ESBD_540156_1784577123429_RFP 2607-002 Stop Loss Insurance.pdf

Request for Proposals

RFP 2607-002

Stop Loss Insurance

July 20, 2026

Contact: Central Health Purchasing Office 1111 E. Cesar Chavez St. Austin, TX 78702 Phone: 512-978-8157 Email: CHPurchasingDLDL@centralhealth.net

PROPOSALS DUE: Wednesday, August 19, 2026 - 2:00 P.M. Prevailing Central Time

RFP 2607-002 Stop Loss Insurance P a g e 2

RFP 2607-002 HR Stop Loss Insurance Procurement Schedule

Action Date Time Responsibili ty Location / Details

Solicitation Issue Date

Monday, July 20, 2026 5:00 PM Central Health

Bidnet and Electronic State Business Daily ("ESBD")

Pre-Proposal Conference (optional)

Monday, July 27, 2026 11:00

AM

Central Health

MS Teams

Question Submittal Monday, August 3, 2026 5:00 PM Proposers Bidnet or

CHpurchasing@centralhealth .net

Question Response Monday, August 10, 2026 5:00 PM Central

Health Bidnet and ESBD

Proposal Submission

Wednesday, August 19, 2:00 PM Proposers Bidnet or 1111 E. Cesar Chavez, Austin

TX 78702

Proposals received after the Proposal Submission time at the designated location will not be considered.

Protest Deadline See Section II.A.11 Proposers

Initial Contract Duration: 1 Year

Contract Renewal: Optional - Four (4) one-year renewal periods after initial term

Proposals and Prices Good for: 90 days

Multiple Awards: No

RFP 2607-002 Stop Loss Insurance P a g e 3

PROPOSAL INSTRUCTIONS

Proposers should note that this Request for Proposals (RFP) is published and accessible through electronic means. Proposers who received notification of this solicitation by means other than through any of the three websites listed below should register with Bidnet in order to receive timely notification of any addenda, amendment, and/or other forms of information that may be issued prior to the solicitation submittal date:

http://www.centralhealth.net/finance/purchasing https://www.txsmartbuy.com/esbd https://www.bidnetdirect.com/texas/traviscountyhealthcaredistrictdbacentralhealth

Registration is free.

Proposal Submissions: Proposers are strongly encouraged to submit proposals online via Bidnet.

Submission via Bidnet is the preferred method of submission.

A secondary option is to deliver one (1) printed Proposal via USPS mail, FedEx, DHL, etc.

DUE TO STAFF HYBRID WORK SCHEDULES AND CURRENT BUILDING ACCESS

RESTRICTIONS, IF YOU PLAN TO DELIVER A PRINTED COPY TO THE PURCHASING OFFICE,

YOU MUST CONTACT THE PROCUREMENT AUTHORITY PRIOR TO DELIVERY. The printed Proposal with any supporting and/or sample documentation must be delivered in a sealed container that is labeled and addressed as follows:

Attn: RFP 2607-002 - Stop Loss Insurance Central Health - Purchasing Office 1111 East Cesar Chavez Street Austin, TX 78702

Should a Proposer submit both a proposal via Bidnet and deliver a printed Proposal, the Bidnet submitted Proposal will be the proposal of record and will be used for the purposes of the RFP. Proposals submitted in a format other than 1) online via Bidnet or 2) delivery of a printed proposal to the address above will not be considered.

It is the Proposer’s sole responsibility to ensure that it obtains any and all addenda and/or amendments to this RFP; addenda and amendments will be posted on Bidnet the day they are released.

In the event of a conflict between a version of the RFP in the Proposer’s possession and the version maintained by Central Health, the version maintained by Central Health will control.

All Proposals will be submitted and/or delivered on or before the closing date and time for receipt of Proposals. Proposals received at the designated location after the published time and date will not be considered.

http://www.centralhealth.net/finance/purchasing

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TABLE OF CONTENTS

I. INTRODUCTION

A. Entity Background B. Purpose of Request for Proposals C. Procurement Authority D. Definition of Terminology A. Pre-proposal Conference B. Deadline to Submit Questions C. Response to Written Questions D. Submission of Proposal E. Proposal Evaluation F. Selection of Finalists G. Interviews of Short-listed Finalists ............................................ Error! Bookmark not defined.

H. Contract Award I. Protest Deadline

III. PROPOSER RIGHTS AND OBLIGATIONS

A. Rights

Amending Proposals Withdrawing Proposals Designating Proposal Contents as Confidential or Proprietary

B. Obligations

1. Conditions and Contract Terms Associated with RFP

2. Costs Associated with Procurement

3. Electronic Mail Address

4. Identification and Selection of Subcontractors

5. Historically Underutilized Business (HUB) Program and Good Faith Effort

6. Suspension and Debarment Certification

7. Conflict-of-Interest Questionnaire (CIQ Form)

8. Certificate of Interested Parties (Form 1295)

9. Good-Faith Negotiations

IV. CENTRAL HEALTH RIGHTS

Summary of Rights

Reject any or all Proposals without obligation or liability to any Proposer;

Accept a Proposal other than the lowest-price Proposal (as applicable);

3. Award a Contract on the basis of an initial Proposal received without discussions or requests for Best and Final Offers;

4. Request Best and Final Offers from any or all Proposers;

Procure the Services in whole or in part by other means;

