Stop Loss RFP Large Claim Report 2024.xlsx

The document is a spreadsheet detailing large medical claims for the City of Jersey City's self-funded medical and prescription drug plan for 2024, covering claims through July 30th. The City is seeking excess stop loss coverage for its self-insured medical and prescription drug plans, with the current coverage set to expire on December 31, 2025. This Request for Proposals (RFP) invites licensed stop loss insurers and Managing General Underwriters to submit proposals for excess loss coverage, with a paper-only submission process requiring original signatures and completion of all specified forms.

The spreadsheet reveals a comprehensive breakdown of 439 individual medical claims, with total paid amounts ranging from approximately $37,000 to over $2.6 million for the most expensive claim. The claims cover a wide variety of medical conditions, including cancer treatments, cardiovascular issues, neurological disorders, orthopedic procedures, and substance abuse treatments. The claims data provides detailed information including primary ICD diagnosis codes, specific procedures performed, and precise payment amounts, which would be critical for insurers evaluating the stop loss coverage risk. The RFP emphasizes the importance of precise documentation, with a strict requirement that failure to acknowledge receipt of addenda could result in bid rejection, underscoring the technical and procedural rigor of the proposal process.