Pre-Proposal Conference Minutes.docx

Tirana GMC Health Insurance Contract Minutes from Pre-Proposal Conference

RFP 19AL6020R0001

October 20, 2020 @11.00 A.M. Local time

The pre-proposal conference for health insurance solicitation, number 19AL6020R0001, was scheduled and took place via google meet on Tuesday, October 20, 2020. The conference began at 11.00 a.m. local time as planned.

In attendance were representatives from the following companies:

· SIGAL UNIQA

· INTERSIG VIG

· EUROSIG

· DHIG – Bulgaria Branch Sally Lewis, General Services Officer and Contracting Officer for the HI Solicitation, began the meeting with a welcome and introductions.

I. Introduction by Contracting Officer:

Sally: Thank you for the interest shown in the Request for Proposal for LE Staff Health Insurance. My name is Sally Lewis and I am the Contracting Officer/General Service Officer at U.S. Embassy Tirana.

Let me introduce the other attendees from the Embassy.

Saimira Haxhi – Procurement Supervisor/ GSO office Bic Leu – Financial Management / HR Officer – who is the Contracting Officer’s Representative for the Health Insurance Contract Alba Ibrahimi and Irsilda Ismaili from the HR office Before explaining the importance of the Pre-Proposal Conference I would like to highlight that:

1. The Embassy encourages prospective offerors to offer off-the-shelf plans that meet at least the minimum benefit levels required in this solicitation.

2. Proposals that contain less than the minimum reimbursement levels or do not provide all benefit categories may be deemed technically unacceptable.

3. Offerors will be evaluated on acceptable relevant experience and past performance.

Back to the pre-proposal conference: This meeting is useful:

· To disclose any ambiguities, errors, or omissions in the RFP that may later be corrected in a written amendment.

· To give clarification on the Scope of Work

· I must make clear that statements made at the conference do NOT change the solicitation. All changes will be by written amendment to the solicitation.

· Also, all questions and answers will be provided to all companies on the solicitation mailing list. If an answer changes something in the solicitation an amendment will be required.

· Written questions submitted to date have been reviewed and replies are being drafted. Once cleared will be available and circulated to everyone. The cleared document will be published on Beta.Sam.Gov

· The offer due date and time is specified in the Standard Form 33 Block 9 and no offers will be considered that do not meet the deadline.

· Clause 52.217-9, Option to Extend the Term of the Contract, allows the exercise of options to be the choice of the Government, not the contractor.

· The offerors must follow the guidelines in the appropriate section of the solicitation.

· Dun and Bradstreet number is required for all actions over $30,000. Please make sure to register in SAM. www.sam.gov

Sally: “All the questions that have been submitted to date have been reviewed, and replies are being drafted and cleared. We also want to inform everyone that full copies of all the questions and our respective answers would be circulated and posted to ensure a fair and open solicitation process”.

Sally further explained Section 301 of the James Zadroga Health and Compensation Act of 2010:

You might have read in the Solicitation document SECTION 301 OF THE JAMES ZADROGA 9/11 HEALTH AND COMPENSATION ACT OF 2010

· The location of the Clause 52.229-11 on Section K (K.13) If exemption is available (Albania is not on that list of Tax Treaties) W-14 must be submitted with the offer. In the Solicitation document you have the link with the information on where to find this form.

· W-14 must be submitted with each voucher or invoice

· If exemption is not available 2% will be withheld from each invoice

Public Law 111-347

· Imposes 2% tax on any foreign person for contract payments received from U.S. Government for goods and services

· Purpose is to fund The World Trade Health Program

· Applies to contracts entered into on or after 5 June 2020

· Work is performed wholly or partly overseas

· Applies to each payment

· Foreign Person:

- Defined as persons and/or companies not US

· Taxes imposed under 26 U.S. C. 5000C may not be:

· Included in the contract price nor Reimbursed to the contractor by the U.S. Government

Sally: “If you have any questions regarding above, please go ahead or send them in writing”.

SIGAL representative: “I have a question. What is the procedure we should follow for the 2% tax on each invoice to be retained by the Government?”

Sally: “Thank you. We will respond to this question in writing”.

II. Saimira explains Section L Submission of offers and Section M Evaluation Factors

Saimira: Hello everyone and thank you for your participation. I will explain briefly Section L and Section M.

This solicitation is for the provision of insurance and services described in Sections C under the terms and conditions set forth herein.

