Stop Loss Insurance for Metropolitan Transit Authority of Harris County, Texas

The Metropolitan Transit Authority of Harris County (METRO) is procuring stop loss insurance coverage through a Request for Proposal with a submission deadline of June 16, 2026, for an effective coverage date of October 1, 2026. This procurement encompasses comprehensive stop loss insurance services for both the agency's non-union employee population (approximately 4,789 regular full-time employees working at least 30 hours weekly) and union employees working at least 40 hours weekly. Proposers must submit two distinct options: a standalone quote for the existing non-union population currently insured under Cigna's individual stop loss program with a $275,000 deductible, and a combined quote covering both non-union and newly transitioned union populations. Required services include administration of individual excess risk benefits for medical and prescription drug coverage, claims management and reimbursement above the Individual Stop Loss level, stop loss claims tracking and payment, premium billing, aggregate stop loss administration, annual underwriting services, clinical evaluation of large claimants, implementation support, financial reporting and analysis, claims activity reporting and reconciliation, regulatory compliance support, competitive multi-year pricing guarantees, and dedicated account team support. All pricing quotes must remain firm for 60 days and must include alternative deductible options at $300,000 and $325,000, submitted net of commissions. The evaluation scorecard allocates 35 points for financial considerations including premium rates and contract strength, 25 points for claims management and administration capabilities, 20 points for client service and support quality, 10 points for proposer qualifications and experience including public sector experience and financial rating, and 10 points for implementation and transition support. Interested vendors must first submit intent to quote to receive detailed plan documents, historical data, and census reports necessary for proposal development.

The RFP documentation does not specify set-aside designations or restrictions limiting response to particular organizational types or disadvantaged enterprise categories. Current stop loss coverage is provided by Voya and Cigna, with medical and pharmacy administration remaining with Cigna and OptumRx through the 2026-2027 contract period, indicating that the successful vendor must coordinate with existing infrastructure and administrative systems. The RFP includes specific technical requirements such as a no-laser option with a 50% renewal rate cap and mandatory inclusion of Spec Advance Funding with waived AAW requirements; proposals must strictly avoid any mention of renewal language or renewal dates, with non-compliance potentially resulting in disqualification. The current stop loss premium structure reflects an Individual Stop Loss premium of $160.69 per employee per month and an Aggregate Stop Loss premium of $130.57 per employee per month for the 2024-2025 period, providing a reference point for pricing considerations, though specific award values or budget ranges for the 2026-2027 contract are not disclosed in the available documentation.