OCA-DGCP-035 UCS Group Vision Benefits Plan

I. OVERVIEW 1.1 Purpose and Scope The New York State Unified Court System (“UCS”), Office of Court Administration ("OCA"), on behalf of the Judiciary Benefits Office (“JBO”), is soliciting sealed bids for the procurement of an insurer of the UCS Group Vision Benefits Plan, henceforth “the Plan” or “Plan” to provide vision benefits to judges, justices, management confidential and other unrepresented employees, retirees and their dependents, henceforth, “Plan Members” or “Members”, as described below. For the purposes of this Request for Proposals (“RFP”), it is understood that an “insurer” will provide a fully insured product, assumes the financial risk and pays all covered claims in exchange for a fixed premium. This fixed premium is the only amount UCS will pay the insurer. This amount will be paid on a monthly basis. For a detailed compilation of vision plan membership during the period 1/1/2020 through 1/1/2025, please see the most recent censuses in Exhibit F.1 (Active Census) and Exhibit F.2 (Retiree Census). Basic plan benefits costs will be employer-paid. Certain optional costs will be paid by the Members (as defined below). For a listing of Member Eligibility, see Exhibit B (Project Services), “Plan Requirements”. For the purposes of this RFP, “Participating Provider” shall mean a legally qualified and appropriately licensed ophthalmologist, optometrist, optician, or other licensed eye care professional who is contracted with the Bidder to provide covered vision services to Enrollees under the contract resulting from this RFP, and who agrees to accept the negotiated fee schedule, plus applicable member cost-sharing, as payment in full for covered vision services. ** See EXHIBIT B PROJECT SERVICES for detailed specifications. ** Key Bid Dates (Note: OCA reserves the right to modify any Key Bid Date as it may deem appropriate.) EVENT/DATE Bid Issue Date: Thursday, May 14, 2026 Initial Question Due Date: Wednesday, June 3, 2026 at 2:00pm Eastern Final Question Due Date: Wednesday, June 24, 2026 at 2:00pm Eastern Bid Submission Deadline Date: Wednesday, July 15, 2026 at 2:00pm Eastern Estimated Contract Start Date: March 1, 2027 1.2 Designated Contact The designated contact for this RFP is: Jillian Halse [email protected] IMPORTANT: All questions regarding this RFP must be in writing by email and directed solely to the attention of the above designated person. Contact by any prospective bidder, or any representative thereof, with any other personnel of the UCS in connection with this RFP may violate the Procurement Lobbying Act of 2005 (see Attachment IV), will jeopardize the respective bidder's standing and may cause rejection of its proposal. 1.3 Questions Any and all questions bidders may have in connection with this RFP are to be directed by email only to the designated contact listed above. a. Initial Period to Ask Questions Any and all questions bidders may have in connection with this solicitation are to be directed by email only to: Jillian Halse [email protected] Please indicate in "Subject" field: “RFP# OCA-DGCP-035 - Question(s).” The deadline to submit questions for this initial period (also referred to herein as the “Initial Question Due Date”) is Wednesday, June 3, 2026 at 2:00pm Eastern. A written response to all submitted questions in the form of a Questions & Answers (Initial Q&A) sheet will be posted on the UCS website at www.nycourts.gov/admin/bids under RFP# OCA-DGCP-035 shortly thereafter. b. Final Period to Ask Questions Upon release of the Initial Q&A compilation, the UCS will accept additional questions from Bidders to be submitted to the designated contact in the manner described above. The deadline to submit final questions (also referred to herein as the “Final Question Due Date”) is Wednesday, June 24, 2026 at 2:00pm Eastern. A Final Q&A will be posted on the UCS Current Solicitations website at https://www.nycourts.gov/grants-contracts-procurement/current-solicitations, RFP# OCA-DGCP-035 shortly thereafter. No further questions will be entertained after the Final Q&A deadline. 1.4 Pre-Bid Conference A pre-bid conference will not be held. 1.5 Procedure for Bidders to Request a Copy of Exhibits F.1, F.2, and G Information contained in Exhibits F.1, F.2, and G is sensitive and is therefore not attached to this RFP. Bidders may request copies of these Exhibits by contacting the designated contact of this RFP. Bidders will be required to enter into a non-disclosure agreement before receiving a copy of these Exhibits. II. MINIMUM QUALIFICATIONS MANDATORY REQUIREMENTS UCS will only consider proposals submitted directly by duly licensed insurers authorized to do business in New York State that, at the time of proposal submission, demonstrate the following: Minimum Qualifications 1. A minimum of three (3) years of experience in the provision of vision insurance services similar to those set forth in the RFP; 2. A minimum of three (3) years of experience in the provision of vision insurance services to employers with beneficiaries comparable to the UCS Plan Members (as that term is defined in Section 1.1, Purpose and Scope); 3. The provision of vision insurance services for a minimum of at least five hundred thousand (500,000) covered lives in total and with at least one (1) current client with one hundred thousand (100,000) covered lives and demonstrate that the Bidder meets or exceeds these requirements to the satisfaction of UCS. To demonstrate that Bidder meets these requirements as of the Proposal Due Date, Bidder must provide a list of current clients with the number of covered lives for each. In determining covered lives, the Bidder should include both at-risk and fee-for-service business and count all lives (i.e., an employee, spouse or other dependents); and 4. Possess all certificates of authority, licenses, and other approvals necessary to lawfully provide all benefit plans required to provide the services required under this solicitation. Proposals will not be considered by brokers on behalf of insurers. Mandatory Requirements UCS will only consider proposals from Bidders that meet the following mandatory requirements: 1. The proposal must indicate that the Bidder offers a unified single tier plan for vision insurance coverage, which is defined as a. The term unified identifies that all Members are covered (employee, dependent, retiree) under a single contracted plan; and b. The term single tier plan indicates one method of submitting a claim and receiving reimbursements for all Plan Members. 2. Claims processing must be performed in the contiguous United States. 3. Regarding customer service: a. Bidder must maintain a nationwide toll-free number to service program Members; b. Bidder’s customer service representatives and supervisors must be available, at a minimum, between 8:00 AM Eastern and 8:00 PM Eastern on Monday through Friday, except for legal holidays observed by UCS and 9:00 AM Eastern to 4:00 PM Eastern on Saturday; and c. Customer service representatives and supervisors must be based in the contiguous United States. d. Provide resources to assist non-English speaking and hearing-impaired customers to address and resolve their inquiries. e. Bidder must utilize an integrated system for customer service representatives to log and track all Enrollee calls. The system must create a record of the Enrollee contacting the call center, the call type and all customer service actions and resolutions. f. Bidder must maintain a back-up telephone system located in the United States (preferably in New York State). 4. There must be a dedicated account representative team who will be responsible for the UCS’s account. 5. The turnaround time to process claims must be completed within a maximum of fourteen (14) calendar days from submission. 6. Bidder will notify UCS of any allowed for Composite Rate Increase no later than one hundred and twenty (120) days prior to the end of the period immediately preceding the period to which the increase would apply. 7. The turnaround time for receiving eyewear should be return shipment within seven (7) calendar days after an order is received by the lab processing the eyewear. 8. The Bidder must understand and indicate its agreement to comply with all specific duties and responsibilities set forth in Section 5.2.4 of this RFP (“Implementation Plan”). Any Bidder who fails to satisfy any of the above Minimum Mandatory Requirements shall be eliminated from further consideration. III. AWARD 3.1 Term of Award UCS will award a single estimated quantity term contract (“Contract”) to the successful Bidder (“Awarded Contractor”) consisting of an Implementation Period of a minimum of ninety (90) days, followed by a three (3) year term of Project Services with two (2) optional one (1) year renewals (the “Contract Term”). The Project Services Start Date shall be on or about March 1, 2027, and the Initial Contract Term shall continue through June 30, 2030. The Implementation Period shall commence upon final approval of the Contract by the oversight agencies, including the New York State Office of the State Comptroller, and shall conclude on or about June 30, 2027. The Parties may agree to adjust the duration of the Implementation Period as necessary to ensure continuity of coverage and a smooth transition. The Contract will be subject to the approval of the NYS Attorney General’s Office and the NYS Office of the State Comptroller. 