UNMH Stop Loss Insurance Coverage FY27

The objective of this Request for Proposal (RFP) is to secure a qualified insurance carrier to provide Stop-Loss Coverage for the University of New Mexico Hospital’s (UNMH) self-funded health plan in accordance with the requirements described in the Scope of Work.

As New Mexico's sole academic medical center and only Level One Trauma Center, UNMH treats nearly 90,000 emergency patients and manages over 500,000 outpatient visits annually. UNMH is the largest clinical component of the UNM Health Sciences Center (UNMHSC).

Currently, UNMH operates one self-funded health plan featuring two options: a PPO and a High Deductible Health Plan (HDHP). Effective January 1, 2027, the plan will transition to a proprietary network managed directly by UNMH, with claims administration handled by Community Care Partners (CCP). Eligible participants include active, benefits-eligible employees with a 0.5 FTE or higher status; retiree coverage is not provided.

**1.2. Scope of Work:** Contractor will provide the following services for UNMH:

Individual Stop Loss (also known as Specific Stop Loss)

• $525,000 Deductible
• $550,000 Deductible
• $600,000 Deductible
• $1,000,000 Deductible

Claims

• Include medical and pharmacy
• Mirror Plan document for eligibility
• Mirror Plan document for benefit design and benefit inclusions/exclusions

Network

• Acknowledge that the underlying network is a proprietary network owned and managed by UNM Hospital
• Claims that fall outside the domestic network (in-network) will be managed by letters of Agreement/Authorization
• Offeror must clearly provide details on any usage of offeror-based contracts to be eligible for reimbursement

Stop Loss Contract Type

Offerors are invited to submit proposals for all three types below or in their discretion only one or two of the following, note the contract types are listed in order of preference:

• Paid contract (preferred), or
• 36/12 (Incurred in 36 Prior and Paid in the 12-month contract period), or
• 24/12 (Incurred in 24 Prior and Paid in the 12-month contract period)

Stop Loss Contract must include claims run-in from previous carrier BCBSNM.

Underwriting Terms & Conditions

• Pricing must be net of commissions
• Coverage must be bindable through email or application process as contract may take longer to get into place
• Firm pricing with data through September
• Multi-year rate guarantees are preferred

Service

• Stop loss carrier rating must be a minimum AM Best Rating of A-
• Preference will be given to offerors that reimburse 100% of the claims above the requested stop loss deductible
• If selected, offeror will have a dedicated account manager to allow for questions related to various stop loss inquiries throughout the plan year
• Claims must be reimbursed timely (preferably within 10 business days)

Required to enter bid

• Please sign and upload a copy of the attached Conflict of Interest Form.
• Please review and accept the attached insurance requirements.
• Please upload your firms letter of interest here.

Evaluation

• Organizational Experience, Quality and Stability (20 Possible Points)
• Technical Approach (30 Possible Points)
• Cost Proposal (50 Possible Points)

Please attach and upload a copy of your firms Certificate of Insurance here.

Proposers should reach out to Lynn Brownlee at Lynn_Brownlee@ajg.com and cc Kat O'Neil-Dreher kaoneildreher@salud.unm.edu for the census and claims file necessary for the completion of their response to this RFP.