Stop Loss

The Metropolitan Transit Authority of Harris County (METRO) is soliciting proposals for stop loss insurance coverage for its self-funded employee health plan, with a proposed effective date of October 1, 2025. The scope of work includes comprehensive administration of individual and aggregate excess risk, encompassing claims processing, underwriting, financial reporting, and clinical reviews of high-cost claims. The selected provider must coordinate with METRO's existing medical and pharmacy administrators, Cigna and OptumRx, to ensure seamless integration. Proposals are due by July 8, 2025, and must be submitted via Gallagher Benefit Services. The contract requires a 24/12 structure, consisting of a 24-month primary period with a 12-month tail, and must feature firm pricing submitted net of commissions. Bidders are required to provide quotes for individual specific deductible levels of $275,000, $300,000, and $325,000, as well as a no-laser option with a renewal rate cap of 50%. Additional requirements include the provision of spec advance funding and a corporate statement affirming that the employer's plan documents will govern claims determinations. Award decisions will be based on a trade-off methodology using a weighted scorecard. The evaluation criteria are prioritized as follows: Financials (35 points), Claims Management and Administration (25 points), Client Service and Support (20 points), Qualifications and Experience (10 points), and Implementation and Transition Support (10 points). Performance will be measured by claims processing efficiency, reporting accuracy, and the effectiveness of the transition and account management teams.