Attachment_B_-_UPDATED_Stop_Loss_Questionnaires_(MOA_and_QE)-RETURN_WITH_BID.xlsx
XLSX spreadsheet 28 KB Posted
- Attached to
- SPECIFIC STOP LOSS INSURANCE
- Solicitation number
- 260220
- Issued by
- Pima County, Arizona
About this file
This is a Stop Loss Questionnaire document for the City of Tucson's specific stop loss insurance procurement, with an effective date of July 1, 2026. The City seeks to obtain specific stop loss insurance coverage for its 4,508 covered employees and retirees, with the plan covering medical and prescription drug expenses. The City is transitioning from Cigna to Blue Cross Blue Shield of Arizona (AZ Blue) for its medical TPA/network services and OptumRx for pharmacy benefit management. Recent plan paid claims totaled approximately $43.5 million over the most recent 12-month period through March 2026. The questionnaire comprises two main sections: a Method of Approach (MOA) section and a Qualifications and Experience (Q&E) section, requiring offerors to respond in Microsoft Excel format without altering questions or numbering.
The MOA section establishes minimum requirements including five years of business experience performing the proposed services, 10,000 full-service covered members, and at least three municipal clients with 10,000 members each (preferably in Arizona), along with no bankruptcy filings in the past five years and compliance with all applicable regulations. Contractual requirements address HIPAA compliance, data protection, 30-day notice for major operational changes, indemnification provisions, and specific stop loss coverage terms including waiver of pre-existing conditions and actively-at-work provisions. The Q&E section requires offerors to provide company information, current financial ratings from Standard and Poor's, Duff and Phelps, A.M. Best, and Moody's, references from similar public sector clients, confirmation of proper state licensure, and details regarding reinsurance arrangements. All responses must address specific stop loss coverage terms, claims processing procedures, reimbursement timelines, reporting requirements, and termination provisions clearly outlined within the questionnaire.
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Questionnaire Instructions
| Questionnaire Instructions to Offerors: |
| ***DO NOT ALTER THE QUESTIONS OR QUESTION NUMBERING***. |
| Ø Provide answers to the questionnaires in MS Excel format (per instructions on the Excel files--Questionnaires. |
| Ø Provide an answer to each question even if the answer is “not applicable” or “unknown.” |
| Ø Answer the question as directly as possible. |
| Ø If the questions ask “How many…” provide a number. |
| Ø If the question asks “Do you…” indicate Yes or No first, followed by your additional narrative explanation. |
| Ø Lengthy responses may be truncated when displayed. Be concise in your response. Use bullet points as appropriate. Reconsider how to word any response that exceeds 200 words in length so that the response contains the most important points you want displayed. |
| Ø Where you desire to provide additional information to assist the reader in more fully understanding a response, refer the reader of your RFP response to your appendix/attachments. |
| Ø RFP responses will become part of the contract between the winning Contractor and the City of Tucson. |
| Ø Any references to “Client” in the questionnaire refer to the City of Tucson. |
Answers to the questions must be provided in MS Excel format. Failure to complete the questionnaire and submit in MS Excel format without alterations will make it difficult to thoroughly understand your proposal.