6. Award more than one Contract; and/or Not award any Contract

Termination of RFP C. Waive Minor Irregularities D. RFP Amendments E. Negotiate Additional Contract Terms F. Accept Contract Deviations G. Investigate Proposers H. Request Change in Proposer Representatives I. Assert Ownership of Proposals

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V. PROPOSAL FORMAT AND ORGANIZATION

A. Proposal Format

Proposal Organization Letter of Transmittal – Required Table of Contents - Optional Proposal Summary - Optional Response to Narrative Prompts - Required Completed and Signed Acknowledgement of Receipt Form - Required Completed Historically Underutilized Business (HUB) Form - Required Completed and Signed Conflict of Interest Questionnaire (CIQ) – Required upon selection Completed and Signed Certificate of Secretary – Required if Proposer is a corporation

Completed Insurance Coverage Form - Required

Other (optional) supporting material (may be included on the electronic device)

VI. PROPOSAL CONTENT REQUIREMENTS

A. Narrative Prompts/Evaluation Criteria B. Evaluation Process

Exhibit A: Scope of Work Attached

Exhibit A-1: Census Attached

Exhibit A-2: Stop Loss Questionnaire Attached

Exhibit A-3: 2026 Medical SBCs Attached

Exhibit A-4: Medical Plan & Claim Information Attached

Exhibit A-5: Medical Large Claims Report Attached

Exhibit A-6: Top 50 Drugs Report Attached

Exhibit B: Pricing Sheet Attached

Exhibit C: Acknowledgement of Receipt Attached

Exhibit D: Historically Under-Utilized Business Form Attached

Exhibit E: Conflict of Interest Questionnaire Attached

Exhibit F: Certificate of Secretary Attached

Exhibit G: Sample Contract with Required Contracts Terms and Conditions Attached

Exhibit H: Business Associate Agreement Attached

Exhibit I: Certificate of Interested Parties Attached

Exhibit J: Not Used N/A

Exhibit K: Insurance Coverage Attached

Exhibit L: Not Used N/A

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I. INTRODUCTION

A. Entity Background The Travis County Healthcare District d/b/a Central Health (“Central Health” or the “district”) is a hospital district created under Chapter 281 of the Texas Health and Safety Code that is responsible for providing or arranging for the provision of hospital and medical care to low-income residents of Travis County. Central Health’s mission is to improve the health of the community by caring for those who need it most – particularly the uninsured and underinsured.

Central Health is making healthcare better through the direct practice of medicine, partnerships and collaborations with other providers, and building facilities to provide care in the communities most in need. The district’s Healthcare Equity Plan, adopted in early 2022, is guiding up to $700 million in investments to close the gaps that persist throughout the safety-net healthcare system.

Central Health owns Sendero Health Plans, a community nonprofit insurer that covers members through the Affordable Care Act Health Insurance Marketplace. Central Health clinical partner, CommUnityCare Health Centers, is a federally qualified health center network with more than 27 primary care locations throughout Central Texas. A network of partners, including Integral Care (behavioral health), Lone Star Circle of Care (a Federally Qualified Health Center), and the Dell Medical School at The University of Texas at Austin, help Central Health extend services deeper into the community.

B. Purpose of Request for Proposals

The purpose of this Request for Proposal (RFP) is to assist Central Health in identifying and securing comprehensive stop loss insurance solution for the Travis County Healthcare District System that meets the following objectives:

• Delivers high-quality, cost-effective stop loss coverage that protects the System’s self-funded medical/Rx plan and provides financial risk mitigation.

• Conducts a thorough evaluation of current stop loss insurance arrangements against new and enhanced stop loss coverage options in the marketplace.

• Partner with vendor capable of delivering superior claims management, risk management services, and ongoing support to both the System and its benefits administration team.

C. Procurement Authority

Central Health has designated a Procurement Authority who is responsible for the conduct of this procurement on behalf of Central Health; therefore, all deliveries (including Proposal delivery) shall be addressed as follows:

RFP 2607-002/ Stop Loss Insurance Central Health – Purchasing Office 1111 East Cesar Chavez Street Austin, TX 78702 CHPurchasingDL@centralhealth.net

Any inquiries or requests regarding this procurement should be submitted to the Procurement Authority as identified on Bidnet and Central Health’s Website:

RFP 2607-002 Stop Loss Insurance P a g e 7 http://www.centralhealth.net/finance/purchasing. Inquiries must reference the solicitation number on any and all correspondence. Proposers shall ONLY contact the Procurement Authority regarding this procurement. Proposers shall NOT contact individual Central Health Board Members, Central Health executive team leaders or staff regarding this solicitation. Such contact may result in disqualification of the Proposer initiating the contact.

D. Definition of Terminology This section contains definitions and abbreviations that are used throughout this procurement document.

“BAFO” request for a Best and Final Offer.

"Bidnet Website" is the following link:

https://www.bidnetdirect.com/texas/traviscountyhealthcaredistrictdbacentralhealth

"Central Health Website" is the following link:

http://www.centralhealth.net/finance/purchasing.

"Close of Business (COB)" means 5:00 PM Prevailing Central Time.

"Contract" means a written agreement for the procurement of items of tangible personal property or services.

"Determination" means the written documentation of a decision by the Procurement Authority, including findings of fact supporting a decision. A Determination becomes part of the procurement file.

