2-MAC Stop Loss RFP Workbook for 01.01.2027 Effective Date.xlsx

XLSX spreadsheet 1 MB Posted Jul 15, 2026

Attached to: Stop Loss Administration RFP
Solicitation number: Solicitation182
Issued by: Minnesota

About this file

Written by GovTribe AI · Jul 16, 2026

This is a Stop Loss Insurance RFP Workbook prepared by Holmes Murphy for a Minnesota-based Multiple Employer Arrangement (MAC) seeking stop loss insurance coverage for medical and pharmacy plan administration, effective January 1, 2027. The workbook requires vendors to provide comprehensive proposals including administrative services organization (ASO) stop loss fees structured on a four-tier basis (Employee, Employee+Spouse, Employee+Child, and Family), with rate quotations for 2027 through 2031. Vendors must submit responses to detailed questionnaires covering general business operations, underwriting experience, contractual terms, claims practices, and premium administration. The RFP specifies that firm quotes must be issued with a minimum of 15 calendar days before expiration and include a minimum of 8 months of data. Key contractual requirements include waiving active-at-work provisions on new business, offering no new laser/rate cap contracts with a maximum 5% load, providing plan mirroring language, and confirming participation in all applicable states.

Pricing is structured on both a per-contract and per-member basis, with the current 2026 ISL monthly administrative fees established at $30.18 for Employee tier and $75.45 for the three family tier options. The estimated annual premium baseline is $9,471,096 with corresponding monthly estimates of $789,258. The stop loss contract features an Individual Stop Loss (ISL) deductible of $350,000 on a per-contract basis with a 125% attachment point, unlimited annual maximum coverage including medical and pharmacy benefits, a terminal liability option, and an excess corridor of $100,000. Vendors must address cost containment capabilities, gene therapy program offerings, claims processing turnaround times, and advance funding or quick-pay options. The MAC requires that premium grace periods be a minimum of 45 days and timely filing requirements for prior claim years be a minimum of 180 days, with reimbursement options including checks, ACH, and wire transfers.

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File	Type	Posted
3-Stop Loss RFP Final.pdf	PDF	Jul 15, 2026
1-W9 Blank.pdf	PDF	Jul 15, 2026

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Fees & Contract - Stop Loss Stop Loss - Fees & Contract

Please note that you must complete rate information in the following requested format in order for your quote to be considered. All highlighted cells must be completed.

Vendor Name

Financial Rating (A.M. Best, etc.)

ASO - Stop Loss Fees 2026 Current

(BCBS Carved In)	Proposed
2027	Proposed
2028	Proposed
2029	Proposed
2030	Proposed

ISL Monthly PEPM Administrative Fee*			$	$	$	$	$
Employee		$30.18	$	$	$	$	$
EE+SP		$75.45	$	$	$	$	$
EE+CH(REN)		$75.45	$	$	$	$	$
FAM		$75.45	$	$	$	$	$
	ISL Deductible Level - PER CONTRACT basis	$350,000	$	$	$	$	$	Please quote on a Per Contract basis AND Per Member basis
	Annual Maximum	Unlimited
	Medical & Rx Included?	Medical & Rx	Medical & Rx	Medical & Rx	Medical & Rx	Medical & Rx	Medical & Rx
	ISL Contract Type?	Paid
	Individuals/Groups Excluded from the ISL?	N/A
	Lasers on Individuals?	N/A
	Terminal Liability Option?	Yes
	Excess Corridor?	Yes; $100,000						Please provide a quote with this included AND without
Aggregate Stop Loss Admin Fee		Included in ISL fees above	$	$	$	$	$
	Attachment Point	125%
Optional Rider Fees		N/A
Commissions		Net of Commisions
Rate Cap		None for 2027
No New Laser Provision		No Lasers
Estimated Monthly Premiums		$789,258	$	$	$	$	$
Estimated Annual Premiums		$9,471,096	$	$	$	$	$
Other
Note: This Stop Loss RFP is managed by Holmes Murphy and Avant Specialty Benefits
*Please quote on a 4 tier basis

&"Segoe UI,Bold"

