Market Conduct Health Examination Support

ATTACHMENT A

QUESTIONNAIRE

Attachment A - Questionnaire

Date Completed:

Instructions: This form must be completed and signed by a corporate officer with authority to bind the prospective Vendor and submitted by all Vendors responding to the Request for Qualifications. Responses must be provided for each individual item in the questionnaire and all accompanying attachments. The Pennsylvania Insurance Department’s (Department) review of the Vendor’s qualifications will be based upon the responses to this questionnaire and all accompanying attachments.

Vendor Information

1. Vendor Name:
Vendor Address:
Contact Person:
Contact E-mail:
Contact Telephone Number:
Federal ID Number:

All Principal Services referenced below require the following:

• Knowledge of and experience with applicable Pennsylvania Insurance Laws, Regulations and Statutes.

• Knowledge of and skills and experience with the Pennsylvania Insurance Department’s Examination Testing and Record Retention Database (currently, Teammate).

• Knowledge of and experience with an FTP Server (secure file exchange system).

• Use of TeamMate software, or a similar platform or software program (including ownership of sufficient licenses for all Vendor staff assigned to any particular market conduct examination).

• Knowledge and experience using Audit Command Language (ACL).

• Sufficient information technology hardware and software to effectively and efficiently conduct market conduct examinations.

• Knowledge and experience performing comprehensive, targeted, multi-state, and limited-scope market conduct examinations as defined in the NAIC Market Regulation Handbook, which include, but are not limited to the following areas:

o Company Operations and Management;

o Producer Licensing and Commissions;

o Consumer Complaints;

o Forms and Disclosures;

o Marketing, Sales, and Advertising;

o Underwriting and Underwriting Manuals;

o Policy Rating;

o Claims and Claims Manuals; and

o Market Conduct Annual Statement (MCAS) validation.

• Development of a workplan that meets the Department’s approval.

• Development of a Preliminary Examination Packet (Data Call) to be sent to the entity being examined.

• Performance of sampling (random and/or stratified).

• Development of a File Request Letter that meets the Department’s approval.

• Testing of selected sample files utilizing Department work papers and templates (excel worksheets).

• Identification of areas of noncompliance in written format using Department work papers and templates (Initial Summary Reports, Exit Summary Reports, and Final Examination Report).

• Development of Corrective Action Plans.

• Preparation of Summaries of Findings, reports and other documentation requested by the Department throughout the course of the examination.

• Providing the Department constant and continuous access to all work papers through TeamMate, or another software or platform designated by PID, regardless of the quality control aspects set in place by the Vendor.

• Providing training, as needed, to Department staff assigned to the examination.

• Providing subject matter experts to assist Department staff, as required, within the scope of an assigned market conduct examination.

• Providing follow-up services relating to examination recommendations and ensuring examinations completed by Vendor staff will meet Department standards.

• Access to sources of Pennsylvania laws, regulations and statutes (such as a NILS subscription; including ownership of sufficient licenses, subscriptions, identifications, etc. for all Vendor staff assigned to any particular market conduct examination).

Principal market conduct examination services offered by Vendor

Please indicate the market conduct examination areas you wish to be considered for qualification by checking the box(es) below.

◊ Principal Service 1:  INDIVIDUAL HEALTH, MEDICARE SUPPLEMENT & LONG TERM CARE PRODUCTS: 

◊ 1a: Affordable Care Act Coverage 

◊ 1b: Major Medical Products (HMO, PPO, POS, EPO) 

◊ 1c: Specified Disease Products 

◊ 1d: Accident & Sickness Products 

◊ 1e: Disability Products 

◊ 1f: Hospital Indemnity Products 

◊ 1g: Hospital/Surgical Products 

◊ 1h: Prescription Drug Coverage 

◊ 1i: Vision Coverage 

◊ 1j: Medicare Supplement Products 

◊ 1k: Long-Term Care Products 

◊ 1l: Short-Term Care Products 

◊ 1m: Short-Term, Limited-Duration Products 

◊ Principal Service 2:  GROUP HEALTH, MEDICARE SUPPLEMENT & LONG TERM CARE PRODUCTS:  

◊ 2a: Affordable Care Act Coverage 

◊ 2b: Major Medical Products (HMO, PPO, POS, EPO)

