ESBD_503812_1777066516977_Invoice Sample.pdf
PDF 102 KB Posted
- Solicitation number
- RFP-01-SBA-26-280
- Issued by
- Brazos County, Texas
About this file
This is an Invoice Sample document related to a Request for Proposal (RFP SBA-26-280) issued by the Texas A&M University System Office of Procurement and Business Services for claims administration and fully-insured group life and accidental death and dismemberment (AD&D) insurance services. The procurement encompasses group life insurance and group AD&D coverage for approximately 42,285 employees and retirees in Basic Life coverage and 18,066 in AD&D coverage across the A&M System. Required deliverables include benefit contract administration, claims management and processing, monthly and quarterly management reports, representation at approximately 20 to 25 open enrollment meetings throughout Texas, actuarial analysis and rate recommendations, and assessment of Waiver of Premium eligibility cases. The proposal submission deadline is May 4, 2026, at 2:00 p.m. Central Time, with questions due by April 17, 2026, addendum release scheduled for April 24, 2026, presentations or interviews on May 18, 2026, and respondent selection by May 22, 2026. The initial contract term commences September 1, 2026, and runs through August 31, 2029, with potential renewal for up to three additional one-year periods not to exceed August 31, 2032.
All pricing must be guaranteed for the initial three-year contract term on a fully-insured basis, with pricing covering Basic Life, Optional Life, Dependent Life, Supplemental AD&D, and Basic AD&D plans. The incumbent vendor is The Hartford Life and Accident Insurance Company, currently providing coverage under policy numbers 681794G and 681835G, effective since September 1, 2020. The invoice sample document reflects detailed premium and payment data across multiple life insurance product lines, including Basic Life/AD&D coverage, Premium Waiver plans, and Optional Life plans with varying coverage amounts. Basic Life and Basic AD&D coverage is funded through statutory contributions by the State of Texas, while Optional Life, Dependent Life, and Supplemental AD&D plans are paid entirely by participants through payroll deduction or accounts receivable basis. The A&M System currently operates on a self-bill arrangement with a 40 to 50-day premium lag due to payroll system limitations. Financial experience reports from The Hartford covering the five-year period from September 2020 through August 2025 demonstrate a combined loss ratio of 85.7% on total billed premiums of $108,220,432. Respondents must demonstrate financial stability by submitting audited financial statements for the past two years and must maintain minimum insurance coverage including Workers' Compensation, Commercial General Liability ($1,000,000 per occurrence), Cyber Liability ($2,000,000), and Professional Liability/Errors & Omissions ($2,000,000 each occurrence), with a required HUB Subcontracting Plan including a 2% VetHUB goal.
View the file
Other files
Show all 21