"Desirable" means that the terms “may”, “can”, “should”, “preferably”, or “prefers” identify a Desirable or discretionary item or factor (as opposed to “Mandatory”).

“Duly Authorized Representative” means the individual who is authorized to submit a Proposal to this RFP on behalf of Proposer and to bind the Proposer to any Contract that may result from the Submission of Proposal.

“ESBD” is the Electronic State Business Daily at the following link:

https://www.txsmartbuy.com/esbd

"Evaluation Committee" means a body appointed by Central Health management to perform the evaluation of Proposals.

"Evaluation Committee Report" means a document prepared by the Procurement Authority and the Evaluation Committee for Contract/s award. It contains all written Determinations resulting from the RFP.

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"Finalist" is defined as a Proposer who meets all the Mandatory specifications of this Request for Proposals and whose score on evaluation factors is sufficiently high to merit further consideration by the Evaluation Committee.

"Mandatory" means that the terms “must”, “shall”, “will”, “is required”, or “are required” identify a Mandatory item or factor (as opposed to “Desirable”). Failure to meet a Mandatory item or factor will result in the rejection of the Proposer's Proposal.

“Principal” is a person in charge of an organization who takes leadership.

"Proposer" is any person, entity, corporation, or partnership that submits a Proposal.

"Procurement Authority" means a person or designee authorized by Central Health to manage or administer a procurement requiring the evaluation of the RFP Proposal.

"Request for Proposal" or “RFP” means all documents, including Attachments and Exhibits, which are hereby incorporated by reference and considered a part of the Proposals.

"Responsible Proposer" means a Proposer who submits a Proposal and who has furnished, when required, information and data to prove that on the basis of demonstrated competence and qualifications, its financial resources, production and service facilities, personnel, service reputation and experience are adequate to satisfactorily perform the Services or provide items of tangible personal property described in the Proposal.

"Responsive Proposal” means a Proposal that includes all required documentation and conforms in all material respects to the requirements set forth in the Request for Proposals. The Proposal to this Request for Proposals must include responsive information, which support the Proposer’s competence, qualifications, and ability to perform the Services, including, but not limited to, quality, quantity, and delivery requirements.

“Timely Response” means the potential vendor or contracted vendor will respond to all requests from the Procurement Authority or any Central Health representative by the deadlines provided in the request. Vendor may propose an alternative deadline to the Procurement Authority, but the decision whether or not to extend any deadline is solely within the discretion of Central Health. Failure to respond timely to requests may be grounds for invalidating a bid or canceling an awarded contract.

II. PROCUREMENT SCHEDULE

This section of the RFP describes all major events listed in the RFP Schedule. The Procurement Authority will make every effort to adhere to the Procurement Schedule set forth in this RFP.

A. Pre-proposal Conference

If a pre-proposal meeting is held the date and time of that conference will be noted in the Procurement Schedule on page 2 of this RFP. Conference call and video conference information

RFP 2607-002 Stop Loss Insurance P a g e 9 will be available the day before the meeting and will be posted on Bidnet and Central Health’s website.

B. Deadline to Submit Questions All Proposers are expected to carefully examine this RFP. Any ambiguities or inconsistencies therein should be brought to the attention of the Procurement Authority as described in this RFP.

Additionally, it is the responsibility of the Proposer to obtain clarification of any information contained herein that is not fully understood. Proposers may submit written questions via Bidnet.

C. Response to Written Questions Written responses to all questions submitted by potential Proposers will be addressed in either a RFP addendum or question and answer document that will be posted on Bidnet by Close of Business per the Question Response Date as indicated in the Procurement Schedule on page 2 of this RFP.

Any verbal statement made by Central Health regarding the RFP prior to the award will be considered non-binding. The only formal interpretation of the RFP will be made by addendum or a question-and-answer document issued by the Procurement Authority.

D. Submission of Proposal The Procurement Authority or designee must receive all proposals for review and evaluation no later than 2:00 PM Central Time per the Proposal Submission Date as indicated in the Procurement Schedule on page 2 of this RFP. Proposals received after this deadline will not be accepted. Refer to Proposal Instructions on page 3 of this RFP for Proposal Submission instructions.

Proposals submitted via Bidnet (preferred method), Bidnet.com will automatically record the date and time of receipt of each correctly submitted Proposal.

The date and time of receipt will be recorded on each printed Proposal. The Proposal must be addressed and delivered to the Procurement Authority in a sealed container at the address listed in 1.C above. Proposals submitted by facsimile or other electronic means will not be accepted.

A public log will be kept of the names of all organizations that submit a Proposal. Unless required by law, the contents of any Proposal will not be disclosed to competing Proposers prior to Contract award.

E. Proposal Evaluation The Evaluation Committee will evaluate the Proposals. The Procurement Authority may initiate discussions with Proposers who submit Responsive or potentially Responsive Proposals, but Proposals may be accepted and evaluated without such discussion. Any resulting clarifications will be issued to all Proposers. While Proposers may initiate requests for clarifications pursuant to above, general discussions SHALL NOT be initiated by the Proposers. The Evaluation Committee will evaluate and score written Proposals using the evaluation criteria identified in

RFP 2607-002 Stop Loss Insurance P a g e 10 section VII. EVALUATION CRITERIA.

F. Selection of Finalists The selection process may be conducted in two steps. In step one, the Evaluation Committee will evaluate and score written Proposals using the evaluation criteria identified in section VII.

