RMTS Request for Proposal (RFP) Requirements

For RMTS to provide an accurate and competitive quote in a timely manner, we require the following:

  • TPA complete name and address
  • Description of the employer group-including
    • the employer’s name
    • complete address
    • size of group and nature of group’s business
  • Groups requested stop loss requirements-including
    • the effective date,
    • specific deductible,
    • contract period maximum
    • type of contract desired
    • coverage desired (Spec & Agg or Spec Only)
    • benefits to be covered by stop loss
    • contract features (ie specific advancement)
    • commission requirements
  • Group’s current coverage arrangement including
    • in-force rates/factors
    • TPA Name
    • Carrier Name
  • 2-3 years aggregate claim and participation history broken out by benefit type (medical, dental, RX, etc)
  • Large claims report including diagnosis, amount paid and current treatment plan/prognosis
    • Paid/pending in excess of 50% specific deductible requested
    • Precertification
    • Large case management
  • Census listing of all participants under the plan(s), provided in electronic format (ie Excel, MS Word or Text) broken out by plan then by Active, Cobra, and Retiree including:
    • Gender
    • Date of birth
    • Coverage Type
    • Current plan document with any proposed plan changes
  • Managed care information including:
    • Current and Proposed PPO Network
    • Pre-certification/UR Vendor
    • Case Management Vendor
    • Managed Care Programs

All RFPs should be sent to quotes@rmts.net