18-4. Attachment E - Vendor Workbook Response.xlsx
XLSX spreadsheet 2 MB Posted
- Attached to
- 27-002V Stop Loss Insurance
- Solicitation number
- 27-002V
- Issued by
- Savannah CDP, Texas
About this file
Stop Loss Insurance Vendor Workbook Response
This is a vendor workbook response template for stop loss insurance coverage issued by Schertz-Cibolo-Universal City Independent School District (ISD) in Texas, with assistance from Foundation Risk Partners, d/b/a Corporate Synergies. The District seeks stop loss reinsurance coverage with an effective date of January 1, 2027, for a one-year contract term with one optional one-year renewal. The proposal requires vendors to quote three Individual Stop Loss (ISL) deductible options of $200,000, $250,000, and $300,000 with a 24/12 contract basis and 120% corridor. The workbook consists of ten sections including General Information, Scope of Work, Proposal Specifications, Deviations, pricing for each option level, a Stop Loss Request for Information, and a Medical Administration Questionnaire. All workbook sections must be completed and returned with proposals, along with an Executive Summary, in the prescribed template format. The District will transition from its current United Healthcare/Aetna and Express Scripts arrangement to Sage TPA effective January 1, 2027, while maintaining a two-tier plan structure covering full-time employees and variable employees working at least 18.5 hours per week, excluding retirees.
Pricing proposals must include both Individual and Aggregate Stop Loss premiums on a per-member-per-month and annual basis for Single, Spouse, Children, Family, and Composite coverage categories. The maximum annual aggregate refund options are $1,000,000 and Unlimited, with 100% reimbursement and per-member claim accumulation basis. Vendors must waive actively-at-work provisions, late entrant penalties, and agree to unlimited run-in coverage with no new lasers at renewal. Spec and Aggregate Advance Funding options and Plan Mirroring options must be quoted separately if additional costs apply. XL Benefits serves as the Stop Loss General Agent and should receive standard General Agent Compensation; no commission should be built into proposals for Corporate Synergies. Vendors must acknowledge understanding that RFP responses will be incorporated into the overall contract and must agree to release renewal proposals within 120 days of expiration. Preliminary renewal rates must be submitted six months prior to the effective date, and the District requires a dedicated reporting contact for ad hoc reporting at no additional cost, HIPAA compliance, 90-day termination notice provisions, and the ability to terminate coverage at any time without penalties.
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Cover
| ATTACHMENT E |
| VENDOR WORKBOOK RESPONSE |
Workbook tabs include:
| 1. Cover Sheet |
| 2. General Information |
| 3. Scope of Work |
| 4. Proposal Specifications |
| 5. Deviations Tab |
| 6. Option 1 - Stop Loss Pricing $200K |
| 7. Option 2 - Stop Loss Pricing $250K |
| 8. Option 3 - Stop Loss Pricing $300K |
| 9. Stop Loss Request for Information (RFI) |
| 10. Medical Administration Questionnaire |
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&"Arial,Regular"&7 © 2018 ARTHUR J. GALLAGHER & CO. &"Arial,Regular"&7AJG.COM
General Information
| General Information | ||
| Please consider the following information for your proposal. | ||
| 1. | EFFECTIVE DATE: | January 1, 2027 |
2. CONTRACT DURATION: 1-year with one (1) additional, 1-year renewal option. Please note that the district completed a 12-month contract period from September 1, 2024 through August 31, 2025, followed by a four-month renewal period to align the health plan with a January 1 effective date. This transition was designed to position the plan for a calendar-year renewal cycle beginning January 1, 2026.
