10-Attachment C - Vendor Workbook Response.xlsx

XLSX spreadsheet 2 MB Posted Sep 22, 2025

Attached to: 26-002V Stop Loss Insurance
Solicitation number: 26-002V
Issued by: Savannah CDP, Texas

About this file

Written by GovTribe AI · Sep 24, 2025

This document is a Request for Proposal (RFP) issued by Schertz-Cibolo-Universal City Independent School District (SCUCISD) for stop loss insurance coverage, with Gallagher Benefit Services acting as the district's consultant. The RFP seeks proposals for stop loss insurance with specific deductible levels of $200,000, $250,000, and $300,000, effective January 1, 2026, for a 12-month contract period. The district currently has three Aetna/ESI Plans and is seeking comprehensive stop loss coverage that includes medical and prescription drug benefits for full-time employees working at least 18.5 hours per week, with coverage beginning the first of the month following employment.

The pricing specifications include a 120% corridor, paid or 24/12 contract basis, and requirements for unlimited specific coverage maximums. The current vendor is HM Insurance, with an existing annual stop loss premium of $1,384,382. Key proposal requirements include submitting rates net of commissions, providing preliminary renewal rates six months prior to the effective date, offering monthly claims reporting, complying with HIPAA regulations, and waiving certain provisions like "actively at work" requirements. The district is seeking proposals that mirror their existing plan document, with no new lasers at renewal and 12 months of run-out coverage included in the rates.

View the file

Other files

File	Type	Posted
3-Exhibit A-2 - Stop Loss Insurance Policy Sept 1 2024 - Aug 31 2025.pdf	PDF	Sep 22, 2025
4-Exhibit C-2 - YTD UHC Medical Claim Analysis Sept 2023 - Aug 31 2024.pdf	PDF	Sep 22, 2025
6-Exhibit D-1 - SBC Aetna Medical ACO Plan 20240901.pdf	PDF	Sep 22, 2025
1-Exhibit E - YTD Aetna Medical Claim Analysis Sept 1 2024 - Aug 31 2025.pdf	PDF	Sep 22, 2025
12-Stop Loss Insurance RFP (26-002V).pdf	PDF	Sep 22, 2025
5-Exhibit D-3 - SBC Aetna Medical POS Plan 20240901.pdf	PDF	Sep 22, 2025
7-Exhibit B - Medical Census Report 08-27-2025.xlsx	XLSX spreadsheet	Sep 22, 2025
11-Required Forms (26-002V).doc	DOC document	Sep 22, 2025
13-RFP Bid Notice (26-002V).pdf	PDF	Sep 22, 2025
8-Exhibit D-2 - SBC Aetna Medical HSA Plan 20240901.pdf	PDF	Sep 22, 2025
9-Exhibit A-1 - Stop Loss Insurance Policy Sept 1 2025 - Dec 31 2025.pdf	PDF	Sep 22, 2025
2-Exhibit C-1 - YTD UHC Medical Claims Analysis Sept 2022 - Aug 31 2023.pdf	PDF	Sep 22, 2025

Show all 12

On GovTribe

Work with this file

Download the original file
Contacts named in this file
Similar government files
Ask GovTribe AI about this file

Try for free Login

Text version

The file's text, extracted by GovTribe without its formatting.

Cover

Schertz-Cibolo-Universal-City ISD

Request for Proposal # 26-002V

for

Stop Loss Insurance

Disclaimer: Much effort has been made to provide all necessary and accurate information in this Request for Proposal. It is the sole responsibility of the proposers to ensure that they have all information necessary to complete submission of their proposals. If more information is needed, please contact purchasing.

General Information

General Information
Please consider the following information for your proposal.
1.	EFFECTIVE DATE:	January 1, 2026

2. CONTRACT DURATION: 12 months

3. VENDOR HISTORY: HM Insurance September 2024 - Present

4.	ELIGIBILITY:
	Full Time Employees (EEs) as defined by the Client and variable EEs working ACA 18.5 Hours/week; Retirees are not covered. Full-time professional and para-professional - coverage is effective the first of the month following the employment date - i.e. employees hired on February 15th, will receive coverage as of March 1st.

5. District Plan is a PPACA is a "non-grandfathered" plan.

6. The client has three current Aetna/ESI Plans. Please refer to the 2024-2025 SBCs for further information. The client will consider these three models for weighted average scoring. Proposals will be scored on these three models.