SUMMARY OF INSTRUCTIONS. Each proposal must consist of the following separate volumes:

AND OTHER STATEMENTS OF OFFERORS

The offeror shall submit the complete offer to the address indicated at Block 7, if mailed, or Block 9, if hand delivered, of Standard Form 33, Solicitation, Offer and Award.

CONTENTS OF PROPOSALS. The proposals shall contain documents filled out in strict conformance with the detailed instructions set forth as follows:

L.4.1. Volume 1 -- Standard Form 33: Complete Blocks 12 through 18, as appropriate and fill in all the blanks in Section K of this solicitation.

L.4.2. Volume 2 -- Price Proposal and fill in Section B.

(a) Price proposal for the base year;

(b) Price proposal for the option years; however, a price proposal for an option year with no proposal for the base year will not be considered, nor will a proposal for a base period which does not include a proposal for all option periods.

Section L.4.3. Volume 3, Technical Proposal Instructions to Offerors The technical proposal must be submitted in four separate parts as described below.

Part 1, Health Insurance Services: Section C.1 defines the required minimum benefits and corresponding coverages. These are the minimally acceptable levels of coverage. If offerors choose to include additional benefits or higher coverages than the required minimums this is acceptable; however, evaluations will be based on meeting the stated minimums only. For each benefit listed, proposals must clearly state its coverage. Any proposal that reduces a benefit definition or offers lower than the minimum required coverage may be determined technically unacceptable. The resultant contract will contain the actual proposed coverages or increased benefit offerings if they exceed the solicitation’s minimum requirements.

Multiple proposals - If an offeror has multiple plans available that meet or exceed the minimum benefit levels and wants to propose them, a separate proposal with its respective prices must be submitted individually for each.

Suggested format – It’s the offeror’s responsibility to ensure their proposal is clear and meets all requirements. An example of an acceptable format for Part 1 is to submit a table that lists the Section C benefit definitions in one column and in the adjoining column list the proposed coverage.

Part 2, Understanding of the Requirement: Part 2 requires the offeror to demonstrate it understands the solicitation requirements and has an acceptable approach to managing the contract. This may be shown through corporate literature, medical plan brochures, reports, surveys and other narrative descriptions of its internal systems.

Part 3, Experience and Past Performance:

The offeror must list all contracts and subcontracts it has held over the past three years for the same or similar work. Provide the following information for each contract and subcontract:

1. Current or previous customer's organization name, address, email address, and telephone number for whom similar insurance and services were provided.

2. Identifying contract number, when (period of performance), and where the insurance was provided.

3. Type of insurance provided and range of population covered, as well as total dollar amount.

4. Brief description of and comparability to the work required under this solicitation.

5. Brief description of any performance problems and how they were resolved.

Part 4, Licensing Information:

The offeror shall include a notarized copy of the most current license/certificate/-accreditation, which demonstrates that the offeror is licensed/certified/accredited or otherwise authorized by the Government of the Republic of Albania or its agent (e.g., insurance commission, board) to provide health insurance coverage to persons (to include organizations, companies, groups) within the host country. If the offeror is not licensed/certified/accredited or otherwise authorized by the Government of the Republic of Albania it must demonstrate that it is licensed/certified/accredited by a government other than Albania to provide health insurance for persons in Albania and must demonstrate its capacity to provide health benefits in Albania to meet the minimum requirements and other conditions set forth in this solicitation.

SECTION M

EVALUATION FACTORS FOR AWARD

M.1. To be acceptable and eligible for evaluation, proposals must be prepared in accordance with Section L - INSTRUCTIONS, CONDITIONS AND NOTICES TO OFFERORS, and must meet all the requirements set forth in the other sections of this solicitation. Acceptable proposals will be evaluated pursuant to this section, and award shall be made as set forth in M.3 below

M.2. OVERALL EVALUATION

Proposals will be evaluated in two phases: a technical evaluation to determine the acceptability of the offer to the solicitation technical requirements; and a price evaluation to determine the total evaluated price proposed by each offeror. The "total evaluated price" is the cumulative total of the base year insurance plus all option years for the total estimated quantity specified in Section B. The “total evaluated price” will not include any Rider pricing.

The Government will make a responsibility determination by analyzing whether the apparent successful offeror complies with the requirements of FAR subpart 9.1

M.3. AWARD SELECTION

M.3.1. General. The award selection will go to the lowest priced, technically acceptable, responsible offeror. As described in FAR 52.215-1, "Instructions to Offerors - Competitive Acquisition,” which is incorporated by reference in Section L, award may be made based upon initial offers, without discussions. The offeror must also be licensed/certified/accredited.