EVALUATION CRITERIA. Based on the scoring in step one, the Evaluation Committee, as step two, may develop a “short list” of Proposers who may be invited to interview or provide a demonstration with the Evaluation Committee. Only "short listed" Finalists will be considered for further evaluation and invited to participate in the subsequent steps of the procurement process.

G. Interviews of Short-listed Finalists Based on step one of the selection process, Central Health, at its sole discretion, may determine that it is necessary to interview or request a demonstration from the short-listed finalists prior to making a recommendation to ask for a Best and Final Offer (“BAFO”) or to recommend Contract award. If Central Health desires to conduct interviews/demonstrations, short-listed finalists will be invited to present their Proposals to the Evaluation Committee. The purpose of interviews/demonstrations, if conducted, is to ensure the Evaluation Committee’s understanding of the Proposals and Proposer’s qualifications, as well as, to evaluate the Proposer’s team under the criteria set forth in section VII. EVALUATION CRITERIA. When conducted, interview/demonstration scores will be used as an additional consideration for recommendation and award of a Contract. The Procurement Authority will schedule the time for each Proposer presentation, if applicable. All Proposer presentations will be held as virtual, conference call presentations. Each interviewee will have time to present followed by a question/answer period from the evaluation team. Time limits for the presentation and question/answer period will be determined by Central Health. The selected interviewees will receive an official Interview/Demonstration Invitation letter with the meeting information and duration defined.

H. Contract Award Central Health may but is not obligated to award one or more Contracts to the Proposer/s that best satisfies Central Health’s requirements and provides the best overall value to Central Health for the Scope of Work.

As of the date of issuance, a single award is contemplated.

I. Protest Deadline Protest of Contract award by a Proposer that was not recommended for same must be submitted in writing to the Procurement Authority within ten (10) calendar days after Central Health notifies Proposers of a Contract award. The written protest must clearly set forth the arguments supporting the protest and, if desired, should include a request for an expedited hearing with the Procurement Authority. The Procurement Authority will rule on the protest in writing within ten

(10) business days from the date it receives the written protest and any hearing. Any appeal of the Procurement Authority’s decision must be made within ten (10) calendar days after receipt thereof and submitted to the Procurement Authority, who will present the matter for final

RFP 2607-002 Stop Loss Insurance P a g e 11 resolution to the Central Health President and CEO or his/her designee. The Proposer will be notified of the time and place the appeal is to be heard and afforded an opportunity to present evidence to the Central Health President and CEO or his/her designee in support of the appeal.

Central Health's decision on appeal is final.

Protests received after the deadline will not be accepted.

III. PROPOSER RIGHTS AND OBLIGATIONS

A. Rights Amending Proposals

Any Proposer may submit an amended Proposal before the deadline for receipt of Proposals.

Such amended Proposals must be complete replacements for a previously submitted Proposal and must be clearly identified as such in the transmittal letter. Central Health will not merge, collate, or assemble Proposal materials.

Withdrawing Proposals Proposers will be allowed to withdraw their Proposals at any time prior to the deadline for receipt of Proposals. To withdraw a Proposal, the Proposer must submit a written withdrawal request signed by the Proposer’s Duly Authorized Representative and addressed to the Procurement Authority.

Designating Proposal Contents as Confidential or Proprietary Proposers may mark, stamp, or imprint the words “proprietary” or “confidential” on any pages of the Proposal that include information of this type. However, Proprietary or confidential information should be readily separable from the Proposal in order to facilitate eventual public inspection of the other portions of the Proposal. Central Health will not sort, otherwise isolate, or redact proprietary or confidential information embedded within the body of a Proposal.

B. Obligations

1. Conditions and Contract Terms Associated with RFP Proposers must indicate their acceptance of all conditions governing the RFP in their letter of transmittal. However, a Proposer’s failure to do so will not operate to exempt Proposer from these conditions, as the act of submission itself constitutes acceptance of the conditions, including the evaluation criteria contained in section VII. EVALUATION CRITERIA of this RFP.

Additionally, Proposers must agree to include the terms contained within Exhibit G – Sample Contract with Required Contract Terms and Conditions, which is incorporated in this RFP, in any Contract that results from this RFP and to execute the Business Associate Agreement contained within Exhibit H, of this RFP.

2. Costs Associated with Procurement Any and all costs incurred by the Proposer in preparation, transmittal, and presentation of any Proposal or material submitted in response to this RFP will be borne solely by the Proposer.

3. Electronic Mail Address

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A large part of the communication regarding this procurement will be conducted by electronic mail (e-mail). Therefore, all Proposers must have a valid e-mail address to receive correspondence.

4. Identification and Selection of Subcontractors The term “subcontractor” includes sub-consultants. Proposer’s intended use of subcontractors must be clearly explained in its Proposals, and major subcontractors must be identified by name.

The awarded Proposer will be wholly responsible for the entire performance of the Contract, whether or not subcontractors are used, and Proposer expressly acknowledges that in entering into such subcontract(s), Central Health is in no manner liable to any subcontractor(s). Awarded Proposer further acknowledges that Central Health will make Contract payments only to the awarded Proposer.

5. Historically Underutilized Business (HUB) Program and Good Faith Effort Proposers are asked to make a "good faith effort" to take all necessary and reasonable steps to ensure that certified HUBs (see next paragraph) have the maximum opportunity to participate in the performance of any Contract that results from this RFP as subcontractors.