STOP LOSS RFP WORKBOOK

&"Arial,Regular"&10&A &"Arial,Regular"&10Holmes Murphy - CONFIDENTIAL &"Arial,Regular"&10&P

Questionnaire - Stop Loss Stop Loss Services Questionnaire

Vendor Name
General Questions	Response
1.1. Legal Entity Name*
1.2. Name of Person Completing RFI*
1.3. Date of Completion*
1.4. Responses effective until what date*
1.5. Provide your AM Best Rating*
1.6. Explain your ownership structure.*
1.7. How long has your organization been in business for stop loss insurance?*
1.8. Has your company done business under other names (legal or d/b/a)?*
1.9. Please provide historical background information.*
1.10. Identify any interests your organization may have with associated vendors (claims administrators, brokerage firms, managed care firms, etc.).*
1.11. Have you ever been suspended from writing stop loss coverage?*
1.12. If the answer to 1.11 was 'Yes', Please describe.*
1.13. Is your organization licensed to do business in all 50 states and U.S. territories?*
1.14. Identify the states/territories in which you are not currently licensed.*
1.15. What groups/organizational structures (tribal, MEWA, associations, trusts, etc) does your company consider to be “ineligible”? Please list.*
1.16. Please describe your product portfolio to us, and please let us know of any package discounting available for the sale of additional product lines/types.*
1.17. How often does actuarial complete evaluations of network (PPO) performance and adjust underwriting discounts based on evaluations? Is there information about network performance available to Avant based on those findings?*
1.18. What is your usual process to evaluate an RBP (referenced based pricing) vendor? What information is needed to evaluate the vendor and offer binding quotes?*
1.19. Do you provide any offsets for an employer implementing clinical programming (for example Regenexx, Livongo, etc)*
1.20. Please provide a list of approved vendors (we will complete an NDA if needed for this)*
1.21. Do you utilize AI platforms (Gradient, Verikai, Curv) to underwrite? If so can it be used on any groups or is it solely for fully-insured transitions?*
1.22. Please outline your underwriting structure. Do you have new and renewal underwriting teams, or does the selling underwriter continue with the case throughout the relationship?*
Experience
2.1. How much stop loss annualized premium do you currently have in your block of business?*
2.2. Please provide historical block renewal increases, loss ratio, and persistency for the last 5 years*
2.3. 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.*
2.4. Who has final claim decision-making authority with respect to specific and aggregate claims?* If another carrier is involved, please described amounts for which they have authority?*
2.5. Formal Disclosure: Will you agree to no client signature required on new business (with no admin change)?*
2.6. Formal Disclosure: Will you agree to no client signature required on renewals (with no admin change and less than 25% change to population)?*
2.7. Please provide a full listing of your cost containment vendors*
2.8. If you offer any programs for a step down deductible please list them here*
2.9. Please list any gene therapy programs/solutions you currently have (or are in the pipeline)*
2.10. In the event of a one-time high-cost gene therapy claim, how do you handle (underwrite) at renewal?*
2.11. Please confirm that firm quotes will be issued with a minimum of 15 calendar days before expiring. If a firm quote is issued prior to the firm RFP due date, the 15 calendar days must 'start' on the RFP due date.*
2.12. Please confirm you will provide firm quotes with 8 months of data*
Contractual
3.1. What is your minimum group size (enrolled)?*
3.2. What is the minimum and maximum IER deductible offered?*
3.3. Are there any ineligible networks or TPAs?*
3.4. Please list any ineligible networks or TPAs*
3.5. Waive Active at Work: On new business, 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?*
3.6. Do you match exclusions and limitations to the underlying plan document? If not, please outline standard exclusions/limitations.*
3.7. Do you offer no new lasers/rate cap contracts?* Please advise if you have minimum premium/enrollment thresholds for this*
3.8. Under your no new laser contract, do you have the ability to increase the lasered amount at renewal?*
3.9. What is the standard rate cap %?*
3.10. Please outline costs* NOTE: We are requesting a maximum of a 5% load for NNLRC.*
3.11. Are No New Laser/Rate Cap Contracts Evergreen or can they be revoked?*
3.12. Please explain how your no new laser/rate cap contracts apply to Aggregating Specific Deductibles (does a 50% NNLRC increase the ASD by 50% as well)?*
