3-Attachment G - CoA Stop Loss Questionnaire 2027 Locked.xlsx

XLSX spreadsheet 36 KB Posted Oct 13, 2026

Attached to: 2027 Stop Loss Insurance Policy
Solicitation number: RFP 200-27 MRH
Issued by: Orange County, Texas

About this file

Written by GovTribe AI · Oct 15, 2026

This is a Stop Loss Insurance questionnaire for the City of Amarillo's 2027 stop loss insurance policy procurement. The questionnaire serves as the primary evaluation instrument for prospective carriers and requires comprehensive responses across multiple categories including general company information, financial details, customer service capabilities, references, and stop loss-specific coverage terms. Respondents must complete all designated tabs within the Excel workbook, including General Information, Financial Information, Customer Service, References, Stop Loss, and Rate or Fee sections. All questions must receive complete answers; responses indicating information cannot be provided at the time of submission will be considered non-responsive by evaluators.

The questionnaire collects detailed information regarding carrier qualifications, including parent and subsidiary company formation dates, Texas licensing history, employee counts, experience with similar-sized groups (both private and public sector), and use of subcontractors. Financial evaluation requires three years of detailed financial statements, credit ratings from major rating agencies, and disclosure of any corrective actions from state or federal authorities. The stop loss section contains 51 specific questions addressing reinsurance practices, claims handling procedures, coverage limitations, policy terms, and renewal guarantees. Carriers must provide rate quotations for the 2027 contract period beginning January 1, 2027, using a standardized pricing spreadsheet with PEPM (per employee per month) rates and specified coverage parameters including individual stop loss levels, reimbursement percentages, and claim accumulation methodologies. The questionnaire explicitly prohibits contingent responses and requires binding commitments regarding renewal terms, rate guarantees, and lasering policies.

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Other files

File	Type	Posted
2-2. Stop Loss RFP for 2027 Scope of Work.pdf	PDF	Oct 13, 2026
9-Attachment L - 2025 ACTIVE MEDICAL PLAN 1 BOOKLET.PDF	PDF	Oct 13, 2026
20-Attachment R - CoA 2026 Stop Loss Policy.pdf	PDF	Oct 13, 2026
10-01. RFP 200-27 MRH Notice to Bidders.pdf	PDF	Oct 13, 2026
17-Attachment K - 2025 ACTIVE MEDICAL PLAN 2 SCHEDULE OF BENEFITS.PDF	PDF	Oct 13, 2026
19-Attachment F - CoA MedRx Claims Experience 08-2026.pdf	PDF	Oct 13, 2026
1-Attachment A - Respondent Information and Signature Page.pdf	PDF	Oct 13, 2026
13-Attachment O - 2025 RETIREES MEDICAL PLAN 2 BOOKLET.PDF	PDF	Oct 13, 2026
6-Attachment J - 2025 ACTIVE MEDICAL PLAN 1 SCHEDULE OF BENEFITS.PDF	PDF	Oct 13, 2026
21-Attachment Q - CoA De-ID High-Cost Claimants 08-2026.pdf	PDF	Oct 13, 2026
12-Attachment I - 2025 RETIREES SCHEDULE OF BENEFITS MEDICAL PLAN 2.PDF	PDF	Oct 13, 2026
5-Attachment E - COA Medical Membership 09-24-2026.xlsx	XLSX spreadsheet	Oct 13, 2026
15-Attachment M - 2025 ACTIVE MEDICAL PLAN 2 BOOKLET.PDF	PDF	Oct 13, 2026
14-Attachment H - 2025 RETIREES SCHEDULE OF BENEFITS MEDICAL PLAN 1.PDF	PDF	Oct 13, 2026
8-Attachment B - City of Amarillo Vendor Acknowledment Form.pdf	PDF	Oct 13, 2026
4-Attachment S - Certificate of Insurance Requirements Sample.pdf	PDF	Oct 13, 2026
11-08. Attachment C - CEP List Revised 10.03.2024 .pdf	PDF	Oct 13, 2026
18-Attachment P - PRESCRIPTION BENEFIT COVERAGE 01.01.2026.pdf	PDF	Oct 13, 2026
7-Attachment D - RFP References Template.pdf	PDF	Oct 13, 2026
16-Attachment N - 2025 RETIREES MEDICAL PLAN 1 BOOKLET.PDF	PDF	Oct 13, 2026

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COVER

QUESTIONNAIRE TABS

General Information	All respondents complete this tab
Financial Information	All respondents complete this tab
Customer Service	All respondents complete this tab
References	All respondents complete this tab
Stop Loss	All respondents complete this tab
Rate or Fee Tabs	All respondents complete this tab

Notice: All questions must be answered. Please refrain from responding with a phrase such as “cannot provide at this time or will provide at a later date if selected, etc.” The reviewer will consider these answers non-responsive to the question. All responses must be made within the designated cell(s) of the worksheet provided.

