NWACC Official Solicitation Price Sheet

Description

RFP-25-008 Benefits Question and Answer Note: The Bid Number Referenced at the header should read RFP-25-008 Vendors shall list all costs on the Official Price Sheet. Additional lines may be added if necessary for optional items that may or may not be purchased. OFFICIAL SOLICITATION PRICE SHEET Unit Cost DESCRIPTION 1. Rate Basis Ex: PEPM/PPPM Medical Admin Fee: Network Access Fee List any additional Fees Employee + Spouse Employee + Child(ren) Employee + Family Total Annual Price Unit Cost Rate Per _? Critical Illness 0-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 Assuming current enrollment $ $ $ $ DESCRIPTION 3. Unit Cost Dental Monthly Premium Employee Only Assuming current enrollment $ $ DESCRIPTION 2. Total Annual Price $ $ $ $ $ $ $ $ $ $ $ $ $ 70-74 75-79 80+ 4. DESCRIPTION Life & Disability - Employee Unit Cost Rate per __ Total Annual price Assuming current enrollment Life Rate AD&D Rate 5. DESCRIPTION Vol Life / AD&D Unit Cost Total Price Rate Rate per $10 weekly benefit Rate Rate per $100 monthly covered payroll Assuming current enrollment Indicate Employee/Spouse/Child 0-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80+ DESCRIPTION 6. Voluntary STD $ DESCRIPTION 7. Voluntary LTD DESCRIPTION $ Unit Cost Rate Basis Ex: Estimated annual 8. Cobra Administration 9. Retiree/Direct Bill Administration DESCRIPTION 10. PEPM/PPPM cost Unit Cost Rate Basis Ex: PEPM/PPPM Estimated annual cost Unit Cost Rate Basis Ex: PEPM/PPPM Estimated annual cost FSA Healthcare Flexible Spending Account Dependent Care Flexible Spending Account DESCRIPTION 11. Financial Wellness 12. Family forming