Medical and Pharmacy Reinsurance

Northside Independent School District (NISD) in San Antonio, Texas, is seeking proposals for Medical and Pharmacy Reinsurance services for the 2026 plan year through a competitive Request for Proposal (RFP). The district is soliciting qualified insurance carriers and Managing General Underwriters (MGUs) to provide comprehensive stop loss coverage for its self-funded medical and pharmacy plans. The procurement covers stop loss insurance with specific and aggregate reinsurance options, targeting coverage for approximately 10,000 participating employees across six United Healthcare self-funded medical plan options with integrated Optum Rx pharmacy benefits. Proposers must submit detailed pricing for multiple deductible levels ($400K, $500K, $600K, $750K, and $1M) and provide comprehensive documentation including a sample reinsurance contract, contract disclosures, and client references. The evaluation will be weighted 30% on pricing, with additional criteria considering reputation, service quality, meeting district needs, and value-added services. Proposals are due on November 13, 2025, at 2:00 PM (CT) through the Bonfire electronic portal, with a contract term of one year (January 1, 2026 - December 31, 2026) and options to renew for two additional one-year periods.

The RFP does not explicitly outline specific set-aside designations or restrictions for disadvantaged enterprises. The current incumbent vendor is UnitedHealthcare, with the district's existing infrastructure including six medical plan options and an integrated Optum Rx pharmacy program. The current stop loss coverage features a $500,000 specific deductible and a 120% aggregate corridor, with a maximum aggregate coverage of $5,000,000. Proposers must demonstrate proof of Errors & Omissions coverage and provide comprehensive client references. The current annual stop loss premium is $38.51 Per Employee Per Month (PEPM), totaling $2,233,888, which provides context for potential budget ranges. Vendors must be prepared to mirror the existing plan structure, potentially include advanced funding options, and offer additional endorsements such as gene therapy coverage, with the ultimate goal of providing financial risk management for the district's healthcare expenditures.