Stop Loss Insurance Administration Services

The Vendor is required to provide for providing Stop Loss Insurance to eligible employees and their dependents.
- Objectives:
• To provide health plan with reinsurance coverage for the medical and pharmacy claims;
• To ensure costs and conditions are managed effectively by providing specialized programs designed to manage high-cost medical conditions and reduce the financial burden;
• To responsibly utilize governmental dollars.
- Services of the Consultant may include, but are not limited to, assisting the employer in the analysis of existing benefit designs and funding arrangements; strategic planning of alternative programs; preparation of health and prescription drug insurance program specifications and criteria; the analysis and evaluation of proposal responses; and preparation of final reports and recommendations for award(s).
- Provide necessary and appropriate program administration and services for each covered member, by account/division number (i.e. County, Schools, other agencies); maintaining payment record; and furnish monthly accounting statements by member showing reimbursements.
- Maintain a local or toll-free customer service number for employees and dependents.
- Provide a systematic procedure for the appeal of claims.
- Accept the no gain or loss provision and waive any actively-at-work provisions.