13-NISD 2026 Stop Loss Workbook.xlsx

XLSX spreadsheet 665 KB Posted Oct 22, 2025

Attached to: Medical and Pharmacy Reinsurance
Solicitation number: 2025-133
Issued by: Bexar County, Texas

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General Information

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

2. VENDOR HISTORY:

Self-Funded Medical with United Healthcare	Since 1/2024
Integrated Rx with Optum	Since 1/2024

3.	ELIGIBILITY:
	Full Time Employees (EEs) working 20+ hours per week. Grandfathered Retirees (5) and their dependents plans are covered. Northside ISD is solely responsible for determing eligibility for participation in the District's Employee Benefits Programs.

4. The District offers 6 medical plans. Please refer to the 2025 SBCs for additional information.

5. The District is requesting stop loss reinsurance quotes only.

6. Vendors are to propose all fees and premiums without commission.

7. All workbook pages (affirmation and BRIEF discussion response) past the 3rd tab (Proposal Specifications) must be completed and returned with your proposal.

8. The District does not want competing multiple proposals from the same vendor, so manage your internal proposal process to assure that one (1) proposal is presented.

9. 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.

&"-,Bold"&16NORTHSIDE ISD

STOPLOSS RFP WORKBOOK

Scope of Work Scope of Work

Please consider the following information / requirements for your proposal.
A.	Stop Loss Reinsurance Coverage
	Please quote the following ISLs: $400K, $500K, $600K, $750K, and $1M
	Please quote without TLO.
	Please quote both specific/individual and aggregate coverage.
	Please quote 115%, 120%, and 125% corridor.
	The following endorsements, riders or supplemental coverage are requested: Renewal Rate Cap, Individual Advanced Funding, Plan Mirroring Coordination, Gene Therapy

Proposal Specifications

Company Legal Business Name: __________________________________________________________________

All vendors must complete this section.
Proposal Specifications
#	Specification	Agree / Disagree
1.	The effective date of coverage (1/1/2026) is acknowledged and accepted.
2.	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.
3.	Stop Loss Contract basis: 15/12, 18/12 or Paid
4.	Stop Loss ISL options: $400K, $500K, $600K, $750K, and $1M
5.	Pharmacy is included in the Aggregate
6.	Include an overall composite rate covering all available medical plans.
7.	Corridor: 115%, 120%, and 125%
8.	Max Aggregate Annual Payment: Options of $5,000,000 and Unlimited
9.	Spec & Agg Advance Funding option. If there is a cost associated with it, please break it out in your proposal.
10.	Include Plan Mirroring option. If there is a cost associated with it, please break it out in your proposal.
11.	Renewal Rate Cap noted for each proposal, if included (preferred cap is 50%, no new lasers at renewal)
12.	Vendor must waive any “actively-at-work provisions"
13.	Vendor must waive any late entrant penalties
14.	Run-in shall not be limited
15.	Please include 12 months of run-out coverage in your rates
16.	Vendor must agree to no new lasers at renewal
17.	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.
18.	Vendor must agree to release the stop loss renewal proposal within 120 days of expiration