3. VENDOR HISTORY: United Healthcare (UHC) since 2016. The current medical plan administrator is Aetna, with Express Scripts (ESI) providing pharmacy benefit management services effective September 1, 2024. Effective January 1, 2027, the District will transition to Sage TPA and will continue utilizing a two-tier plan structure. Tier 1 will utilize the EHN network with ClaimsBridge and a reimbursement target of 150% of Medicare. Tier 2 will utilize HealthSmart professional providers with reimbursement at 200% of Medicare on a cash-pay basis. In addition, the District will implement Rx Valet to oversee international sourcing and cost-containment strategies for prescription medications.
| 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 District has two (2) current Aetna/ESI Plans. See Exhibits D-1 and D-2 for information regarding the 2026 SBCs. Effective January 1, 2027 the District will continue to have two (2) plans through Sage. The District will consider these models for weighted average scoring.
| 7. | While no commission should be built into your stop loss proposal for Corporate Synergies, please note that XL Benefits is serving as the Stop Loss General Agent. XL Benefits should be provided standard General Agent Compensation. |
| 8. | All reporting files and other supporting documentation can be found attached to the bid posting. |
| 9. | All workbook pages must be completed and returned with your proposal. |
| 10. | 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. |
| 11. | 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. |
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© 2018 ARTHUR J. GALLAGHER &"Arial,Regular"&7AJG.COM
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: 24/12 | |
| Corridor: 120% | |
| Include ASL |
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© 2018 ARTHUR J. GALLAGHER &"Arial,Regular"&7AJG.COM
Proposal Specifications
| 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, 2027 is acknowledged and accepted. | |
| 2 | While no commission should be built into your stop loss proposal for Corporate Synergies, please note that XL Benefits is serving as the Stop Loss General Agent. XL Benefits should be provided standard General Agent Compensation. | |
| 3 | Preliminary renewal rates must be submitted six months prior to the effective date. | |
| 4 | You completed all sections of the workbook in their entirety, in the format requested. | |
| 5 | Vendor agrees to provide all communication materials in electronic (pdf) format. | |
| 6 | 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. | |
| 7 | You have reviewed and accept the Plan’s eligibility provisions. | |
| 8 | 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. | |
| 9 | 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. | |
| 10 | 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. | |
| 11 | You must permit the employer to have access to all files on request (e.g., a claims audit). | |
| 12 | 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. | |
| 13 | Stop Loss Contract basis:24/12 | |
| 14 | Stop Loss ISL options: $200,000, $250,000, and $300,000 | |
| 15 | Pharmacy is included in the Aggregate | |
| 16 | Include an overall composite rate covering all available medical plans. | |
| 17 | Corridor: 120% | |
| 18 | Max Aggregate Annual Payment: Options of $1,000,000 and Unlimited | |
| 19 | Spec & Agg Advance Funding option. If there is a cost associated with it, please break it out in your proposal. | |
| 20 | Include Plan Mirroring option. If there is a cost associated with it, please break it out in your proposal. | |
| 21 | Vendor must waive any “actively-at-work provisions | |
| 22 | Vendor must waive any late entrant penalties | |
| 23 | Run-in should not be limited | |
| 24 | Vendor must agree to no new lasers at renewal. | |
| 25 | 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. | |
| 26 | Vendor must agree to release the stop loss renewal proposal within 120 days of expiration | |
| 27 | The client intends to include your RFP responses as part of the overall Contract. Please acknowledge you understand and agree to this expectation. |
