Questionnaire No. 2 - Stop Loss Insurance.pdf

City of Miami Questionnaire for RFP No. 2130386

Questionnaire 2 Stop Loss Insurance

Completion of this questionnaire is not mandatory, but it is strongly encouraged as failure to do so could negatively impact the overall evaluation score of the Proposal. Responses will strengthen your technical evaluation and may contribute to your overall proposal score. Please answer in the order presented. Incomplete responses may affect scoring.

I. Financial Stability and Experience

1. Provide the Proposer’s current rating with A.M. Best, Moody’s, Fitch, and/or Standard &

Poor’s.

2. Include the full business name of the Proposer, contact details, FEIN history, and company overview.

3. Identify the primary office servicing the City and list the services offered at that office.

4. List affiliated companies (e.g., insurance companies, Preferred Provider Organizations

(“PPOs”), Health Maintenance Organization (“HMOs”), Managing General Underwriter

(“MGUs”), Brokerage operations, General Agencies, etc.).

5. Disclose any mergers, name changes, lawsuits, bankruptcies, or regulatory actions within the past seven (7) years.

6. Describe experience with stop-loss insurance, including the number of years and public sector clients.

II. Contract Terms and Exclusions

1. Confirm whether lasering is applied and if terms are guaranteed at renewal.

2. List standard contract terms and unique provisions

3. Describe contractual caveats for coverage effectiveness.

4. Confirm that prescription drug claims are included under the stop loss.

5. Explain how maternity claims are handled for the mother and newborn in relation to member spend (deductible/copay/OOP).

III. Reporting and Claims Access

1. Indicate if State reporting is required and available.

2. Describe standard and ad hoc reporting capabilities.

3. Confirm City’s access to claim data and customized reports.

IV. Coverage Details

1. Confirm availability of both specific and aggregate coverage.

2. List policy limits and deductible options.

3. Describe claim handling process and how timely payment is ensured.

V. Underwriting and Premiums

1. List underwriting data required at quote and renewal.

2. Describe how premiums are calculated and how renewal rates are set.

3. Provide average annual premium increases for the last five (5) years.

4. Complete the following:

Plan Costs for Stop Loss (Requested Contract Type – 36/12* or 24/12) *preferred

Please enter the proposed costs:

Specific Composite: $ _________ per month

Aggregate: $ _________ per month

Aggregate Attachment Factors

Employee $ _________ per month

Family $ _________ per month

Provide alternative stop loss levels as well (e.g., $300,000.00, $350,000.00, $375,000.00).

Indicate how long these premiums are guaranteed.

VI. Value-Added Services

1. List Risk Management and cost containment services.

2. Describe report types, frequency and customization.

VII. Legal and Compliance

1. Describe how the Proposer will ensure compliance with relevant healthcare laws and regulations, including those specific to Federal and Florida-specific laws and regulations.

VIII. Support and Dispute Resolution

1. Identify the main point of contact, with name, contact info, and resume or biography.

2. Describe the support structure and process for handling claims disputes.

3. Detail how plan administrators access claims and data.