&A &F&D &P of &N

General Information

GENERAL INFORMATION

1	Parent Company Name:
2	Address:
3	City/State/Zip:
4	Company Name: (If not same as above)
5	Address:
6	City/State/Zip:
7	Contact Person: (Employee of vendor)
8	Contact Phone #:
9	Contact Cellular #:
10	Contact Email:
11	Contact Fax #:
12	Local Address:
13	Local City/State/Zip:
14	Local Contact Person: (Employee of vendor)
15	Local Contact Phone #:
16	Local Contact Cellular #:
17	Local Contact Email:
18	Local Contact Fax #:
19	Federal Tax ID Number:
20	Date Parent Company formed:
21	Date Subsidiary Company formed:
22	Date Company contracted with first group in State of Texas:
23	Date Company was licensed to transact the appropriate line of insurance or administrative related services in the State of Texas:
24	Number of employees employed in Texas and Nationwide:
25	Number of groups you provide similar services to with over 2,000 employees in force.
	Private Sector
	Texas
	Nationwide
	Public Sector
	Texas
	Nationwide
27	Is your company using any sub-contractors? If so, please provide the following information in your response for each sub-contractor: Name of sub-contractor, the scope of services the sub-contractor will perform, the reasons why you are sub-contracting these services, the benefit of sub-contracting these services, the depth of experience of the sub-contractor performing these services, and how you evaluated the sub-contractor, and why you selected this vendor to perform these services.

28	Has your company recently been acquired or been involved with any merger/acquisition? If yes, briefly describe.
29	Is your company involved in any pending or contemplated acquisition in the next 36 months? If yes, briefly describe.
30	Under what other or former names has your company operated? If yes, briefly describe.
31	Identify any officer, director, employee or agent of your organization who is also an employee, or contractor, of City of Amarillo.
32	Disclose the name of any City of Amarillo employee who owns, directly or indirectly, an interest of 5% or more in your firm or any of its subsidiaries. Also disclose any familial or financial relationship anyone in your firm may have with any employee of City of Amarillo or member of the family of an employee of City of Amarillo.
33	Identify any affiliation your firm, or an employee of yours, currently has with City of Amarillo such as a current contract, sub-contractor on a current contract, a member of an advisory board, etc.
34	Describe your company’s disaster recovery and contingency plans. Have you ever tested or actually implemented these plans?

35	State your type of business: corporation, non-profit corporation, partnership, joint venture, etc.
36	Has your company been involved in any litigation over the last five years; pending, settled, or dismissed? Explain each separately. If there is any pending litigation, please include an opinion of counsel as to whether the pending litigation will impair the proposer’s performance in a contract under this RFP.)
37	Has the proposer or any of the proposer’s employees, agents, independent contractors or sub-contractors ever been convicted of, pled guilty to, or pled nolo contendere to any felony; and if so, provide an explanation of the relevant details.
38	Has your company, within the last 10 years, filed (or had filed against it) any bankruptcy or insolvency proceeding, whether voluntary or involuntary, or undergone the appointment of a receiver, trustee, or assignee for the benefit of creditors; and if so, provide an explanation of the relevant details.
39	What separates your firm from other competitors?

40	Has the interested firm, its principals, officers, or predecessor organization(s) been debarred or suspended from bidding by any government during the last five (5) years? If yes, provide details.
41	Have you ever failed to complete any work awarded to you? If so, where and why?

McLennan County RFP #16-008

&A &F &D &P of &N

Financial Information

FINANCIAL INFORMATION

1	Ratings (if applicable):
	AM Best
	Moody’s
	Standard & Poors
	Fitch
2	Describe your firm’s financial condition for the last three years. Specify fiscal period, retained earnings, debt, and equity. Detail each year separately:
	Year 1
	Year 2
	Year 3
3	Has your company received any corrective action requests from any State or Federal Government in the last 5 years? If yes, briefly explain.
4	Provide a copy of your most recent audited financial statements with your response.

