Consolidated QA - Cleared_16JUN2026.pdf

19AL6026R0001 Questions & Answers

June 16, 2026

All Prospective Offerors

Re: Solicitation 19AL6026R0001: Health and Life Insurance Contract

Dear Prospective Offerors:

In reference to this solicitation, we received some questions from prospective offerors.

These questions are listed below, with responses embedded therein. We have combined some questions from perspective offerors because of their similarity. When appropriate to support our responses, we have included respective data.

Question No. 1: Do the claims amounts provided in Exhibit E, Section J include life insurance claims as well? Please provide a separate breakdown of health insurance claims and life insurance claims for each of the last five years: 2021, 2022, 2023, 2024, and 2025. Please state if they are only claims paid under Health Insurance (Part 1), or if they include claims paid under Life Insurance (Part 2) as well. If they are mixed, please separate health claims from life claims.

Response No. 1: The claims amounts provided in Exhibit E, Section J do not include life insurance but only Health Insurance. Regarding Life Insurance, there was only 1 claim case (1 death).

Question No. 2: Please confirm if the claims data provided in Exhibit E, Section J includes claims from ORE employees, AERA employees, and Peace Corps staff.

Response No. 2: As we have noted in Exhibit E, Section J: *The numbers below do not include individuals covered under a rider, that means claims from ORE employees, AERA employees, and Peace Corps staff are not included.

Question No. 3: Please provide the member count for Health & Life Insurance for the last 5 years – 2021, 2022, 2023, 2024 & 2025. It is standard practice in the insurance industry (and in other Department of State insurance solicitations) to provide this information to ensure equal/fair opportunity for all offerors in an open solicitation.

Response No. 3: Please refer to Exhibit A in Section J of the solicitation, which provides current employee statistics. The solicitation shows 234 total premiums for the base year (56 Self- Only, 41 Self Plus One, 137 Family), representing 659 total insured individuals (employees + dependents). Historical year-by-year member counts for 2021-2025 are not available in the solicitation documents.

Question No. 4: Please provide a detailed breakup of employees' salaries and ages. Could you provide a list with age, gender and currently monthly basic salaries in Albanian Lek? This information is essential in preparing the offer for life insurance.

Response No. 4: Please see SECTION J, LIST OF EXHIBITS/ATTACHMENTS, already provided in the RFP.

Question No. 5: Are dental implants covered under this contract? If yes, could you please clarify any applicable limitations or conditions? Please clarify whether medically necessary implants are intended to be covered under the proposed insurance policy, as the current documentation does not expressly specify implants as a covered benefit. Specifically, please confirm: (1) Whether implants are covered under the policy; (2) Which categories of implants are included and/or excluded; (3) Whether coverage is subject to any sublimits, prior authorization requirements, or medical necessity criteria; and (4) Whether coverage applies both to the implant device itself and the related implantation procedure.

Response No. 5: Implants are considered false teeth and are covered.

Per C.1.1.11 Dental Care: Examinations and Treatment: Dentist’s fees, x-rays, examinations and treatment, cleanings, fillings, extractions, false teeth (dentures), crowns, and bridges. The maximum coverage is USD 3200 per covered individual per contract year. 80% Minimum Coverage: with annual cap.

Question No. 6: Could you please clarify the definition of the "contract lifetime cap"? We noticed references to two different types of limits:

• Lifetime limit

• Contract lifetime limit.

Is the "lifetime limit" intended to include medical expenses incurred prior to the current contract period, while the "contract lifetime limit" refers to the potential full contract duration (1+4 years)?

Response No. 6: Anything that occurred before this contract or will occur after this contract is irrelevant to the offeror’s proposal. Any cap or limit applies only to this contract (base + options). In the solicitation document, there is only one reference to a "lifetime limit" under section C.1.1.11 Dental Care. The "lifetime limit" is the maximum amount that will be paid for orthodontia treatment per covered individual. The phrase "with contract lifetime cap" suggests this limit applies during the term of the contract. In this case “lifetime limit” and “contract lifetime limit” should be used interchangeable.

Question No. 7: Is it up to the insurance company to define and structure these limits within the proposal, provided they are clearly disclosed?

Response No. 7: No, the limits are defined by the solicitation. Section C specifies minimum coverage percentages and maximum benefit amounts for each type of service. However, Section L.4.3 states: "Section C 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." Therefore, offerors must meet or exceed the specified minimums but may propose higher coverage levels if clearly disclosed in their proposal.