&"-,Bold"&14Attachment B - Stop Loss Questionnaire
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MOA Questionnaire
| MINIMUM REQUIREMENTS | OFFEROR RESPONSE | |
| 1 | Please confirm you have been in business, performing the services being proposed herein, for a minimum of five (5) years. | |
| 2 | Confirm you have ten thousand (10,000) full-service Contractor covered members | |
| 3 | Confirm you have at least three (3) municipal clients(preferably in Arizona) under contract with a minimum of ten thousand (10,000) total members per client | |
| 4 | Confirm you have had no bankruptcy filings within the last five (5) years | |
| 5 | Acknowledge you are compliant with all City of Tucson and federal applicable regulations and currently not restricted or prohibited from conducting business in all states where City of Tucson’s members reside or access related goods and services | |
| 6 | Confirm you have no current senior officer, board member, or director with a felony conviction on record. |
| METHOD OF APPROACH - CONTRACTUAL | Yes | No | |
| 1 | Do you agree that if you were provided any individually identifiable health information (IIHI) in order to price this bid, you are prohibited from using the IIHI for any purpose other than as required by law and further, agree to promptly destroy such IIHI if you are NOT the successful bidder? | ||
| 2 | If you receive individually identifiable health information (IIHI) in order to perform underwriting, premium rating, or other activities relating to the renewal or replacement of a contract of health insurance or health benefits, that you will protect such IIHI as required by HIPAA Privacy regulations? | ||
| 3 | Proposal and Best and Final Responses Become Part of Contract: Do you agree that your written response to this RFP, written information provided as part of an interview and written responses provided during a Best and Final negotiation become part of the contract between your organization and the City of Tucson? | ||
| 4 | Effective Date of Offer: Bid terms are guaranteed upon receipt of a Best & Final offer (note: if you require a disclosure agreement, provide a copy with your initial proposal so the City can provide a signed copy for your use in the Best & Final). | ||
| 5 | Variance Provision: Any provisions relating to reevaluation of proposed rates due to variation in enrollment or other contingencies of the quote must be clearly noted in the financial section of your proposal. | ||
| 6 | Prior Notice of Major Operational Changes: Do you agree to provide no less than 30 days’ notice to the City of Tucson for any changes involving the sale, merger, data breaches, layoffs, participating provider facility terminations, consolidation or outsourcing of services to foreign workers that will impact the City of Tucson? | ||
| 7 | Subcontracting: Unless otherwise explained in this RFP, do you agree that you will disclose all subcontractor arrangements, and any additional fees associated with the subcontractor arrangements, that involve the services provided to the City of Tucson? | ||
| 8 | Indemnification: Do you agree to the indemnification clause in the RFP standard terms and conditions? | ||
| 9 | HIPAA Compliance: Offeror attests to meeting all applicable HIPAA EDI, Privacy, Security, and HITECH requirements and agrees to hold the City of Tucson harmless for breaches that are the result of Offeror actions. As relates to the service specified in this proposal, Offeror will become a HIPAA Business Associate of the City of Tucson? | ||
| 10 | Waiver of Actively-at-Work and Non-Confinement: Current participants in any of the City’s sponsored health care plans will be eligible for stop loss regardless if they are actively-at-work or hospital confined on the effective date? | ||
| 11 | Eligibility Rules and Uncertain Claimant Eligibility Situations: The Offeror agrees to the specified eligibility rules established by the City of Tucson? | ||
| 12 | No Member Communication Without the City’s Consent: The Offeror will not automatically enroll the City of Tucson in any programs that involve any type of communication with members, without express written consent from the City of Tucson? | ||
| 13 | Termination Provisions: The City of Tucson may terminate the contract at any time after the first complete plan year without cause, by giving 30 days written notice. The City of Tucson can terminate with cause with 30 days notice unless proper remedy is provided by the Offeror? | ||
| 14 | Any Early Termination provision contained in your contract can only be tied to non-payment of premium or a breach of duty by the City? | ||
| 15 | Assignment or Transfer of Rights: Do you agree that you will not assign or transfer the rights or obligations of the contract or any portion thereof, without the prior written approval of the City of Tucson? | ||
| 16 | Do you agree to the City’s Special Terms & Conditions? | ||
| 17 | Do you agree to the City’s Standard Terms & Conditions? | ||
| 18 | Please include a sample specific stop loss contract that is inclusive of any contract related responses provided in this RFP. |
| If you answered "No" to any of the questions above, please enter the number and provide an explanation below: | |
| Requirement No. | Explanation |
| METHOD OF APPROACH - SPECIFIC STOP LOSS | OFFEROR RESPONSE | |
| 1 | Do you agree to waive any pre-existing condition limitation for employees, retirees and dependents to the extent satisfied |
under the current plan?
2 Do you agree to waive actively at work provisions for employees and non-hospital confinement rules for retirees and dependents as of the effective date of your coverage?
3 Does your contract allow you to limit or exclude coverage for individuals who are disabled/receiving treatment that you were not made aware of through this RFP process or that occurred after you were awarded the contract, but prior to the contract effective date? If so, please explain the provisions.