HUB contractors and subcontractors must be certified as a HUB, Minority/Women-Owned Business Enterprises, or Disadvantaged Business Enterprise source by a recognized governmental program, such as:

• City of Austin Municipal Government;

• Texas Unified Certification Program; or

• State of Texas; or

• Other certification entity recognized by Travis County, Texas

Any subcontractor who Proposer intends to subcontract with at the time of Proposal submission and that is identified, as a HUB will be required to submit a copy of its certification with this Proposal. Central Health reserves the right to verify any entity's HUB status prior to Contract award.

6. Suspension and Debarment Certification The Proposer will certify, by signing the Acknowledgement of Receipt Form, attached hereto as Exhibit C, that to the best of its knowledge and belief that the Proposer and/or its Principals or subcontractors are not and have not been debarred, suspended, proposed for debarment or declared ineligible for the award of Contracts by any federal department or district.

7. Conflict-of-Interest Questionnaire (CIQ Form) Pursuant to Chapter 176 of the Texas Local Government Code, the awarded Proposer, if any, will be required to complete the Conflict-of-Interest Questionnaire ("CIQ"), which is attached to this RFP as Exhibit E, and submit it together with the Contract, if the Proposer has: (i) an employment or other business relationship with a local government officer of Central Health or a family member of same; (ii) given a local government officer of Central Health or a family member of same one or more gifts having an aggregate value as specified in Exhibit E or (iii) has a family

RFP 2607-002 Stop Loss Insurance P a g e 13 relationship with a local government officer of Central Health. For additional information concerning filling out the CIQ, see https://www.ethics.state.tx.us/forms/conflict/.

8. Certificate of Interested Parties (Form 1295) Section 2252.908 of the Texas Government Code prohibits a governmental entity, like Central Health, from entering into certain Contracts, unless the business entity submits a Certificate of Interested Parties form, attached to this RFP as EXHIBIT I, to the governmental entity at the time the business entity executes a Contract. Form 1295 is applicable to any of awarded Proposer’s directors, officers, or employees who hold a controlling interest (10% or more ownership) in the business entity and who actively participated in facilitating the Contract or negotiating the terms of same (broker, intermediary, advisor, and/or attorney), if any.

The Proposer for such Contract award will be required to electronically file a Form 1295 with the Texas Ethics Commission upon notification of selection from Central Health. The online filing process will generate a Certificate Number and Date Filed. The Proposer will submit that information Central Health as part of its contract.

For more information, visit:

https://www.ethics.state.tx.us/filinginfo/1295/

9. Good-Faith Negotiations The Procurement Authority or designee will participate in all discussions with Proposers.

Discussions will only be conducted with responsible Proposers who submit Responsive Proposals to the RFP, which are determined to be reasonably acceptable of being selected for award. Those Proposers will be accorded fair and equal treatment with respect to any opportunity for discussion and revision of Proposals. Proposers may be required to submit additional information and/or clarify previously submitted information during negotiations.

Revisions and supplements to Proposals may also be permitted after submission and before Contract award for the purpose of obtaining BAFOs in Central Health’s sole discretion. Any BAFO, as well as the entire Proposal, will become part of Central Health’s awarded Contract.

Central Health reserves the right to negotiate the price and any other term with any, all, or none of the Proposers. Any oral negotiations must be confirmed in writing prior to an award.

IV. CENTRAL HEALTH RIGHTS

Summary of Rights Central Health may:

Reject any or all Proposals without obligation or liability to any Proposer;

Accept a Proposal other than the lowest-price Proposal (as applicable);

3. Award a Contract on the basis of an initial Proposal received without discussions or requests for Best and Final Offers;

4. Request Best and Final Offers from any or all Proposers;

Procure the Services in whole or in part by other means;

6. Award more than one Contract; and/or Not award any Contract.

https://www.ethics.state.tx.us/forms/conflict/ https://www.ethics.state.tx.us/filinginfo/1295/

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Termination of RFP

This RFP may be canceled at any time and any and all Proposals may be rejected in whole or in part if Central Health determines such action to be in Central Health’s best interest.

C. Waive Minor Irregularities

The Evaluation Committee reserves the right to waive minor irregularities (e.g. Proposer submits the incorrect number of Proposal copies or does not sign all Proposal copies) in the Proposals.

The Evaluation Committee also reserves the right to waive certain, non-mandatory requirements contained herein if the Proposal otherwise meets the mandatory requirements and/or waiving the minor irregularity does not otherwise materially affect the procurement. This right may be exercised at the Evaluation Committee’s sole discretion.

D. RFP Amendments Central Health reserves the right to issue amendments to this RFP before the date on which Proposals are due.

E. Negotiate Additional Contract Terms Central Health reserves the right to modify and negotiate with a successful Proposer provisions in addition to those attached to this RFP. The contents of this RFP, as revised and/or supplemented, and the successful Proposer's Proposal will be incorporated into and become part of the Contract.

F. Accept Contract Deviations Any additional terms and conditions, which may be the subject of negotiation, will be discussed only between Central Health and the selected Proposer and will not be deemed an opportunity to amend the Proposer’s Proposal. If a Proposer requests significant changes to either the required Contract terms or the terms of the Business Associate Agreement, Proposer’s Proposal may be considered non-Responsive and result in Proposers’ disqualification or, if such changes are requested post-Proposal submission in violation of this RFP, will result in termination of negotiations and Contract award.

