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
Employer
Captive
Reinsurer
Agreement/Stop Loss Policy
Reinsurance Agreement

3. Structure Sample Reinsurance Coverage Captive Retained
(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