3.2 Method of Award A single award will be made pursuant to this RFP. The Awarded Contractor must: (1) meet the Minimum Qualifications and Mandatory Requirements outlined in Article II above; (2) be a responsible bidder as determined in accordance with the criteria articulated in the “Responsible Bidder” paragraph set forth in in Article VIII (General Bid Requirements); and (3) receive the highest average composite (technical + cost) score where the technical score (average among evaluators) exceeds the minimum score as determined by the selection criteria set forth herein. Proposals will be reviewed and rated by a team of qualified UCS staff. Total Technical Criteria Point Scores for each evaluator will be averaged together, and then combined with Total Cost Point Scores to determine a Composite Score for each proposal. The Composite Scores will be used for ranking bidders. In the event of a tie composite score, the Bidder with the higher cost score, i.e., lowest total cost, will prevail. When price and other factors are found to be substantially equivalent, UCS will select the winning bidder in its sole discretion. Proposals will be scored as follows: Technical Criteria Maximum Points Organizational Capacity and Experience 18 Technical Proficiency and Proposed Services 30 Plan Specifications 37 Composite Rates 18 Maximum Technical Points 103 Cost 30 Maximum Cost Points 30 MAXIMUM TOTAL POINTS 133 3.2.1 Scoring for Technical Criteria (maximum of 103 points available) Each Bidder’s Technical Criteria Score will be the average of the individual scores of all of the evaluators. For Example: Bidder A’s proposal receives the following individual technical criteria scores by evaluator: Evaluator 1 gives 55 points. Evaluator 2 gives 52 points. Evaluator 3 gives 59 points. Bidder A’s Technical Criteria Score is 55.33 points (the sum of 55 + 52 + 59 divided by 3). A minimum Technical Criteria point score of 90 (average of all evaluators) is required for an award to be made. 3.2.2 Scoring for Cost (maximum of 30 points available) Cost submissions will be scored as follows: The proposal with the lowest cost will be awarded maximum cost points (30 points). Lowest dollar cost proposal is defined as the lowest total cost for the Initial Term of three years, as indicated by bidders in the Exhibit A/Pricing Sheet. Each higher priced proposal will be scored according to the following formula: Lowest cost proposal (divided by) Higher cost proposal (multiplied by) 30 For Example: Bidder A’s Total 3-year Cost is $100,000. Bidder B’s is $ 125,000. Bidder C’s is $95,000. Bidder D’s is $ 200,000. Bidder C would be scored 30 points for having the Lowest Total Cost Proposal. Bidder A would be scored 28.50 points ($95,000 / $ 100,000 * 30) Bidder B would be scored 22.80 points ($95,000 / $ 125,000 * 30) Bidder D would be scored 14.25 points ($95,000 / $200,000 * 30) 3.2.3 Total Combined Score (maximum of 133 points available) Each bidder’s combined score (Method of Award) will be calculated the following way: Cost Score + Technical Criteria Score = Total Combined Score For example (see bold in score examples above): Bidder A’s Total Combined Score is 28.50 (Cost) plus 55.33 (Technical Criteria) equals 83.83. 3.3 Bid Protest Procedure The bid protest procedures for this RFP may be found in Attachment I. V. PLAN SERVICES 5.1 Organizational Capabilities 5.1.1 Organizational Capacity Consistent with the Minimum Qualifications and Mandatory Requirements as set forth in Article II, the Bidder must possess all certificates of authority, licenses, and other approvals necessary to lawfully provide the services required under this RFP. Bidder’s response to this RFP (“Proposal”) must include copies of documents confirming Bidder’s ability to conduct business in New York State and provide the services as outlined in this RFP, such as a copy of its license, certificate to conduct business and provide insurance, or registration as may be applicable to this RFP. The Proposal should demonstrate the Bidder’s record of providing vision plan enrollees with superior customer service and access to a robust network of participating providers while also delivering excellent value to the taxpayer. Accordingly, UCS requests information about the Bidder’s organizational structure, the Bidder’s strengths relative to competitors, and the superiority of the proposed services. UCS also requests information concerning whether Bidder is accredited by the National Committee for Quality Assurance (“NCQA”), denied accreditation, or has not been reviewed by the NCQA. To help UCS assess the Bidder’s stability and soundness, the Bidder must provide information about the Bidder’s credit rating, its level of coverage for errors and omission insurance, its history with cybersecurity incidents, and its protocols for backing up and recovering information in the event of a disaster. 5.1.2 Organizational Experience Consistent with the Minimum Qualification and Mandatory Requirements as set forth in Article II, the Proposal will need to demonstrate that the Bidder has at least three (3) years of experience providing vision insurance services to public-sector entities with beneficiaries comparable to the UCS Plan Members (as that term is defined in Section 1.1, Purpose and Scope). Include in the Proposal a list of current clients receiving vision administration services (especially any public-sector clients and union labor organizations); a list of current clients with the number of covered lives for each, including both at-risk and fee-for-service business and count all lives (i.e., an employee, spouse or other dependents); and copies of Bidder’s audit reports or certified financial statements for the most recent three (3) years (or a statement as to why no reports or statements are available). If Bidder has defaulted on a contract to administer vision services, disclose that information and explain. 