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Basic Life Sum BL Cov Amount Sum BL Enrolled Sum BL Payments Sum BL Billed Total File EDW File Raw File Sum of TotalBilled (blank) Sum of BL Payments 174,592.55$ Sum of BL Payments 174,592.55$ ADD 23,611.82$ (blank) (40.70)$ 5,537.69$ Sum of BL Billed 59,039.18$ Sum of ADD Payments 75,421.59$ BL 59,039.18$ Basic Life/AD&D - The Hartford (Employee) Sum of ADD Payments 75,421.59$ Sum of SL + CL Payments 144,360.31$ DL 67,201.57$ $7,500 305,370,000.00$ 40,716 142,731.66$ 48,715.51$ Sum of ADD Billed 23,611.82$ Sum of OL Payments 1,162,079.95$ OL 381,930.18$ Basic Life/AD&D - The Hartford Premium Waiver (Employee) Sum of SL + CL Payments 144,360.31$ 1,556,454.40$ Grand Total 531,782.75$ $7,500 15,000.00$ 2 -$ Sum of SL + CL Billed 67,201.57$ Alternate Basic Life/AD&D - The Hartford (Employee) Sum of OL Payments 1,162,079.95$ $50,000 50,750,000.00$ 1,015 31,832.10$ -$ Sum of OL Billed 381,930.18$ $25,000 100,000.00$ 4 62.60$ -$ 2,088,237.15$ $10,000 10,000.00$ 1 6.26$ -$ $1,000 1,000.00$ 1 0.63$ -$ Alternate Basic Life/AD&D - The Hartford Retiree - Age 80+ (Employee) $13,000 13,000.00$ 1 8.14$ $30,000 4,230,000.00$ 141 2,647.98$ $7,500 315,000.00$ 42 197.40$ $10,000 10,000.00$ 1 6.26$ Alternate Basic Life/AD&D - The Hartford - Retiree Under Age 80 (Employee) $50,000 3,000,000.00$ 60 1,878.00$ $38,000 38,000.00$ 1 23.79$ $39,000 39,000.00$ 1 24.41$ Grand Total 363,891,000.00$ 41,986 174,592.55$ 59,039.18$
Optional Life Sum OL Cov Amount Sum OL Enrolled Sum OL Payments Sum OL P&A Billed (blank) 191.40$ -$ (blank) (blank) Non-Smoker <25 -$ 25-29 -$ 30-34 -$ 35-39 (45.10)$ -$ 40-44 (59.15)$ -$ 45-49 69.84$ -$ 50-54 48.27$ -$ 55-59 -$ 60-64 -$ 65-69 -$ 70-74 -$ 75+ 177.54$ -$ Smoker <25 -$ 25-29 -$ 30-34 -$ 35-39 -$ 40-44 -$ 45-49 -$ 50-54 -$ 55-59 -$ 60-64 -$ 65-69 -$ 70-74 -$ 75+ -$ Retiree Optional Life - Under Age 70 154,323,000.00$ 1,804 (200.00)$ 101,180.76$ Non-Smoker 45-49 395,000.00$ 4 47.40$ 50-54 2,375,000.00$ 25 467.00$ 55-59 17,058,000.00$ 183 (200.00)$ 5,837.68$ 60-64 39,089,000.00$ 439 20,379.44$ 65-69 70,115,000.00$ 840 50,061.00$ 70-74 14,088,000.00$ 171 10,706.88$ Smoker 50-54 100,000.00$ 1 40.00$ 55-59 1,250,000.00$ 13 804.00$ 60-64 3,388,000.00$ 42 3,530.56$ 65-69 5,387,000.00$ 72 7,668.24$ 70-74 1,078,000.00$ 14 1,638.56$ Optional Life 3,981,977,000.00$ 12,071 1,162,088.55$ 360.00$ Non-Smoker <25 10,878,500.00$ 75 551.98$ -$ 25-29 79,921,500.00$ 499 4,072.95$ -$
30-34 213,595,500.00$ 966 11,228.29$ -$ 35-39 348,418,000.00$ 1,249 21,642.74$ -$ 40-44 524,229,000.00$ 1,570 38,983.77$ -$ 45-49 621,345,000.00$ 1,672 72,109.19$ -$ 50-54 645,947,500.00$ 1,664 125,187.17$ -$ 55-59 663,760,500.00$ 1,720 223,267.55$ 360.00$ 60-64 399,370,000.00$ 1,159 215,795.84$ -$ 65-69 225,991,500.00$ 640 177,103.82$ -$ 70-74 75,093,000.00$ 230 106,198.14$ -$ 75+ 42,584,500.00$ 129 97,577.00$ -$ Smoker <25 510,000.00$ 4 51.30$ -$ 25-29 3,505,000.00$ 17 363.70$ -$ 30-34 4,903,000.00$ 28 518.60$ -$ 35-39 9,483,000.00$ 46 1,165.07$ -$ 40-44 15,859,000.00$ 56 2,327.90$ -$ 45-49 23,302,000.00$ 76 5,160.73$ -$ 50-54 22,668,500.00$ 75 8,013.00$ -$ 55-59 24,236,500.00$ 85 16,252.12$ -$ 60-64 16,145,000.00$ 67 16,548.42$ -$ 65-69 5,960,000.00$ 28 9,353.56$ -$ 70-74 4,012,500.00$ 14 7,398.38$ -$ 75+ 258,000.00$ 2 1,217.33$ -$ Retiree Optional Life - Age 70 - 79 118,309,000.00$ 2,191 202,708.32$ Non-Smoker 70-74 49,468,000.00$ 916 66,584.57$ 75+ 63,198,000.00$ 1,169 117,980.25$ Smoker 70-74 2,970,000.00$ 56 8,038.60$ 75+ 2,673,000.00$ 50 10,104.90$ Retiree Optional Life -Age 80+ (EE) 37,550,000.00$ 1,339 76,581.10$ Non-Smoker 75+ 36,814,000.00$ 1,314 73,637.10$ Smoker 75+ 736,000.00$ 25 2,944.00$ Retiree Optional Life - Grandfathered Age 80+ 550,000.00$ 10 1,100.00$ Non-Smoker 75+ 550,000.00$ 10 1,100.00$ Optional Life - The Hartford Premium Waiver ( 330,000.00$ 2 -$ Non-Smoker 60-64 330,000.00$ 2 -$ Grand Total 4,293,039,000.00$ 17,417 1,162,079.95$ 381,930.18$
Spouse Life SumSL Cov Amount Sum SL Enrolled Sum SL+CL Payments Sum SL+CL Billed (blank) 144,360.31$ 67,201.57$ (blank) (blank) Non-Smoker <25 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 70-74 75+ 65-69 Smoker <25 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 70-74 75+
65-69 Spouse Life -Plan A Grandfathered (Spouse) 71,133,000.00$ 525 Non-Smoker 35-39 75,000.00$ 1 40-44 317,000.00$ 3 45-49 4,440,000.00$ 38 50-54 10,293,000.00$ 84 55-59 21,846,000.00$ 157 60-64 15,307,000.00$ 117 70-74 3,389,000.00$ 19 75+ 3,567,000.00$ 22 65-69 9,799,000.00$ 66 Smoker 50-54 635,000.00$ 5 55-59 463,000.00$ 4 60-64 824,000.00$ 7 65-69 178,000.00$ 2 Spouse Life - Plan A (Spouse) 267,048,000.00$ 2,857 Non-Smoker <25 275,000.00$ 4 25-29 4,350,000.00$ 45 30-34 15,675,000.00$ 168 35-39 29,005,000.00$ 293 40-44 43,855,000.00$ 422 45-49 45,400,000.00$ 455 50-54 44,680,000.00$ 453 55-59 38,575,000.00$ 433 60-64 21,500,000.00$ 265 70-74 3,358,000.00$ 45 75+ 1,450,000.00$ 25 65-69 8,600,000.00$ 123 Smoker 25-29 250,000.00$ 2 30-34 550,000.00$ 5 35-39 625,000.00$ 8 40-44 1,200,000.00$ 13 45-49 2,125,000.00$ 21 50-54 2,325,000.00$ 26 55-59 1,500,000.00$ 20 60-64 1,175,000.00$ 19 70-74 125,000.00$ 2 65-69 450,000.00$ 10 Spouse Life - Plan B (Spouse) 6,525,000.00$ 1,305 Non-Smoker <25 10,000.00$ 2 25-29 330,000.00$ 66 30-34 730,000.00$ 146 35-39 765,000.00$ 153 40-44 935,000.00$ 187 45-49 665,000.00$ 133 50-54 815,000.00$ 163 55-59 785,000.00$ 157 60-64 520,000.00$ 104 70-74 220,000.00$ 44 75+ 95,000.00$ 19 65-69 470,000.00$ 94 Smoker 30-34 5,000.00$ 1 35-39 15,000.00$ 3 40-44 15,000.00$ 3 45-49 40,000.00$ 8 50-54 25,000.00$ 5 55-59 40,000.00$ 8 60-64 25,000.00$ 5 70-74 10,000.00$ 2 65-69 10,000.00$ 2 Spouse Life - Plan C (Spouse) 1,386,000.00$ 58 Non-Smoker 25-29 75,000.00$ 3 30-34 75,000.00$ 3 35-39 75,000.00$ 3 40-44 216,000.00$ 9 45-49 210,000.00$ 9
50-54 145,000.00$ 6 55-59 160,000.00$ 7 60-64 250,000.00$ 10 70-74 50,000.00$ 2 75+ 50,000.00$ 2 65-69 50,000.00$ 2 Smoker 40-44 5,000.00$ 1 55-59 25,000.00$ 1 Retiree Spouse Life - A - Age 70 - 79 (Spouse 17,211,000.00$ 621 Non-Smoker 70-74 7,215,000.00$ 257 75+ 8,963,500.00$ 326 Smoker 70-74 542,000.00$ 19 75+ 490,500.00$ 19 Retiree Spouse Life - Plan A - Age 80+ (Spous 3,562,000.00$ 243 Non-Smoker 75+ 3,532,000.00$ 241 Smoker 75+ 30,000.00$ 2 Retiree Spouse Life - The Hartford Plan A - un 27,505,500.00$ 