7. Assume that current 2024-2025 benefit coverage will remain intact for purposes of developing your cost, network, utilization management, modeling strategies.

8.	Vendors are to propose all fees and premiums net of broker/agent commissions; the client is not requesting services of an agent/broker.
9.	All reporting files and other supporting documentation can be found attached to the bid posting.
10.	All workbook pages must be completed and returned with your proposal.
11.	The client does not want competing multiple proposals from the same vendor, so manage your internal proposal process to assure that one (1) proposal is presented.

12.	PLEASE provide an Executive Summary, as well as your standard Proposal with this submission. PLEASE note, you MUST provide your responses in our standard template in order to be considered for this RFP.
Disclaimer:
Much effort has been made to provide all necessary and accurate information in this Request for Proposal. It is the sole responsibility of the proposers to ensure that they have all information necessary to complete submission of their proposals. If more information is needed, please reach out to purchasing.

Scope of Work Scope of Work

Please consider the following information / requirements for your proposal.
A.	Stop Loss Reinsurance Coverage
	Please quote the following specifications:
	ISL Deductibles: $200,000, $250,000, and $300,000
	Contract Period: Paid or 24/12
	Corridor: 120%
	Include ASL
	NOTE: SCUCISD is moving from a 9/1 effective date to 1/1. This move is effective 1/1/26.

Proposal Specifications

Company Legal Business Name: __________________________________________________________________

All vendors must complete this section.
Proposal Specifications
#	Specification	Agree / Disagree
1	The effective date of coverage January 1, 2026 is acknowledged and accepted.
3	All fees / premiums are quoted NET of commissions; no commissions or fees are to be paid to any entity.
4	Preliminary renewal rates must be submitted six months prior to the effective date.
5	You completed all sections of the workbook in their entirety, in the format requested.
10	Vendor agrees to provide all communication materials in electronic (pdf) format.
12	Vendor agrees to provide all standard reports to the client and its professional advisor.
13	Do you agree to provide the consultant with monthly reports for the data warehouse at no additional charge?
14	Claims experience must be provided at least monthly, including each renewal.
15	You are in compliance with all HIPAA Privacy, Electronic Data Interface (EDI) and Security Regulations and will use HIPAA 834 (ASC X12N 834) for the file transmission layout.
16	You have reviewed and accept the Plan’s eligibility provisions.
17	Your contract must require no more than a 90-day notice of termination. Your contract cannot prohibit the group from terminating coverage at any time. There must be no penalties for late notification or for termination off anniversary.
19	Vendor has specifically listed all deviations from the RFP and coverage requirements. NOTE: Deviations MUST be listed; vendors cannot simply make “general” references to the proposal.
20	If the client wishes to carve-out the pharmacy benefit, TPA agrees to take weekly feeds from the pharmacy vendor and will mine/integrate the data into the medical management program.
23	Vendor agrees to provide a dedicated reporting contact for the client and its consultant. This person would be responsible for running ad hoc reports for the client and/or its consultant’s discretion, at no additional cost to the client.
26	You must permit the employer to have access to all files on request (e.g., a claims audit).
29	Benefits should be payable based on the plan documents of the coverages being quoted and the Stop Loss contract should not supersede those plan documents of the quoted coverages.
30	Stop Loss Contract basis: Paid or 24/12
31	Stop Loss ISL options: $200,000, $250,000, and $300,000
32	Pharmacy is included in the Aggregate
33	Include an overall composite rate covering all available medical plans.
34	Corridor: 120%
35	Max Aggregate Annual Payment: Options of $1,000,000 and Unlimited
36	Spec & Agg Advance Funding option. If there is a cost associated with it, please break it out in your proposal.
37	Include Plan Mirroring option. If there is a cost associated with it, please break it out in your proposal.
38	Vendor must waive any “actively-at-work provisions
39	Vendor must waive any late entrant penalties
40	Run-in should not be limited
41	Please include 12 months of run-out coverage in your rates
42	Vendor must agree to no new lasers at renewal.
43	As part of your proposal response, please compare the employer’s current plan document, which has been included, to your proposed stop loss policy and identify any areas where there are gaps in coverage or include in your proposal a statement that you will mirror the employer’s plan document.
44	Vendor must agree to release the stop loss renewal proposal within 120 days of expiration
45	The client intends to include your RFP responses as part of the overall Contract. Please acknowledge you understand and agree to this expectation.