G. Investigate Proposers The Evaluation Committee and/or Central Health Purchasing staff may make such investigations as necessary to determine the qualifications and ability of the Proposer to adhere to the requirements specified within this RFP. The Evaluation Committee will reject any Proposal that is submitted by a Proposer who it deems unqualified or who otherwise fails to submit a responsive Proposal. Central Health may also investigate a Proposer’s prior contract relationships, contact references provided by Proposer, and explore and consider prior public statements or actions by a Proposer or any of its key personnel that may be relevant to the performance of the tasks in the RFP or the ability of the Proposer to perform such tasks. Further, Central Health reserves the right to evaluate Proposers’ information technology security throughout the solicitation and contracting process. Failure to meet any security requirement may be grounds for immediate disqualification.

RFP 2607-002 Stop Loss Insurance P a g e 15

H. Request Change in Proposer Representatives Central Health reserves the right to require a change in the representatives that Proposer submits with the Proposal, if the assigned representatives are not, in the opinion of Central Health, able to adequately meet Central Health’s needs.

I. Assert Ownership of Proposals All documents submitted in response to this Request for Proposals will become the property of Central Health.

V. PROPOSAL FORMAT AND ORGANIZATION

This section of the RFP describes the format and organization of the Proposer's Proposal. Failure to conform to the requirements contained herein may result in disqualification of the Proposal.

A. Proposal Format All Proposals, electronic or printed, must delineate each section. The page limit should be no more than forty (40) pages (20 front/back if printed) not including tabs and required forms (see item B. below), or as further instructed in this RFP. If submitting a printed Proposal, the Proposal must be in a binder with tabs delineating each section.

Proposal Organization The Proposal must be organized and indexed in the following format and must contain, as a minimum, all items that are listed as required in the sequence indicated.

Letter of Transmittal – Required

• Identify the submitting organization;

• Identify the name, title, e-mail address and telephone number of the person authorized to contractually obligate the organization or individual proposing;

• Identify the name, title, e-mail address, and telephone number of the person authorized to negotiate a Contract on behalf of the organization;

• Identify the names, titles, e-mail addresses, and telephone numbers of persons to be contacted for Proposal clarification;

• Explicitly indicate acceptance of Sections II through IV of this RFP;

• Be signed by the person authorized to contractually obligate the organization; and

• Acknowledge receipt of all, if any, addenda to this RFP.

Table of Contents - Optional Proposal Summary - Optional Response to Narrative Prompts - Required Completed and Signed Acknowledgement of Receipt Form - Required Completed Historically Underutilized Business (HUB) Form - Required Completed and Signed Conflict of Interest Questionnaire (CIQ) – Required upon selection Completed and Signed Certificate of Secretary – Required if Proposer is a corporation Completed Insurance Coverage Form - Required Other (optional) supporting material (may be included)

RFP 2607-002 Stop Loss Insurance P a g e 16

The forms listed behind the numbers 5, 6, 8 and 9 must be thoroughly completed, executed and witnessed, if and as required, and included in the appropriate section of the Proposal. Proposals must include all Attachments and Exhibits in order to be considered Responsive.

Any Proposal that does not adhere to these requirements may be deemed non-responsive and rejected on that basis.

VI. PROPOSAL CONTENT REQUIREMENTS

Proposers shall respond in the form of a detailed narrative to each of the narrative prompts contained in Item A below and based on information provided in in Exhibit A: Scope of Work and Exhibit B: Price/Cost. The narratives, along with supporting materials, will be evaluated and awarded points accordingly.

Failure to respond to the following mandatory narrative prompts will result in disqualification of the Proposal as non-responsive.

RFP 2607-002 Stop Loss Insurance P a g e 17

A. Narrative Prompts/Evaluation Criteria

Item EVALUATION CRITERIA Weight (%)

1. Account Management 10

2. Claims Administration 30

3. Technical and Reporting Capabilities 10

4. Fee Structure 25

Underwriting and Renewal Process 25

Total 100%

5. Interview 20

Please provide answer on Exhibit A-2/Stop Loss Insurance Questionnaire

• Account Management – [Question Rows 15-22] o Account Manager and Team (if applicable) can be provided to oversee the Stop Loss program

Can attend meetings as needed (monthly, quarterly, etc.).

o Proposer has the ability to coordinate with the Central Health System, its consultant(s), and third-party administrators to fulfill the tasks in the scope.

o Provide (3) references that are currently using your services. At least one reference should currently use a benefit plan similar to the option being considered by Central Health. Please indicate which specific services/programs they use.

o Please complete rows 15-22 on the Stop Loss tab in Exhibit A-2: Questionnaire.

• Claims Administration - [Question Rows 24-35] o Proposer can fulfill the process for receiving, adjudicating, and paying stop loss claims in a prompt and timely manner.

o Proposer can coordinate with providers, including the third party administrator and PBM, to complete the claim processing process, avoid payment or coverage errors, and verify stop loss benefits and coverage.

o Proposer proactively outreaches to client for additional information as needed to successfully file claims, o Proposer can provide notifications to Central Health for issues related to stop loss claims, appeal procedures, and instances of fraud and abuse.

o Please complete rows 24-35 on the Stop Loss tab in Exhibit A-2: Questionnaire.

