Exhibit_5_-_Stop_Loss_Information.pdf

This is a Stop Loss Policy Information exhibit for the City of Orlando's Health Plan Administrative Services procurement (RFP26-0046), detailing insurance coverage for the city's self-funded group medical and pharmacy benefit plans. The document establishes the parameters for stop-loss insurance protection underwritten by Symetra Life Insurance Company, which will provide catastrophic coverage for the city's healthcare benefits program. The stop-loss policy includes a specific deductible of $1,000,000 per covered unit for the 2025 policy period, protecting the city against exceptionally high individual claims. The procurement itself covers administrative services for approximately 9,000 covered lives across three plan options (HMO, Point-of-Service, and Narrow Network), with the contract effective January 1, 2027. Proposals are due December 15, 2025, with a non-mandatory pre-proposal conference scheduled for November 10, 2025. The initial contract term is three years with potential renewal options for up to seven additional one-year periods.

The stop-loss premium rate is $6.79 per covered unit for the 2025 policy period, with the city's current annual healthcare claims projected at $85 million (comprised of 65% medical and 35% pharmacy claims). The current incumbent vendor is UnitedHealthcare, which has administered the plans since 2001. The city funds 95% of employee-only premiums and 73% of dependent-tier premiums for the Choice HMO Plan. The procurement explicitly excludes Medicare-eligible retiree plans and stop-loss insurance from the scope of services being solicited, as existing stop-loss coverage through Symetra remains in place. The city seeks a collaborative administrative partner with experience in alternative care delivery models, value-based contracting, and population health management, with particular emphasis on supporting a high-performance network anchored by a Clinically Integrated Network for the Narrow Network Plan option.