5.2 Technical Proficiency and Proposed Services 5.2.1 General UCS will only accept bids that propose a unified single tier plan to administer vision insurance coverage, as defined in Article II, Minimum Qualifications and Mandatory Requirements. Bidders are generally expected to agree to the Contract Terms and Requirements set forth in Article IX which will form the basis of the Contract; provided, however, if the Bidder has any objections to such Contract Terms and Requirements, it must specifically detail its objections and propose alternative language. UCS reserves the right to reject a Proposal that proposes to materially alter the Contract Terms and Requirements. Any terms and conditions to which the Bidder does not object will be deemed accepted, and UCS reserves the right to disallow proposed modifications to such terms and conditions on that basis if UCS selects Bidder’s Proposal. The Contract will also contain the provisions set forth in Appendix A – Standard Clauses for UCS Contracts, which is included in Attachment I. The provisions in Appendix A are non-negotiable and must be accepted by the Bidder. 5.2.2 Personnel UCS expects the successful bidder to assign a dedicated account team with a primary point of contact (account manager) for UCS. The Proposal must identify which personnel will compose the account team, including their names, titles, and functions. The Proposal should also identify which matters can be resolved directly by the designated account manager and which matters, if any, will require approval from the account manager’s superiors (i.e., home office approval). The Proposal should also identify and explain the role of back-up personnel. Key staff must also be identified, and the Proposal must include either a resume for any current employee who will fill a key staff position or a job description for such role(s). Proposals must also identify whether any claims administrators, customer service representatives, supervisors, or account team members will work from a remote location (e.g., the employee’s residence). Remote work is only permitted in the contiguous United States (“CONUS”). If any such employees will work remotely, the Proposal must describe policies, procedures, and employer-provided systems pertaining to those remote employees’ access to and storage of: (i) UCS data; and (ii) Plan Members’ personally identifiable information, including medical data and claims data. The successful bidder must have a robust plan to train staff on the specifics of the UCS vision insurance program. The successful bidder must also have effective backup and continuity procedures in place should key personnel leave the firm. 5.2.3 Financial Administration and Data Management The successful bidder is expected to accept the transfer of funds via wire after checks/drafts are presented to a bank for payment and have cleared. Describe in the Proposal the Bidder’s policy regarding claim/reimbursement checks that have not been cashed. Address whether the policy requires Bidder to reissue checks and, if so, after how much time has elapsed since the check was first issued. UCS reserves the right to regularly audit membership / enrollment and claims data. It is essential that UCS have access to up-to-date reports containing such information to ensure data integrity and minimize financial risks with claim operations. See the reporting requirements set forth in Section 5.3, below, and in Exhibit B. Describe in the Proposal how the Bidder will ensure that its information management processes comply with IT-specific laws, policies, and standards, including, but not limited to the requirements in Exhibit J, Additional Information Security Terms and Conditions, the data security, storage, and access requirements contained in Article IX, and specify the Bidder’s backup, business continuity, and disaster recovery procedures. All bidders must complete and submit UCS’s Standard Data Security Questionnaire and Attestation for All Bidders attached hereto as Exhibit K as part of their proposal. Prior to finalizing any award, the tentative Awarded Contractor must also complete UCS’s standard Data Security Risk Assessment for Third-Party Vendors, a sample of which is attached hereto as Exhibit L, PLEASE NOTE: Completion of the assessment by the tentative Awarded Contractor and approval of the required form by the UCS Department of Technology is a prerequisite for finalizing the contract award. UCS will contact the Bidder to initiate this process. 