Medical Stop Loss

The University of Maine System is seeking responses to provide medical stop loss coverage as defined in this document. [...] The University of Maine System seeks medical stop loss coverage to support its self-funded employee health plan. Stop loss coverage protects the Plan against large and catastrophic claims, helping ensure long-term financial stability while maintaining comprehensive benefits for employees, retirees, and dependents. The selected carrier will work collaboratively with the University's health plan partners, including the medical administrator (Anthem Maine), pharmacy benefit manager (CapRx, now JudiRx), and other applicable vendors, to support effective plan administration and claims management.

The University of Maine System seeks a qualified medical stop loss carrier to provide specific and, if applicable, aggregate stop loss coverage for its self-funded employee health plan. The selected carrier will be expected to protect the Plan from catastrophic and high-cost claims while providing timely reimbursement, responsive account management, and effective coordination with the University's health plan vendors.

Responsibilities include:

• Providing specific stop loss coverage as proposed and ultimately contracted.
• Reviewing and underwriting plan experience and risk data.
• Coordinating eligibility, claims, and reimbursement processes with the University's third-party administrators, pharmacy benefit manager, and other applicable benefits vendors.
• Processing reimbursements accurately and within standards.
• Providing dedicated account management and service support.
• Supplying reporting, additional claim monitoring, service management and reimbursement documentation as requested.
• Identifying and communicating potential high-cost claim risks and reimbursement opportunities.
• Complying with all applicable federal and Maine laws and regulations.

The desired outcomes are competitive financial protection for the Plan, accurate and timely reimbursement of eligible claims, effective vendor coordination, and a high level of service that supports efficient plan administration. Services will primarily be performed remotely in coordination with the University of Maine System and its designated benefit partners.

**Submission method:** A SIGNED virus-free electronic copy must be submitted to UMSResponses@maine.edu by **November 13, 2026, 2:00 p.m. EST**. Email Subject Line – Stop Loss Bid Proposal - RFB#2027-032. Response submissions that exceed 20 MB will be submitted with multiple emails modifying the email subject line to include: Submission 1 of X (‘X’ representing the number of files being submitted).

Qualifying Respondents are insurers licensed to provide stop loss in the State of Maine. MGUs, Brokers and other vendors are not qualified bidders. Please contact WTW for materials needed to provide quotes (blinded census, claims information, plan documents, bid forms).

Award will be made to the low bidder provided that all other requirements are satisfactorily met, as outlined in Section 1.1.4 of this document. The University will NOT seek a best and final offer (BAFO) from any Respondent in this procurement process.

Unless specified otherwise, all responses shall be valid for ninety (90) days from the due date of the response.

The winning Respondent will be required to execute a contract in the form of a University of Maine System Master Agreement, which is attached to this response as Appendix D. The Master Agreement initial term and renewal periods are reflected in Section 2 of Appendix D, Master Agreement.

Estimated Agreement Start Date (subject to change): January 1, 2027.