Stop Loss Insurance

The City of Palm Beach Gardens is soliciting proposals for a new stop loss insurance contract to replace its expiring agreement with Symetra Life Insurance Company, which terminates September 30, 2026. This insurance protects the city’s self-funded health plan from catastrophic claims by reimbursing costs that exceed predetermined attachment levels, currently set at $450,000, $475,000, and $500,000 per individual. The city currently pays approximately $627,000 annually for this coverage and seeks a new contract with a one-year base period and five optional one-year renewal terms, exercisable solely at the city’s discretion. Proposals must be submitted via the OpenGov e-procurement platform by 3:00 p.m. local time on May 29, 2026, with no physical submissions accepted. The evaluation is based on a trade-off approach, prioritizing value over lowest price, and assigns weighted points across seven factors: cost (40 points), coverage terms and plan compatibility (20 points), underwriting methodology (15 points), carrier financial strength (10 points), administrative services (5 points), clinical cost containment programs (5 points), and implementation support (5 points). A minimum A.M. Best financial rating of A- is required for eligibility, and proposers must demonstrate experience serving public sector self-funded plans. The contract requires strict compliance with Florida state laws, HIPAA, the Affordable Care Act, and E-Verify participation, with proposers submitting an Incorporation Affidavit that includes certifications on public records compliance, drug-free workplace requirements, and non-collusion. Attachments such as the benefit booklet, schedule of benefits, and conflict of interest disclosures are mandatory. Evaluation criteria also include the clarity of pricing, rate guarantee duration, claims administration processes, and integration capabilities with the city’s third-party administrator, Florida Blue. The city retains audit rights and requires proposers to include run-out obligations for claims in case of termination. Contract administration details, including payment and accounting codes, are not explicitly defined, though internal identifiers like GRP-NO: 91062 may be used for tracking. Proposals must follow a strict tabbed format with seven sections, and only the cover letter is limited to one page. No formal FAR clauses are used; instead, the city relies on internally structured provisions addressing compliance, affidavits, and the superiority of governing documents. The