City_of_Edinburg_-_Stop_Loss_Insurance.docx

City of Edinburg

Request for Proposal (RFP# XXXXXX) Stop Loss Insurance (Medical & Rx)

Effective Date: October 1, 2025 Deadline for Proposals: 03:00 P.M., July 15, 2025

Prepared by: Roger Garza, Insurance Consultant Valley Risk Consulting, Inc., 1200 Fresno, Suite C, McAllen, Texas 78501

The City of Edinburg is accepting proposals for:

RFP# XXXXXX Stop Loss Insurance (Medical & Rx)

Proposals must be submitted electronically to: https://secure.procurenow.com/portal/cityofedinburg, no later than Tuesday, July 15, 2025 @ 03:00 p.m.”

Proposals will be accepted until 03:00 p.m. on Tuesday, July 15, 2025. Any proposals received late will not be accepted.

Any questions about this Request for Proposal should be submitted through the procurement portal by 05:00 p.m. Thursday, July 3, 2025.

The proposal will be awarded at a City Commission meeting in August. The city reserves the right to accept or reject any and/or all proposals, waive minor technicalities, or award the proposal to the most responsible offeror who best serves the City's interests.

Please fill out, sign, and submit with your proposal response the enclosed IRS Form, W-9, and Conflict of Interest Questionnaire.

We look forward to hearing from you. Sincerely, Erica Balli, Director of Human Resources

Executive Summary Notice Request for Proposals (RFP) General Information:

1. The purpose of this Executive Notice is to highlight the key requirements of the Request for Proposal (RFP).

2. The City of Edinburg is requesting proposals from qualified firms to provide Stop Loss Insurance (Medical & Rx). Requested Policy terms: Specific Deductible-$125,000 & Contract Basis-12/12, Aggregate Corridor 125%, Max Liability $1,000,000.

3. Where applicable, all companies submitting proposals must be licensed by the Texas Department of Insurance and be permitted to contract with the State or any of its subdivisions. All insurance carriers must be rated by AM Best Company. Proposers who fall under the guidelines of the Interlocal Cooperation Act, Chapter 791, Title 7, Government Code, will be acceptable.

4. City of Edinburg may award to contract to the bidder who provides goods or services at the best value for the City. In determining the best value for the City, the City may consider:

(1) the purchase prices.

(2) the reputation of the bidder and the bidder's goods or services.

(3) the quality of the bidder's goods or services.

(4) the extent to which the goods or services meet the City's needs.

(5) the bidder's past relationship with the City.

(6) the impact on the ability of the City to comply with laws and rules relating to contracting with historically underutilized businesses and nonprofit organizations employing persons with disabilities.

(7) the total long-term cost to the City to acquire the bidder's goods or services; and

(8) any relevant criteria specifically listed in this request for bids or proposals

5. The contract will be effective as per the Insurance Policy, or after city council approval, whichever occurs later. The city would prefer a one-year contract with the option to renew for two (2) additional (separate) one (1) year terms, if there are no changes in terms and conditions, insurance agent or underwriting company, and the insurance rates do not increase more than 5% per year.

6. Any questions about this RFP and requests for additional information shall be requested no later than Thursday, July 3, 2025, 5:00 p.m. via https://secure.procurenow.com/portal/cityofedinburg. The city will not respond to verbal inquiries. Any form of contact by an offeror or potential offeror regarding this RFP, at any time during the solicitation process from initial advertisement through award, with the Commissioners or any person employed by the City of Edinburg, other than through the communication channels stipulated in the Request for Proposal, or as subsequently instructed by the City of Edinburg through the solicitation process, will constitute grounds for rejection of their Proposal.

7. Public sector employers are not allowed, under current state law, to execute a document containing a Hold Harmless/Indemnification Clause causing the employer to be responsible for other parties’ liability. Therefore, your documents should not contain any such clauses.

8. Since the City of Edinburg is interested in limiting costs associated with the acquisition process, offerors not intending to continue with the RFP are requested to submit a letter requesting they be taken off the mailing list for this solicitation. City of Edinburg reserves the right to reject any or all proposals, waive technicalities, and award the contract in the best interest of the City. Price alone will not be the sole determining criterion in the selection process.