◊ 2c: Specified Disease Products 

◊ 2d: Accident & Sickness Products 

◊ 2e: Disability Products 

◊ 2f: Hospital Indemnity Products 

◊ 2g: Prescription Drug Coverage 

◊ 2h: Vision Coverage

◊ 2i: Medicare Supplement Products 

◊ 2j: Long-Term Care Products 

◊ 2k: Short-Term Care Products 

◊ 2l: Hospital/Surgical Products  

◊ 2m: Short-Term, Limited-Duration Products 

◊ Principal Service 3:  PHARMACY BENEFIT MANAGERS (PBMs)  

  

2. Describe the organizational structure of the Vendor (corporation, etc.), its affiliation with other companies (parent, subsidiary, etc.), its use of fictitious names, and the Vendor’s employment model (employees, independent contractors/subcontractors, etc.) with respect to the services checked above.

3. List office locations of the Vendor and provide a list of any personnel residing in Pennsylvania, if applicable.

4. (a) How long has the Vendor been in business?

(b) How long has the Vendor been providing insurance regulatory support services with respect to each of the services that the Vendor wishes to be qualified as identified above?

Principal Service Requirements

Detail regarding Vendor’s qualifications, capabilities, and prior experience in the performance of each principal service for which Vendor is requesting qualification, including a general description of capabilities and prior experience relating to the principal services described above.

Provide specific information and documentation (if available) relating to Vendor’s qualifications and prior experience for the following:

• Documentation of any examination findings or deficiencies to the Department on a timely basis.

• Utilization of TeamMate software (or another similar software or platform designated by PID) in managing and administering Market Conduct examination support services.

• Performance of examinations in accordance with Pennsylvania’s laws and regulations and the NAIC Market Regulation Handbook.

• Maintenance of the security of work papers in compliance with the Department’s Vendor Computer Use Agreement.

• Provision of training.

• Availability of subject matter experts to assist Department staff.

• Provision of expert testimony in regulatory or legal proceedings relating to Market Conduct examination support services.

Vendor Facilities

Describe the Vendor’s capability to perform work and provide documentation using software applications compatible with TeamMate, or another similar software or platform, such as:

• Documents and spreadsheets (e.g., MS Word, Adobe, and MS Excel).

• Process flow charts to include a description of how records are migrated from the Company and/or Department secured network to the Teammate Project, or another similar software or platform.

• A description of the Vendor’s standard computer configuration requirements, including type of hardware, operating system, encryption and anti-malware software used and frequency of auditing for updates.

Client Information

1. Does the Vendor have relevant experience with performing market conduct examination services for state insurance regulators similar to those required for the principal services described above?

Yes _____ No _____

If yes, please provide the following for each project:

State	Agency Personnel (name, title, phone, email)	Description of services provided by Vendor

Has the Vendor or any of its employees (including contractors/subcontractors) ever been dismissed, terminated or otherwise separated from a Market Conduct Examination assignment?

Yes _____ No _____

If yes, please provide the following for each incident:

State	Agency Personnel (name, title, phone, email)	Description of circumstances regarding termination

Training and Quality Assurance

1. Describe the Vendor’s process for ensuring that staff participates in ongoing training relevant to Market Conduct Examination processes, including, but not limited to NAIC training and/or other organizations that offer training.

2. Describe the Vendor’s processes for peer review, examiner oversight, and quality assurance.

Conflict of Interest

1. Describe what method the Vendor utilizes to identify or resolve any conflicts of interest, actual, perceived or potential, prior to accepting a work assignment/examination engagement.

2. Does the Vendor provide services, or otherwise operate, so that an actual, perceived, or potential conflict of interest may arise with any licensees subject to market conduct examination by the Department? For example, does Vendor provide services to an insurance company that may be subject to an examination by the Department?

Yes _____ No _____

If yes, identify those entities on a separate list and provide actions taken to reduce potential conflicts of interest. This information may affect whether a consultant would be permitted to provide market conduct examination services for a particular individual entity where there is an actual, perceived or potential conflict. In addition, depending upon the degree and extent of conflicts, the Department, in its discretion, may disqualify a Vendor in its entirety.