4 Are there any individuals who are being excluded from coverage or provided different/limited coverage under your contract
| 5 | Please describe any underwriting contingencies. |
| 6 | Will you accept the City’s records as the final authority on eligibility? |
| 7 | Do you agree that the City’s plan documents (including any signed amendments) will be the sole determinant of what is covered or not covered as a reimbursable expense by your stop loss policy? |
| 8 | Are there any exclusions, limitations, or different recognized charge limits under your contract(s) that are covered expenses under the City’s SPD? Detail all exceptions on the Deviations/Exceptions forom. |
| 9 | Does your stop loss policy cover gene therapy drugs and if so, please explain the coverage. |
| 10 | Do you agree to not limit or exclude coverage (“laser”) on covered persons at renewal unless requested as an option by |
the City?
| 11 | If lasering is requested by the City as an option, do you normally provide a dollar for dollar reduction in premium for any increase in deductible? |
| 12 | Do you require a disclosure statement be completed at renewal? |
| 13 | If a disclosure statement is required to be completed, what is the maximum number of days in advance of the effective date it can be completed? Please provide a copy of the disclosure statement form. |
| 14 | What reporting information and frequency of reports do you require from the City’s claims administrator regarding claims |
activity?
| 15 | Will you accept claim filings directly from the City’s claims administrator on behalf of the City? |
| 16 | Reporting and Notifications |
| 16a | Provide a detailed description of all reporting and/or notification requirements for which the City will be responsible. |
| 17 | How will you interface with the claim administrators on large, individual claims to ensure treatment is medically necessary, |
reasonable, and appropriate for the patient’s condition?
| 18 | Case Management with Large Claims |
| 18a | How will you coordinate with the City’s TPA/case manager regarding a large claim? |
| 19 | Please provide a description of your process to collaboratively and effectively work with the current claims administrator. |
| 20 | Describe in detail your procedures and time frame for reimbursement of claims exceeding the specific stop loss level. Clearly describe the overall procedure you utilize from start to finish in reimbursing the City, including your interaction with the claims administrator, utilization review firm, and large case management service. |
| 21 | Payment of Claims |
| 21a | Based on your book of business, what was the average time from receipt of claim to payment of claim in 2025? |
| 22 | Advanced Funding |
| 22a | Do you have a program for Advanced Funding of eligible stop loss claims? |
| 22b | Describe how the program works? |
| 22c | Is there any additional cost to add? |
| 23 | Do you agree to provide to the City’s consulting firm monthly reports showing claimant name, amount submitted, amount |
pended, amount denied, date payments made, and amount paid?
| 24 | Define clearly the terms and conditions of your contract as they apply to termination. |
| 25 | After termination, what is the maximum number of days allowed for submission of a valid claim that was paid by the administrator within the contract period? |
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Q&E Questionnaire
| QUALIFICATIONS AND EXPERIENCE | OFFEROR RESPONSE | ||
| 1 | Offeror Information | ||
| 1a | Organization Name: | ||
| 1b | Date Founded: | ||
| 1c | Contact Person's Name: | ||
| 1d | Title | ||
| 1e | Address | ||
| 1f | City/State/Zip | ||
| 1g | Phone Number | ||
| 1h | Email Address | ||
| 2 | Financials: | ||
| 2a | What are the most recent ratings for your company by the following | Current | |
| Rating | Prior Rating | Date |
Changed
| 2b | Standard and Poor’s (S&P) | ||||
| 2c | Duff and Phelps | ||||
| 2d | A.M. Best | ||||
| 2e | Moody’s | ||||
| 3 | Please confirm any changes in financial strength rating agencies (downgrades or upgrades) shall be disclosed to the City of Tucson within 30 days of the effective date of the change. | ||||
| 4 | References: | ||||
| Current Public Sector Client References (Similar Sized Arizona Clients Preferred) | |||||
| Client Name | Contact Name | Phone Number and Client Location | Number of Members | Contract Start Date | |
| 4a | |||||
| 4b | |||||
| 4c | |||||
| Recently Terminated Public Sector Clients (Similar Sized Arizona Clients Preferred) | |||||
| Client Name | Contact Name | Phone Number and Client Location | Number of Members | Contract Start Date | |
| 4d | |||||
| 4e | |||||
| 4f | |||||
| 5 | Proper Licensure: Do you agree to maintain proper licensure as required by any state law where it relates to the services that you will be performing for the City of Tucson? | ||||
| 6 | Reinsurance | ||||
| 6a | Will your firm reinsure any of the risk? | ||||
| 6b | If so, identify what reinsurer(s) would be involved and at what levels of reinsurance? |
&"-,Bold"&14Attachment B - Stop Loss Questionnaire
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