9. Proposers must submit electronically https://secure.procurenow.com/portal/cityofedinburg.

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Stop Loss Insurance (Medical & Rx)

Section 1:

General Information

General Requirements, Instructions, and Conditions

Section 2:

Proposer Questionnaires

Stop Loss Insurance (Medical & Rx)

Section 3:

City Forms

Anti-Collusion Certification

W-9

Conflict of Interest Form 1295 Certificate of Interested Parties

Felony Conviction Notice

Section 4:

Benefit Exhibits (Available on Website)

Section

General Information

Stop Loss Insurance (Medical & Rx)

GENERAL REQUIREMENTS AND INSTRUCTIONS

A. Information

1. The information contained in these specifications is confidential and is to be used only in connection with preparing a proposal for the following services or coverages:

Stop Loss Insurance (Medical & Rx)

2. The City of Edinburg reserves the right to accept or reject all or any part of the proposals, waive minor technicalities, and award the proposal to best serve its interest. The City of Edinburg also reserves the right to waive or dispense with any of the formalities contained herein.

3. Proposals are to be submitted based on the specifications contained herein. Alternate proposals will also be considered, provided the alternatives are clearly explained. All deviations from the specifications must be identified and explained.

4. The information contained herein is believed to be accurate and up to date but is not intended to be an express or implied warranty.

5. No mailed or faxed proposals will be accepted.

B. Legal All parties submitting proposals are expected to comply with federal, state, and local insurance laws and regulations relative to the preparation and submission of insurance proposals. Specifically, the services to be provided are expected to follow the Americans with Disabilities Act (ADA), Family and Medical Leave Act (FMLA), Health Insurance Portability and Accountability Act (HIPAA), insurance laws, and insurance regulations. All proposals that are submitted will be presumed to follow all applicable laws.

C. Communication and Time Frame

1. Any questions about this RFP and requests for additional information shall be requested no later than Thursday, July 3, 2025, 5:00 p.m. via https://secure.procurenow.com/portal/cityofedinburg. Requests from vendors by phone, email, or correspondence to the City of Edinburg or the agency’s consultant to check the status of the proposal will not be permitted.

2. Copies of all correspondence relevant to this assignment will be distributed to all interested participants.

3. The RFP specifications will be available to interested parties no later than 5:00 pm Wednesday, June 25, 2025, on the City of Edinburg’s website: https://secure.procurenow.com/portal/cityofedinburg.

4. The agreement's effective date will be determined by the Commissioners of the City of Edinburg.

D. Proposals

1. Proposals must be clearly explained. All costs, including optional programs, must be clearly stated and summarized. Exceptions to or deviations from the specifications must be explicitly identified.

2. Each party submitting a proposal is asked to screen their designated proposals for correctness and compliance with the specifications. They shall include an inventory list of products submitted, attached to each proposal.

3. The proposal is to be based on duplication of the existing Plan of Benefits. Any deviations must be identified and explained. All proposals will be assumed to have been submitted without any deviations unless clearly noted.

4. The contents of the proposals shall be kept confidential during the process of negotiations. After the insurance agreement is awarded, all proposals will be available for public inspection.

Stop Loss Insurance (Medical & Rx) E. Disqualification and Rejection of Proposals Failure to comply with the requirements or the procedures set forth herein, or to satisfy the insurance and servicing criteria as outlined in the specifications, may result in disqualification. It is not intended that exceptions to the specifications will, in and of themselves, result in disqualification.

F. Selection of Vendor City of Edinburg reserves the right to reject any or all of the proposals, in whole or in part; to waive any informality in any proposal, and to accept the proposal which, in its discretion, is in their best interest of the City. The insurance consulting firm, Valley Risk Consulting, will review Proposals for completeness and compliance with bid specifications. Eligible vendors should be available for questions and answers by telephone or personal appearance at the Consultant’s or City Staff’s request. The Commissioners of the City of Edinburg will make the final award decision.

G. Terms of Agreement The City of Edinburg is seeking a contract for a primary term to commence upon award by the Commissioners of City of Edinburg for an initial one-year term with the option to renew the agreement for two (2) additional one (1) year terms. The agreement will not commence before October 1, 2025.

The City of Edinburg reserves the right to terminate the agreement at the expiration of the budget period, during the term of the agreement, or at the end of the first anniversary date on sixty (60) days’ notice. The agreement will be for current revenues only, under Local Government Code Section 271.903, to terminate the agreement.

The agreement is to contain a cancellation provision that provides for sixty (60) days’ notice of cancellation (except for non-payment) and sixty (60) days’ notice for non-renewal or material change.