Stop Loss Pricing $400K option

	Stop Loss Pricing Spreadsheet
	Please record all answers on this excel spreadsheet
	Company Legal Business Name: _________________________________________________________________
	Plan Provisions		Current		Option 1		Option 2		Option 3
			1/1/25		1/1/26		1/1/26		1/1/26
			PEPM	Annual	PEPM	Annual	PEPM	Annual	PEPM	Annual
	VENDOR		UHC
	AM Best Fnancial Rating (required)
		# EE
	Administrative Fees	5560		$0		$0		$0		$0
	Coverages included for Specific \| Aggregate		Med/Rx	Med/Rx	Med/Rx	Med/Rx	Med/Rx	Med/Rx	Med/Rx	Med/Rx
	Individual Stop Loss Level		$500,000		$400,000		$400,000		$400,000
	Individual Policy Year Stop Loss Payment Limit		Unlimited
	Individual Lifetime Stop Loss Payment Limit		Unlimited
	Maximum Annual Aggregate Refund		$5,000,000
	Claim Accumulation Basis		Per Member
	Reimbursement Percentage		100%
	Contract Basis		12/12
	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 - Specific \| Aggregate		NA	NA
	Retirees Included		Yes
	INDIVIDUAL STOP LOSS PREMIUM
	Single	2504	$35.82	$1,076,319		$0		$0		$0
	Spouse			$0		$0		$0		$0
	Children			$0		$0		$0		$0
	Family	2330	$35.82	$1,001,527		$0		$0		$0
	Composite	4834	$35.82	$2,077,847	$0.00	$0	$0.00	$0	$0.00	$0
	AGGREGATE STOP LOSS PREMIUM
	Single	2504	$2.69	$80,829		$0		$0		$0
	Spouse	0	$0.00	$0		$0		$0		$0
	Children	0	$0.00	$0		$0		$0		$0
	Family	2330	$2.69	$75,212		$0		$0		$0
	Composite	4834	$2.69	$156,042	$0.00	$0	$0.00	$0	$0.00	$0
	TOTAL ANNUAL STOP LOSS PREMIUM		$38.51	$2,233,888	$0.00	$0	$0.00	$0	$0.00	$0
	Monthly Aggregate Deductible Factors		125% Corridor		115% Corridor		120% Corridor		125% Corridor
	Single	2504	$1,025.89	$30,825,943		$0		$0		$0
	Spouse	0	$1,025.89	$0		$0		$0		$0
	Children	0	$1,025.89	$0		$0		$0		$0
	Family	2330	$1,025.89	$28,683,884		$0		$0		$0
	Composite	4834	$1,484.68	$86,123,317	$0.00	$0	$0.00	$0	$0.00	$0
	TOTAL COMBINED ESTIMATED MAX LIABLITY	4834	$1,523.19	$88,357,206	$0.00	$0	$0.00	$0	$0.00	$0
	Lasers
Text is limited to 25 characters	1.	None	None	Enter Member Initials	Enter Laser Amount	Enter Member Initials	Enter Laser Amount	Enter Member Initials	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 $500K option

	Stop Loss Pricing Spreadsheet
	Please record all answers on this excel spreadsheet
	Company Legal Business Name: _________________________________________________________________
	Plan Provisions		Current		Option 1		Option 2		Option 3		Option 4
			1/1/25		1/1/26		1/1/26		1/1/26		1/1/26
			PEPM	Annual	PEPM	Annual	PEPM	Annual	PEPM	Annual	PEPM	Annual
	VENDOR		UHC
	AM Best Fnancial Rating (required)
		# EE
	Administrative Fees	5560		$0		$0		$0		$0		$0
	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
	Individual Stop Loss Level		$500,000		$500,000		$500,000		$500,000		$500,000
	Individual Policy Year Stop Loss Payment Limit		Unlimited
	Individual Lifetime Stop Loss Payment Limit		Unlimited
	Maximum Annual Aggregate Refund		$5,000,000
	Claim Accumulation Basis		Per Member
	Reimbursement Percentage		100%
	Contract Basis		12/12
	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 - Specific \| Aggregate		NA	NA
	Retirees Included		Yes
	INDIVIDUAL STOP LOSS PREMIUM
	Single	2504	$35.82	$1,076,319		$0		$0		$0		$0
	Spouse			$0		$0		$0		$0		$0
	Children			$0		$0		$0		$0		$0
	Family	2330	$35.82	$1,001,527		$0		$0		$0		$0
	Composite	4834	$35.82	$2,077,847	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	AGGREGATE STOP LOSS PREMIUM
	Single	2504	$2.69	$80,829		$0		$0		$0		$0
	Spouse	0	$0.00	$0		$0		$0		$0		$0
	Children	0	$0.00	$0		$0		$0		$0		$0
	Family	2330	$2.69	$75,212		$0		$0		$0		$0
	Composite	4834	$2.69	$156,042	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	TOTAL ANNUAL STOP LOSS PREMIUM		$38.51	$2,233,888	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	Monthly Aggregate Deductible Factors		125% Corridor		115% Corridor		120% Corridor		125% Corridor		125% Corridor
	Single	2504	$1,025.89	$30,825,943		$0		$0		$0		$0
	Spouse	0	$1,025.89	$0		$0		$0		$0		$0
	Children	0	$1,025.89	$0		$0		$0		$0		$0
	Family	2330	$1,025.89	$28,683,884		$0		$0		$0		$0
	Composite	4834	$1,484.68	$86,123,317	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	TOTAL COMBINED ESTIMATED MAX LIABLITY	4834	$1,523.19	$88,357,206	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	Lasers
Text is limited to 25 characters	1.	None	None	Enter Member Initials	Enter Laser Amount	Enter Member Initials	Enter Laser Amount	Enter Member Initials	Enter Laser Amount	Enter Member Initials	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 $600K opt

