Self-funded medical & prescription drug excess stop loss coverage
Closed State & local contract opportunity Posted
- Solicitation number
- RFP_F - 25
- State
- New Jersey
- Responses due
Opportunity facts
- Jurisdiction
- NIGP codes
- UNSPSC codes
- 78100000 Mail and cargo transport
- 94000000 Organizations and Clubs
- 80161510 Serious accident prevention and management services
- 92110000 Military services and national defense
- 70100000 Fisheries and aquaculture
- 70160000 Wildlife and flora
- 70120000 Livestock services
- 85150000 Food and nutrition services
- 93000000 Politics and Civic Affairs Services
- 81130000 Statistics
- Points of contact
-
- Raquel Y. Tosado rtosado@jcnj.org (201) 547-5156
- Patricia Vega vegap@jcnj.org (201) 547-4278
Opportunity details come from bidnetdirect.com. Updated .
About this opportunity
The City of Jersey City is seeking proposals for self-funded medical and prescription drug excess stop-loss coverage through a Request for Proposals (RFP) issued on September 22, 2025. The procurement targets licensed stop-loss insurers and Managing General Underwriters to provide comprehensive excess loss coverage for the city's self-insured medical and prescription drug plans, effective January 1, 2026. The coverage will encompass approximately 2,530 active employees, 2,433 retirees, and 3,843 active and early retirees, including 2,034 Medicare-eligible retirees. The RFP requires a paper-only submission with original signatures, due by October 16, 2025, at 4:00 PM, with a planned City Council contract award on November 12, 2025. Proposers must submit coverage options for specific deductibles of $300,000, $350,000, and $400,000, covering both medical and prescription drug expenses. The current coverage, administered by Horizon Blue Cross and Blue Shield for medical services and Express Scripts for prescription drugs, includes various plan options like Direct Access, EPO, OMNIA, and HSA plans. Evaluation will likely consider the comprehensive stop-loss coverage details, including advanced funding, unlimited lifetime maximum, and full claim administration services.
The RFP does not explicitly mention set-aside designations or restrictions for disadvantaged enterprises. The current medical and prescription drug plans are administered by Horizon Blue Cross and Blue Shield and Express Scripts, which may provide context for potential proposers. Existing infrastructure includes multiple medical plan groups (#08503J, #086220, and #08518E) with varying coverage options, deductibles, and out-of-pocket maximums. The city's current excess loss coverage has an individual specific deductible of $300,000, an aggregating specific deductible of $400,000, and a specific composite monthly rate of $84.97 per member. Historical claims data from 2024 and 2025 shows significant variation in medical expenses, with individual claims ranging from $37,000 to over $2.6 million, which will be crucial for insurers assessing risk and developing pricing strategies. While a specific budget range is not explicitly stated, the comprehensive claims reports and membership data suggest a complex and potentially high-cost insurance environment that will require detailed financial analysis by potential stop-loss coverage providers.
Opportunity text
Jersey City self-insures its employee medical and prescription drug coverages. As such, the City purchases excess loss coverage. The City's current excess loss coverage expires on December 31, 2025. This Request for Proposals (RFP) provides extensive information about the City of Jersey City and its self-insured medical and prescription drug plans. Licensed stop loss insurers and Managing General Underwriters are invited to submit proposals for excess loss coverage in accordance with the specifications provided herein. NOTE: THIS PROCESS REQUIRES A PAPER-ONLY SUBMISSION WITH ORIGINAL SIGNATURES AND THE COMPLETION/INCLUSION OF ALL FORMS IN THE BID. YOU MUST DOWNLOAD THE BID IN ORDER TO RECEIVE ANY ADDENDA(S) THAT MAY OCCUR. Failure to acknowledge receipt of all addenda will cause the bid to be considered non-responsive, and the bid will be rejected. Acknowledgement of receipt of each addendum must be clearly established and included with the bid pursuant to N.J.S.A. 40A:11-23.2 (e).
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