Final Questions_SL RFP_Suffolk Public Schools.xlsx
XLSX spreadsheet 15 KB Posted
- Attached to
- This IFB cancelled, per request of Agency
- Solicitation number
- 1155
- Issued by
- Greene County, Roanoke City, Virginia
About this file
This document is a Request for Proposals (RFP) from Suffolk Public Schools (SPS) for a Stop Loss Provider to provide coverage for their medical and prescription drug plans. The RFP includes detailed questions regarding the qualifications, experience, methodology, and contract provisions of potential stop loss providers. Key requirements include a 24/12 plan basis, 100% reimbursement percentage, no new lasers, rate caps, client dividends, unlimited specific maximums, and mirroring of the employer's plan document. Respondents are asked to provide pricing for $200,000 and $250,000 specific deductible levels, as well as information on their proposed Third-Party Administrator (TPA) and network. The contract term is 1-year effective January 1, 2023, with the potential for renewal.
The RFP also includes detailed questions related to the respondents' financial strength, claim management practices, and value-added services. Respondents are asked to confirm their licensing, any suspensions, ownership structure, customer base, and experience in the school system market. Particular emphasis is placed on the respondents' approach to managing large claims, covering new cell and gene therapies, and addressing claims that were denied in one coverage period but subsequently paid in another.
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Other files
| File | Type | Posted |
|---|---|---|
| RFP stop loss.pdf | ||
| stoplossadd1v2.pdf |
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Text version
Suffolk SL RFP and Questions
| Qualifications and Experience 5 pts | ||
| Question | Reponses | |
| Stop Loss Provider/Company Name | Name of Organization | |
| Explain your ownership structure | Please explain | |
| How long has your organization been in business? | Year Established | |
| Total number of customers and total premium under management? | # of customers | |
| Annualized Premium | ||
| Total number of school system customers? | # of customers | |
| Total numbe of customers with Anthem of VA as the TPA? | # of customers | |
| Have you ever been suspended from writing any line of coverage? | Yes or No | |
| If Yes - please explain | ||
| Is your organiztion licensed to do business in all 50 states and U.S. territories? | Yes or No | |
| If No, identify territoies in which you are not licensed |
| Methodology and Contract Provisions - 50 points | ||
| Question | Reponses | |
| What percentage if the risk does your company assume? If less than 100%, please identify additional reinsurer(s) and the respective percentage of assumed liability | Yes or No | |
| If less than 100%, please explain | ||
| Who has final claim decision making authority with respect to specific & aggregate claims? | Details | |
| Does your stop loss policy contain an actively at work provision? | Yes or No | |
| If yes, please explain | ||
| If no, will you indicate that in your proposal? | ||
| Upon contract renewal, will you commit to a firm rate guarantee more than 3 months prior to effective date? | Yes or No | |
| If no, please explain | ||
| Does your organization offer No New Laser and Rate Caps provision? | Yes or No | |
| If no, please explain | ||
| What fees will be considered part of claims? For example shared savings fees, etc) | Details | |
| Do you offer advanced funding or quick pay option for stop loss claims? If yes please provide details | Yes or No | |
| If Yes - please explain: | ||
| Do you offer the potential for a client dividend if favorable claim expereince/loss ratio? | Yes or No | |
| If Yes - please explain: | ||
| To ensure there are no gaps between the employer's plan document and the stop loss contract will you agree to accept for claims reimbursment the employers plan document? If no, then will you review the employer's plan document and identify gaps between the employers plan document and your stop loss contrat? | Yes or No | |
| If No - please explain: | ||
| What is the timing for filing a specific claim? | Details | |
| Define specific deductible claim accumulation (individual or Family) | Details | |
| Will you guarantee you are responsible for getting claims data from the payor/TPA? | Yes or No | |
| If no - please explain: | ||
| Do you offer any special contract provisions or features? | Details | |
| Do you have any preferred TPA relationships? | Details | |
| Are any networks inelligible? | Details | |
| How are you effectively managing large claims? | Details | |
| Will you agree to cover any new cell or gene therapies upon FDA approval and if coveraged by the employer? | Details | |
| Under health care reform, non-grandfathered plans must include an external review option. A claim filed in a timely manner (consistent with the requirement of the stop loss policy) and denied by the claim adminsitrator is subject to appeal. A claim properly incurred and adjudicated (denied) in one covareg period and subsequently appealed by the participant, including an external review, could easily extend beyond that covarage period. |
| How does your organization address claims that were denied in one coverage period and paid in another coverage period? | Please explain | |||
| Requested Contract Terms | ||||
| Contract Term | Requested | Carrier Response | In No - please explain | |
| Contract Basis | 24/12 | |||
| Plan Effective Date | 1-Jan-23 | |||
| Coverages Included | Medical & Rx | |||
| Claim Accumulation Basis | Per individual | |||
| Actively at Work | Waived | |||
| Reimbusment Percentage | 100% | |||
| Lasered Claimants | No | |||
| No New Laser | Yes | |||
| Rate Cap | Yes | |||
| Rate Cap Amount | Less than or equal to 50% | |||
| Client dividend | Yes-if available | |||
| Specific Max (Annual & Lifetime) | Unlimted | |||
| Mirroring of Plan Document | Yes | |||
| Dollar Limit on Run-in claims | No | |||
| Retirees Included | Yes | |||
| Commissions in rates | 0% | |||
| Individual Deductible | $200K (current) and $250K (option) | |||
| Advanced Funding | Yes | |||
| Proposed TPA & Network | Anthem | |||
| Proposed Rates & Terms- to be completed by proposing carrier / please also included full proposal document with all caveats 45 points | ||||
| ISL Level | $200,000 | $250,000 | ||
| Single Rate PEPM | ||||
| Family Rate PEPM |
| Rate Cap % | ||
| No New Laser | ||
| Plan Mirroring? | Yes | Yes |
| Proposal Expirtation Date | ||
| Lasers? | ||
| Proposed TPA and Network | Anthem | Anthem |
| Retirees Included | Yes | Yes |
| Actively at Work? | Waived | Waived |
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