Deviations Tab

Proposal Specifications

Company Legal Business Name: __________________________________________________________________

If you have any Deviations to the Proposal Specifications, OR need to add additional commentary on any item of the Questionnaire, please include this here
Proposal Specifications
#	Specification	Deviation/Commentary
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.

Stop Loss Pricing $200K

	Stop Loss Pricing Spreadsheet
	Please record all answers on this excel spreadsheet
	Company Legal Business Name: _________________________________________________________________
	Plan Provisions		Current
HM		Option 1		Option 2		Option 3		Option 4		Option 5		Option 6
			9/1/25		1/1/26		1/1/26		1/1/26		1/1/26		1/1/26		1/1/26
			PEPM	Annual	PEPM	Annual	PEPM	Annual	PEPM	Annual	PEPM	Annual	PEPM	Annual	PEPM	Annual
	Network:		Aetna ACO & PPO
		# EE
	Coverages included for Specific \| Aggregate		Med/Rx	Med/Rx	Med/Rx	Med/Rx	Med/Rx	Med/Rx	Med/Rx	Med/Rx	Med/Rx	Med/Rx	Med/Rx	Med/Rx	Med/Rx	Med/Rx
	Individual Stop Loss Level		$200,000		$200,000		$200,000		$200,000		$200,000		$200,000		$200,000
	Individual Policy Year Stop Loss Payment Limit		Unlimited
	Individual Lifetime Stop Loss Payment Limit		Unlimited
	Maximum Annual Aggregate Refund		$1,000,000
	Claim Accumulation Basis		Per Member
	Reimbursement Percentage		100%
	Contract Basis		16/4		24/12		24/12		24/12		24/12		24/12		24/12
	Agree to waive any "actively at work" provisions		Yes
	Agree to mirror employer's plan document		Yes
	Terminal Liability Option		No
	Dollar Limit on Run-in Claims - Speciific \| Aggregate		NA	NA
	Retirees Included		No
	INDIVIDUAL STOP LOSS PREMIUM
	Single	824	$92.83	$917,903		$0		$0		$0		$0		$0		$0
	Spouse			$0		$0		$0		$0		$0		$0		$0
	Children			$0		$0		$0		$0		$0		$0		$0
	Family	355	$92.83	$395,456		$0		$0		$0		$0		$0		$0
	Composite	1179	$92.83	$1,313,359	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	AGGREGATE STOP LOSS PREMIUM
	Single	824	$5.02	$49,638		$0		$0		$0		$0		$0		$0
	Spouse	0		$0		$0		$0		$0		$0		$0		$0
	Children	0		$0		$0		$0		$0		$0		$0		$0
	Family	355	$5.02	$21,385		$0		$0		$0		$0		$0		$0
	Composite	1179	$5.02	$71,023	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	TOTAL ANNUAL STOP LOSS PREMIUM		$97.85	$1,384,382	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	Expected Claims
	Single	824	$736.54	$7,282,924	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	Spouse	0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	Children	355	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	Family	355	$736.54	$3,137,668	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	Composite	1179	$736.54	$10,420,592	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	Monthly Aggregate Deductible Factors		120% Corridor		120% Corridor		120% Corridor		120% Corridor		120% Corridor		120% Corridor		120% Corridor
	Single	824	$883.85	$8,739,509		$0		$0		$0		$0		$0		$0
	Spouse	0		$0		$0		$0		$0		$0		$0		$0
	Children	355		$0		$0		$0		$0		$0		$0		$0
	Family	355	$883.85	$3,765,201		$0		$0		$0		$0		$0		$0
	Composite	1179	$883.85	$12,504,710	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	Minimum Attachment Point		100%	$12,504,710		$0		$0		$0		$0		$0		$0
	TOTAL COMBINED ESTIMATED MAX LIABLITY	1179	$981.70	$13,889,092	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	Lasers
Text is limited to 25 characters	1.	None	None	Enter Member Name	Enter Laser Amount	Enter Member Name	Enter Laser Amount	Enter Member Name	Enter Laser Amount	Enter Member Name	Enter Laser Amount	Enter Member Name	Enter Laser Amount	Enter Member Name	Enter Laser Amount
		2.
		3.
		4.
	Proposal Contingencies
Text is limited to 60 characters	1.
		2.
		3.
		4.
		5.