• Technical and Reporting Requirements - [Question Rows 37-42] o Proposer can provide timely and detailed stop loss reports as needed (monthly, quarterly, upon request).

Secure portal access preferred for retrieving reports and accessing stop loss claims data.

If portal is not offered, reports may be sent encrypted over email.

Can reports be customized to the needs of Central Health and the System?

o Proposer can collaborate with the System’s consultant(s) for all reporting needs.

o Sample reports are included in the proposal (see SOW for sample requirements).

o Satisfies HIPAA Compliance and Security requirements.

RFP 2607-002 Stop Loss Insurance P a g e 18 o Please complete rows 27-42 on the Stop Loss tab in Exhibit A-2: Questionnaire.

• Fee Structure - [Question Rows 44-50] o Solution fulfills the tasks in the scope and provides the best value to Central Health.

o Cost proposal is net of commissions and other fees or administrative costs are disclosed.

o Please complete rows 44-50 on the Stop Loss tab in Exhibit B: Pricing Sheet.

o Please complete Exhibit B: Pricing Sheet.

• Underwriting and Renewal Process - [Question Rows 52-57] o Proposer demonstrates their standard underwriting and renewal process for Stop Loss insurance including the timeline for renewal offers, data requirements for renewal underwriting, and the methodology used to determine initial and renewal rates.

Option for early renewal offers is available upon request.

o Proposer is capable of providing benchmarking data or insights to Central Health, including comparisons against similar organizations in the marketplace.

o Please complete rows 52-57 on the Stop Loss tab in in Exhibit A-2: Questionnaire.

B. Evaluation Process

1. Proposals will be reviewed for compliance with the above criteria for this solicitation.

Proposals deemed non-responsive will be eliminated from further consideration.

2. The Procurement Authority may contact the Proposer for clarification of the Proposal as specified in above.

3. The Evaluation Committee may use other sources of information to perform the evaluation as specified in Proposal Evaluation.

4. Responsive Proposals will be evaluated using the criteria set forth in the table above. The

Responsive and Responsible Proposers with the highest scores may be selected as short-listed Finalists. Said short-listed Finalists may be invited to present their Proposals to the Evaluation

5. Committee. Points awarded from the interviews, if any, will be added to Proposer’s overall score.

6. The Proposer whose Proposal is most advantageous to Central Health, taking into consideration the stated EVALUATION CRITERIA, may be recommended for Contract award as specified in above. Proposers who are asked or chosen to submit a revised Proposal for the purpose of obtaining Best and Final Offers may have their points recalculated accordingly. Please note however, that a serious deficiency in the initial Proposal may be grounds for rejection regardless of overall score.

7. Proposers or potential contracted vendors will respond to all requests by the Central Health Purchasing Office within the deadline timeframe provided in the request. Proposers or potential contracted vendors may propose an alternative deadline to the Procurement Authority, but the decision whether or not to extend any deadline is solely within the discretion of Central Health. Failure to respond by the given deadline may result in proposer being deemed non-responsive.

RFP 2607-002 Stop Loss Insurance P a g e 19

EXHIBIT A

SCOPE OF WORK

RFP 2607-002

Stop Loss Insurance

Please provide your narrative response to these items in Exhibit A-2: Stop Loss Questionnaire.

Task 1: Account Management – Vendor is experienced in providing the necessary and requested account management personnel, resources, and services. The following must be provided during the duration of the contract:

• Account Management team o A dedicated primary account manager responsible for overseeing the stop loss insurance program for the System.

o Any additional team members (if applicable) who will provide stop loss-specific support.

o Identify the primary contact(s) concerning billing, claims resolution, and service-related inquiries specific to stop loss coverage.

• Capability of the account management team to coordinate closely with the System its consultant(s), and any third-party administrators to resolve claims inquiries, data requests, stop loss contract compliance issues, etc.

o Must be available for meetings as requested (i.e. monthly, quarterly, as needed).

• Stop Loss related reporting o Including but not limited to claims experience, financial exposure, and risk mitigation analytics.

o Must be able to collaborate with the System’s consultant(s) for all reporting needs.

In your proposal, please address the following:

• Outline any value-added stop loss services your team can provide, if any (e.g., claims advocacy, risk consulting, predictive modeling).

o Include examples of how these services have demonstrably helped other clients or if there are any associated metrics.

o Include pricing for value-added services on Exhibit B – Pricing Sheet.

• Please list out (3) client references who are currently using your services on Attachment A-2:

Stop Loss Questionnaire.

o At least one reference should currently use a benefit plan similar to the option being strongly considered by Central Health. Please indicate which specific services/programs they use.

Task 2: Claim Administration – Vendor must provide the following services pertaining to Claims Administration.

• Coordinate with third party administrators to complete the claim processing process.

RFP 2607-002 Stop Loss Insurance P a g e 20 o Detail your procedure for requesting additional documentation or information from providers and participants when necessary to complete stop loss claim processing.

o Describe coordination with other insurers or benefit plans to avoid duplication of payments or coverage gaps.

o What procedures and processes does your company have in place to work with the TPA (Third Party Administrator), Aetna, to obtain claims information on an ongoing basis?

o Describe your process and turnaround times for receiving, adjudicating, and paying stop loss claims in accordance with Central Health’s plan design and contract terms.

