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 manage financial risks associated with high-cost health insurance claims by securing both individual and aggregate stop loss coverage. This procurement aims to protect the agency's self-funded health plan from catastrophic losses through structured risk transfer and diligent claims management. The scope of work covers the administration of individual excess risk benefit levels, which must include both medical and prescription drug benefits. The selected provider will handle underwriting services for the annual procurement of stop loss and factors, track and pay stop loss claims, and bill stop loss premiums. Additional responsibilities include the clinical evaluation of large claimants, financial reporting and analysis, and coordination with existing health plan providers and other programs. The agency requires the administration of aggregate stop loss factors inclusive of the same medical and prescription drug benefits, along with the tracking of the annual aggregate attachment point. The provider must deliver implementation support to ensure a seamless transition of services, as well as regular reporting on claims activity, reimbursement status, and reconciliation. All performed work must take place onsite within the United States, as the agency limits eligibility to onshore entities. Bidders must submit their proposals digitally, either via email or through the designated online portal. The agency has not disclosed a specific budget and is looking for proposals to determine the financial terms. Key dates and specific evaluation criteria are not detailed in the procurement launch, but the agency will evaluate submissions based on the outlined administrative, clinical, and financial requirements.