No
Yes - 3 months
Yes - 6 months
	Per Member	Yes
	Per Family	No

Stop Loss Pricing $250K

	Stop Loss Pricing Spreadsheet
	Please record all answers on this excel spreadsheet
	Company Legal Business Name: _________________________________________________________________
	Plan Provisions		Current
HM		Option 1		Option 2		Option 3		Option 4		Option 5		Option 6
			9/1/25		1/1/26		1/1/26		1/1/26		1/1/26		1/1/26		1/1/26
			PEPM	Annual	PEPM	Annual	PEPM	Annual	PEPM	Annual	PEPM	Annual	PEPM	Annual	PEPM	Annual
	Network:		Aetna ACO & PPO
		# EE
	Coverages included for Specific \| Aggregate		Med/Rx	Med/Rx	Med/Rx	Med/Rx	Med/Rx	Med/Rx	Med/Rx	Med/Rx	Med/Rx	Med/Rx	Med/Rx	Med/Rx	Med/Rx	Med/Rx
	Individual Stop Loss Level		$200,000		$250,000		$250,000		$250,000		$250,000		$250,000		$250,000
	Individual Policy Year Stop Loss Payment Limit		Unlimited
	Individual Lifetime Stop Loss Payment Limit		Unlimited
	Maximum Annual Aggregate Refund		$1,000,000
	Claim Accumulation Basis		Per Member
	Reimbursement Percentage		100%
	Contract Basis		16/4		24/12		24/12		24/12		24/12		24/12		24/12
	Agree to waive any "actively at work" provisions		Yes
	Agree to mirror employer's plan document		Yes
	Terminal Liability Option		No
	Dollar Limit on Run-in Claims - Speciific \| Aggregate		NA	NA
	Retirees Included		No
	INDIVIDUAL STOP LOSS PREMIUM
	Single	824	$92.83	$917,903		$0		$0		$0		$0		$0		$0
	Spouse			$0		$0		$0		$0		$0		$0		$0
	Children			$0		$0		$0		$0		$0		$0		$0
	Family	355	$92.83	$395,456		$0		$0		$0		$0		$0		$0
	Composite	1179	$92.83	$1,313,359	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	AGGREGATE STOP LOSS PREMIUM
	Single	824	$5.02	$49,638		$0		$0		$0		$0		$0		$0
	Spouse	0		$0		$0		$0		$0		$0		$0		$0
	Children	0		$0		$0		$0		$0		$0		$0		$0
	Family	355	$5.02	$21,385		$0		$0		$0		$0		$0		$0
	Composite	1179	$5.02	$71,023	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	TOTAL ANNUAL STOP LOSS PREMIUM		$97.85	$1,384,382	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	Expected Claims
	Single	824	$736.54	$7,282,924	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	Spouse	0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	Children	355	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	Family	355	$736.54	$3,137,668	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	Composite	1179	$736.54	$10,420,592	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	Monthly Aggregate Deductible Factors		120% Corridor		120% Corridor		120% Corridor		120% Corridor		120% Corridor		120% Corridor		120% Corridor
	Single	824	$883.85	$8,739,509		$0		$0		$0		$0		$0		$0
	Spouse	0		$0		$0		$0		$0		$0		$0		$0
	Children	355		$0		$0		$0		$0		$0		$0		$0
	Family	355	$883.85	$3,765,201		$0		$0		$0		$0		$0		$0
	Composite	1179	$883.85	$12,504,710	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	Minimum Attachment Point		100%	$12,504,710		$0		$0		$0		$0		$0		$0
	TOTAL COMBINED ESTIMATED MAX LIABLITY	1179	$981.70	$13,889,092	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	Lasers
Text is limited to 25 characters	1.	None	None	Enter Member Name	Enter Laser Amount	Enter Member Name	Enter Laser Amount	Enter Member Name	Enter Laser Amount	Enter Member Name	Enter Laser Amount	Enter Member Name	Enter Laser Amount	Enter Member Name	Enter Laser Amount
		2.
		3.
		4.
	Proposal Contingencies
Text is limited to 60 characters	1.
		2.
		3.
		4.
		5.

