2-2. Stop Loss RFP for 2027 Scope of Work.pdf

REQUEST FOR PROPOSAL

Stop Loss Reinsurance

RFP #200-27 MRH

Effective Start Date January 1, 2027

Contract Term The contract term for Stop Loss Reinsurance will be January 1, 2027, through December 31, 2027.

RFP SCOPE OF WORK

General Information The City of Amarillo (“the City”) currently makes available to its employees a self-funded plan of medical and dental benefits.

At this time, by means of this Request for Proposal ("this RFP"), the City is seeking proposals from qualified persons or entities who can provide the following services, as more fully described in this RFP (the "Services") for a January 1, 2027, effective date.

Our current provider is PartnerRe America Insurance Company.

Approximate Timeline

Issuance of RFP Tuesday, October 13, 2026 @ 8:00am Deadline for RFP Questions Monday, October 26, 2026 @ 3:00pm Proposal Due Date Thursday, November 5, 2026 @ 3:00pm

The City of Amarillo is seeking qualified proposers to provide the services for Individual Stop-Loss coverage for medical and prescription drug coverage, in accordance with local, state and federal laws. You may submit a response for the service requested. Your response should indicate pricing for each service along with the required additional items for review and evaluation.

Scope of work shall include, but not be limited to the following:

The ability to timely reimburse the City for eligible claims expenses in excess of the stop loss deductible. The City is also interested in any other services that are available as a result of being a customer, such as access to Centers of Excellence and Transplant networks, or other value-added services.

Overview of Administrative Requirements Your proposal’s response should be based on the following assumptions:

Rates and Fees

Quotes shall be provided net of fees, taxes and commissions.

All fees should be guaranteed on a per employee per month (PEPM) basis for all services.

Fee/Billing Administration Proposers should invoice The City on a prospective basis.

Plan Year January 1 through December 31. However, The City reserves the right to change the plan year time frame in the future.

Proposed Plan Options No changes in calendar year 2027.

Stop Loss Coverage Stop Loss coverage is currently provided by PartnerRe America Insurance Company. The Individual Stop Loss deductible is $750,000 and the terms of the agreement are currently based upon a 24/12 contract. Please refer to the documentation provided in the Exhibits section.

Aetna will remain as the Health Plan administrator and RxBenefits, Inc., with OptumRx will remain as the Pharmacy Benefit Manager for 2027.

Proposers should illustrate offers on a 24/12 basis including coverage for medical and prescription drugs for the following deductibles - $750,000, $800,000, and $850,000. Each quotation should include an option for no new lasers upon renewal, as indicated in the rate tab of the questionnaire (Attachment G). The City does not purchase aggregate coverage. This is for a one-year contract term from January 1, 2027, through December 31, 2027.

RFP RESPONSE ELEMENTS AND FORMAT

Questionnaire Response A detailed questionnaire is provided in an Excel file attachment in Attachment G. All appropriate tabs related to your response should be completed. Response lengths are restricted in the file; however additional information may be provided to supplement the response in a separate attachment. Responses in the separate attachment should clearly identify the question being responded to. Your response to the Questionnaire must be returned in an Excel File Format.

Respondent’s submittal should demonstrate the following:

Purchase Price and Discount, Quality of Vendors Goods, Extent to Which the Goods or Services Meet the City’s Needs, Vendors Past Relationship with the City, Any Other Relevant Factor(s) Specifically List in the Request for Proposal, and Reputation of the Vendor and of the Vendor’s Goods and Services.

Pricing A detailed questionnaire is provided in an Excel file attachment in Attachment G and there is a tab Stop Loss Rates for pricing information. Firm and final rates are based on claims data provided in Attachment F. Commissions are not to be included.

BASIS OF PROPOSALS AND SELECTION CRITERIA

The City uses the Competitive Sealed Proposals procurement method as authorized by the Texas Legislature and further defined by Texas Government Code Section 2269. The Maximum Point value is equal to 100 points. The weight factor is 40 points for Price, 20 points for Quality of Vendors Goods, 20 points for Extent to Which the Goods or Services Meet The City’s Needs, and 10 points for Vendors Past Relationship with The City, 5 points for Any Other Relevant Factor(s) Specifically Listed in the Request for Proposals, and 5 points for Reputation of the Vendor and of the Vendor’s Goods and Services. The selection criteria used to evaluate each proposal include the following:

[40 POINTS] - PRICE: Purchase price [including without limitation, as applicable to a particular category of Services, price competitiveness, any extended rate, fee or financial guarantees, and other financial arrangements such as guaranteed cost contracts].

