Stop Loss Insurance (ISL)/Aggregate Stop Loss Insurance (ASL) (Medical & Rx)

The City of Edinburg, Texas (located in Hidalgo County) is issuing Request for Proposal #2025-010 to procure Stop Loss Insurance (ISL)/Aggregate Stop Loss Insurance (ASL) covering medical and prescription drug benefits. The procurement seeks qualified insurance carriers to provide stop loss coverage with specific policy parameters including a $125,000 specific deductible, 12/12 contract basis, 125% aggregate corridor, and maximum liability of $1,000,000. The city currently provides medical benefits through a fully funded program with Blue Cross/Blue Shield of Texas and is seeking a stop loss insurance provider to manage potential high-cost claims. All proposing carriers must be licensed by the Texas Department of Insurance, rated by AM Best Company, and permitted to contract with the state or its subdivisions. Proposals must be submitted electronically through the city's procurement portal by July 15, 2025, at 3:00 PM, with a deadline for written questions set for July 3, 2025. The contract will be effective October 1, 2025, for an initial one-year term with options to renew for two additional one-year periods, contingent upon no changes in terms, conditions, insurance agent, or underwriting company, and with annual rate increases not to exceed 5%. Vendor selection will be evaluated on a points-based system across five criteria: qualifications and experience (20 points), scope of work (30 points), rates/fees/expenses (30 points), references (10 points), and responses to the proposal questionnaire (10 points), with the final award decision made by City Commissioners in August 2025.

The City of Edinburg has not designated specific set-asides or disadvantaged business enterprise restrictions for this procurement; however, the city will consider impact on compliance with historically underutilized business requirements as one factor in determining best value. Blue Cross/Blue Shield of Texas is identified as the current group health insurance carrier providing the underlying fully funded medical benefits program with which the stop loss provider must integrate. No specific award value or budget range is disclosed in the RFP documents; however, the city's employee census data indicates 1,410 employees across multiple departments with varying employment classifications and salary ranges, which will inform the anticipated claims exposure and premium calculations. Proposers must submit comprehensive proposals including a completed questionnaire, rates schedule, benefit descriptions, limitations, exclusions, and required forms such as conflict of interest questionnaires, W-9s, and anti-collusion certifications. The city reserves the right to reject any and all proposals and emphasizes that price alone will not be the sole determining factor in vendor selection; instead, award will be based on best overall value considering purchase price, vendor reputation, service quality, meeting the city's needs, past relationships, and total long-term costs.