	Stop Loss Pricing Spreadsheet
	Please record all answers on this excel spreadsheet
	Company Legal Business Name: _________________________________________________________________
	Plan Provisions		Current		Option 1		Option 2		Option 3		Option 4
			1/1/25		1/1/26		1/1/26		1/1/26		1/1/26
			PEPM	Annual	PEPM	Annual	PEPM	Annual	PEPM	Annual	PEPM	Annual
	VENDOR		UHC
	AM Best Fnancial Rating (required)
		# EE
	Administrative Fees	5560		$0		$0		$0		$0		$0
	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
	Individual Stop Loss Level		$500,000		$600,000		$600,000		$600,000		$600,000
	Individual Policy Year Stop Loss Payment Limit		Unlimited
	Individual Lifetime Stop Loss Payment Limit		Unlimited
	Maximum Annual Aggregate Refund		$5,000,000
	Claim Accumulation Basis		Per Member
	Reimbursement Percentage		100%
	Contract Basis		12/12
	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 - Specific \| Aggregate		NA	NA
	Retirees Included		Yes
	INDIVIDUAL STOP LOSS PREMIUM
	Single	2504	$35.82	$1,076,319		$0		$0		$0		$0
	Spouse			$0		$0		$0		$0		$0
	Children			$0		$0		$0		$0		$0
	Family	2330	$35.82	$1,001,527		$0		$0		$0		$0
	Composite	4834	$35.82	$2,077,847	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	AGGREGATE STOP LOSS PREMIUM
	Single	2504	$2.69	$80,829		$0		$0		$0		$0
	Spouse	0	$0.00	$0		$0		$0		$0		$0
	Children	0	$0.00	$0		$0		$0		$0		$0
	Family	2330	$2.69	$75,212		$0		$0		$0		$0
	Composite	4834	$2.69	$156,042	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	TOTAL ANNUAL STOP LOSS PREMIUM		$38.51	$2,233,888	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	Monthly Aggregate Deductible Factors		125% Corridor		115% Corridor		120% Corridor		125% Corridor		125% Corridor
	Single	2504	$1,025.89	$30,825,943		$0		$0		$0		$0
	Spouse	0	$1,025.89	$0		$0		$0		$0		$0
	Children	0	$1,025.89	$0		$0		$0		$0		$0
	Family	2330	$1,025.89	$28,683,884		$0		$0		$0		$0
	Composite	4834	$1,484.68	$86,123,317	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	TOTAL COMBINED ESTIMATED MAX LIABLITY	4834	$1,523.19	$88,357,206	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	Lasers
Text is limited to 25 characters	1.	None	None	Enter Member Initials	Enter Laser Amount	Enter Member Initials	Enter Laser Amount	Enter Member Initials	Enter Laser Amount	Enter Member Initials	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 $750K