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© 2018 ARTHUR J. GALLAGHER &"Arial,Regular"&7AJG.COM
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 |
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© 2018 ARTHUR J. GALLAGHER &"Arial,Regular"&7AJG.COM
Stop Loss Pricing $200K
| Stop Loss Pricing Spreadsheet | ||||||
| Please record all answers on this excel spreadsheet | ||||||
| Company Legal Business Name: _________________________________________________________________ | ||||||
| Plan Provisions | Current | |||||
| Sun Life | Option 1 | |||||
| 1/1/26 | 1/1/27 | |||||
| PEPM | Annual | PEPM | Annual | |||
| Network: | Aetna ACO & PPO | |||||
| # EE | ||||||
| Coverages included for Specific | Aggregate | Med/Rx | Med/Rx | Med/Rx | Med/Rx | ||
| Individual Stop Loss Level | $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 | 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 | 844 | $61.93 | $627,227 | $0 | ||
| Spouse | $0 | $0 | ||||
| Children | $0 | $0 | ||||
| Family | 378 | $189.59 | $859,980 | $0 | ||
| Composite | 1222 | $101.42 | $1,487,207 | $0.00 | $0 | |
| AGGREGATE STOP LOSS PREMIUM | ||||||
| Single | 844 | $3.10 | $31,397 | $0 | ||
| Spouse | 0 | $0 | $0 | |||
| Children | 0 | $0 | $0 | |||
| Family | 378 | $3.10 | $14,062 | $0 | ||
| Composite | 1222 | $3.10 | $45,458 | $0.00 | $0 | |
| TOTAL ANNUAL STOP LOSS PREMIUM | $104.52 | $1,532,666 | $0.00 | $0 | ||
| Expected Claims | ||||||
| Single | 844 | $469.13 | $4,751,298 | $0.00 | $0 | |
| Spouse | 0 | $0.00 | $0 | $0.00 | $0 | |
| Children | 378 | $0.00 | $0 | $0.00 | $0 | |
| Family | 378 | $1,313.58 | $5,958,376 | $0.00 | $0 | |
| Composite | 1222 | $730.34 | $10,709,674 | $0.00 | $0 | |
| Monthly Aggregate Deductible Factors | 120% Corridor | 120% Corridor | ||||
| Single | 844 | $562.95 | $5,701,558 | $0 | ||
| Spouse | 0 | $0 | $0 | |||
| Children | 378 | $0 | $0 | |||
| Family | 378 | $1,576.29 | $7,150,051 | $0 | ||
| Composite | 1222 | $876.41 | $12,851,609 | $0.00 | $0 | |
| Minimum Attachment Point | 100% | $12,851,609 | $0 | |||
| TOTAL COMBINED ESTIMATED MAX LIABLITY | 1222 | $980.92 | $14,384,275 | $0.00 | $0 | |
| Lasers | ||||||
| Text is limited to 25 characters | 1. | None | None | 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 | |||||
| Sun Life | Option 1 | |||||
| 1/1/26 | 1/1/27 | |||||
| PEPM | Annual | PEPM | Annual | |||
| Network: | Aetna ACO & PPO | |||||
| # EE | ||||||
| Coverages included for Specific | Aggregate | Med/Rx | Med/Rx | Med/Rx | Med/Rx | ||
| Individual Stop Loss Level | $200,000 | $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 | 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 | 844 | $61.93 | $627,227 | $0 | ||
| Spouse | $0 | $0 | ||||
| Children | $0 | $0 | ||||
| Family | 378 | $189.59 | $859,980 | $0 | ||
| Composite | 1222 | $101.42 | $1,487,207 | $0.00 | $0 | |
| AGGREGATE STOP LOSS PREMIUM | ||||||
| Single | 844 | $3.10 | $31,397 | $0 | ||
| Spouse | 0 | $0 | $0 | |||
| Children | 0 | $0 | $0 | |||
| Family | 378 | $3.10 | $14,062 | $0 | ||
| Composite | 1222 | $3.10 | $45,458 | $0.00 | $0 | |
| TOTAL ANNUAL STOP LOSS PREMIUM | $104.52 | $1,532,666 | $0.00 | $0 | ||
| Expected Claims | ||||||
| Single | 844 | $469.13 | $4,751,298 | $0.00 | $0 | |
| Spouse | 0 | $0.00 | $0 | $0.00 | $0 | |
| Children | 378 | $0.00 | $0 | $0.00 | $0 | |
| Family | 378 | $1,313.58 | $5,958,376 | $0.00 | $0 | |
| Composite | 1222 | $730.34 | $10,709,674 | $0.00 | $0 | |
| Monthly Aggregate Deductible Factors | 120% Corridor | 120% Corridor | ||||
| Single | 844 | $562.95 | $5,701,558 | $0 | ||
| Spouse | 0 | $0 | $0 | |||
| Children | 378 | $0 | $0 | |||
| Family | 378 | $1,576.29 | $7,150,051 | $0 | ||
| Composite | 1222 | $876.41 | $12,851,609 | $0.00 | $0 | |
| Minimum Attachment Point | 100% | $12,851,609 | $0 | |||
| TOTAL COMBINED ESTIMATED MAX LIABLITY | 1222 | $980.92 | $14,384,275 | $0.00 | $0 | |
| Lasers | ||||||
| Text is limited to 25 characters | 1. | None | None | 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 | |||||