The City of Edinburg reserves the right to terminate the agreement at any time for any or no reason.

Authorized Signature All proposal forms must be signed by persons who have the legal authority to bind the insurer and administrator to the services that are proposed.

H. Enrollment The selected Providers will also be responsible for providing enrollment materials before the employee benefit enrollment meetings. The selected provider must provide a plan for non-contact enrollment, such as Virtual Enrollment.

Group Health Insurance City of Edinburg currently provides medical benefits through a fully funded benefit program. The City’s current group insurance carrier is Blue Cross/Blue Shield of Texas.

City of Edinburg Stop Loss Insurance (Medical & Rx)

Description of Plan must be in the labeled format below and include the following:

Section A – Questionnaire (Attached)

Section B - Schedule of Rates

Section C - Complete Description of Benefits

Section D - Complete Description of All Limitations & Exclusions

Section E - Signed Conflict of Interest Questionnaire (Attached)

Section F – Completed and signed Anti-Collusion Certification Form (Attached)

Section G – Completed and signed W-9 Form (Attached)

Section H – Completed and signed Form 1295 Certificate of Interested Parties (Attached)

Company Name

Authorized Signature

Address

Type Signatory’s Name and Title

Telephone Number

Agent Name

Fax Number

Proposer Questionnaire Individual Stop Loss Insurance (ISL)/Aggregate Stop Loss Insurance (ASL)

1. Describe the business entity submitting the proposal:

a. Insurance Company Name: ______________________________________

b. Address: ____________________________________________________

c. Contact Person: ______________________________________________

d. Telephone Number: Fax Number:

e. Name of submitting Insurance Agency: ___________________________________________

f. Address of submitting Insurance Agency: _________________________________________

g. Year Founded (Managing Underwriter): ___________________________________________

2. Describe the Financial Stability of the Insurance Company: Financial Rating Service Current Rating Prior Year Rating Prior Two (2) Years Rating

A.M. Best

3. Is the Insurance Company authorized to do business in Texas? □Yes □ No

4. Provide three (3) Texas client references:

Name of Client

Contact Person

Telephone Number

Number of Employees

5. Has the carrier or business entity been a defendant in any lawsuit in any State or Federal Court during any of the preceding five (5) years? □Yes □ No

6. Does the carrier or business entity have any claims filed against it that are unresolved and presently pending before any State of Texas Administrative agency? □Yes □ No

If yes, please provide a full description of the matter: ________________________________________________________________________________

7. Is advance claim funding available? □Yes □ No

8. Insurance coverage

The business entity must provide satisfactory evidence of existing insurance coverage for $1,000,000.00 for Errors and Omissions or other fiduciary liability. If the business entity is selected to provide services, it must provide evidence that such coverage will be in effect for the duration of the agreement. (Include Copy of Insurance Certificate)

9. If an MGU, do you administer claims in-house? □Yes □ No

10. If not, who is the administrator? _____________________________________________________

11. If an MGU, are there additional Insurance Carriers accepting layers of risk? □Yes □ No Please disclose the names, addresses, and phone numbers of those carriers and the percentage of risk taken.

12. Please describe the specific incurred/paid contract period (i.e., 12/12, 12/15, etc.) that you offer.

13. Are there any run-in limits? □Yes □ No If yes, what are they? ________________________________________________________________________________________________________________________________________________________________

14. ISL and ASL claim payment:

a. Where is the claim payment office located? __________________________________________

b. What is the definition of “paid claim” to be eligible for reimbursement? _____________________________________________________________________________

c. Can the City’s Insurance Department speak directly to the claim examiner for questions related to payment of claims? □Yes □ No

d. What is the normal processing time for ISL claims? ____________________________________

e. What is the normal processing time for an ASL claim? __________________________________

f. If the city has negotiated with providers, will these discounts be accepted in place of doing a hospital audit? □Yes □ No

g. Describe documentation needed for ISL claim reimbursement: ____________________________________________________________________________

h. What is the maximum Aggregate Liability limit? ____________________________________________________________________________

i. Do you provide/require access to transplant networks(s)-centers of excellence directly or through TPA? □Yes □ No

j. Do quoted rates include advance funding for:

k. What are the minimum and maximum expected funding levels? ____________________________________________________________________________

