in queuei. Number of calls assigned to SCRj. Longest wait time for a callk. SCR skilling

2.7.f IVR (Interactive Voice Response): The Contractor’s IVR shall allow phone users to use their telephone keypad as a keyboard to input values in response to voice prompts played by a computer. A caller selects menu entries by pressing keys on a telephone. Based on the caller's choice, an auto attendant can offer a submenu, transfer a call to a queue, or perform many other actions. Each menu is owned by a single schedule. Menus become active when the conditions stipulated by the schedule form are met. In other words, a menu is not available to callers unless its parent schedule is active including, but not limited to, the following menu structure:1. CCSB Main Menu




Requires Modification to Meet Requirement Other Information2. CCSB Agent Menu (includes General Agents)

3. CCSB Employer Menu4. CCSB Employee Menu

2.7.g Auto answer: The Contractor’s system shall be set to automatically connect ACD interactions to a SCR’s phone. When an interaction alerts on a user's queue, Interaction Desktop plays a tone to inform the SCR about the incoming interaction.

2.7.h Skills-based routing: Skills assigned to an SCR or interaction by the ACD Specify Skill tool are only considered if the workgroup requires certain skills and proficiencies. Otherwise, all SCRs and interactions effectively have equal scores in all skills, so new interactions go to the SCR with the longest available time.

2.7.i Call prioritization:Priority can be set based on type of call.

2.7.j Courtesy callback. The Contractor’s system shall have the ability for customers to have the option while they are in queue to leave their information and not lose their spot in queue.

1. If the customer chooses this option, they will be asked to enter the ten- (10-) digit phone number they want to be called back on. 2. The request then gets processed as any other call in queue would and when a SCR becomes available the caller information is presented to the SCR and they click a button to call the customer back.3. Callbacks. ANI (Caller ID) Data about the call is examined at runtime to capture the caller's telephone number, and a new callback request object is placed on




Existing Software

Requires Modification to Meet Requirement Other Informationthe workgroup queue specified in the form. The callback

occurs when an SCR picks up the callback from the queue. The attendant currently does not allow callers to schedule callbacks to occur at a specific date or time.

2.7.k Interaction Client feature shall enable SCRs to handle all interaction types with a universal desktop application.1. Contractor shall record one hundred percent (100%) of voice transactions with twenty percent (20%) of the transactions having screen recordings. 2. Contractor shall make configuration changes, work with schedules, and evaluate intra-day differences between forecast and actual values within Contractor’s workforce management tool.

2.7.l Once a call has reached the Contractor’s ACD, it shall be routed into n queue processing menu that will have menus and prompts specified by Covered California. After any additional routing logic has been applied to the call by the Contractor-operated queue processing menu, it shall be directed to an appropriately skilled SCR for handling.

2.7.m Contractor shall make changes to the ACD menu and prompts within a timeframe mutually agreeable to the parties by written request from Covered California. All efforts shall be made to implement urgent changes as quickly as possible.

2.7.n Contractor shall provide Covered California with an interface to view real-time ACD queue performance on Covered California’s programs. 1. For monitoring purposes, Contractor shall provide Covered California with three (3) licenses to the monitoring platform. 2. Additional licenses shall be charged at a rate determined by the parties at the time of request.




Existing Software

Requires Modification to Meet Requirement Other Information2.7.o Contractor shall provide complete testing of the ACD call-

routing process to ensure all functionality meets Covered California’s criteria.

2.8.a Key Performance Indicators. This section sets forth the performance metric(s) (“Performance Metric(s)”) which will be measured periodically, but not less frequently than once monthly.

Definitions and Targets:2.8.a.1 Answer within Standard or “Service Level” (SL)

a. Definition: 80% of all Calls Offered answered within a 30-second wait timeb. Calculation: Service Level = [Number of calls answered within 30 seconds/Number of calls offered] *100c. SL is measured both on a monthly average and daily frequency

Important Note: Covered California requires cost alternatives for the following Answer within Standard requirements.• 30 Seconds (to be included in “Base” bid submission)• 60 Seconds increased by 30 second increments up to 360 seconds.

Accommodation for these alternatives are made in Exhibit B, Attachment 1 – Pricing Worksheet.

2.8.a.2 Abandonment Ratea. Definition: No more than 5% of all Calls to the IVR may be abandoned (disconnected by caller) before it is answered by an SCR




Existing Software

Requires Modification to Meet Requirement Other Informationb. Calculation: Abandonment Rate % = [Number of

Calls to the IVR – Number of Calls Handled]/Number of Calls to the IVR]*100

2.8.a.3 Average Handle Timea. Definition: Average is in range of 8-12 minutes. b. Calculation: Add total talk time + total hold time + total after-call tasks, and then divide by the number of total calls.c. Contractor and Covered California agree to review this measure annually or as otherwise mutually agreed.

2.8.a.4 SCR Call Quality Assurance Score a. Definition: Maintain a 90% monthly SCR Call Quality Assurance Score average site-wide using the approved quality assurance process as defined in this scope of workb. Monthly individual SCR QA score will be based on 1 call scored per SCR per week

2.8.a.5 Email Response Timea. Definition: 85% of electronic and written inquiries shall be responded to within 1 business dayb. Calculation: Response time is calculated based upon total hours elapsed between the “open” date stamp in CRM and the “closed” date stamp in the same CRMc. Auto-responses cannot be considered a reply to meet the desired service leveld. Monthly average service level is site-wide and based upon total monthly inbound email interaction in the CRM

2.8.a.6 Customer satisfaction survey a. Contractor and Covered California agree to a customer satisfaction survey measure. This measure will be a transactional post-call survey focused on the




Existing Software

Requires Modification to Meet Requirement Other Informationinteraction with the SCR. It is further mutually agreed to

establish a minimum measure for the first year post go-live with modification of measures to be performed after baseline period of six months.