| Sun Life | Option 1 | |||||
| 1/1/26 | 1/1/27 | |||||
| PEPM | Annual | PEPM | Annual | |||
| Network: | Aetna ACO & PPO | |||||
| # EE | ||||||
| Coverages included for Specific | Aggregate | Med/Rx | Med/Rx | Med/Rx | Med/Rx | ||
| Individual Stop Loss Level | $200,000 | $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 | 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 | 844 | $61.93 | $627,227 | $0 | ||
| Spouse | $0 | $0 | ||||
| Children | $0 | $0 | ||||
| Family | 378 | $189.59 | $859,980 | $0 | ||
| Composite | 1222 | $101.42 | $1,487,207 | $0.00 | $0 | |
| AGGREGATE STOP LOSS PREMIUM | ||||||
| Single | 844 | $3.10 | $31,397 | $0 | ||
| Spouse | 0 | $0 | $0 | |||
| Children | 0 | $0 | $0 | |||
| Family | 378 | $3.10 | $14,062 | $0 | ||
| Composite | 1222 | $3.10 | $45,458 | $0.00 | $0 | |
| TOTAL ANNUAL STOP LOSS PREMIUM | $104.52 | $1,532,666 | $0.00 | $0 | ||
| Expected Claims | ||||||
| Single | 844 | $469.13 | $4,751,298 | $0.00 | $0 | |
| Spouse | 0 | $0.00 | $0 | $0.00 | $0 | |
| Children | 378 | $0.00 | $0 | $0.00 | $0 | |
| Family | 378 | $1,313.58 | $5,958,376 | $0.00 | $0 | |
| Composite | 1222 | $730.34 | $10,709,674 | $0.00 | $0 | |
| Monthly Aggregate Deductible Factors | 120% Corridor | 120% Corridor | ||||
| Single | 844 | $562.95 | $5,701,558 | $0 | ||
| Spouse | 0 | $0 | $0 | |||
| Children | 378 | $0 | $0 | |||
| Family | 378 | $1,576.29 | $7,150,051 | $0 | ||
| Composite | 1222 | $876.41 | $12,851,609 | $0.00 | $0 | |
| Minimum Attachment Point | 100% | $12,851,609 | $0 | |||
| TOTAL COMBINED ESTIMATED MAX LIABLITY | 1222 | $980.92 | $14,384,275 | $0.00 | $0 | |
| Lasers | ||||||
| Text is limited to 25 characters | 1. | None | None | 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
| Foundation Risk, dba. Corporate Synergies | 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 Texas? | 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 | Who has final claim decision-making authority with respect to specific and aggregate claims? | Details: | organizational structure | RFI 9 | ||
| 8 | 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 | ||||||
| 9 | How many stop loss clients do you currently have with Foundation Risk, dba. Corporate Synergies and what is the annualized premium? | # of Clients | organizational structure | New | ||
| Annualized premium | ||||||
| 10 | 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 | ||||
| 11 | In most cases, we require that your organization work directly with Foundation Risk, dba. Corporate Synergies 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 | ||||||
| 12 | 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 | |||||
| 13 | 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: | ||||||
| 14 | 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 | |||||
| 15 | 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 | ||||
| 16 | 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 | |||||
| 17 | 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 | ||||
| 18 | What fees will be considered as part of claims (example, shared savings fees, negotiated savings, and state surcharges) | Details: | RFI 16 | |||
| 19 | 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 | |||||
| 20 | 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: | ||||||
| 21 | 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 | |||||
| 22 | 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 | ||||
| 23 | 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: | ||||||
| 24 | 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: | ||||||
| 25 | Do you offer any special contract provisions or features (please include potential cost)? | Details: | New | |||
| 26 | Are there any networks ineligible? | Details: | New | |||
| 27 | 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 | |||
| 28 | 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 | |||||
| 29 | 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, 2027. | |
| 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)? |
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