Texas DIR/ESBD #2607002

Stop Loss Insurance Coverage for Self-Funded Medical and Prescription Drug Plans

This opportunity is for vendors to provide stop loss insurance coverage for the Travis County Healthcare District's self-funded medical and prescription drug plans. - Government Buyer: - Travis County Healthcare District d/b/a Central Health - Central Health Purchasing Office - Products/Services Requested: - Comprehensive stop loss insurance for self-funded medical and Rx plans - Includes both specific and aggregate stop loss coverage - Claims management, risk mitigation, and ongoing support services - Notable Requirements: - Integration with Aetna, the current third-party administrator (TPA) and pharmacy benefit manager (PBM) - Dedicated account management and detailed claims/risk reporting - Value-added services such as claims advocacy and predictive modeling - Vendors must evaluate current stop loss arrangements and propose new or enhanced options - Multi-year rate guarantees and renewal rate caps are requested - Proposals must address technical and reporting capabilities - No specific OEMs or insurance carriers are named in the solicitation, but Aetna is referenced for integration purposes - Contract Structure: - Initial term of one year, with up to four optional one-year renewals - Pricing to cover various employee coverage tiers for both specific and aggregate premiums

Description

This Request for Proposal (RFP) aims to assist Central Health in securing a comprehensive stop loss insurance solution for the Travis County Healthcare District System. The solution should provide high-quality, cost-effective stop loss coverage to protect the System's self-funded medical/Rx plan and mitigate financial risk. The RFP includes evaluation of current stop loss insurance arrangements against new market options and seeks a vendor capable of superior claims management, risk management services, and ongoing support to the System and its benefits administration team. The contract duration is one year with optional renewals for up to four additional years.

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