Introduction

As the existing Dental Manage Care Services contract terminates on 31 December 2022 with the current service provider, Bonitas Medical Fund (“the Scheme” or “Bonitas”) has embarked on a Request for Proposal (RFP) exercise. The process will allow the Scheme to benchmark on the current services and pricing against other service providers. This exercise will also ensure that the Scheme continues to apply the principles of good corporate governance by evaluating all service providers at regular intervals.

Background

Bonitas is an open medical scheme registered in terms of the Medical Schemes Act of South Africa, No. 131 of 1998, as amended (“the Act” or “MSA”) under registration number 1512. The Scheme is incorporated and domiciled in the Republic of South Africa. Bonitas is one of the top three medical schemes registered in South Africa and one of the top two open medical schemes in the country. The Scheme is administered by Medscheme Holdings Proprietary Limited (“the administrator”). We have been in operation for forty years providing cover for more than 730 000 lives. The Scheme offers twelve (12) registered options and three (3) efficiency discount options (“EDO”) to suit a range of member needs.

All suitably qualified service providers/respondents/registered managed care organisations are expected to fully acquaint themselves with the conditions, requirements, and specifications of this RFP before submitting the requested information. Failure to do so will be at the respondents own risk and the respondent cannot secure relief on the grounds of any mistakes. Bonitas will not be held liable for any costs incurred by all respondents in connection with their response to this RFP.

To facilitate the review of all submissions, the Scheme requires that all interested, suitably qualified service providers/respondents/registered managed care organisations submit comprehensive information. Only the requested information should be provided. The Scheme requires clear, concise, and factual responses. The proposal submitted by the respondent constitutes an offer. All respondents are required to provide a full written response to this RFP.

For a set of our Annual Report or details on the benefit options, we refer you to our website at www.bonitas.co.za.

Confidentiality

This information document may not be used for any purpose by the respondent other than for developing their response to it and all reasonable efforts must be taken by the respondent to ensure confidentiality of any information provided. This document and any other information of a confidential nature provided to the respondent during the course of this RFP process are and shall be covered by a written undertaking.

Bonitas however, reserves the right to share the information received from interested parties with its administrator, legal and financial advisors, and any other entity or person who advises Bonitas on matters relating to the purpose for which this RFP is issued.

Scope of services

1. A dedicated and extensive dental network within all provinces.
2. Management of the network and non-network dental service providers for purposes of cost containment and improved access to treatment for members, including communication to all dental service providers on the Scheme’s rules and/or relevant information. This service shall include but not be limited to monitoring the profiles of dental service providers on the network or out of network, contracting new dental service providers and reporting to the Scheme on all matters pertaining to the network.
3. The receipt, clinical processing and payment of approved dental claims that comply with the benefit rules and clinical protocols. This shall include payments to dental service providers and/or members.
4. Provide detailed remittance advice notices to dental service providers and members pertaining to treatment rendered.
5. Provide a clinical pre-authorisation function, where applicable.
6. Provide a clinical advisory service, as may be reasonable required by the Scheme.
7. Fraud, waste and abuse monitoring and interventions across the network and non-network dental service providers and claims.
8. Dedicated call centre for Bonitas members, the Scheme’s administrator and dental service providers.
9. Ability to electronically interface via secure means with the Scheme’s administrator and/or managed care service provider for data transfer, which may include membership data, claims data, authorization data.
10. Provide the Scheme members and/or dental service providers with a formal mechanism which deals with appeals, complaints and/or disputes, which mechanism does not prevent the complainant from lodging the matter with the Scheme or the Council of Medical Schemes.
11. Provide comprehensive and detailed operational reporting to the Scheme on a monthly basis, which shall include but not be limited to SLA reporting, utilisation per option, trends identified, financial reporting reflecting all transactions, etc. This will also include information and technology (I&T) reporting requirements as per the Schemes I&T Governance Framework.
12. All the above services are to be rendered within the ambit of the Medical Scheme’s Act, No. 131 of 1998 and the registered scheme rules.

