Denton Ionwave #9161 Addendum 2

City of Denton stop-loss insurance for self-funded medical and prescription plans

The City of Denton is seeking stop-loss insurance proposals for its self-funded employee medical and prescription plans. - Buyer: City of Denton, Denton Purchasing, Denton County, Texas. - Requested coverage: Specific (individual) and aggregate stop-loss insurance for eligible active employees, retirees, and dependents. - Quote specific deductible options of $185,000, $200,000, $225,000, and $250,000; none may include an aggregating specific deductible. - Proposals must offer a 24/12 or paid contract basis and cover medical and prescription claims. - Key coverage requirements and preferences: The City expects no plan-design changes and seeks no-loss/no-gain continuity, including waivers of applicable pre-existing-condition, actively-at-work, and non-confinement provisions for members who have satisfied current-plan limitations. It prefers clean contracts without lasers or run-in limitations, but will consider risk provisions and enhancements such as no-new-laser renewals and second-year rate caps. - Named vendors and administrators: UnitedHealthcare (UHC) is identified as the current stop-loss carrier and retiree administrator; Sun Life as the prior stop-loss carrier; Surest as the medical claims administrator for the Surest plan; and OptumRx as the outpatient prescription administrator. These names describe existing or historical arrangements, not designated suppliers for the requested coverage. - Existing plan context: The Surest plan is self-insured and has no deductible, with in-network out-of-pocket maximums of $6,500 per individual and $13,000 per family. OptumRx administers outpatient prescription benefits; network pharmacy copayments vary by tier. These plan details provide context for the requested coverage, rather than separate purchases in the solicitation. - Pricing and evaluation: Quotes must show all City costs and be net of commissions and consulting fees, excluding taxes. The City requests rates be held firm for 45 days, subject to updated claims and disclosure information. Evaluation weights are price/total cost of ownership (60%), probable performance (30%), and specification compliance and quality (10%).

Description

The City of Denton is requesting proposals for specific and aggregate stop loss insurance for its medical and prescription plan. Coverage is sought for eligible active employees, retirees, and their dependents enrolled in the City’s self-insured health plan. Proposals should address the requested coverage options and assume a January 1, 2027 effective date. Submissions may be made through IONWAVE or by hard copy; email submissions are not accepted.

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