No
Yes - 3 months
Yes - 6 months
	Per Member	Yes
	Per Family	No

Stop Loss Pricing $300K

	Stop Loss Pricing Spreadsheet
	Please record all answers on this excel spreadsheet
	Company Legal Business Name: _________________________________________________________________
	Plan Provisions		Current
HM		Option 1		Option 2		Option 3		Option 4		Option 5		Option 6
			9/1/25		1/1/26		1/1/26		1/1/26		1/1/26		1/1/26		1/1/26
			PEPM	Annual	PEPM	Annual	PEPM	Annual	PEPM	Annual	PEPM	Annual	PEPM	Annual	PEPM	Annual
	Network:		Aetna ACO & PPO
		# EE
	Coverages included for Specific \| Aggregate		Med/Rx	Med/Rx	Med/Rx	Med/Rx	Med/Rx	Med/Rx	Med/Rx	Med/Rx	Med/Rx	Med/Rx	Med/Rx	Med/Rx	Med/Rx	Med/Rx
	Individual Stop Loss Level		$200,000		$300,000		$300,000		$300,000		$300,000		$300,000		$300,000
	Individual Policy Year Stop Loss Payment Limit		Unlimited
	Individual Lifetime Stop Loss Payment Limit		Unlimited
	Maximum Annual Aggregate Refund		$1,000,000
	Claim Accumulation Basis		Per Member
	Reimbursement Percentage		100%
	Contract Basis		16/4		24/12		24/12		24/12		24/12		24/12		24/12
	Agree to waive any "actively at work" provisions		Yes
	Agree to mirror employer's plan document		Yes
	Terminal Liability Option		No
	Dollar Limit on Run-in Claims - Speciific \| Aggregate		NA	NA
	Retirees Included		No
	INDIVIDUAL STOP LOSS PREMIUM
	Single	824	$92.83	$917,903		$0		$0		$0		$0		$0		$0
	Spouse			$0		$0		$0		$0		$0		$0		$0
	Children			$0		$0		$0		$0		$0		$0		$0
	Family	355	$92.83	$395,456		$0		$0		$0		$0		$0		$0
	Composite	1179	$92.83	$1,313,359	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	AGGREGATE STOP LOSS PREMIUM
	Single	824	$5.02	$49,638		$0		$0		$0		$0		$0		$0
	Spouse	0		$0		$0		$0		$0		$0		$0		$0
	Children	0		$0		$0		$0		$0		$0		$0		$0
	Family	355	$5.02	$21,385		$0		$0		$0		$0		$0		$0
	Composite	1179	$5.02	$71,023	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	TOTAL ANNUAL STOP LOSS PREMIUM		$97.85	$1,384,382	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	Expected Claims
	Single	824	$736.54	$7,282,924	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	Spouse	0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	Children	355	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	Family	355	$736.54	$3,137,668	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	Composite	1179	$736.54	$10,420,592	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	Monthly Aggregate Deductible Factors		120% Corridor		120% Corridor		120% Corridor		120% Corridor		120% Corridor		120% Corridor		120% Corridor
	Single	824	$883.85	$8,739,509		$0		$0		$0		$0		$0		$0
	Spouse	0		$0		$0		$0		$0		$0		$0		$0
	Children	355		$0		$0		$0		$0		$0		$0		$0
	Family	355	$883.85	$3,765,201		$0		$0		$0		$0		$0		$0
	Composite	1179	$883.85	$12,504,710	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	Minimum Attachment Point		100%	$12,504,710		$0		$0		$0		$0		$0		$0
	TOTAL COMBINED ESTIMATED MAX LIABLITY	1179	$981.70	$13,889,092	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	Lasers
Text is limited to 25 characters	1.	None	None	Enter Member Name	Enter Laser Amount	Enter Member Name	Enter Laser Amount	Enter Member Name	Enter Laser Amount	Enter Member Name	Enter Laser Amount	Enter Member Name	Enter Laser Amount	Enter Member Name	Enter Laser Amount
		2.
		3.
		4.
	Proposal Contingencies
Text is limited to 60 characters	1.
		2.
		3.
		4.
		5.