3. The Vendor Certifies that any of its employees or their family members as defined in the Public Official and Employee Ethics Act, 65 Pa. C. S.A §1102:

a. Are not directors, owners, partners, agents, or representatives of any of the firms in the industry that may be subject to market conduct examination by the Department.

b. Do not hold any stock or financial interest in any of the firms in the industry that may be subject to market conduct examination by the Department.

c. Are not current or former employees of any of the firms in the industry may be subject to market conduct examination by the Department.

Yes _____ No _____

Fee Schedule

1. Complete and sign the Fee Schedule included with this RFQ as Attachment B. Your fee schedule will be reviewed to ensure that the fees are reasonable and consistent with prevailing market rates.

• The entity being examined will directly pay the Department’s engaged Vendors based upon an hourly fee schedule and reimbursement for actual expenses. Vendors are to manage and administer examinations in an effective and efficient manner so as to minimize the cost of the examination for the examined entity. For example, work assignments should be made so that the appropriate level of work is assigned to the lowest billing personnel classification capable of completing those assignments, and travel should be made in the most cost-effective manner according to Pennsylvania Travel Policy.

• Transparency law details. Under the transparency provisions of Pennsylvania’s exam law (40 P.S. § 323.4b), the Department must provide to the licensee or entity that is the subject of the examination a detailed budget estimate prior to commencing the examination.

• The Department will not permit a Vendor to charge and bill for indirect or other similar expenses on anything other than actual costs incurred in the course of performing the market conduct examination. Miscellaneous overhead or indirect cost add-ons will not be reimbursed. Actual travel and related expenses will be billed by Vendor to the company being examined as an additional expense in accordance with the Commonwealth of Pennsylvania’s travel policy and procedures in effect at the time of the engagement. All fees and expenses are subject to pre-approval prior to billing the company. The Commonwealth travel policies in effect at the time of publication of this RFQ may be found at the following link: http://www.budget.pa.gov/Services/ForCommonwealthTravelers/PoliciesAndProcedures/Pages/default.aspx

• The Department utilizes a holdback provision for professional fees on every Vendor engagement.

Personnel

1. On a separate page, list the personnel qualified to provide each principal service identified above. Attach resumes and copies of the active designations or certifications and include the number of years of insurance industry experience (specifically indicating market conduct examination experience, a description of regulatory examination work performed, and work directly related to principal service). For each individual, identify the maximum hourly billing rate and any information that supports the hourly billing rate. Use the following billing classifications for all personnel, including subject matter experts:

• Vendor Supervisory Partner: responsible for overall client relationship, peer review, quality control and ensuring a coordinated client service delivery process.

• Market Conduct Examination Manager: can serve as the Examiner-in-Charge or assist the Vendor Supervisory Partner with review and client service matters. Must maintain an active Certified Market Conduct Examiner (CIE) designation.

• Examiner-in-Charge (“EIC”): responsible for the day-to-day management of the examination procedures performed by staff examiners. The EIC ensures appropriate approval and execution of all risk focused examination procedures and that the Department’s needs are completely met or exceeded.

• Senior Market Conduct Examiner: works closely with the EIC in the conduct of examination procedures, administration functions of the examination, and in the supervision of other staff members.

• Staff Market Conduct Examiner: performs specific examination procedures under the direction of the EIC and/or Senior Market Conduct Examiner.

• Lead IT Specialist/Manager: works closely with the EIC in the identification of critical data and systems, the evaluation of the company’s IT governance structure, and the identification and assessment of general IT controls and application specific IT controls and their impact on the integrity and availability of the company’s critical data. Must maintain an active Certified Information Systems Auditor (“CISA”) certification. An active Automated Examination Specialist (“AES”) designation is strongly preferred.

• Senior IT Specialist: supports Lead IT Specialist/Manager and may work closely with the EIC in the conduct of IT examination procedures and in the supervision of Staff IT Examiners.

• Staff IT Examiner: performs specific IT examination procedures under the direction of the Lead IT Specialist/manager or Senior IT Specialist.

• Clerical and Administrative support: performs photocopying, faxing, scheduling, billing, and various other administrative duties in support of the engagement that would not be performed by any of the professional classifications listed above.

Signature

I hereby confirm that this response, including attachments, is accurate, that the fees identified in the Fee Schedule will be the maximum offered for all work performed from July 1, 2026, through June 30, 2031, and that I have authority to bind the submitting Vendor to the terms and conditions identified in this RFQ.

Signature Title Date