2.8.a.7 First Call Resolution: a. Contractor and Covered California agree to measure first call resolution. It is further mutually agreed to establish measures to be met after baseline period of 120 days post go live.

3.1 DefinitionsA. Abandoned Call: A phone call that has been received by a call center’s communications switch, but is terminated by the caller before any conversation begins.B. Abandonment Rate: The percentage of callers who hang up before a SCR answers, or before they make a selection in an interactive voice response (IVR) unit. The inverse of answer rate. C. Automatic Call Distributor (ACD) - A specialized phone system used for handling incoming calls. The ACD recognizes an incoming call and scans for predetermined identifying information. This information is cross-referenced against a database of call routing instructions and distributes the call accordingly. D. California Healthcare Eligibility, Enrollment and Retention System (CalHEERS): An automated system that serves as the consolidated system support for eligibility, enrollment, and retention for Covered California individual market enrollment and Medi-Cal programs. The system includes a web-based portal that is used by consumers to self-enroll as well as administrative users to assist consumers in enrolling in any of these programs. Administrative users include Covered California Service Center Representatives, County Eligibility Workers, and the




Requires Modification to Meet Requirement Other InformationCovered California salesforce.

E. Cal-COBRA: The California health continuation law that has similar provisions to federal COBRA. Cal-COBRA requires employers with 2 to 19 employees to provide their employees (and their dependents) the right to continue health insurance coverage after a qualifying event occurs. Health coverage protection for larger group sizes of 20 or more fall under federal COBRA laws.F. Certified Insurance Agents - An agent certified by the Exchange to transact in the Individual and Small Business Health Options Program (SHOP) Exchanges.G. Certified Enrollment Entities - An entity or individual registered by the Exchange to provide one-on-one Consumer Assistance.H. Certified Enrollment Counselors - An individual who is certified by the Exchange to provide one-on-one Consumer Assistance.I. Consolidated Omnibus Budget Reconciliation Act, COBRA: A health insurance program that allows an eligible employee and his or her dependents the continued benefits of health insurance coverage in case that employee loses his or her job or experiences a reduction of work hours.J. Consumers: Those calling into SBASC staff or to who SBASC staff make outbound calls. These typically include Employers, Agents, General Agents. While less likely, they may also include Employees of Employers offering coverage through CCSB and Covered California staff.K. Customer Relationship Management System, CRM: A category of integrated, data-driven software solutions that improve interactions with both current and potential customers. It uses data analysis about




Existing Software

Requires Modification to Meet Requirement Other Informationcustomers' history with a company to improve business

relationships with customers, specifically focusing on customer retention and ultimately driving sales growth.L. DE-9C: Form DE9C is the quarterly wage and withholding report for California employers. The form is used to report wage and payroll tax withholding information for California employers. In a way, it is the California equivalent of the Form 941 except the detailed withholding for each employee is reported.M. Interactive Voice Response (IVR): An automated retrieval and processing device that provides information to callers via telephone keypad signaling and/or voice recognition. The response may be a recorded, artificial or synthesized voice.N. Joint Application Design (JAD): JAD Sessions are an opportunity to introduce system functionality to key project stakeholders, gain a common understanding of requirements and how they support business, validate and approve functionality that fully meets the requirements, and define the scope of work for the detailed design sessions for product configuration and/or extension changes.O. Offered Call: Offered calls are those received by the automatic call distributor (ACD), whether they have been answered or abandoned.P. Open Enrollment Period: The period each year during which a qualified individual may enroll or change coverage in a Qualified Health Plan through the Exchange. Q. Plan Based Enrollers: An individual who provides Enrollment Assistance to Consumers in the Individual Exchange through a Certified Plan-Based Enroller Program.R. Salesforce: The term used to collectively describe Covered California Certified Insurance Agents, Certified




Existing Software

Requires Modification to Meet Requirement Other InformationEnrollment Counselors, Plan Based Enrollers and Certified

Enrollment Entities. NOTE: The term “salesforce” should not be confused with the application Salesforce.com which the current Customer Relationship Management software standard for Covered California.S. Service Center Representative, SCR: Staff employed by Contractor to answer inquiries from Consumers. T. Service Channel: The term to describe any of the contributors to Covered California’s salesforce. U. Special Enrollment Period: A period during which a qualified individual or enrollee who experiences certain qualifying events may enroll in, or change enrollment in, a Qualified Health Plan through the Exchange outside of the initial and annual open enrollment periods. V. Talk Time: The time between when a SCR answers a call and when they disconnect.

3.2 Background Clearance If the Contractor or any of its subcontractors must access any confidential information, this provision must be completed prior to implementing any portion of this scope of work.

Prior to accessing any confidential information, personally identifiable information (PII), protected health information (PHI), federal tax information, or financial information contained in the information systems and devices of Covered California, or any other information as required by federal and State law or guidance, all staff, including employees, contract or subcontract personnel, vendors or volunteers who perform services under this Agreement must comply with the criminal background check requirements set forth in Government Code section 1043,




Existing Software

Requires Modification to Meet Requirement Other Informationand its implementing regulations set forth in California

Code of Regulations, Title 10, section 6456. Contractor shall bear all costs associated with obtaining clearance for each said employee.

3.3 Contract Amendment Covered California may, at its sole discretion, extend the term of the contract for up to two extensions with each extension no longer than two (2) years each. Total number of contract years shall not exceed (7) years. If mutually agreed upon by Covered California and the Contractor, this contract shall be amended to include additional funding at the same rates provided in the Contractor’s proposal.

