Stop Loss Insurance

The City of Palm Beach Gardens, FL, is soliciting sealed responses for Stop Loss Insurance. Responses are to be submitted via the City's eProcurement Portal via https://procurement.opengov.com/portal/pbgfl PRIOR TO 3:00 pm on Friday, May 29, 2026. Late responses will not be accepted.

The City is seeking an insurance provider for stop loss insurance coverage to support its self-insured group health insurance and pharmacy plan, in accordance with the terms, conditions, and specifications in the Request for Proposals. Proposers must demonstrate they possesses the relevant experience, ability, and have the adequate resources to perform the services at the high level of service required by the City.

Background

The City has an existing contract, RFP2021-063HR, Stop Loss Insurance, with Symetra Life Insurance Company which will expire September 30, 2026.  The contract has no available options to renew, so a new agreement is needed to maintain continuity of service.

Stop loss insurance is a type of commercial insurance that protects self-insured businesses in the case of catastrophic or large health insurance claims.  This coverage is utilized by businesses that have opted to pay their employees’ health benefits out-of-pocket instead of using traditional group health insurance.  With stop loss insurance, businesses can receive reimbursement for claims that exceed a pre-determined level.  Stop loss insurance is used by the City to support the goals of the self-funded Group Health Insurance Program.

The City currently pays about $627,000 per year for these services.

Stop loss insurance contracts are usually awarded for one-year or two-year periods depending on the risk evaluation actors and the claims experience.

Project Details

• Reference ID: RFP2026-081HR
• Department: Human Resources
• Department Head: Sheryl Stewart (Human Resources Administrator)

Evaluation Criteria

• Cost/Financial Proposal (40 pts) —

  Competitiveness of rates for all deductible levels; overall value; transparency of pricing; rate guarantees; contract basis; fees and contingencies

• Coverage Terms & Plan Compatibility (20 pts) —

  Alignment with current plan design; contract terms (e.g., 12/12, 12/15); exclusions; limitations; reimbursement provisions; aggregate terms (if applicable)

• Underwriting Approach (15 pts) —

  Soundness and transparency of underwriting methodology; appropriateness of assumptions; handling of large claimants; renewal methodology; rate stability

• Carrier Experience & Financial Strength (10 pts) —

  Experience with public sector/self-funded plans; organizational capabilities; financial ratings; references

• Administrative Services & Reporting (5 pts) —

  Claims reimbursement process; reporting capabilities; integration with existing vendors (e.g., Florida Blue); ease of administration

• Clinical Programs & Cost Containment (5 pts) —

  Availability and effectiveness of care management, large case management, specialty pharmacy oversight, and cost containment programs

• Implementation & Service Support (5 pts) —

  Quality of implementation plan; assigned personnel; service model; responsiveness; ongoing account management

Submission Requirements

• Respondent Submittals (without Cost) (required) —

  Please Upload your COMPLETE response, including any and all required forms listed in the solicitation and the corresponding attachments.

  (Do not upload cost information in here)

• Separate Cost Proposal (required) —

  Confirm that your fee proposal is not attached in your Proposal and is attached separately here.

• I certify that I have read, understood and agree to the terms in this solicitation, and that I am authorized to submit this response on behalf of my company. (required)
• Pricing (required) —
  • Choose Option 1 when you have set line items, for example:
    • This is a quote for goods or commodities.
    • This is a public works bid, with a pricing table that can be uploaded into OpenGov Procurement from an Excel spreadsheet.
    • Seeking services for hourly rate schedules.
  • Choose Option 2 when you need vendors to provide you with the line items. 
• Evaluation Committee? (required) —

  Will there be an evaluation committee to review the proposals and score them based on weights and multiple criteria?

• Procurement and/or Project Contact —

  Select the information you would like display.