	Stop Loss Pricing Spreadsheet
	Please record all answers on this excel spreadsheet
	Company Legal Business Name: _________________________________________________________________
	Plan Provisions		Current		Option 1		Option 2		Option 3		Option 4
			1/1/25		1/1/26		1/1/26		1/1/26		1/1/26
			PEPM	Annual	PEPM	Annual	PEPM	Annual	PEPM	Annual	PEPM	Annual
	VENDOR		UHC
	AM Best Fnancial Rating (required)
		# EE
	Administrative Fees	5560		$0		$0		$0		$0		$0
	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
	Individual Stop Loss Level		$500,000		$750,000		$750,000		$750,000		$750,000
	Individual Policy Year Stop Loss Payment Limit		Unlimited
	Individual Lifetime Stop Loss Payment Limit		Unlimited
	Maximum Annual Aggregate Refund		$5,000,000
	Claim Accumulation Basis		Per Member
	Reimbursement Percentage		100%
	Contract Basis		12/12
	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 - Specific \| Aggregate		NA	NA
	Retirees Included		Yes
	INDIVIDUAL STOP LOSS PREMIUM
	Single	2504	$35.82	$1,076,319		$0		$0		$0		$0
	Spouse			$0		$0		$0		$0		$0
	Children			$0		$0		$0		$0		$0
	Family	2330	$35.82	$1,001,527		$0		$0		$0		$0
	Composite	4834	$35.82	$2,077,847	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	AGGREGATE STOP LOSS PREMIUM
	Single	2504	$2.69	$80,829		$0		$0		$0		$0
	Spouse	0	$0.00	$0		$0		$0		$0		$0
	Children	0	$0.00	$0		$0		$0		$0		$0
	Family	2330	$2.69	$75,212		$0		$0		$0		$0
	Composite	4834	$2.69	$156,042	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	TOTAL ANNUAL STOP LOSS PREMIUM		$38.51	$2,233,888	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	Monthly Aggregate Deductible Factors		125% Corridor		115% Corridor		120% Corridor		125% Corridor		125% Corridor
	Single	2504	$1,025.89	$30,825,943		$0		$0		$0		$0
	Spouse	0	$1,025.89	$0		$0		$0		$0		$0
	Children	0	$1,025.89	$0		$0		$0		$0		$0
	Family	2330	$1,025.89	$28,683,884		$0		$0		$0		$0
	Composite	4834	$1,484.68	$86,123,317	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	TOTAL COMBINED ESTIMATED MAX LIABLITY	4834	$1,523.19	$88,357,206	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	Lasers
Text is limited to 25 characters	1.	None	None	Enter Member Initials	Enter Laser Amount	Enter Member Initials	Enter Laser Amount	Enter Member Initials	Enter Laser Amount	Enter Member Initials	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 $1M

	Stop Loss Pricing Spreadsheet
	Please record all answers on this excel spreadsheet
	Company Legal Business Name: _________________________________________________________________
	Plan Provisions		Current		Option 1		Option 2		Option 3		Option 4
			1/1/25		1/1/26		1/1/26		1/1/26		1/1/26
			PEPM	Annual	PEPM	Annual	PEPM	Annual	PEPM	Annual	PEPM	Annual
	VENDOR		UHC
	AM Best Fnancial Rating (required)
		# EE
	Administrative Fees	5560		$0		$0		$0		$0		$0
	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
	Individual Stop Loss Level		$500,000		$1,000,000		$1,000,000		$1,000,000		$1,000,000
	Individual Policy Year Stop Loss Payment Limit		Unlimited
	Individual Lifetime Stop Loss Payment Limit		Unlimited
	Maximum Annual Aggregate Refund		$5,000,000
	Claim Accumulation Basis		Per Member
	Reimbursement Percentage		100%
	Contract Basis		12/12
	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 - Specific \| Aggregate		NA	NA
	Retirees Included		Yes
	INDIVIDUAL STOP LOSS PREMIUM
	Single	2504	$35.82	$1,076,319		$0		$0		$0		$0
	Spouse			$0		$0		$0		$0		$0
	Children			$0		$0		$0		$0		$0
	Family	2330	$35.82	$1,001,527		$0		$0		$0		$0
	Composite	4834	$35.82	$2,077,847	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	AGGREGATE STOP LOSS PREMIUM
	Single	2504	$2.69	$80,829		$0		$0		$0		$0
	Spouse	0	$0.00	$0		$0		$0		$0		$0
	Children	0	$0.00	$0		$0		$0		$0		$0
	Family	2330	$2.69	$75,212		$0		$0		$0		$0
	Composite	4834	$2.69	$156,042	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	TOTAL ANNUAL STOP LOSS PREMIUM		$38.51	$2,233,888	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	Monthly Aggregate Deductible Factors		125% Corridor		115% Corridor		120% Corridor		125% Corridor		125% Corridor
	Single	2504	$1,025.89	$30,825,943		$0		$0		$0		$0
	Spouse	0	$1,025.89	$0		$0		$0		$0		$0
	Children	0	$1,025.89	$0		$0		$0		$0		$0
	Family	2330	$1,025.89	$28,683,884		$0		$0		$0		$0
	Composite	4834	$1,484.68	$86,123,317	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	TOTAL COMBINED ESTIMATED MAX LIABLITY	4834	$1,523.19	$88,357,206	$0.00	$0	$0.00	$0	$0.00	$0	$0.00	$0
	Lasers
Text is limited to 25 characters	1.	None	None	Enter Member Initials	Enter Laser Amount	Enter Member Initials	Enter Laser Amount	Enter Member Initials	Enter Laser Amount	Enter Member Initials	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

Sheet5 (13)

File details come from the government source that posted it. Updated May 1, 2026.