7-04 - Stop Loss Questionnaire.pdf
PDF 89 KB Posted
- Solicitation number
- 26-71-P
- Issued by
- Denton County, Little Cypress CDP, Texas
About this file
This Stop Loss Questionnaire is a required document for vendors responding to the City of Lewisville's competitive sealed proposal for Employee Health and Welfare Benefits in Texas. The questionnaire serves as an evaluation tool to assess Stop Loss reinsurance carriers' qualifications, policies, and operational procedures. Bidders must provide detailed responses addressing the reinsurer's financial rating, claims processing requirements, policy amendments related to the Affordable Care Act, external review processes, contract termination conditions, and coverage terms. Key evaluation areas include the carrier's A.M. Best rating, specific claim documentation requirements, audit procedures for large hospital bills, definitions of incurred and paid claims, reimbursement turnaround times, and the carrier's position on determinations made by Independent Review Organizations (IROs). Additionally, vendors must clarify the allocation of policy risk between the reinsurer and Managing General Underwriter, identify any risk cession to third parties, and explain unusual policy provisions such as organ transplant coverage restrictions.
The questionnaire requires vendors to confirm critical coverage details, including dependent coverage, protection for employees on approved leave, alignment of policy terms with the underlying plan document, and the date through which claims must be submitted to finalize the contract. Responses must address contract termination provisions, non-renewal agreements, and treatment of ongoing claims at contract inception. The City seeks comprehensive transparency regarding policy structure, operational procedures, and compliance with applicable healthcare regulations. All questions and responses must be submitted through the Bonfire platform in the questions and answers section, and the successful bidder will be required to certify compliance with the Americans with Disabilities Act and all related regulations.
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Text version
CITY OF LEWISVILLE PURCHASING DIVISION – REQUIRED DOCUMENT
STOP LOSS QUESTIONNAIRE
1. What is the Reinsurance carrier’s current A.M. Best rating?
2. What information do you require to process a Specific claim?
3. Do you require an audit of large hospital bills?
4. What is your definition of an “incurred claim”?
5. What is your definition of a “paid” claim?
6. How are advanced funded claims handled? Do you reimburse, then conduct an audit? What is the turnaround time?
7. How do you provide reimbursement once a claim exceeds the Specific deductible?
8. To what extent are you amending your Stop Loss policies due to the ACA, including the external review process and the independent review organizations?
9. What is your company’s position with respect to determinations made by IROs?
10. If a claim goes to external review, and an IRO decides that the claim us valid, will your company honor that determination?
11. Does your company have to approve the IROs that plan sponsors elect to utilize?
12. Define clearly the terms and conditions of your contract as they apply to the contract termination.
13. Describe how you will treat ongoing claims as of the inception date of a contract.
14. Will your company agree not to laser at renewal?
15. What portion of the policy risk does the reinsurer retain?
16. What portion of the policy risk does the Managing General Underwriter retain?
17. If the MGU cedes any portion of the policy risk to any other person or entity, please identify those persons or other entities, providing the names and addresses.
18. Please provide an explanation of any unusual competitive provision or restrictions in your proposed contract, such as organ transplant coverage.
19. Please confirm that:
a) The policy covers dependents as well as the subscribers who are covered under the plan.
b) There are no exclusions for those plan members who are not actively at work, but are on approved leave, vacation or other leave approved by the employer.
c) Your contract mirrors the underlying plan document.
20. Date claims are needed through to firm.
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