No
Yes - 3 months
Yes - 6 months
	Per Member	Yes
	Per Family	No

Stop Loss RFI

Gallagher Benefit Services	2019 notes	2019 notes	2019 notes
Request for Information
Specific and Aggregate Stop Loss Insurance

Questions RESPONSES

Stop Loss Provider Name
Date Completed		2018 Johns notes
Responses Effective Through	sample answer: 12/31/2021 or 1/1/2022

Questions RESPONSES Category Previous Question

1	Explain your ownership structure in detail.	Please explain:			organizational structure	RFI 1
2	How long has your organization been in business for stop loss insurance?	Year established			organizational structure	RFI 2
		Additional Information:
3	Has your company done business under other names? If yes, please provide historical background information. Identify any interests your organization may have with associated vendors (claims administrators, brokerage firms, managed care firms, etc.).	Yes No			organizational structure	RFI 3
		If yes, please explain:
		Additional Information:
4	Have you ever been suspended from writing this line of coverage?	Yes No			organizational structure	RFI 4
		If yes, please explain:
		Additional Information:
5	Is your organization licensed to do business in all 50 states and U.S. territories? If no, identify the states/territories in which you are not currently licensed.	Yes No			organizational structure	RFI 5
		If no, please explain:
		Additional Information:
6	What percentage of the risk does your company assume? If less than 100%, please identify additional reinsurer(s) and the respective percentage of assumed liability.	%			organizational structure	RFI 8
		If less than 100%, please explain:
		Additional Information:
7	Do you allow your paper to be used by MGUs? If yes then please identify those MGU(s).	Yes No			organizational structure	RFI 8
		If yes, then list the MGU(s)
		Additional Information:
8	Do you have a relationship with another carrier that would prohibit your ability to quote a particular case?	Yes No			organizational structure	RFI 8
		If yes, please explain:
		Additional Information:
9	Who has final claim decision-making authority with respect to specific and aggregate claims?	Details:			organizational structure	RFI 9
10	How many stop loss clients do you currently have in your block of business and what is the annualized premium?	# of Clients			organizational structure	RFI 6
		Annualized premium
11	How many stop loss clients do you currently have with Gallagher and what is the annualized premium?	# of Clients			organizational structure	New
		Annualized premium
12	BUCA Block of Business: What percentage of your block of business is with BUCA's?	Aetna		marginally important	organizational structure
		BCBS				Key Question 7 (split into 2 questions)
		Cigna
		UHC
13	Do you have ineligibles industries or other ineligible categories?	Yes No		less important	organizational structure	RFI 12
	a. Captives	Eligible Ineligible				RFI 12
	b. Casinos	Eligible Ineligible				RFI 12
	c. Employee Leasing / PEOs	Eligible Ineligible				RFI 12
	d. Hospitals	Eligible Ineligible				RFI 12
	e. Indian Tribes	Eligible Ineligible				RFI 12
	f. METS / MEWAs	Eligible Ineligible				RFI 12
	g. Mining	Eligible Ineligible				RFI 12
	h. Other ineligible industries or categories	Please list:				RFI 12
14	Do you have a minimum specific deductible amount?	Yes No				RFI 12
		If yes, add minimum amount:
15	Do you have a minimum group size?	Yes No				RFI 12
		If yes, add minimum # of EEs:
16	Do you offer a pharmacy only policy?	Specific: Yes No		less important	organizational structure	New
		Aggregate: Yes No		less important	organizational structure
		Additional Information:		less important	organizational structure
17	Claims covered period: Do you agree to offer a Paid claims covered period? If yes, under what criteria?	Yes No		less important	organizational structure
		If no, please explain:		less important	organizational structure	Key Question 1
		Additional Information:		less important	organizational structure
	Define a paid contract.	Details:				New
18	Formal Disclosure: Will you agree to no client signature required at new business or renewal?	Yes No		less important	organizational structure
		If no, please explain:		less important	organizational structure	RFI 10/Key Question 5
		Additional Information:		less important	organizational structure
19	In most cases, we require that your organization work directly with Gallagher Benefit Services rather than our client’s claims administrator (TPAs, BCBS plans, carriers, etc.) on such things as:	Agree Disagree		less important	organizational structure	RFI 11
10	Ø Renewals	If disagree, please explain:		less important	organizational structure
	Ø Specific & Aggregate contract concerns
	Ø Plan Document/SPD adoption / approval	Additional Information:		less important	organizational structure
	Ø Plan amendments
20	Does your stop loss policy contain an Actively at Work provision?	Yes No
		If yes, please explain:				RFI 14/Key Question 8
		Additional Information:			terms
21	Waive Active at Work: On new business and renewals, do you agree to waive actively at work for covered employees and dependents per the employer's plan document other than any lasers put in place on new business?	Agree Disagree		less important	organizational structure
		If disagree, please explain:				RFI 13/Key Question 10
		Additional Information:
