2-METRO Stop Loss RFP Scope of Work FY2027 Final.pdf
PDF 204 KB Posted
- Solicitation number
- RFP 2026000008
- Issued by
- Harris County, Texas
About this file
This is a Scope of Work and Evaluation Scorecard for Stop Loss Insurance services for the Metropolitan Transit Authority of Harris County, Texas for fiscal year 2027. The RFP requests comprehensive stop loss insurance administration services including individual excess risk benefit coverage for medical and prescription drug claims, claims management and reimbursement for triggers above the Individual Stop Loss (ISL) level, aggregate stop loss administration with annual attachment point tracking, underwriting services, clinical evaluation of large claimants, implementation support, and financial reporting. The vendor will also provide billing administration, coordination with health plan providers, regulatory compliance support, and dedicated account team and call center support to manage the authority's self-funded health plan and mitigate financial risk associated with high-cost claims.
Evaluation of proposals will be based on a 100-point scorecard weighted as follows: Financial terms including premium rates and contract strength (35 points), Claims Management and Administration including processing efficiency, coordination with medical and pharmacy administrators, compliance with plan documents, and reporting accuracy (25 points), Client Service and Support including account management, availability, and escalation procedures (20 points), Qualifications and Experience of the proposer including public sector experience, years in business, financial rating, and past performance history (10 points), and Implementation and Transition Support addressing clarity of implementation and level of transition support provided (10 points). The RFP emphasizes competitive pricing with multiple-year pricing guarantees and evaluation of the proposer's ability to ensure a seamless service transition.
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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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