McLennan County RFP #16-008

&A &F&D &P of &N

References

REFERENCES
Provide the contact information for three current and three Texas Municipality Clients or other Public Entity clients of similar size. Include Organization Name, Address, Contact Person Name and Phone #, number of employees, indicate private/public sector, and briefly explain what services you provided and for how long was your contract.
1	#1 Current
	Organization Name:
	Address:
	Contact Person:
	Phone #:
	Fax #:
	Email:
	Number of Employees:
	Private/public sector:
	Length of Service:
	Services Provided:
2	#2 Current
	Organization Name:
	Address:
	Contact Person:
	Phone #:
	Fax #:
	Email:
	Number of Employees:
	Private/public sector:
	Length of Service:
	Services Provided:
3	#3 Current
	Organization Name:
	Address:
	Contact Person:
	Phone #:
	Fax #:
	Email:
	Number of Employees:
	Private/public sector:
	Length of Service:
	Services Provided:
4	#1 Former
	Organization Name:
	Address:
	Contact Person:
	Phone #:
	Fax #:
	Email:
	Number of Employees:
	Private/public sector:
	Length of Service:
	Services Provided:
	Reason for termination:
5	#2 Former
	Organization Name:
	Address:
	Contact Person:
	Phone #:
	Fax #:
	Email:
	Number of Employees:
	Private/public sector:
	Length of Service:
	Services Provided:
	Reason for termination:
6	#3 Former
	Organization Name
	Address:
	Contact Person:
	Phone #:
	Fax #:
	Email:
	Number of Employees:
	Private/public sector:
	Length of Service:
	Services Provided:
	Reason for termination:

McLennan County RFP #16-008

&A &F &D &P of &N

Stop Loss

STOP LOSS

1 How long have you (the stop loss reinsurance carrier) been in business?

2 Provide the most recent financial statement for the stop loss reinsurance carrier.

3	What percentage of your overall business is medical stop loss reinsurance related?
4	Please indicate your company’s annual stop-loss premium.
5	Please indicate your company’s total number of stop-loss cases (clients) (United States only).
6	Do you reinsure the stop-loss coverage? If so, provide details.
7	If you purchase reinsurance protection, does the reinsurer need to review all claims before they are paid, or are your decisions binding on the reinsurance?
8	If a claim is delayed beyond the end of the contract period, do you grant a waiver of the time limits for payments if the circumstances are reported to you prior to the end of the period? If not, how are such situations handled?
9	What is the maximum time allowed for submission after the termination date, for valid claims that were paid within the contract period?
10	Please provide the definition of experimental procedures and note how this provision is interpreted for a claim approved for payment under the medical plan.
11	Is your organization capable and willing to contact the claims administrator (TPAs, carriers, etc.) or Case Management firm directly to obtain additional information related to large claimants?
12	Coverage is considered to be “bound” when the new carrier is in receipt of the binder check or first month’s premium payment and executed application. Do you agree with this statement?
13	Once firm rates are presented and coverage is bound, under which circumstances, if any, would your organization modify rates / factors mid-year?
14	What are your proof of claim and timely filing requirements for claim reimbursement requests?
15	What is your company’s timing requirements with respect to notification and claim filing?
16	Do you designate a Large Case Management firm with whom the claims administrator (or Pre-cert vendor) must coordinate potentially catastrophic cases?
17	Are there any conditions or circumstances (i.e., diagnosis, procedure, medical services, etc.) that require pre-approval by your case managers?
18	Is there a Transplant Center of Excellence provision in your contract?
19	Are case management fees reimbursable to the client?
20	Will you allow “non-covered” alternative care, if approved by your case managers?
21	Are there any charges and/or fees that standardly do not apply to specific or aggregate coverage?
22	Does your contract recognize all eligible employees, spouses, domestic partners, dependents, FMLA, retirees (if applicable), and COBRA beneficiaries as defined by the employer’s Plan Document / SPD?
23	Other than the employer’s Plan Document / SPD, does the contract allow for guidelines found in the employer’s Employee Handbook (i.e., leave of absence policy)?
24	Please identify any restrictions and limitations pertaining to an off-anniversary termination.
25	With respect to specific claims submitted for reimbursement, please describe any limitations (i.e., minimum dollar amounts).
26	With respect to specific claims submitted for reimbursement, please describe any limitations (i.e., minimum dollar amounts).
27	How do you comply with the guidance regarding participation in clinical trials?
28	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.

How does your organization address claims that were denied in one coverage period and paid in another coverage period?

