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Captive Insurance RFP: Membership Demographics and Claims Data

This RFP seeks to gather membership demographics and claims data for a captive insurance company, including network information and census demographics. Additional information required includes financials, articles of incorporation, captive certificate of authority, and sample policy issued by the captive. The relationship of parties, roles, and responsibilities are outlined in the RFP.

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Captive Insurance RFP: Membership Demographics and Claims Data

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  1. Data Requirements • General Information Needed: • RFP • Membership • Demographics • Claims Data for 3-5 years • Network information • Census information including demographics • Captive information (subject to confirmation of no drop down exposure): • Domicile address • Financial pro forma • Current captive financials • Articles of incorporation • Bylaws • Captive certificate of authority • Sample policy issued by the captive • Copy of underwriting guidelines

  2. Relationship of Parties Agreement/Stop Loss Policy Reinsurance Agreement

  3. Structure Sample Reinsurance Coverage (covers risk in excess of the selected captive reinsurance retention) Captive Retained (covers risk in excess of employer’s specific deductible up to retention of reinsurance agreement) Employer Retained Layer (retains risk up to selected specific deductible of stop-loss policy)

  4. Roles and Responsibilities Employer: • Creating and maintaining summary plan documents • Funding claims • Medical management/TPA relationship Captive Client: • Plan administration • Underwriting and policy issuance • Disperse claims payments • Prepare balance sheets and income statements • Comply with regulatory requirements of the captive’s domicile • Data reporting • Risk management Reinsurer: • Provide risk protection • Underwriting and pricing reinsurance risk • Issues reinsurance agreement • Provides medical cost management resources • Pay claims in the reinsurance layer

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