5.2.4 Transfer of Services at Commencement and Expiration/Termination It is essential that the commencement of services under the Contract occur as smoothly and seamlessly as possible for UCS and its Plan Members. Accordingly, the Proposal must detail the steps the Bidder will take to ensure a smooth transition, or if the Bidder is the current incumbent vendor, the steps to transition to providing Plan services in accordance with the requirements herein. Bidder must provide a detailed work plan and schedule (“Implementation Plan”) Specifically, the schedule must indicate the date or time period by when Bidder needs to receive data from the incumbent vendor in order to handle claims and payments by the switchover date for this project. The schedule must also show when the Bidder, if selected, will issue administrative materials to UCS and summary plan descriptions (“SPDs”) to Enrollees. The Implementation Plan must include evaluation and assessment activities and development of a project plan to achieve Contract requirements and deliver the Project Services. All implementation activities must be completed by the Project Services Start Date. The Implementation Period shall be a minimum of 90 days before the Project Services Start Date. The Parties may agree to a shorter Implementation Period if such change best meets the needs of the UCS. Describe in the Proposal the Bidder’s standard procedures for handling transition of care issues for Plan Members in treatment. For example, address how the Bidder will process claims already in progress for an exam and vision supplies (glasses and contacts) that have been administered and ordered under a previous plan. Explain how the Bidder proposes to minimize disruption to Plan Members receiving care with a provider that has covered the member in the previous network but not the current network and explain how the bidder will ensure an efficient transition to the new plan offered. The Awarded Contractor is required to provide contractor-related obligations and deliverables to the UCS (as indicated in Article II under Mandatory Requirements, Article V Plan Services, and Exhibit B Project Services) under the Vision Plan through final expiration or other termination of the Contract awarded under this RFP, to ensure that the transition to a successor entity provides Plan Members with uninterrupted access to all Vision Plan benefits and associated customer services. This includes but is not limited to ensuring that Plan Members can continue to receive services from network(s) providers as necessary, processing all network(s) and non-network claims; verification of enrollment; and, providing sufficient staffing to ensure Plan Members continue to receive quality customer service even after the termination date of the Contract. It is also imperative that the Awarded Contractor’s key personnel continue to have dialogue with UCS, maintain access to online systems and receive data/reports and other information regarding the Vision Plan after the effective end date of the Contract. In addition, the Awarded Contractor and the selected successor shall fully cooperate with the UCS to create and establish a Transition Plan in a timely manner, no later than six months before the end of the Contract Term. Within fifteen (15) Business Days from receipt of the Transition Plan, UCS shall either approve the Transition Plan or notify the Awarded Contractor, in writing, of the changes required to the Transition Plan so as to make it acceptable to UCS. 5.2.5 Enrollee Communications UCS believes that acceptance of and appropriate participation by Enrollees in the UCS vision program can be realized only with a thorough and highly-professional communication effort. Subject to UCS approval, the Awarded Contractor will be responsible for providing Enrollees with the information needed to assure a smooth transition for Plan Members. Explain in the Proposal how the Bidder will design, produce, and deliver sufficient quantities of all necessary forms, printed or video materials, and/or other communication tools to be used in introducing the UCS Vision Plan and to promote and operate the program. Examples of materials include, but are not limited to, newsletter, brochures, posters, participating provider directories, satisfaction surveys for Enrollees, etc. The Bidder will be responsible for the cost of all postage and materials incurred to disseminate UCS vision program communication materials to Enrollees. Include an outline of the Enrollee communications campaign for the UCS vision program’s first year and sample communication and enrollee educational materials. Explain in narrative and/or flow chart format how printing and distribution of materials will be handled. Describe the types of information an Enrollee may access on Bidder’s website about the UCS Vision Plan. The Awarded Contractor must provide a portal for a dedicated UCS Vision Plan Experience, with UCS content and ensure all UCS data is securely maintained. At minimum, the custom vision website must contain program branding, network provider directory, benefit summary materials and communications, confirm eligibility for services, and Awarded Contractor’s contact information. Also, describe what steps, if any, Bidder will take to incorporate UCS logos or branding on its website for Enrollees if authorized by UCS to do so. The website must have both public-facing and password-protected content. Public-facing content, available without login, shall include general plan information, provider directory, and contact information; and a secure, passwordprotected member portal which shall allow Enrollees to access personalized information such as eligibility, claims status, and Explanations of Benefits. There must be the capability for Enrollees to download forms and materials including claim forms and other plan-related documents. There must also be multi-factor authorization (“MFA”) to access the information. 