Question No. 8: We intend to submit a joint offer. In the event of an award, would separate invoicing by each entity be required, or would consolidated invoicing be acceptable? Can we bill the health insurance and life insurance premiums in the same invoice, or do you need separate invoices? Under the legislation of Albania when life and health insurance is sold as a single policy, no insurance tax is applied on health insurance.

Response No. 8: Consolidated invoicing is acceptable. Per Section G.4.1, invoices should be submitted to the designated billing office. The solicitation does not require separate invoicing for health and life insurance components. However, offerors proposing joint ventures or consortium structures should clearly identify their arrangement in their proposal and designate a single point of contact for invoicing and contract administration purposes.

Question No. 9: What is "off the shelf" plan definition?

Response No. 9: Off-the-shelf plans are standard commercial insurance products that the vendor currently offers, which can be proposed as long as they meet the minimum requirements specified in the solicitation.

Question No. 10: Could you please clarify whether the Embassy would accept participation through two affiliated insurance companies within the same group structure, where one company would provide the Health Insurance component and another would provide the Group Life Insurance component, considering that each company operates under its respective insurance license? Alternatively, would the Embassy require submission under a formal Joint Venture / Consortium / Prime Contractor–Subcontractor structure for this procurement? Additionally, in such a structure, if one component (Health or Life Insurance) does not meet the required criteria, would this affect the evaluation of the entire proposal, or could the Embassy evaluate and award the services separately?

Response No. 10: The Embassy will accept proposals from affiliated companies within the same group structure, provided that: (1) each entity holds the appropriate licenses as required in Section L.4.3, Part 4; (2) the proposal clearly identifies which entity will provide which services;

(3) one entity is designated as the prime contractor responsible for overall contract performance;

and (4) both entities meet all applicable representations and certifications in Section K. The prime contractor completes Section K, but specific representations regarding responsibility, telecommunications, and tax matters must also be obtained from each affiliate performing a discrete component, consistent with FAR 9.104 responsibility determination requirements. The proposal will be evaluated as a single, integrated offer. If either component (Health or Life Insurance) fails to meet the minimum requirements specified in Section C, the entire proposal may be deemed technically unacceptable per Section M.5.

Question No. 11: In the event of a Joint Venture or consortium structure, would both entities be required to submit the full documentation and proposal package?

Response No. 11: One complete proposal package should be submitted with one entity designated as the prime contractor. However, the proposal must include: (1) licensing documentation for each entity as required in Section L.4.3, Part 4; (2) past performance information for each entity as required in Section L.4.3, Part 3; (3) completed representations and certifications in Section K for the prime contractor; and (4) a clear description of the roles and responsibilities of each entity in the joint venture/consortium arrangement in the technical proposal. The prime contractor completes Section K, but specific representations regarding responsibility, telecommunications, and tax matters must also be obtained from each affiliate performing a discrete component, consistent with FAR 9.104 responsibility determination requirements

Question No. 12: Can the Embassy share historical premium and claims data for the past 3–5 years? Please provide data on the premium paid in the previous contract. Please confirm whether any revision of the premium has been made under the existing contract to date. If so, kindly provide details of the revision, including the effective date and the basis for the adjustment.

Response No. 12: We have shared the Claims for Health in Section J and regarding the claims for Life there was only 1 reimbursement case.

Question No. 13: What is the approximate monthly volume of: reimbursements, direct pay requests, and pre-authorizations? Please provide the approximate annual number of claims submitted under the policy.

Response No. 13: Specific monthly volumes for reimbursements, direct pay requests, and pre-authorizations are not available. However, offerors should use the information provided in Exhibit E, Section J. Offerors should use the employee statistics in Exhibit A and the historical claims data to estimate processing volumes.

Question No. 14: Are there currently any employees undergoing long-term or high-cost treatments requiring continuity of care? Please indicate whether any ongoing high-cost treatments, chronic illnesses, or terminal medical conditions are currently under treatment and may impact future claims experience (aggregate information only, without personal data). Could you please provide us with information on whether there are any individuals diagnosed with terminal illnesses or are currently undergoing chemotherapy or radiotherapy treatment? Kindly note that we are not requesting any sensitive personal data or identifying information; we only require the number of individuals.

Response No. 14: Currently we do not have any employees on extended sick leave.

Question No. 15: For catastrophic coverage, are there historical examples of claims exceeding the standard annual limit? Please provide the number of catastrophic or high-cost claims incurred during the contract period. Please provide, if possible, the total amount paid for catastrophic/high-cost claims. Please provide the largest individual claim paid during the previous contract period.