M.3.2. Profit Sharing Credit Plan

In the event of equal proposals and in the event that one offeror presents an acceptable Profit Sharing Credit plan, the offeror proposing the most generous plan, in terms of benefit to the Government will receive the award. This profit sharing credit plan will be part of the resultant contract.

M.4. FIXED PRICES

Offerors must propose fixed prices for the coverage identified in Section B - SERVICES AND PRICES. Proposals that do not include fixed prices cannot be evaluated for the total requirement and will be rejected.

(i) Meeting each of the individual mandatory requirements/minimums for health insurance coverage specified in Section C through H and submitting an acceptable management approach (Part 2 under L.4.3) indicating how vendor will administer the plan and demonstrate an understanding, knowledge and familiarity of the requirements. The Government may reject, as technically, unacceptable proposals that:

(a) Fail to provide at least the minimum reimbursement levels for each benefit required by the solicitation; or

(b) Fail to demonstrate how solicitation requirements will be met.

M.7. PRICE EVALUATION

For the purpose of evaluation, and for no other purpose, evaluation of prices submitted will be made on the basis that the Government will order the estimated quantities shown in Section B – SERVICES AND PRICES, of this solicitation. The price evaluation will not include the price of any riders.

M.8. SEPARATE CHARGES

Separate charges, in any form, are not solicited. For example, proposals containing any charges for failure of the Government to exercise any options will be rejected. The Government shall not be obligated to pay any charges other than the contract price, including any exercised options.

M.9 AWARD WITHOUT DISCUSSIONS

In accordance with FAR provision 52.215-1 (included in Section L of this RFP), offerors are reminded that the Government may award this contract based on initial proposals and without holding discussions, pursuant to FAR 15.305(a).

M.10 52.225-17 EVALUATION OF FOREIGN CURRENCY OFFERS (FEB 2000):

If the Government receives offers in more than one currency, the Government will evaluate offers by converting the foreign currency to United States currency using the exchange rate used by the Embassy in effect as follows:

Saimira: “If you have any questions regarding the sections explained, please go ahead”.

SIGAL representative: “In case two companies will be joined together to offer health insurance services, what is the technical procedure required to be followed? In case of joint venture are both companies required to fill in Section K?”

Saimira: “Thank you. We will respond to this question in writing.”

Sally asks if there are any question with regards to the Administrative part of the Solicitation Package, or if translation in Albanian is necessary per above, and then passes over to COR for Discussion of SOW III. Discussion of the Scope of Work by COR:

Bic: Good morning everyone, as the Contracting Officer’s Representative for the Health Insurance Contract, I’m here to advise on the scope of work’s technical matters. I’d like to emphasize the below points in Sections C (Description/Specification/Work statement) and H (Special Contract Requirements) of the RFP.

1. C.1.1 Reasonable and customary costs: “Reimbursement of covered expenses is limited to the stated percentages of reasonable and customary costs.”

a. In the proposal, please explain your standard for determining reasonable and customary costs.

b. Provide a closed list of these reasonable and customary costs for all services covered under Section C, and update this list regularly, at least twice per year.

SIGAL representative: “Excuse me for interrupting, but we have a question regarding the Reasonable and Customary costs. Can you clarify the Reasonable and Customary costs disposition? Do we need to share the prices provided by the medical providers in Albania?”

Bic: “Yes. We are not only asking you to provide a closed list of these reasonable and customary costs, but we request as well to share with us the standard you have used to come up with these reasonable and customary costs.”

Bic continues to explain points based on the Scope of Work:

2. C.1.1.4 Outpatient Services: In regards to the annual physical examinations: “The Contractor shall provide a check-up list of covered services and tests by gender and age group”.

a. In the proposal, provide a closed check-up list of covered services with a fixed number of tests covered.

b. Explain your standard for determining the check-up list of covered services and tests.

3. C.1.1.7 Prescription Drugs: “Medications prescribed by a licensed health care provider that are medically required. Medications must follow EU standards or be on the list of authorized drugs from the Government of Albania. Examples include, but are not limited to prescription antibiotics to treat an infection, medication used to treat an ongoing condition, such as high cholesterol, prophylaxis, contraceptive medication. Expenses incurred for medicines, vitamins, supplements, cold remedies, etc., that are available over the counter without a prescription will not be reimbursed even if prescribed by a physician.”

a. The goal is cover medically necessary drugs with a prescription by a licensed health care provider.