15. Underwriting:

a. How recent must claims experience be to provide “final terms”? __________________________

b. Will any claimants be excluded or assigned a higher deductible? □Yes □ No If yes, please describe: ____________________________________________________________________________

c. Will renewal rates be provided to the city 90 days before the renewal date? □Yes □ No

d. Does your Stop Loss insurance contract have any exclusions or limitations that are more restrictive than those used in the City’s Plan document? □Yes □ No If yes, please describe: _____________________________________________________________________________

e. Are the active-at-work and disabled dependent provisions waived for the effective date of the contract? □Yes □ No

16. Is the quote based on the services of a particular claim administrator or provided Network? □Yes □ No

17. Do you require your TPA to provide Errors & Omissions coverage? □Yes □ No At what limits? ____________________________________________________________________

18. Will your proposal allow for the city to select any:

19. For what period are quoted rates guaranteed? _________________________________ Is a longer rate guarantee available? □Yes □ No

20. Please state any variations to the Request for Proposals or other qualifications for your quote:

21. Is the actual Stop Loss Agreement attached? □Yes □ No

Company Name Authorized Signature

Address Type Signatory’s Name and Title

Telephone / Fax Number

Email Address

Required Forms

Implementation of House Bill 1295 Certificate of Interested Parties (Form 1295):

In 2015, the Texas Legislature adopted House Bill 1295, which added section 2252.908 of the Government Code. The law states that a governmental entity or state agency may not enter into certain contracts with a business entity unless the business entity submits a disclosure of interested parties to the governmental entity or state agency at the time the business entity submits the signed contract to the governmental entity or state agency. The law applies only to a contract of a governmental entity or state agency that either (1) requires an action or vote by the governing body of the entity or agency before the contract may be signed or (2) has a value of at least $1 million. The disclosure requirement applies to a contract entered into on or after January 1, 2016.

The Texas Ethics Commission was required to adopt rules necessary to implement that law, prescribe the disclosure of interested parties form, and post a copy of the form on the commission’s website. The commission adopted the Certificate of Interested Parties form (Form 1295) on October 5, 2015. The commission also adopted new rules (Chapter 46) on November 30, 2015, to implement the law. The commission does not have any additional authority to enforce or interpret House Bill 1295.

Filing Process:

By January 1, 2016, the commission will make available on its website a new filing application that must be used to file Form 1295. A business entity must use the application to enter the required information on Form 1295 and print a copy of the completed form, which will include a certification of filing that will contain a unique certification number. An authorized agent of the business entity must sign the printed copy of the form and have the form notarized. The completed Form 1295 with the certification of filing must be filed with the governmental body or state agency with which the business entity is entering into the contract.

The governmental entity or state agency must notify the commission, using the commission’s filing application, of the receipt of the filed Form 1295 with the certification of filing not later than the 30th day after the date the contract binds all parties to the contract. The commission will post the completed Form 1295 to its website within seven business days after receiving notice from the governmental entity or state agency.

Information regarding how to use the filing application will be available on this site by January 1, 2016.

A sample Form 1295 is included in this procurement document to make prospective vendors aware of this requirement. Vendors are NOT required to complete the enclosed form and include it in their response. Complete instructions and important information can be located from the following link:

https://www.ethics.state.tx.us/whatsnew/elf_info_form1295.htm

CERTIFICATE OF INTERESTED PARTIES FORM 1295

Complete Nos. 1 - 4 and 6 if there are interested parties.

Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties.

OFFICE USE ONLY

1 Name of business entity filing form, and the city, state, and country of the business entity's place of business.

2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed.

3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the goods or services to be provided under the contract.

Name of Interested Party

City, State, Country (place of business) Nature of Interest (check applicable)

5 Check only if there is NO Interested Party.

6 AFFIDAVIT I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct.

Signature of authorized agent of contracting business entity

AFFIX NOTARY STAMP / SEAL ABOVE

Sworn to and subscribed before me, by the said, this the day of, 20, to certify which, witness my hand and seal of office.

Signature of officer administering oath, Printed name of officer administering oath, Title of officer administering oath

ADD ADDITIONAL PAGES AS NECESSARY

CONFLICT OF INTEREST QUESTIONNAIRE - FORM CIQ

For a vendor or other person doing business with a local governmental entity

This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session.

This questionnaire is being filed by Chapter 176, Local Government Code, by a vendor who has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the vendor meets requirements under Section 176.006(a).

By law, this questionnaire must be filed with the records administrator of the local government entity not later than the 7th business day after the date the vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1), Local Government Code.

A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code. An offense under this section is a misdemeanor.

