Medical and Pharmacy Reinsurance Services

The Vendor is required to provide for medical and pharmacy reinsurance that cover stop loss coverage, including both specific and aggregate stop loss reinsurance for its self-funded medical and pharmacy plans.
- All carrier quotes, with fees and premiums net of broker/agent commissions.
- Current coverage includes a $500,000 specific deductible and a 120% aggregate corridor, with a 12/12 contract basis for the initial year. Coverage applies to both medical and pharmacy claims. The maximum aggregate coverage is $5,000,000. The Opt-Out plan is excluded.
- Monthly reporting of open claims and activity, plus a comprehensive year-end summary, is required.
- Agents or Third Party Administrators must carry Errors and Omissions insurance with a minimum $1,000,000 limit; proof must be included.
- Within 45 days after each calendar quarter, the carrier must provide a consolidated account summary statement indicating account status (Paid in Full, Overpaid, or underpaid). Any discrepancies must be detailed.
- The carrier is responsible for all costs related to interface development and maintenance.
- Carrier must accept enrollments, maintain eligibility files, and receive electronic updates exclusively via the District’s online enrollment systems (BTR/Swift and/or Tyler Munis).

- Contract Period/Term: 1 year
- Questions/Inquires Deadline: November 04, 2025