22	If a client acquires a new company during the contract year, do you agree to waive the actively at work, dependent non-confinement and pre-existing condition limitation provisions for the newly acquired employees, their dependents, spouses, domestic partners, FMLA, retirees (if applicable), and COBRA beneficiaries?	Agree Disagree				RFI 18
		If disagree, please explain:
		Additional Information:			terms
23	Firm Rate Guarantee: Will you commit to a rate guarantee at least 3 months prior to effective date and for public sector more than 3 months?	Yes No
		If no, please explain:				RFI 14/Key Question 8
		Additional Information:			terms
	How many months of claims are needed to produce an illustrative quote and a firm quote?	Details:				New
24	Laser Policy: Do you agree to offer a no new lasers at renewal option? If yes, at what cost and under what terms?	Yes No				RFI 15/Key Question 2
		If yes, please explain:
		Additional Information:			terms
25	Rate Cap Guarantee at Renewal: Will you offer a rate cap at renewal? If yes, please provide details including any additional cost.	Yes No
		If yes, please explain:				Key Question 3
		Additional Information:
	What various rate caps are offered? 35%, 40% etc.	Details:				New
26	What fees will be considered as part of claims (example, shared savings fees, negotiated savings, and state surcharges)	Details:				RFI 16
27	Will you allow “non-covered” alternative care, if approved by your case managers or negotiated as part of an out of network cost negotiation?	Yes No			terms	RFI 17
		If no, please explain:
		Additional Information:			terms
28	Do you offer advance funding or quick pay options for stop loss claims? If yes, please provide details including any additional cost.	Yes No Specific
		Yes No Aggregate				RFI 19
		If yes, please explain:
		Additional Information:			terms
29	Dividend Eligible: Do you offer the potential for a client dividend? If yes, please explain and note any additional costs? (Include any renewal requirements)	Yes No
		If yes, please explain:		changed wording slightly.	terms	Key Question 4
		Additional Information:
30	Changes in Rates and Terms: Do you agree to no change in rates or terms unless the nature of the risk is impacted by 15% or more from changes in enrollment, benefits, networks, and/or claim administrators?	Agree Disagree
		If disagree, please explain:				Key Question 6
		Additional Information:			terms
31	Specific Coverage Maximums: All GBS clients must have unlimited specific coverage maximums. Do you agree to this?	Agree Disagree
		If disagree, please explain:			terms	Key Question 9
		Additional Information:			terms
32	When do you require notification of a specific claim?	% of Specific Deductible or
		Amount of Claim, or				RFI 20
		Or other, please explain:
		Additional Information:		Less important	terms
	How often do you require aggregate claim reporting information?	Details:				RFI 21
	What is the timing for filing of an aggregate claim?	Details:				RFI 21
	What is the timing for filing of an specific claim?	Details:				RFI 21
	How is the claim filing period extended due to COVID-19 ("Outbreak Period" or other extensions)	Details:				RFI 21
	Define specific deductible claim accumulation definition vis-à-vis individual v family?	Details:				RFI 21
33	Will you guarantee you are responsible for getting claims data directly from the payor?	Yes No			organizational structure	RFI 8
		If no, then please explain.
		Additional Information:
34	BUCA Reconciliation: Will you commit to reconcile issues with BUCA's?	Yes No
		If no, please explain:				Key Question 7 (split into 2 questions)
		Additional Information:		less important	terms
35	Who are your preferred TPA's? Will you commit to reconcile issues with them?	Preferred TPA's
		Yes No
		If no, please explain:		less important/all typically have this	terms	New
		Additional Information:
36	Do you offer any special contract provisions or features (please include potential cost)?	Details:				New
37	If you cover hospitals then what is your domestic reimbursement percentage?	Details:				New
38	Does your organization offer “preferred provider network” pricing based upon the client’s network(s)?	Details:				New
	If yes, provide a listing of the preferred provider networks your organization has rated; identify the status level for each and the associated percentage of savings discount.
Details:				New
39	Are there any networks ineligible?	Details:				New
40	How are you effectively managing large claims?	Details:				New
41	How many business days, on average, does it take to underwrite stop loss for a group? Does the amount of time change during peak season?	Details:				New
42	Will you offer 2, 3, 4 and 5 tier quote options when requested?	Details:				New
				less important/all typically have this	terms
HEALTHCARE REFORM RELATED			RESPONSES
43	External Review Appeals	Please explain:
	Under health care reform, non-grandfathered plans must include an external review option. A claim filed in a timely manner (consistent with the requirement of the stop-loss policy) and denied by the claim administrator is subject to appeal. A claim properly incurred and adjudicated (denied) in one coverage period and subsequently appealed by the participant, including an external review, could easily extend beyond that coverage period.			Less important	procedure	RFI 22