606 Non-Smoker 45-49 150,000.00$ 3 50-54 500,000.00$ 10 55-59 2,985,000.00$ 63 60-64 7,040,000.00$ 151 70-74 2,343,000.00$ 52 65-69 12,470,500.00$ 281 Smoker 50-54 50,000.00$ 1 55-59 200,000.00$ 4 60-64 602,000.00$ 15 70-74 175,000.00$ 4 65-69 990,000.00$ 22 Spouse Life - The Hartford Plan A Grandfathe 29,000.00$ 1 Non-Smoker 60-64 29,000.00$ 1 Retiree Spouse Life - The Hartford Plan C - Ag 135,000.00$ 6 Non-Smoker 70-74 50,000.00$ 2 65-69 85,000.00$ 4 Retiree Spouse Life - The Hartford Plan B (Sp 10,000.00$ 2 Non-Smoker 75+ 10,000.00$ 2 Grand Total 394,544,500.00$ 6,224
Child Life Sum CL Cov Amount Sum CL Enrollment Sum SL+CL Payments Sum SL+CL Billed Child Life - The Hartford Plan A (Child(ren)) 32,390,000.00$ 6,153 144,360.31$ 67,201.57$ Child Life - The Hartford Plan A Grandfathered 37,000.00$ 1 Child Life - The Hartford Plan A Grandfathered 66,039,000.00$ 877 Child Life - The Hartford Plan B (Child) (Child(r 6,390,000.00$ 2,333 Child Life - The Hartford Plan C (Child(ren)) 165,000.00$ 91 Grand Total 105,021,000.00$ 9,455
SL+CL Sum SL+CL Payments Sum SL + CL Billed (blank) (blank) Non-Smoker 139,081.32$ 63,458.35$ <25 18.22$ -$ 25-29 416.77$ -$ 30-34 1,671.08$ -$ 35-39 3,501.05$ -$ 40-44 6,470.53$ -$ 45-49 9,158.54$ 39.22$ 50-54 15,574.76$ 293.30$ 55-59 28,071.10$ 1,725.13$ 60-64 27,648.98$ 5,750.22$ 65-69 21,602.18$ 14,130.79$ 70-74 11,660.66$ 16,107.89$ 75+ 13,287.45$ 25,411.80$
Smoker 5,278.99$ 3,743.22$ <25 -$ 25-29 16.80$ -$ 30-34 40.63$ -$ 35-39 85.35$ -$ 40-44 184.23$ -$ 45-49 358.72$ -$ 50-54 804.71$ 12.10$ 55-59 937.14$ 77.50$ 60-64 1,832.56$ 576.82$ 65-69 725.74$ 1,001.65$ 70-74 293.11$ 1,150.63$ 75+ 924.52$ Grand Total 144,360.31$ 67,201.57$
Standalone AD&D Sum ADD Cov Amount Sum ADD Enrolled Sum ADD Payments Sum ADD Billed (blank) (0.50)$ -$ Optional AD&D - The Hartford Retiree - under 188,790,000.00$ 1,140 4.61$ 8,658.58$ Optional AD&D - The Hartford (Family) 1,874,190,000.00$ 4,866 49,581.73$ -$ Optional AD&D - The Hartford (Employee) 1,913,360,000.00$ 5,725 21,006.26$ -$ Optional AD&D - The Hartford Employer Paid ( 162,480,000.00$ 318 3,880.32$ -$ Optional AD&D - The Hartford Employer Paid ( 75,110,000.00$ 185 751.10$ -$ Optional AD&D - The Hartford <=$25,000 - Em 310,000.00$ 3 7.44$ -$ Optional AD&D - The Hartford <= $25,000 (Fa 3,590,000.00$ 18 92.18$ -$ Optional AD&D - The Hartford <= $25, 000 (Em 9,790,000.00$ 60 99.06$ -$ Optional AD&D - The Hartford <=$25,000 - Em 1,340,000.00$ 8 13.40$ -$ Optional AD&D - The Hartford Retiree - over a 131,010,000.00$ 2,293 (2.00)$ 3,666.60$ Optional AD&D - The Hartford Retiree - over a 109,130,000.00$ 1,875 5,019.98$ Optional AD&D - The Hartford Retiree - Over A 14,490,000.00$ 243 666.54$ Optional AD&D - The Hartford Retiree - under 168,780,000.00$ 1,061 (12.01)$ 4,719.12$ Optional AD&D - The Hartford Retiree - Over A 8,750,000.00$ 149 245.00$ Optional AD&D - The Hartford Retiree - Under 11,160,000.00$ 59 513.36$ Optional AD&D - The Hartford Retiree Under A 4,380,000.00$ 24 122.64$ Grand Total 4,676,660,000.00$ 18,027 75,421.59$ 23,611.82$
Summary
File details come from the government source that posted it. Updated .