Stop Loss Insurance Services

The vendor is required to provide self-funded medical and prescription drug insurance for eligible employees and their eligible dependents.
- Specific Stop Loss Coverage:
• Obtain a competitive proposal for specific stop loss coverage
• Obtain a proposal with reasonable contract terms
• Identify a carrier partner that provides ease of administration and provides timely reimbursements upon claim
- Rate basis:
• Provide monthly premium rates for specific stop loss insurance; monthly premium rates should be provided on a composite basis.
- Self-funded with administrative services provided by anthem utilizing the blue access PPO network.
- Employees pay a portion of the medical/rx premium based on enrollment tier.
- Employee benefits:
• Maintain enrollment records and report eligibility data to carrier.
• Process claims over the specific deductible and submit reimbursement to city in a timely manner.
• Assign a senior level account manager to be responsible for handling all administrative, billing, claims and other issues from city human resource benefit representatives.
• Provide standard premium and claim reports.
• Assurance that the stop loss contract mirrors the carrier’s certificate as far as benefits payable under the plan.
- Specific Stop Loss Coverage: $600,000 specific deductible based on a 24/12 or Paid contract.
- Contract Period/Term: 1 year