2-METRO Stop Loss RFP Scope of Work FY2027 Final.pdf
PDF 204 KB Posted
- Solicitation number
- 2026000008
- Issued by
- Harris County, Houston City, Texas
About this file
This is a Scope of Work document for a Stop Loss Insurance RFP for the Metropolitan Transit Authority of Harris County in Texas for fiscal year 2027. The document outlines comprehensive stop loss insurance services required to support the agency's self-funded health plans and manage financial risk associated with high-cost claims. Services encompassed include administration of individual excess risk benefits covering medical and prescription drug benefits, claims management and reimbursement for stop loss triggers above the Individual Stop Loss (ISL) level, tracking and payment of stop loss claims, billing of stop loss premiums, administration of aggregate stop loss factors, underwriting services for annual stop loss procurement, clinical evaluation of large claimants, implementation support for service transitions, financial reporting and analysis, claims activity reporting and reconciliation, coordination with health plan providers, compliance and regulatory support, competitive pricing with multi-year guarantees, and dedicated account team and call center support.
The evaluation scorecard for vendor selection allocates 35 points for financial considerations including premium rates and contract strength, 25 points for claims management and administration encompassing claims processing efficiency, coordination with medical and pharmacy administrators, plan document compliance, and reporting accuracy, 20 points for client service and support including account management, availability and responsiveness, and escalation procedures, 10 points for proposer qualifications and experience including public sector experience, years in business, financial rating, and past relationship history, and 10 points for implementation and transition support covering implementation simplicity and the level of transition assistance provided.
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Other files
| File | Type | Posted |
|---|---|---|
| 1-2026-2027 METRO Stop Loss RFP Workbook .pdf |
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Text version
1 © 2026 Arthur J. Gallagher & Co.
Stop Loss RFP Scope of Services Stop Loss Insurance services include a range of administrative, advisory, and support functions to help employers manage their self-funded health plans and mitigate the financial risk associated with high-cost claims. Services include, but not limited to:
• Administration of Individual Excess Risk Benefit Level Inclusive of Medical and Prescription drug benefits
• Claims management and reimbursement of stop loss triggers above the ISL level
• Tracking and payment of Stop Loss claims
• Billing of stop loss premiums
• Administration of Aggregate stop loss factors inclusive of the same benefits as listed in the first bullet
• Administration of annual aggregate attachment point and tracking
• Underwriting services for annual procurement of stop loss and factors
• Clinical evaluation of large claimants
• Implementation support ensuring seamless transition of services
• Financial reporting and analysis.
• Reporting on claims activity, reimbursement status and reconciliation
• Coordination with health plan providers and other programs
• Compliance and regulatory support
• Competitive pricing with multiple year pricing guarantees
• Dedicated account team and call center support
2 © 2026 Arthur J. Gallagher & Co.
Scorecard
• 35 points – Financial o Premium rates o Contract strength
• 25 points – Claims Management and Administration o Claims processing efficiency: speed and accuracy of claims processing and reimbursement o Coordination with METROs medical and pharmacy administrators o Meet plan document requirements o Adequate and accurate reporting
• 20 points – Client Service and Support o Account management: dedicated account management and support o Availability and responsiveness o Escalation procedures: procedures for handling complex issues or disputes
• 10 points – Qualifications/Experience of Proposer o Public Sector Experience o Years in Business o Financial Rating o Proposer’s Past Relationship: recommends use of services again, no documented issues previously, never performed business or documented as being poor
• 10 points – Implementation and Transition Support o Simplicity and clarity of implementation o Transition support: level of support provided during the transition period
| Scope of Services |
| Scorecard |
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