3.4 For Service Levels (SL), Management and Process Improvement, Contractor staff will be expected to:A. SL Gap Assessment: Assess gaps that may exist in SLs and the impact that these gaps may have on overall service delivery. Provide recommendations on resolving potential gaps.B. SL Monitoring: Provide both operational and executive level reports or dashboard capabilities on daily, weekly and monthly SL performance analytics.C. Continuous Improvement: Develop and implement a continuous improvement program that includes:1. Quality Improvement2. Service Level Improvement3. Productivity Improvement

3.5.a Facilities. The Services shall be provided at the Contractor’s facilities as the parties mutually agree (collectively “Contractor Facilities,” each, a “Contractor Facility”).




Existing

Requires Modification to Meet Requirement Other InformationService Center facilities and staff shall be located in

California. 3.5.b Provide a turn-key facility including furniture, cubicles,

phones, headsets, computers, office supplies, etc., to perform the required work, including facilities and resources for training. Facilities shall meet HIPAA security and privacy requirements.

3.5.c The Contractor shall provide training rooms with workstations. Each workstation should be large enough to hold at least one monitor, a phone and work area large enough for student comfort. In addition, each training room should be equipped with a trainer workstation area, computer, projector, screen and podium for the trainer/facilitator.

3.5.d Given the highly sensitive nature of the data processed in the service center, the Contractor’s security plan shall ensure physical and technical safeguards which exceed HIPAA compliance standards, and those related to MARS-E v2.0.

3.5.e All necessary hardware and software for the Service Center will be provided by the Contractor.

1. Exception being for SBASC Covered California will provide CRM.

3.5.f Contractor shall provide sufficient redundancy, backup capabilities and/or disaster recovery facilities to ensure service levels can be maintained in the event of network, hardware, or software failures within the service center solution.

3.5.g The facility data services will provide via fiber-optic or like type technologies, with the facility infrastructure being configured to support VoIP technologies. All necessary hardware and software for the Service Center will be




Requires Modification to Meet Requirement Other Informationprovided by the Contractor;

3.6.a Staffing.

The Contractor shall employ in the applicable Contractor Facility or Facilities a permanent base staff sufficient to support services outlined for call volumes experienced. Contractor understands and accepts work volumes will fluctuate and continue to change. Contractor is responsible for determining and providing staffing levels capable to meet service level standards;

3.6.b Staffing levels and long-term staffing plans based on call volume/data entry workload will be the responsibility of Contractor;

3.6.c All Service Center Representatives (SCRs), permanent, and temporary employees contracted under this Scope of Work shall submit to Covered California’s background clearance requirement prior to performing any services.

3.6.d Contractor shall notify Covered California of a new SCR performing services under this scope of work no later than the day of hire in order to provide the SCR with all appropriate system and software access. Contractor shall also notify Covered California immediately upon SCR or other Service Center staff separation and/or termination effective date as far in advance as possible.

3.6.e All bilingual staff must be certified to Contractor defined standard and the certification criteria must be documented in the Contractors Quality and Training Plan;

3.6.f The Contractor shall ensure that ten percent (10%) of SCRs performing services under this scope of work are bilingual in English and Spanish and have effective verbal communication skills in both languages. The Contractor shall establish access to a Language Line that will allow SCRs to complete calls in the thirteen (13) following




Existing Software

Requires Modification to Meet Requirement Other Informationthreshold languages as defined by Covered California:

English, Arabic, Armenian, Farsi, Cambodian, Cantonese, Mandarin, Hmong, Korean, Russian, Spanish, Tagalog, and Vietnamese.

3.6.g The Contractor staff will perform required contact documentation received any method (phone, email, chat) in the appropriate Covered California systems (CalHEERS and/or CRM) as directed by Covered California. This includes, but is not limited to, paper applications, call backs related to paper applications, verification forms and documents, agent verification, other data entry or verification work as directed by Covered California.

3.7 Holidays. As of the date of this scope of work, the Contractor’s staff performing services under this Exhibit will observe the following state-recognized holidays:

A. New Year’s DayB. Martin Luther King Jr. DayC. Presidents’ DayD. Cesar Chavez DayE. Memorial DayF. Independence DayG. Labor DayH. Veterans DayI. Thanksgiving Day and Day after ThanksgivingJ. Christmas Day K. Contractor and Covered California will mutually agree to modification of holidays as needed.

3.8.a Daily Operations. The Contractor shall manage, at its own expense, the daily operations of each Contractor Facility(ies) and of the personnel who perform Services on behalf of Covered




Existing

Requires Modification to Meet Requirement Other InformationCalifornia under this scope of work, including without

limitation:

Provide a point of contact to directly manage all aspects of the partner relationship. This contact shall be responsible for receipt of all Covered California communications and shall have the authority to act on all aspects of the contract for services. This contact will be a Customer Services Manager with an understanding of1. Service center operations2. Covered California programs3. Covered California’s business requirements as documented in this scope of work. 4. Invoicing

3.8.b Maintain one (1) full-time Technical Lead to manage and coordinate all aspects of technology and service center reporting and analysis, including but not limited to forecasts, workforce management analysis, voice, Data, desktops, cloud-based systems, daily, weekly and monthly reporting as defined in the Reporting Section of this Exhibit, and any ad hoc analysis as requested by Covered California.

3.8.c The Contractor shall allow access to on-site operations by Covered California’s Project Management Team and/or their approved representative(s) during normal business hours of operation for scheduled and unscheduled visits;

3.8.d The Contractor shall provide sufficient management staff to support supervisors and perform other operational and project related duties including by not limited to training for all initial hiring wave (ramp-up) activities and on-going training activities, quality assurance, and workforce management.