The existing Bonitas dental managed care service offering includes a risk transfer arrangement and/or management fee for reviewing claims, serviced through an extensive Bonitas Dental network.

Submission Instructions

The following items must be provided for in the submission utilizing the sections as:

Section A:

1. Proposals must be made in the official name of the company or individual under which the business is conducted (showing official business address) and MUST BE SIGNED by a person duly authorized to legally bind the person, partnership, company or corporation submitting the proposal.
2. The company background and profile. This will include the information relating to the shareholding, the association with the Holding company and/or subsidiaries.
3. The latest BEE rating certificate. An official rating to be done by an accredited ratings agency or DTI.
4. Proof of registration/accreditation/licensing (e.g., valid Certificate of Incorporation).
5. Proven track record regarding the provision of the required services and/or benefit.

Section B:

1. The latest South African Revenue Services Tax Compliance Certificate (or exemption) or letter of good standing.
2. The audited financial statements of the company (and/or the Holding company where these are available) for the last financial year. Where audited financial statements are not available, the management accounts for the last twelve (12) months, accompanied by a letter from the accountant or financial manager explaining why there are no audited financial statements.
3. Valid Insurance Certificate for Professional Indemnity.

Section C:

1. Experience – summarize your company’s experience and special expertise in providing the type of services identified in the requested services, include resumes of key personnel.
2. Include the relevant accreditation, professional association, registration with relevant authority bodies (where required). Where no such accreditation or registration is required, this is to be clearly stated.
3. Value proposition and/or differentiated service offering to Bonitas.
4. Provide details on the current provincial network presence in relation to the total number of dental service provider per province.

Section D:

1. Project Approach – provide a brief overview of your project management philosophy, methods, and practices and how they would meet the needs identified in the requested services section.
2. A detailed project timeline utilizing a commencement date of 01 January 2023.

Section E:

1. Proposed fee structure aligned to the Scope of Services:

a.This may include risk transfer structures, management fee structures for clinically reviewing claims and the Scheme pays the claim, or similar.

Section F:

1. Proposed service level agreement detailing the services on offer.

Section G:

1. Confirmation and approach regarding the management and review of all contracted network service providers as well as non-network providers. You may also include the management and approach of fraud, waste and abuse within this section.

Section H:

1. References: include a list of references (including contact names, telephone numbers and email addresses) of at least three (3) recent or current clients within the last four years and accompanying reference letters. The Scheme reserves the right to contact references without prior notification.

Section I:

1. Compliance to POPIA

Section J:

1. Information Technology (you are not required to produce certificates, policies, plans, etc. on the following, just the company/organisation approach to the each):

a. Approach to Cyber Security, including penetration testing, vulnerability assessments or similar.

b. Approach to disaster recovery and business continuity.

c. Approach to IT System audits - ISAE3402 or similar.

d. ISO IT standards.

Section K:

1. A written undertaking regarding the confidentiality of this RFP process is required upon submission of the proposal.

Bonitas reserves the right to engage in a second phase which may require further proposals from other interested service providers. Short listed providers may be invited to present to the Scheme at the Bonitas Medical Fund offices situated in Melrose Arch, Gauteng. Due to Covid-19 lockdown regulations, the presentation may be conducted via a virtual channel. The Scheme will advise short listed providers in advance.

Bonitas hereby invites you to submit a RFP by 12h00 on 08 April 2022. All submissions are to be sent through by email to RFP.INFO@Bonitas.org.za.Please use subject: DMCS RFP 003/2022 – “company name”. All enquiries can also be directed to the above email address.

The following disqualification criteria shall be applicable to the RFP process:

• RFP submitted late.
• RFP wherein the minimum required documents listed above have not been submitted.

The service providers who apply for this contract must adhere and operate within the ambit of all relevant legislations and regulatory standards.

Please note that Bonitas reserves the right to terminate this process, extend it, or otherwise amend or vary any aspect thereof in its sole discretion. Participation in this process does not mean that any participant will be guaranteed of any commercial or other relationship with Bonitas.

Bonitas looks forward to receiving your proposal.

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