[20 POINTS] – QUALTY OF THE VENDOR’S GOODS OR SERVICES: Quality of the Proposer's services [including without limitation, as applicable to a particular category of Services, the quality of service, staff experience, claims processing organization and procedures, management information reporting capabilities, and claims turnaround time].

[20 POINTS] – EXTENT TO WHICH THE GOODS OR SERVICES MEET THE CITY’S NEEDS: Extent to which the services in a proposal meet the City’s needs, including without limitation, as applicable to a particular category of Services, responsiveness to the terms, conditions, and specifications contained in this RFP, the willingness and ability of the Proposer to work well with the current claims administrators, Aetna for Medical Claims Administration and RxBenefits, Inc., with OptumRx for Prescription Drug Administration.

[10 POINTS] – VENDOR’S PAST RELATIONSHIP WITH THE CITY: Past relationship of the Proposer with the City [in this regard, the non-existence of a prior relationship with the City will have a median value, with deductions or additions thereto for poor or good past relationships respectively].

[5 POINTS] – ANY OTHER RELEVANT FACTOR(S) SPECIFICALLY LISTED IN THE REQUEST

FOR PROPOSALS: The completeness of the proposal, the impact on the ability of the City to comply with applicable laws and rules, if any, relating to historically underutilized businesses [however, the City is not currently aware of any such laws or rules applicable in this instance].

[5 POINTS] – REPUTATION OF THE VENDOR AND OF THE VENDOR’S GOODS AND SERVICES:

Reputation of the Proposer and of the Proposer's services [including without limitation the Proposer's references, and the financial strength, stature, stability, and condition of the Proposer].

EVALUATION PROCESS: Evaluators independently review and score each proposal. The Committee meets to discuss the individual scores of each evaluator. If the individual scores are similar, the Chairperson may average the scores then rank Proposers accordingly. If the scores are significantly diverse, the Chairperson initiates and will moderate discussion to determine the reasons for the differences and ensures that all evaluators are fully knowledgeable of all aspects of the proposals. Scores may then be adjusted by the committee based on committee discussion.

Please note that Proposers with higher qualifications scores could be ranked higher than Proposers with slightly better price scores.

PROPOSALS SHALL BE MADE USING THE FORMS PROVIDED

HEALTHCARE CONSULTANT

HUB International Insurance Services has been engaged to assist in preparing this RFP document, the analysis of responses and to consult for the City and to provide guidance in accordance with the policies and procedures adhered to by the Purchasing Department. The award for each particular category of Services will not be made based on price alone, but instead on "best value" to the City. The factors listed above will be those considered by the City in determining the best value and in selecting the Proposer(s) for award for each category of Services.

PROPOSAL SPECIFICATIONS

The City will accept only one proposal per Proposer. Multiple proposals from different Proposer offices or representatives will not be accepted. Proposals should respond clearly and concisely to all the questions contained in this RFP. All exhibits should be completed as requested and returned as part of your proposal.

**Complete EACH tab of the provided questionnaire and return the file in an Excel file format (Attachment G).

ATTACHMENTS

Attachment A: Respondents Information and Signature Page

Attachment B: City of Amarillo Vendor Acknowledgement Form

Attachment C: Cities Excluded Parties List

Attachment D: References

Attachment E: CoA_Medical Membership 08-2026

Attachment F: CoA_MedRx Claims Experience 08-2026

Attachment G: CoA_Stop Loss Questionnaire 2026

Attachment H: 2026 Retirees Schedule of Benefits Medical Plan 1

Attachment I: 2026 Retirees Schedule of Benefits Medical Plan 2

Attachment J: 2026 Active Medical Plan 1 Schedule of Benefits

Attachment K: 2026 Active Medical Plan 2 Schedule of Benefits

Attachment L: 2026 Active Medical Plan 1 Booklet

Attachment M: 2026 Active Medical Plan 2 Booklet

Attachment N: 2026 Retirees Medical Plan 1 Booklet

Attachment O: 2026 Retirees Medical Plan 2 Booklet

Attachment P: Prescription Summary of Drug Coverage

Attachment Q: CoA_De-ID High-Cost Claimants 08-2026

Attachment R: CoA_2026 Stop Loss Policy

Attachment S: Certificate of Insurance Requirements