Existing Software

Requires Modification to Meet Requirement Other Information3.8.e Contractor will strictly follow protocols, use of job aids,

task guides and training materials for all work performed to support Covered California. In addition, quality evaluation monitoring procedures will be in place to ensure Contractor’s staff is delivering services in accordance with approved protocols. Supervisors will monitor staff performance against documented processes and procedures to maintain a high expectation for Customer Service;

3.9.a Network and VoiceThe Contractor must provide appropriate network infrastructure and expert support services to acquire and complete the configuration and implementation of local area access and wide area access, including circuits in support of all business functions.

3.9.b The Contractor must provide local internet services capable of averaging 50% of unused capacity and peak utilization not exceed 75% during business hours with a minimum of 150Mbps.

3.9.c Contractor will assume billing and cost management responsibilities for establishing and maintaining network connectivity

3.9.d The Contractor will be required to implement and manage network access limits;

3.9.e The Contractor will provide a centralized software management suite of tools to manage desktop, push Software updates, security updates.

3.9.f The Contractor should provide and manage the end point protection software along with vulnerability scanner and provide weekly reports

3.9.g The Contractor will provide user access management, provisioning and off-boarding. The Contractor will meet Covered California provisioning and offboarding




Requires Modification to Meet Requirement Other Informationrequirements.

3.9.h The Contractor must provide enough bandwidth to record 100% of all calls.

3.9.i The Contractor must utilize a security vulnerability scanning product. The Contractor will be required to provide a monthly security scan report to Covered California;

3.9.j The Contractor must provide the desktop software, list of software will be provided in the JAD sessions.

3.9.k The Contractor must have the technical capability and skillset of implementing secure connections and VPN connectivity to third party systems approved by Covered California.

3.9.l The Contractor must provide documentation of antivirus management, monitoring and malicious protection/quarantine audits.

3.9.m The Contractor must provide a turnkey facility with WAN (wide area access network) circuit connectivity

3.9.n The Contractor must provide phones, headsets, computers, monitors, keyboards, mice and other peripheral equipment necessary for Service Center Representatives to perform call center activities;

3.9.o The Contractor must supply all network routers, network switches, data center racks, and wiring sufficient to meet network and operational needs;

3.9.p The Contractor should supply a redundant Internet Circuit of equal bandwidth;

3.9.q Contractor will assume billing and cost management responsibilities for establishing and maintaining connectivity (MPLS and Internet)

3.9.r The Contractor will provide the PC image. The Contractor must deploy the standard image to all Contractor PCs;

3.9.s The Contractor will provide a centralized software




Existing

Requires Modification to Meet Requirement Other Informationmanagement suite of tools to manage desktop, push

Software updates, security updates.3.9.ts The Contractor will install, develop, deploy and manage

Active Directory for all PCs and Phones; 3.9.ut The Contractor will provide redundant NTP, DHCP and DNS

network services; 3.9.vu The Contractor will provide E-Mails to all staff (note:

Covered California will provide Covered California email addresses for Contractor to provide to staff).

3.9.wv The Contractor must provide a security vulnerability scanning product. The Contractor will be required to provide a monthly security scan report to Covered California;

3.9.xw The Contractor must provide internet connectivity to the following applications: 1. Covered California’s Learning Management System (LMS) 2. Covered California’s Customer Relationship Management System (CRM) 3. Covered California’s SharePoint.

3.9.yx Voice and Data technology must be capable of supporting SCR access to Covered California’s cloud-based Systems;

3.9.zy The Contractor must provide documentation of antivirus management, monitoring and malicious protection/quarantine audits. The Contractor shall use an industry standard Antivirus and security software on servers and PCs. Contractor shall submit security tools to Covered California for approval. all alerts resulting from antivirus systems will generate a Help Desk tickets for assignment to Contractor IT support staff;

3.9.aaz The Contractor must have dedicated technical roles for Service Desk, Security and Infrastructure.




Existing Software

Requires Modification to Meet Requirement Other Information3.10 Personnel Cost.

The Contractor shall take sole responsibility for all personnel costs and liabilities associated with Contractor’s employment of personnel. Without limiting the foregoing, the Contractor will be solely responsible for payment of all compensation owed to its employees, including Federal and State income tax withholding, Social Security taxes, unemployment insurance and any health or disability insurance, retirement benefits, or other welfare or pension benefits, if any, to which its employees may be entitled.

3.11.a Training. The Contractor shall train using their materials as developed by the Contractor and approved by Covered California.

The Contractor shall deliver such training to Contractor’s SCRs, quality and operations management staff.

3.11.b The Contractor shall require all SCRs to complete ongoing training for system releases and updates to policies as approved and required by Covered California. Contractor trainers will in part utilize Covered California’s support materials and systems as applicable.

3.11.c The Contractor will provide sufficient qualified training staff to ensure all staff are provided with new hire training and on-going training as necessary to support consumers.

3.11.d The new hire training shall last as long as needed for students to pass Covered California and Contractor mutually agreed to proficiency tests and final exam developed by Contractor. Students with scores below a mutually agreed proficiency shall not assist Covered California customers.

3.11.e Initial security awareness and compliance training for all Contractor staff is mandated by Covered California, as well




Existing Software

Requires Modification to Meet Requirement Other Informationas a refresher thereafter on a bi-annual basis. Contractor

shall ensure all employees participate in Covered California’s acceptable use and security training when new employees are hired, and on an ongoing basis thereafter.