Specify where stop loss claims for the Central Health will be adjudicated and paid.

• Notify participants and Central Health regarding stop loss claims, including denied claims and appeal procedures.

o Provide your notification protocols.

o Confirm issuance of clear Explanation of Benefits (EOBs) or equivalent statements for stop loss claims.

• Determine stop loss benefits payable under the contract, including any coordination of benefits.

o Detail eligibility verification processes relevant to stop loss coverage, including handling dependent eligibility as applicable, frequency of eligibility verification occurrence, and if it is an ongoing process.

• Report instances of fraud and abuse to Central Health.

o Describe your Fraud and Abuse Detection Program specific to stop loss claims. Include how findings would be reported to the Central Health and what actions are typically taken.

Please provide the following information.

• Provide a copy of your stop loss contract.

o Can you provide in your contract, a no loss/no gain provision to assure that no one will lose coverage due solely to a change in carriers?

• Provide all necessary stop loss claims forms and instructions.

o Describe the procedure for filing a claim and attach a copy of the claim form.

• Does your company accept monthly eligibility feeds in order to act as the administrator of the plan so that Central Health's involvement in claims processing is minimized?

• Do you offer features including Specific Advance, Monthly Aggregate Accommodation, transplant coverage/programs, hemophiliac programs/limitations, and gene therapy program(s)? Please elaborate and include additional features and innovation (along with pricing) you recommend based on the data provided within this RFP.

Task 3: Technical and Reporting Requirements – Reporting must meet the following criteria and needs. Consultant must also be able to satisfy Central Health’s technical and security requirements.

RFP 2607-002 Stop Loss Insurance P a g e 21

• Provide timely and detailed management reports (monthly, quarterly, as needed), preferably via a secure internet portal to allow for custom data visibility and enable Central Health access to monitor stop loss financial performance and claims experience. If a portal cannot be provided, reports can be sent via encrypted email. Reports should include but not be limited to:

o Enrollment and premiums paid under the stop loss contract.

o Detailed paid claims data with case-level analytics.

o Utilization reports and consultative insights to support risk management and cost containment.

o Please include report examples as attachments within your proposal.

• Do you provide access to stop loss claims data through online portals or reporting tools? What level of detail is available?

• Clearly describe how specific and aggregate deductibles are tracked and accumulated towards satisfaction under the stop loss contract. Can reports be customized to Central Health’s specific needs beyond the listed items?

• Describe your data security protocols, HIPAA compliance measures, and data breach notification procedures relevant to all protected health information (PHI) and other sensitive data shared or processed under the stop loss contract.

• Please fill out Attachment B – Technical Review Questionnaire.

Task 4: Fee Structure – Vendor’s pricing encompasses all of the services in this scope and provides the best value to Central Health. Please provide the following information:

• Confirm that your stop loss insurance proposal pricing is net of commissions and disclose any other fees or administrative costs associated with the coverage.

• Provide a breakdown of these fees and administrative costs.

• Fill out and include Exhibit B – Pricing Sheet within your proposal o The quote needs to encompass the following:

Specific Stop Loss Coverage (medical and Rx) Aggregate Stop Loss Coverage (medical and Rx) o Please use the following files to develop your quote:

Exhibit A-1: Census Exhibit A-3: 2026 Medical SBCs Exhibit A-4: Medical Plan and Claim Information Exhibit A-5: Medical Large Claim Report Exhibit A-6: Top 50 Drugs Report

Task 5: Underwriting and Renewal Process – Consultant must be able to perform underwriting services and successfully renew stop loss coverage plans for the System. Please provide the following information regarding your underwriting and renewal process:

RFP 2607-002 Stop Loss Insurance P a g e 22

• Confirm your process and timeline for renewal underwriting and what information you require from Central Health.

o Central Health currently offers the following medical plans.

Aetna Seton ACO Aetna TMN Aetna HDHP

• Describe your standard renewal process for stop loss coverage, including the timeline for renewal offers, data requirements for renewal underwriting, and the methodology used to determine renewal rates.

o Confirm whether an option for early renewal offers is available upon request, provided all necessary data is submitted and approved.

• Detail your underwriting methodology for both initial rates and renewals, specifically addressing how specific and aggregate deductibles are considered, the application of any laser provisions, and your approach to run-out coverage.

o Explain your philosophy or typical application of lasers.

• Outline your capabilities and process for providing benchmarking data or insights to Central

Health, comparing their stop loss plan performance, costs, and risks against similar organizations in the marketplace.

Applicable Standards:

Compliance with Federal, State, and Local Laws. Vendor shall provide the services and activities to be performed under the terms of this Agreement in compliance with the Constitutions of the United States and Texas and with all applicable federal, state, and local orders, laws, regulations, rules, policies, and certifications governing any activities undertaken during the performance of this Agreement, including, but not limited to: Title VI of the Civil Rights Act of 1964, as amended; Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. Section 794); the Americans With Disabilities Act of 1990, Public Law 101-336 [S.993] ("ADA"), and the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and its implementing regulations. Consultant shall not discriminate against any employee, applicant for employment, based on race, religion, color, gender, national origin, age, or handicapped condition. In performance of all Agreement services and activities, Consultant will comply with applicable state and federal licensing and certification requirements, health and safety standards, and regulations prescribed by the U. S.