How does your organization address claims that were denied in one coverage period and paid in another coverage period?
	less important	procedure

	I understand and hereby certify that all information provided in this RFI is true and correct.
	Questionnaire Completed By
(typed signature is acceptable)		marginally important/usually don't have issues	procedure
	Title
	Stop Loss Provider Name
	Date
	Email Address
	Phone Number
				procedure

Page &P mailto:rreeves@conroeisd.net Questionnaire

Medical Administration Questionnaire

Company Legal Business Name: __________________________________________________________________

Affirmation / discussion must be given on each of the following topics.
Section I - General Company Information
#	Question	Vendor Response
1.	Please confirm your organization will be ready to begin services on January 1, 2026.
2.	Indicate what year the company was founded.
3.	Describe the ownership structure.
4.	What is the total number of employer clients that you have for the services you are proposing? What is the average size of your client as well as the largest?
5.	What is the legal name of your organization as it should appear on the Agreement?
6.	What is the name of your parent organization if you have one?
7.	Please provide the main address, phone number, fax number, email address, web address for your company as well as your internal identification code for this RFP.
8.	Provide the contact information of the individual authorized to answer questions related to this RFP, including their name, title, physical address, direct office phone number, fax number, cell phone number and email address.
9.	To the extent applicable, are you now and will you remain duly licensed and in full compliance with all federal and state statutory administrative requirements?
10.	Do you agree to do what is necessary to execute an agreement within 30 days of award of service(s)?
11.	How many ISDs or other public institutions do you provide similar services for? What is the largest ISD you currently service?
12.	Provide three references for three current accounts comparable in size to the client (prefer public sector account, school district and/or Texas based references). Provide two former accounts lost in the past year also in comparable size to the client. Include reference contact name, office phone number and email address. Include the length of relationship, number of employees of the reference and services provided to the reference.
13.	Where will the account team be located?
14.	If you plan on using any third-party organizations please provide a detailed list of who will participate in the execution of the services you will provide as a part of your proposal response (name, nature of relationship, length of affiliation).
15.	Please provide the number of employees in your organization.
16.	Please provide the ratings of your company (A.M. Best, Moody's, Standard & Poor's).
17.	Have you recently been acquired or been involved with any mergers/acquisitions? If yes, please describe.
18.	Will you need to hire additional customer service personnel if awarded this business?
19.	Provide a detailed implementation plan, including action items and due dates. Include support for implementation and open enrollment
20.	Will you agree to comply with the proposed medical plan Performance Guarantees (as outlined in this RFP)? If you are unable to comply with the proposed guarantees, provide your alternate proposal.

Section II - Stop Loss
#	Question	Vendor Response
1	What type/list data files are required from the client's health plan administrators on a routine monthly and claim filing basis. Will there be any fees for integrating with files?
2	Discuss your renewal philosophy. Be specific as it relates to known ongoing large claims, high deductibles, lasering, rating up, exclusion, etc.
3	To your knowledge, has a renewal ever been denied solely due to claim experience?
4	Is this a 100% direct policy, a captive model, or is an MGU responsible for any claim risk?
5	Define an eligible "paid" claim. Will you adhere to the terms and conditions established by Aetna for member eligibility, benefit adjudication, and provider contractuals? What is your role in determining an eligible claim?
6	Define an eligible "pended" claim. How are year end incurred claims covered retroactively back to the contractual policy period; upon claim resolution, include timeframe limitations if any.
7	How are the answers to Questions 5 and 6 impacted by policy termination?
8	Please provide the definition of experimental procedures and note how this provision is interpreted for a claim approved for payment under the medical plan.
9	Does the proposal include any fiduciary protection in case of provider contractual or procedural reimbursement disputes/denials?
10	Do you offer Advanced Funding or Accelerated Funding options? If so, what is the cost to the base premium rate?
11	Do any capitated claim costs apply to claim accumulators
12	What fees will be considered as part of claims (example, shared savings fees)?

File details come from the government source that posted it. Updated Sep 24, 2025.