29	Is there a Run-In limit (amount or time) on “paid” stop loss coverage for both the initial year of coverage or renewal years?
30	Does your Stop Loss contract have any limits for any of the following? If so, please describe.
	Transplants
	Substance Abuse
	Mental Nervous Conditions
	Any other condition
31	If your company offers discounts for utilizing Centers of Excellence or cost management programs, please provide details on the programs, affiliated costs at the time of claim, and details regarding discounts for utilizing those programs.
32	Is the Stop Loss through an Managing General Underwriter (MGU)? If so, please provide Name, Address, and Phone Number of the MGU being used.
33	If an MGU, do you handle claims “in-house”? If not, who handles them?
34	If an MGU, are there additional Insurance Carriers accepting layers of risk? Please disclose the Names, Address, and Phone Numbers of those carriers and the percentage of risk taken. Answer all of the questions in this RFP relating to any carrier assuming risk.
35	At time of renewal will you agree to quote removing any existing large claim from your rating for the group overall? Please specify what determines a large claim?
36	Will you agree to recognize all eligible claims on the effective date of the contract including hospitalizations, if any, and those related to pre-existing conditions or members not actively at work?
37	Do you require the client to make the initial payment for eligible specific claims and then file for reimbursement, or do you reimburse simultaneously once the claim exceeds the retention level?
38	Provide details on any claims turnaround guarantees.
39	What is the maximum time beyond the date of service that you allow for submission of Stop Loss payments by a Claims Administrator?
40	How recent must claims experience be in order to provide “final terms” and what is the earliest point in time that you will finalize and guarantee your terms and conditions of coverage?
41	Will you agree to waive any “actively-at-work” requirement?
42	Do you require the TPA to provide Errors & Omissions coverage? At what limits?
43	Does your firm have Errors & Omissions coverage? If so, who is the carrier and what are your policy limits?
44	Do you reserve the right to unilaterally terminate a group for poor experience?
45	Are you licensed to conduct business in the State of Texas?
46	Are there any additional surcharges or taxes not disclosed in this proposal? Please explain.
47	Explain how your company will handle lasering of any members, both initially and at renewal. Will you guarantee that future enrollees will not be lasered?
48	If you provide immediate reimbursement for specific stop loss claims, please describe your definition and turn around times for immediate reimbursement.
49	Will you guarantee renewal terms and conditions in advance? Will you guarantee a maximum rate adjustment with no additional lasering upon renewal? If so, please provide a detailed response.
50	Will your contract mirror the SPD for perposes of determining eligible expenses?
51	Offer your rate quotations in your standard format as well in the Stop Loss RatesTab in this questionnaire.

&A &F Page &P of &N

Stop Loss Rates

	Stop Loss Pricing Spreadsheet
	CARRIER	CURRENT- PartnerRE	Option 1
Enter Carrier Name	Option 2
Enter Carrier Name	Option 3
Enter Carrier Name	Option 4
Enter Carrier Name	Option 5
Enter Carrier Name	Option 6

Enter Carrier Name

			1/1/26	1/1/27	1/1/27	1/1/27	1/1/27	1/1/27	1/1/27
			PEPM	PEPM	PEPM	PEPM	PEPM	PEPM	PEPM
		2160
	Coverages included for Specific		Med/Rx	Med/Rx	Med/Rx	Med/Rx	Med/Rx	Med/Rx	Med/Rx
	Individual Stop Loss Level		$750,000	$750,000	$800,000	$850,000
	Individual Policy Year Stop Loss Payment Limit		Unlimited	Unlimited	Unlimited	Unlimited
	Individual Lifetime Stop Loss Payment Limit		Unlimited	Unlimited	Unlimited	Unlimited
	Claim Accumulation Basis		Per Member	Per Member	Per Member	Per Member
	Reimbursement Percentage		100%	100%	100%	100%
	Contract Basis		24/12	24/12	24/12	24/12
	Dollar Limit on Run-in Claims - Speciific		N/A
	Advance Funding Option included (Yes or No)		No
	No New Laser Option (Yes or No)		Yes
	Plan Mirroring (Yes or No)		Yes
	Experience Rateing Refund Provision (Yes/No)		Yes
	AM Best
	INDIVIDUAL STOP LOSS PREMIUM
	Composite	2160	$24.33
	TOTAL ANNUAL STOP LOSS PREMIUM		$630,633.60	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
	Lasers
Text is limited to 25 characters	1.
		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
	Per Family

File details come from the government source that posted it. Updated Oct 15, 2026.