4. C.1.1.17 Out-of-Country Medical Treatment: “Medical expenses incurred out-of-country will be covered at the same benefit levels and subject to the same total maximum annual limit as for medical expenses incurred in-country. The attending physician must certify in advance that such treatment is medically necessary and unavailable locally in Albania.”

a. In the proposal, determine the pre-approval process for medical expenses incurred out-of-country.

5. C.1.6.1 Brochure Requirement: “The brochure shall specify all pre-approval, reimbursement, and appeal procedures – including documentation required to submit a claim, a list of services that require pre-approval, and a list of exclusions.”

SIGAL representative: “In the past, when SIGAL was the health insurance provider for the U.S. Embassy personnel, we have seen cases where for certain services it is required the pre-approval of the insurer. Can we add in the brochure these services?”

Bic: “Yes. Please add those in the brochure.”

Bic continues to explain points based on the Scope of Work:

6. C.1.6.4 24/7 Customer Service Hotline: “The Contractor shall provide and staff a 24/7 customer service hotline that employees can call with questions about benefits coverage and medical care.”

a. The offeror must directly communicate to the insured personnel all updates, questions, clarifications, and special requirements under this contract. Please do not request that the Embassy’s Human Resources and General Services Offices communicate with the insured personnel on your behalf.

7. C.1.3 Exclusions and Limitations: “There is no coverage for elective cosmetic surgery; spa cures; rejuvenation cures; massage; exercise therapy; long-term rehabilitative therapy; non-medical hospital charges (e.g., telephone, television, etc.); home help, family help, or similar household assistance; fees of persons who are not certified health care providers; advanced reproductive technology (e.g., in-vitro fertilization, intra-cellular sperm injection, artificial insemination, microsurgical epididymal sperm aspiration, testicular sperm extraction, cryopreservation, etc.); or services or supplies which have not been prescribed or approved by a certified health care provider. Exclusions to coverage may be amended if provided in an off the shelf plan and is the lowest-cost and technically acceptable. Removal of any exclusions require prior authorization.”

a. The offeror should not interfere with services or supplies prescribed or approved by the attending certified health care provider for the insured personnel. If all required documentation per contract terms is fulfilled properly and submitted by the patient for reimbursement, the offeror should not question the attending provider’s prescription or medical treatment.

SIGAL representative: “Under this disposition it is excluded from coverage the long-term rehabilitative therapy, while in C.1.1.14 Rehabilitative and Habilitative Services and Devices are covered at 50%. How should the offeror understand this? What do you consider as long-term rehabilitative therapy?”

Bic: “Good question. We will respond later in writing.”

Bic continues to explain points based on the Scope of Work:

8. H.4 CONTRACTOR RESPONSIBILITY IN CLAIMS AND REIMBURSEMENT TO CLAIMANTS: “(b)Medical Insurance Claims. Settlement of medical insurance shall be completed as follows:

(1) All medical claims shall be submitted directly to the Contractor by employees, through a drop box in the COR's office. The claims shall be picked up from the COR each Tuesday.

(2) The Contractor shall date stamp and screen all claims submitted on the day of receipt. If there are any missing documents or information thereby disallowing said claim to be payable, the Contractor shall notify the employee within two days, with a copy to the COR (if notification is written).

(3) The Contractor shall settle the claims no later than two weeks from the date the claim is submitted to the Contractor.

(4) Settlement shall be by issuance of checks in the name of the employee for each claim submitted. Each check shall be accompanied by a form providing details of the amount reimbursed with an explanation of deductions, if any.

(5) The Contractor shall accept the employee's or dependent's choice to go for surgery to hospitals designated by the Contractor in order that the Contractor will pay the expenses directly to the hospitals.”

a. In the proposal, provide the in-network list of the hospitals/pharmacies/dental clinics where the Contractor will pay the expenses directly.

b. Determine if you are able to update this list regularly, i.e. twice per year.

9. H.5 Reporting Requirements: “The Contractor shall provide a monthly Employee Claims Report to the COR no later than the 10th day of each month. The report shall report on the previous month's activities. Employee Claims Report. The report shall list all claims paid by the Contractor to a claimant, including the name of the claimant, date claim is received by the Contractor, and the amount claimed. This report shall also include all outstanding claims and a brief description of why the claim has not been paid. The report shall not include any claims information for riders.”

Bic passes to Sally to provide closing remarks.

Sally: “This concludes the pre-proposal conference. Thank you for your participation! Please send your further questions in writing to our email address provided to you earlier. Thank you!”

With no more questions being raised, the meeting was dismissed at approximately 11:40 p.m.

SENSITIVE BUT UNCLASSIFIED