3.13. For aggregating specific deductibles, do you apply a dollar for dollar offset? If not, please confirm percentage.*
3.14. Please confirm that No New Laser Rate Caps will be offered on all cases (above your minimum thresholds)*
3.15. Do you offer monthly aggregate accommodation?*
3.16. Which party is responsible for triggering the accommodation payment request, and what is the standard turnaround time of the accommodation payment from receipt of notification?*
3.17. What fees will be excluded as part of claims?*
3.18. Confirm how you handle fees related to arbitration under the No Surprises Act. Will they be covered under the stop loss policy?*
3.19. 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?*
3.20. What is the enrollment threshold for underwriting repricing?*
3.21. Please confirm minimum and maximum policy lengths (6, 9, 15 months, etc)? Do you have any multi-year programs available for stop loss? Please provide details.*
3.22. Do you offer participating contracts or premium refund agreement based on target loss ratios?*
3.23. Please provide details and outline any case level requirements (size, annual premiums, etc).*
3.24. Other than medical and RX, what other costs can be included in aggregate reimbursement? (ex. Dental, vison, etc) Is there additional cost for this? Please detail.*
3.25. Do you apply claims run in limits to new contracts?*
3.26. If so, please provide additional details*
3.27. Do you agree to provide plan mirroring language or an applicable endorsement to ensure expenses covered by the underlying Plan are covered by the applicable stop loss policy (standardly for all Avant business)?*
3.28. Please identify any states in which your policy would be written on different paper and which carriers would be applicable in such instances.*
3.29. If you cannot provide your traditional policy for certain states (NY for example), please confirm you will notify us of this during the RFP process.*
3.30. If your policy is being refiled, please confirm you will provide us with the changes PRIOR to filing for the year with the states for our review and feedback.*
3.31. At minimum, if your policy is refiled, we need to be notified and provided a copy of the new policy BEFORE placing coverage and NO LATER than 60 days following approval of the new police or any substantive changes to policy language or provisions. Please confirm.*
Claims Practices
4.1. Will you accept screen shots for eligibility and COBRA participation/premium?*
4.2. Please list your reimbursement options (check, ACH, wire, etc)*
4.3. Please provide your standard turn around times for claims payments once all documentation is received.*
4.4. Do you offer advance funding or quick pay options for stop loss claims?*
4.5. Please provide details including any additional cost. Please provide sample of process.*
4.6. If RX is carved out, at what frequency or threshold are the RX and Medical claims combined/evaluated by an examiner for potential reimbursement?*
4.7. How often do you require aggregate claim reporting information?*
4.8. Please confirm that your timely filing requirements for prior claim year are a minimum of 180 days*
4.9. Please confirm that Advanced Funding or Quick Pay options will be included on ALL cases where available.*
Premium
5.1. For premium contingencies on Accelerated Reimbursement requests - please confirm that premium shall be considered 'current' as long as the grace period for the 'payment due' has not lapsed.*
5.2. Please confirm that Premium Grace Periods will be a minimum of 45 days for all business placed through Avant.*
Additional Requests (please acknowledge/confirm)
6.1. Do you have the ability to write Multi-Year Rate Guarantees? Please provide details if so.*
6.2. Please confirm if you will quote with only "enrolled census" when an "all eligible" census is not available*
6.3. In the event of an aggregate breach, do you deduct Rx Rebates from aggregate claims?*
6.4. If a client elects to utilize Avant ClaimSpur (Aegle), please confirm you will be able to reimburse Aegle directly.*
6.5. Please confirm the load to your rates for Expedited Reimbursement / Advanced Funding that we could remove with ClaimSpur in place.*
6.6. How are members treated who are included in the census provided during underwriting, but who are terminated prior to the effective Plan date? Please confirm that these members who have properly covered claims paid under the new policy, will be considered approved for stop loss reimbursement.*

&"Arial,Bold"STOP LOSS RFP WORKBOOK

&"Arial,Regular"&10&A &"Arial,Regular"&10Holmes Murphy - CONFIDENTIAL &"Arial,Regular"&10&P

File details come from the government source that posted it. Updated Jul 16, 2026.