Stop Loss Coverage

Johnson County is seeking a vendor for stop loss coverage for its self-insured medical and prescription drug plans. The selected vendor will be expected to provide exceptional customer service, statutory and regulatory compliance, and monthly participation and status reports. The contract will be effective for a one-year period beginning January 1, 2026, with the option to renew for an additional year. The vendor must have an AM Best rating of A- or better, a history of financial stability, and the ability to provide timely stop loss reimbursements. The vendor will be responsible for providing stop loss coverage, processing claims, and maintaining a stop loss claims database. Some key points to note are: • The County has approximately 3,500 full-time benefits eligible employees within the U.S. • The County covers about 90 COBRA and retiree participants, and elected officials are also included as eligible employees. • The County has implemented various cost containment programs, including a wellness program and a fitness program. • The County contracts with Tria Health for medication therapy management and TouchCare for health advocacy. • The vendor must guarantee a maximum rate increase cap of no more than 40% for the optional renewal period. • The vendor must provide a preliminary stop loss renewal for 2027 by October 1 on a cost not to exceed basis. Some of the key qualifications for the vendor include: • Guaranteed claim reimbursement of two weeks or less when all necessary claims documentation is submitted • Ability to offer an expedited claim capability rider • All stop loss determinations are made solely by the vendor and are not impacted by the status or existence of reinsurance • Vendor will cover all medical and prescription drug claims paid in accordance with the underlying medical and drug plans • Vendor agrees to accept the County’s SPD/plan document’s definition of medical necessity and clinical appropriateness