5.2.6 Customer Service UCS expects the Awarded Contractor to provide excellent customer service to Plan Members. The Awarded Contractor must maintain a nationwide toll-free number to service Plan Members, and such service must comply with applicable laws, including HIPAA and the ADA. An adequate staff of fully trained, courteous customer service representatives and supervisors must be available, at a minimum, between the hours of 8:00 AM Eastern Time and 8:00 PM Eastern Time, Monday through Friday, except for legal holidays observed by the UCS (see Exhibit E), and on Saturday 9:00 AM Eastern to 4:00 PM Eastern. Customer service representatives and supervisors must be based in the contiguous United States. Customer service representatives must be able to respond to questions and inquiries regarding benefits, claims status and explanations of benefits and the Awarded Contractor must adequately resolve inquiries, complaints, problems, and questions from Plan Members and from UCS within a reasonable time of receiving such communication. Indicate in the Proposal the timeline for when UCS and Plan Members can expect a response to such inquiries. Reasonable times are based on the type of inquiry: • Answer customer service calls within 30 seconds for at least 80% of calls; • Acknowledge written or electronic inquiries within one (1) business day; • Resolve standard inquiries within three (3) to five (5) business days; and • Resolve complaints and escalated issues within ten (10) business days. The Awarded Contractor must utilize an integrated system for customer service representatives to log and track all Enrollee calls. The system must create a record of the Enrollee contacting the call center, the call type and all customer service actions and resolutions. Awarded Contractor must also maintain a back-up telephone system located in the United States (preferably in New York State) and provide resources to assist non-English speaking and hearing-impaired customers to address and resolve their inquiries. UCS requires that Awarded Contractor provide a dedicated website, and will prefer proposals that also include access via a pre-existing mobile app, through which Enrollees can obtain claim information. The website and other electronic communications must comply with Section 508 of the Rehabilitation Act of 1973, as amended (29 U.S.C. § 794d) and ADA regulations. If Enrollees will have access to such features, describe in the Proposal what information will be available to Enrollees, including the ability to chat with customer service representatives and supervisors, as well as any security features to safeguard sensitive medical or financial information in compliance with applicable law and this RFP. 5.3 Reporting Requirements Explain in the Proposal how the Bidder will satisfy the claims reporting, auditing, and ad hoc reporting requirements explained below. 5.3.1 Claims Reporting Claims reporting includes providing monthly utilization reports to UCS, providing annual detailed experience and other data to justify premiums, maintaining accounting records necessary to support claim payments, and providing reasonable access to those records for State audit requests. • Monthly: Claims utilization data (before and after coordination of benefits) indicating dollar amount and number of transactions as follows: Active Retired Total Enrollees Dependents Total • Semi-Annual: Procedure Code and Procedure Name Utilization Form: Procedure Code Procedure Name Number of Procedures Charges ($) Averages The above is to be reported as per the group categories and procedure types. 5.3.2 Audit Reports To ensure data integrity and minimize financial risks with claim operations, the Awarded Contractor must implement an auditing system / report which UCS may receive upon request. This audit report will include enrollment information as well as the most recent claims data. UCS prefers access to a dashboard that can provide such updated information on demand. If the Bidder does not offer such a feature, UCS will consider proposals that supply such information upon request provided that the maximum proposed turnaround time is five (5) business days to deliver such reports. See Sample Audit Report in Exhibit I. 5.3.3 Reporting Describe in the Proposal the Bidder’s system for providing monthly, semi-annual, and annual reports to the UCS, including any quality control procedures in place to assure reporting accuracy. Include copies of current or proposed sample reports. Proposals must also describe Bidder’s ability to modify formats as requested by UCS and Bidder’s ability to download data in Microsoft Excel and/or text files. Business enterprises awarded an identical or substantially similar procurement contract within the past five years: Emblem Health