3.11.f After the initial hiring wave, the Contractor shall provide Quality Assurance and ongoing training that will continue the learning cycle by listening to calls and documenting any gaps in training. This shall include training subject to proficiency exam for new system releases/configurations and updates to policies as approved and required by Covered California. The Contractor’s Quality Assurance (QA) and Training Teams will work to develop gap training.

3.11.g Covered California shall provide to Contractor previously developed training materials for use by Contractor in developing training materials and “train-the-trainer” instruction.

3.11.h The initial hiring wave (ramp-up), subsequent hiring, and training costs will be borne by the Contractor.

3.11.i Contractor shall provide training status reports on new hire training, attrition rates, and other information related to training at the request of Covered California.

3.11.j Contractor training staff shall, at the request of Covered California, conduct weekly meeting training staff meetings with Covered California.

3.12.a Quality Assurance.

The Contractor shall develop standards of Quality Assurance and a plan and process to achieve and maintain Quality Assurance standards. The standards and plan must be delivered and approved by Covered California.

3.12.b The Contractor shall document Quality Assurance processes and perform Quality Assurance processes on an ongoing basis. Contractor shall provide written results




Existing

Requires Modification to Meet Requirement Other Informationwith an analysis of key findings to designated Covered

California staff on a monthly basis.3.12.c Covered California may, at its option, alter transaction

quality monitoring forms and evaluation processes upon no less than sixty (60) days’ notice to the Contractor. If the adjustments are mutually agreeable, they will replace previous processes using an agreed upon timeline providing sufficient time for the SCRs and support staff to familiarize themselves with the changes.

3.12.d In addition, Covered California’s staff may monitor live audio, voice recordings and recorded screen captures. The Contractor shall create and maintain a remote monitoring process and procedure for Covered California’s staff.

1. This procedure must allow unassisted remote monitoring of random live and recorded transactions and include voice recordings and recorded screen capture. 2. For monitoring purposes, the Contractor shall provide Covered California with six (6) licenses (three (3) for IASC and three (3) for SBASC) to the monitoring platform. Additional licenses shall be charged at a rate agreed upon at the time of request.3. Contractor shall retain voice recordings for ten (10) years and recorded screen captures for 12 months.

3.12.e Covered California requires the Contractor to record one hundred percent (100%) of voice transactions.

3.12.f Covered California requires the Contractor to record screen captures of no less than 20% of all transactions.

3.12.g The Contractor’s staff shall deploy this process to monitor a mutually agreed to representative sample of all transactions, and a minimum of one inbound call per week per SCR.




Existing Software

Requires Modification to Meet Requirement Other Information1. The Contractor shall provide feedback to each

SCR on his/her performance related to transactions monitored within one (1) business day after monitoring, SCR schedule permitting. 2. Recorded transactions that are required to be monitored must be monitored by the Contractor no more than forty-eight (48) hours old and randomly selected.

3.12.h Contractor shall have supervisor conduct performance reviews with SCRs and Leads no less than monthly.

3.12.i The Contractor shall ensure that all SCR’s meet established quality and performance standards. For any SCR’s not meeting mutually established quality and performance standards, contractor will have the option to provide a corrective action plan to Covered California for approval within five (5) days for review and approval or to remove the SCR from servicing Covered California customers.

3.12.j The Contractor shall provide Covered California with all individual SCR Quality Assurance monitoring documentation and results upon request.

1. Contractor shall implement SCR performance improvement processes and contractor process-level improvements and/or recommend Covered California-related, process-level improvements.

3.12.k The Contractor shall document its performance related to the transaction monitoring requirements and Contractor report to Covered California on a monthly basis.

3.12.l The Contractor shall retain the quality monitoring records in a manner easily accessible to Covered California for six (6) months following the transaction date. and then shall archive the call recordings and provide the records to Covered California upon request via a mutually agreeable




Requires Modification to Meet Requirement Other Informationstorage device.

1. Upon initial recording of transaction, recordings shall be made available automatically through a near-real time voice recording retrieval application. 2. Contractor shall archive recordings after six months. Contractor shall provide Covered California a copy of the recordings via an agreed upon digital medium (e.g. physical storage device or other secure transfer method). Data shall be made available to Covered California within ten days after six-month milestone.

3.12.m Covered California shall be the sole owner of the data collected via all quality monitoring systems.

3.12.n The Contractor must receive prior written consent from Covered California to use quality-monitoring data for any purpose other than SCR performance reviews, mentoring, SCR training, or process improvement within Covered California’s account.

3.12.o Upon receipt from Covered California via DoD 3 pass overwrite standards (DoD 5220.22-M), Contractor will purge such recordings. Covered California does not require archiving of screen recordings, which will be purged at the same time as the voice recordings.

3.13.a Calibration Sessions. Contractor shall schedule Calibration sessions to occur monthly.

3.13.b Covered California shall have option to participate in calibration sessions as they are scheduled.

3.14.a Timeline Contractor shall provide a detailed ramp-up plan for SCR staffing and production readiness in time for go-live date.

3.14.b The Contractor shall provide a detailed timeline demonstrating a plan for proposed facilities, support




Requires Modification to Meet Requirement Other Informationstaffing, and technology readiness.

3.14.c Contractor shall provide a draft work plan within ten (10) calendar days of contract execution and every thirty (30) calendar days thereafter or as otherwise mutually agreed.

3.15.a Support StaffThe Contractor shall provide enough management staff to support supervisors and perform other operational and project related duties.

3.15.b Contractor shall maintain an appropriate level of Workforce Management (WFM) staff to support the operation.

3.15.c The Contractor’s information security department shall provide oversight and operational support.

