6-Attachment H Stop Loss RFP Submission Forms.xlsx

This document is a Stop Loss Submission Form for the City of McKinney, Texas, designed for insurance carriers to propose stop loss insurance plan designs. The form allows carriers to submit their proposed plans either on this template or on their own forms, with the city expressing a preference for options that closely mirror or enhance existing plans. The submission form covers specific deductible levels of $200,000, $250,000, and $300,000, all with a 24/12 contract type and coverage for medical and prescription (Rx) services.

The form requests detailed pricing information including specific and aggregate rates, premiums, and factors for employee and family coverage. Carriers are expected to provide details on lifetime and annual maximum reimbursements, minimum attachment points, and confirm whether retiree coverage is included. Additional considerations include the carrier's AM Best Rating, rate cap information, and potential laser provisions. The submission is part of a competitive solicitation process for stop loss insurance services, with carriers invited to present comprehensive plan designs that meet the City of McKinney's insurance coverage requirements.