Stop Loss Insurance Services

A government authority located in Texas is seeking a vendor to provide comprehensive stop loss insurance services. The agency needs to solve the challenge of managing high-cost medical and prescription drug claims through structured risk mitigation. The selected provider will administer individual excess risk benefit levels and manage claims and reimbursements above the individual stop loss level. The scope of work covers the tracking and payment of stop loss claims, billing of stop loss premiums, and administration of aggregate stop loss factors. The provider must also manage the annual aggregate attachment point, perform underwriting services for annual procurements, and conduct clinical evaluations of large claimants. Additionally, the agency requires implementation support for a seamless transition, financial reporting, claims activity reconciliation, and coordination with existing health plan providers. Eligible bidders must perform all work onsite and must be located onshore within the United States. The agency accepts digital proposal submissions via email or through their online portal. No specific budget is disclosed, as the agency is currently seeking proposals to determine pricing and financial structures.