3.16 Contingency Planning. The Contractor shall develop and maintain business continuity and disaster recovery plans for operations and system recovery/continuity in conjunction with and meeting Covered California requirements. Contractor shall perform disaster recovery tests every 12 month and offer Covered California the option to participate. Test results shall be provided to Covered California.

3.17 Outage. Contractor shall notify Covered California immediately of any incident (service-wide interruptions, limited access, outages, and security violations), and make every effort to provide immediate notification.

3.18.a Phone Lines.

Contractor shall maintain an adequate number of phone lines for fully trained and trainee agents.

3.18.b Covered California reserves the right to bring telecommunications in-house and Contractor will assist




Requires Modification to Meet Requirement Other Informationwith this process at such time.

3.18.c Toll Free Numbers – All inbound toll-free numbers will remain the property of Covered California. 1. Contractor will maintain a distinct phone line and point of access number for CCSB inquiries.

3.18.d Contractor TTY or RTT – Contractor will have the ability to service hearing impaired clients through a TTY or RTT phone line service to support up to 2 simultaneous TTY or RTT callers.

3.19.a Workforce Management (WFM). Contractor will utilize its WFM application to schedule and perform real-time management for Covered California’s program. Contractor’s WFM analysts will use the WFM application to complete all Covered California’s WFM requirements.

The Contractor shall use a workforce management system to monitor and track staffing levels and schedules by work area.

3.19.b The Contractor’s Workforce Management staff will be responsible for entering all schedule exceptions and call-outs; Contractor will follow defined processes for exceptions and call-outs.

3.19.c The Contractor’s Site Director will work with Covered California’s Project Management Team to maintain acceptable schedule adherence and respond quickly to minimize service impacts caused by unexpected events, variations in workload, changes in SCR skills and work rules.

3.19.d The Contractor shall maintain and provide for Covered California access to real-time monitoring of current operational data focusing on KPIs and trend analysis (i.e., Scorecard). The scorecard addresses overall performance.




Existing Software

Requires Modification to Meet Requirement Other InformationContractor’s management will meet at a mutually

agreeable schedule, no less than twice monthly, with Covered California’s Project Management Team to review the scorecard and discuss initiatives in progress and continuous improvement activities.

3.19.e The Contractor’s Director of Project Management will provide Covered California’s Project Management Team with daily start-up and implementation reports that detail the progression of the implementation and integration process as it relates to relevant elements of Covered California. These reports shall be delivered no less than weekly or as otherwise mutually agreed.

3.20.a Contractor and its staff/SCRs performing work under this SOW shall comply with all applicable policies, procedures, task guides, and guidance as provided in the Salesforce CRM Knowledge Base.

Covered California will update the knowledge base and Contractor will add it to the “hot issues” communicated to staff electronically and perform training as applicable

3.20.b The Contractor shall abide by Covered California-defined escalation and help desk processes and protocols

3.20.b.1 The Contractor shall develop escalation rules approved by Covered California for inquiries that cannot be resolved by customer service and need to be routed to appropriate work streams for resolution or escalation to Covered California. All such inquiries shall be tracked and trended by issue type.

3.20.c SBASC staff are logged into the dedicated Covered California queue, they shall work on SBASC work only. This shall at no time drop below two staff members.

3.21 Service Level.




Existing Software

Requires Modification to Meet Requirement Other InformationContractor will manage to the Service Level set forth in this

Exhibit and all provisions of Exhibit AA, Attachment 3 – Service Level Agreements and Liquidated Damages.

3.22.a Reporting. Contractor shall provide a standard Service Center reporting package on a daily, weekly, and monthly cycle. Reports and scorecards shall be automatically generated by Contractor’s solution. Service Center data must be produced directly from applicable IVR.

Contractor’s standard reporting package is desired to fulfill Covered California requirements. This noted, reporting metrics include but are not limited to the below stated outputs. Covered California and Contactor agree to reasonable accommodation to meeting reporting goals:

Call interval reporting enables decisions based on trends in call volume, service level performance, and other KPIs;

3.22.b The Real Time Agent Report provides management with the visibility to monitor the duration of time that SCRs spend in various stages of customer interactions. This type of reporting tool is useful in helping to maintain appropriate phone coverage by ensuring that SCRs are in a productive state;

3.22.c Call Quality Reporting compares performance against set quality goals. From these reports, we can focus on quality components in which agents may require additional training to ensure service quality exceeds customers’ expectations;

3.22.d Call Handling: The Contractor’s Daily Operations Report shows the service center’s performance, day over day, for the date range specified by the end user. Components of this report include Calls to IVR, Calls Offered, Calls




Existing Software

Requires Modification to Meet Requirement Other InformationAnswered, Calls Abandoned, Average Handle Time,

Average Speed of Answer, and Quality Performance, to name a few.

3.22.e Disposition reporting allows us to see the types of customer calls received while also providing insight into handling times per type of call. It also helps to identify possible training needs, as well as the impact on call volume when new products and services are introduced.

3.22.f Statistical information is included in the Daily Operations Report. Statistics such as Speed of Answer, Service Level Performance, Average Handle Time (Talk Time, Hold Time, After Call Work), Percentage of Calls Answered, and Quality Performance all help identify how we are processing calls;

3.22.g Service Center Representative Performance reporting is critical to managing the customer service center staff, as well as coaching and developing SCRs. The Daily Agent Report allows for management to provide feedback to SCRs, reporting on items such as a specific SCR’s Handle Time, Quality Performance, Productivity and other performance metrics;

3.22.h A monthly executive summary enables viewing of performance month after month against the various KPIs specific to the operation. This type of report will help identify trends and the center’s overall performance.