Check this box if you are filing an update to a previously filed questionnaire.

(The law requires that you file an updated, completed questionnaire with the appropriate filing authority not later than the 7th business day after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.)

Name of Officer

This section (item 3, including subparts A, B, C & D) must be completed for each officer with whom the vendor has an employment or other business relationship as defined by Section 176.001(1-a), Local Government Code. Attach additional pages to this Form CIQ as necessary.

A. Is the local government officer named in this section receiving or likely to receive taxable income, other than investment income, from the vendor?

xxxx

Yes No

B. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer named in this section, AND the taxable income is not received from the local governmental entity?

Yes No

C. Is the filer of this questionnaire employed by a corporation or other business entity concerning which the local government officer serves as an officer or director, or holds an ownership of one percent or more?

Yes No

D. Describe each employment or business and family relationship with the local government officer named in this section.

I have no Conflict of Interest to disclose.

Signature of the vendor doing business with the governmental entity

Date

FELONY CONVICTION NOTIFICATION

State of Texas Legislative Senate Bill No. 1, Section 44.034, Notification of Criminal History, Subsection (a), states “a person or business entity that enters into a contract with a City must give advance notice to the City if the person, owner or operator of the business entity has been convicted of a felony. The notice must include a general description of the conduct resulting in the conviction of a felony.”

Subsection (b) states, “a City may terminate a contract with a person or business entity if the City determines that the person or business entity failed to give notice as required by Subsection (a) or misrepresented the conduct resulting in the conviction. The City must compensate the person or business entity for services performed before the termination of the contract.”

THIS NOTICE IS NOT REQUIRED OF A PUBLICLY HELD CORPORATION, BUT THE COMPANY REPRESENTATIVE MUST CHECK OFF A SELECTION BELOW (A, B, OR C)

I, the undersigned agent for the firm named below, certify that the information concerning notification of felony convictions has been reviewed by me, and the following information furnished is true to the best of my knowledge.

VENDOR NAME: _________________________________________________________________

AUTHORIZED COMPANY OFFICIAL’S NAME (PRINTED) AND SIGNATURE:

DATE: _____________________________

***** PLEASE CHECK OFF A SELECTION BELOW*****

( ) A. My firm is a publicly held corporation; therefore, this reporting requirement is not applicable.

( ) B. My firm is not owned and/or operated by anyone who has been convicted of a felony.

( ) C. My firm is owned or operated by the following individual(s) who has/have been convicted of a felony:

Name of Felon: ______________________________________________________________

Details of Convictions(s): ______________________________________________________

NON-COLLUSION STATEMENT & SIGNATURE SHEET

The undersigned affirms that he/she is duly authorized to execute this contract, that this company, corporation, firm, partnership or individual has not prepared this proposal in collusion with any other Offeror, and that the contents of this proposal as to prices, terms or conditions of said proposal have not been communicated by the undersigned nor by any employee or agent to any other person engaged in this type of business prior to the official opening of this proposal.

Further, I affirm that prior to or after the opening of this proposal, I (or any representative of my company) will not discuss the contents of this proposal with any person affiliated with the City of Edinburg, other than the Purchasing Manager or City of Edinburg Designee prior to the awarding of this proposal. I understand that failure to observe this procedure may cause my proposal to be rejected.

I also affirm that no officer or stockholder of the offeror (bidder) is a member of the staff or related to any employee of the City of Edinburg, Mayor, and City Commission, except as noted herein ______________________________________________________________________________.

By signing this proposal, the vendor makes the assurance that the vendor has not been debarred or suspended from conducting business with the U. S. Government according to Executive Order 12549 entitled “Debarment and Suspension.”

I, _________________________________, have read the standard terms and conditions, (Print/Type Name of Company Officer), general proposal requirements and assumptions, background & the proposal specifications requirements, I fully understand them, and will fully execute them if I am awarded this proposal.

I have represented the truth concerning the felony conviction notification. I have checked off one of the three statements and have signed the form.

I have read the criteria for evaluation that the City shall consider awarding this contract, as per Texas Education Code, Subchapter B, Section 44.031 (b).

I fully understand the proposal’s insurance information forms and cost sheets.

COMPANY ________________________________________________________

ADDRESS _________________________________________________________

CITY, STATE, ZIP CODE _____________________________________________

TELEPHONE/FAX __________________________________________________

Signature Title Date

Exhibits

Available on the Website image2.emf image1.jpg