3.22.i In addition to standard reporting, the Contractor must also schedule and facilitate the following with Covered California:

Weekly Reporting Conference Call

1. At least twice weekly, on a schedule mutually




Existing Software

Requires Modification to Meet Requirement Other Informationdetermined by CCA and Contractor, Contractor Service

Center management will conduct a recurring conference call to present and review a compendium of Daily Statistics Reports for the previous operational week with Covered California.2. All Operational Impacts from the previous week will be highlighted and discussed. Covered California will provide any updates to policy and program or service center operations.3. Contractor will distribute reporting package and call agenda weekly

3.22.j Monthly Business Review. Contractor will schedule a monthly business review (MBR) with Covered California at a mutually agreed upon day and time. The monthly review will be scheduled as a conference call or at a mutually agreed location. The business review will be scheduled in person at a mutually agreed location.1. Contractor will provide corrective action plans for those areas where performance targets are not met and shall diligently implement such plans as approved by Covered California. 2. Contractor will partner with Covered California to define and develop the scorecards and set the agenda for these meetings.

3.23 Employee Handbook. Each Contractor employee will have signed an acknowledgement of receipt of the Contractor Employee Handbook.

3.24 Reporting Headquarters LocationThe Contractor is required to perform all services under this Agreement on mutually agreed to site unless directed otherwise by the project representative listed in this Exhibit. Location for project briefings and management




Existing Software

Requires Modification to Meet Requirement Other Informationdiscussions shall take place at Covered California office

located at 1601 Exposition Boulevard, Sacramento, California, 95815 unless otherwise mutually agreed. Travel and expenses for reporting to this headquarters location shall not be reimbursed.

3.25 Reassignment of PersonnelA. The Contractor shall not reassign Manager or above personnel assigned to the contract during the contract term without prior written approval of Covered California. If a Contractor employee is unable to perform duties due to illness, resignation, or other factors beyond the Contractor’s control, the Contractor shall make every reasonable effort to provide suitable substitute personnel.B. Covered California reserves the right to request a Contractor employee be removed from performing any work on the contract and, on written notice to the Contactor, the Contractor shall assign a substitute employee.

3.26 Contractor’s Roles and ResponsibilitiesThe Contractor shall:

A. Designate a person to whom all project communications may be addressed and who has the authority to act on all aspects of the contract. This person will be responsible for the overall project and will be the contact for all invoicing and Contractor staffing issues.B. Provide written reports for review and approval by Covered California and formally respond to Covered California review findings as necessary.C. Make its best efforts to maintain staff continuity throughout the life of the project. If, however, a substitution becomes necessary, the Contractor must submit resumes for review, in advance, for all proposed




Existing Software

Requires Modification to Meet Requirement Other Informationpersonnel substitutions. All Contractor personnel

substitutions must be approved in writing by Covered California Representative. Failure to receive the required approvals may result in termination of the contract.D. At the discretion of Covered California’s Project Management Team, meet as often as daily to discuss progress.E. The Contractor’s Training Team will provide status reports on new hire training, attrition rates, and other training or on information related to training at the request of Covered California.F. Upon request, Contractor shall provide Covered California with any workflows, design documents, internal policy and procedures, and other documents that may impact Covered California operations.G. Contractor shall immediately notify Covered California via email or phone of any issues that pose a serious risk to Covered California operations, system performance, or its service center. Contractor shall provide Covered California with a proposed resolution for any identified issues

Exhibit AB: Small Business Eligibility & Enrollment and Financial Administration (OPTIONAL)Section 2 General Requirements:

Requirements outlined are designed to meet current and evolving business requirements. Covered California and Contractor agree to reasonable accommodation for some variation in stated requirements as implementation and go-live stages of work proceed. Accommodations may be driven by practical, best practice, and/or other opportunities for improved solution.

2.1.a General RequirementsThe Contractor shall be responsible for eligibility and enrollment functions for CCSB in accordance with




Requires Modification to Meet Requirement Other Informationapplicable Federal and State laws, rules and regulations.

2.1.b Contractor shall enable the electronic retention of all employer and employee application and change application for a period 10 years, or greater as required by Federal and State law.

2.1.c Contractor shall provide eligibility and enrollment guidance to consumers, which include employers, employees, Agents, and General Agents in accordance with CCSB Eligibility and Enrollment Regulation and policies.

2.1.d Contractor shall use Covered California provided CRM for management and recording of all SBEE and SBFA activities and reporting

2.1.e Systems utilized by Contractor to support SBEE and SBFA staff other than Covered California provided CRM, if any, shall have ability to establish an API with Covered California’s CRM (currently Salesforce).

Section 3 Small Business Eligibility and Enrollment (SBEE) Team:3.1.a.i Employer and Employee New Enrollment Applications and

Change Applications:Imaging and Documentation of ApplicationsContractor must accept all group enrollment applications and change applications by fax, email, and mail. For all incoming eligibility and enrollment transactions received, Contractor shall scan, track, and link all requests to the consumer application or group case file in CRM and in enrollment system. The documents shall be made available for electronic review by CCSB.

3.1.a.ii Contractor shall scan and attach all undelivered and returned mail in CRM to the applicable group case file.

3.1.a.iii Contractor shall provide upon CCSB’s request complete




Existing Software

Requires Modification to Meet Requirement Other Informationaging inventory report of all cases received from

consumers and agents including but not limited to cases that are open, pended, and closed. The report shall include the turn-around time for processing all applications

3.2.a.i Eligibility and Enrollment Determination:Initial Enrollment, Renewals, and Qualifying EventsContractor shall determine and process all incoming eligibility and enrollment requests by employers, employees, and employees’ dependents for CCSB in accordance with applicable Federal and State law, rules and regulations.

3.2.a.ii Contractor shall reconcile each employer’s DE-9C and additional business documents that are required of the employer in accordance with Federal and State laws, rules and regulations. Contractor shall determine employer’s eligibility with CCSB in accordance with CCSB’s Eligibility and Enrollment Regulations.

3.2.a.iii Contractor shall process all enrollment applications and notate in CCSB’s enrollment system.

3.2.b.i COBRA and Cal-COBRAContractor shall determine, process, and notate all incoming COBRA and Cal-COBRA eligibility and enrollment requests by employers, employees, and employees’ dependents for CCSB in accordance with applicable Federal and State law, rules and regulations.

3.3.a.i Application with Missing InformationApplications that are received with missing information will be considered incomplete. Contractor shall perform the following within 5 business days from receipt of an enrollment application that is missing information prior to




Existing

Requires Modification to Meet Requirement Other Informationentering it into Covered California enrollment services

solution HCPS as a completed application:Notate application as pended in CRM and identify missing information;

3.3.a.ii Provide written notice to the employer of the inconsistency or missing information and attach a copy of this notice in CRM;

3.3.a.iii Make at least one (1) outbound call to the employer or agent that is appointed to the case requesting the missing information; and

3.3.a.iv Notate all outbound calls in CRM, including the date the call was made to the employer or agent.

3.3.b Upon receipt of missing information, application must be processed within 5 business days.

3.4.a.i Eligibility and Enrollment AuditEmployer ApplicationContractor shall audit completed employer new enrollment and change applications within 30 days of application process completion in enrollment system. All employer enrollment information must be identical in Contractor’s enrollment system to that information on the enrollment application, change form, or written requests from other applicable methods or sources.

3.4.b.i Employee ApplicationContractor shall audit completed employee new enrollment and change applications that are entered in enrollment system within 30 days. The following employee and dependents enrollment information must be identical in Contractor’s enrollment system to that information on the enrollment application, change form, or written requests from other applicable methods or sources:




Requires Modification to Meet Requirement Other Information1. First and Last Name;

2. Date of Birth;3. Social Security Number or Tax Identification Number;4. Health and Dental plan selection;5. Coverage Effective Date;6. Physical and Mailing Address.

3.4.c Contractor must provide CCSB monthly audit report that includes all details of the audit samples and results

3.5.a Eligibility and Enrollment Retroactivity TransactionsContractor shall complete an Exception form when an employer or employee requests eligibility retroactive termination or retroactive addition that is outside of the CCSB Eligibility and Enrollment Regulations.

3.5.b For all corrections to eligibility discrepancies identified by the Contractor that require retroactive termination or retroactive addition that is outside of the CCSB Eligibility and Enrollment Regulations, Contractor shall complete an Exception form to CCSB for review and eligibility determination.

3.5.c After CCSB’s review and eligibility determination of the exception request, Contractor shall process eligibility transaction request within 2 business days from receipt of determination.

3.5.d.i Contractor shall provide written notification to the Exception requestor of the eligibility determination decision within 7 business days of the final eligibility determination.The exception eligibility determination written notification shall include employer’s right to appeal in accordance to the CCSB Eligibility and Enrollment Regulations.

3.6.a.1 AppealsContractor shall assist CCSB with the administration of eligibility and enrollment appeals. Contractor shall notify




Existing Software

Requires Modification to Meet Requirement Other InformationCCSB of an appeal within 1 business day of receiving the

email. Such notification shall be sent to CCSB by email. Under the direction of CCSB, the Contractor shall perform research and provide documentation pertaining to the appeals case.Contractor must accept all requests for Book of Business transfers by fax, email, electronically, and mail as per Covered California business rules.

3.6.a.2 Providing timely and effective Customer Service to clients for all requests, inquiries or issues concerning enrollment.

3.6.a.3 Effectively interfacing with internal departments and external vendors, brokers or other business contacts to coordinate interrelated business activities and to resolve eligibility issues as they arise.

3.6.a.4 Consistently meeting processing cycle time standards and production due dates as set forth by management in accordance with CCSB policy and Eligibility and Enrollment regulations.

3.6.a.5 Performing Quality Assurance review on incoming applications and enrollment transactions.

3.6.a.6 Serving as representative of CCSB displaying professionalism, knowledge, customer service and discretion in all interactions with other members of the CCSB community and their customers.

3.6.a.7 Perform and provide CCSB support with group and membership level eligibility reconciliation upon receipt of a discrepancy communication from a carrier, employer, agent or general agent.

Section 4 Small Business Finance Administration (SBFA) Team4.a Small Business Financial Administration (SBFA) Team:

Research and correct cash application issues in Covered California financial system. Determine/correct out of balance ledger items on accounts.




Existing Software

Requires Modification to Meet Requirement Other Information4.b Contact clients to explain and to resolve billing/payment

discrepancies. Verify/authorize refunds for terminations and/or overpayments.

4.c Process all payments received via mail.4.d Work with clients to facilitate payments on time and for

the billed amount.4.e Interface effectively with internal departments and

external vendors, brokers or other business contacts to coordinate interrelated business activities and to resolve billing and payment issues as they arise.

4.f Perform financial transaction reconciliation on new and existing groups including Cal COBRA/COBRA as needed to resolve enrollment issues.

4.g Provide for administering financial requirements in servicing employers, employees, agents, general agents, CCSB staff and others as applicable.

4.h Coordinate with CCSB in managing financial exception processes.

4.i Perform transaction reviews to identify financial and eligibility discrepancies and perform assessment and follow-up to eliminate root cause of issues.

4.j Perform and provide CCSB support with group and membership level financial reconciliation upon receipt of a discrepancy communication from a carrier, employer, agent or general agent.

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