Response No. 15: The number of cases exceeding the contract annual limits was 5 throughout all the contract years.

Question No. 16: From the Embassy's perspective, which operational performance indicators are considered most critical for successful contract performance?

Response No. 16: Per Section E.2 (Quality Assurance and Surveillance Plan), the performance standard is that the Government receives no more than one (1) customer complaint per month.

Additionally, per Section H.4(b)(4), claims settlement must occur no later than two weeks from the date the claim is submitted to the Contractor. Section H.5 requires monthly reports listing all claims paid, outstanding claims, and reasons for delays. Section L.4.3, Part 2, item 6 requests offerors to describe their quality assurance plan including regular internal meetings, customer surveys, and performance reviews with Embassy officials.

Question No. 17: Please confirm whether the contractor may define, under the terms and conditions to be drafted, a list of specific examinations, diagnostic tests, and preventive services to be included within the scope of the check-up benefit (annual physical examinations), differentiated by gender and age categories. In particular, please clarify whether the contractor is permitted to establish eligibility criteria, screening protocols, and benefit parameters based on medically accepted preventive care standards applicable to different demographic groups.

Response No. 17: Section C.1.1.4 specifies that outpatient services include "annual physical examinations" as examples of covered services, and Section C.1.1.8 covers "Preventive and Wellness Services" at 80% minimum coverage. The contractor may propose reasonable protocols for preventive care services based on medically accepted standards, provided they meet or exceed the minimum coverage requirements in Section C. Any such protocols should be clearly described in the technical proposal and included in the brochure required under Section C.1.6. The final terms must be acceptable to the Contracting Officer.

Question No. 18: Given that vitamins, nutritional supplements, cosmetic products, herbal preparations, and similar items do not contain active pharmaceutical ingredients and are generally not classified as medicinal products, please confirm whether this category of products may be expressly defined as an exclusion under the policy terms and conditions. Are OTC and supplements covered if prescribed by a physician?

Response No. 18: Generally, health insurance providers will not cover expenses for over-the-counter remedies that do not require a doctor’s prescription, such as vitamins and cold remedies.

If a vitamin supplement is prescribed at a level that requires a prescription, it would be covered.

If a doctor prescribes a medicine that is prescription strength but is available over the counter that would also be covered. The list of medications OTC and non-OTC are published by Albanian Government Health Institutions.

Question No. 19: C.1.1.9 Hearing Aid Apparatus - Are the limits defined in USD intentional, or could this be a typing error?

Response No. 19: This is a typing error and will be converted in ALL with the exchange rate of the date of Issue of the Solicitation.

Question No. 20: Can you break down the amounts of paid health claims in Exhibit E under specific categories (inpatient, outpatient, obstetric, dental, optical)?

Response No. 20: A detailed breakdown of claims by specific benefit categories is not available.

The claims amounts provided in Exhibit E, Section J represent total health insurance claims paid for each contract year. Per the note in Exhibit E, this data is provided for informational purposes only and shall not become the basis for premium rate adjustments after contract award.

Question No. 21: How many loss of lives have the US embassy had in the last 5 years, due to:

(1) Natural causes (2) Accidental causes?

Response No. 21: There was only 1 life insurance claim (1 death) during the past contract period. Additional details regarding the cause of death are not provided.

Question No. 22: Please provide information on number of individuals (employee or dependent) who currently have diseases.

Response No. 22: Specific medical diagnosis information for covered individuals is not available and cannot be disclosed due to privacy considerations. As stated in Response No. 14, there are currently no employees on extended sick leave.

Question No. 23: Please specify number of individuals currently pregnant. What is the average number of pregnancies per year?

Response No. 23: Specific information regarding current pregnancies and average annual pregnancy rates is not available and cannot be disclosed due to privacy considerations. Offerors should use the demographic data provided in Section J, Exhibits 1-3, which show age and gender distributions, to estimate potential maternity-related claims.

Question No. 24: The first installment of the health and life premium, is paid within a few days from the contract award or signing or is it paid at the end of the quarter, meaning 4 months after the contract signing and issue of the first task order?

Response No. 24: Per Section G.4.2, all funds under this contract will be obligated by issuance of task orders. Invoices may be submitted monthly with payments being made monthly by the Government. Per Section H.3, the Government will issue a task order as soon as possible after contract award, and payments will be made at the conclusion of the period covered. The specific payment schedule will be established in the task order.

Question No. 25: Has the coverage zone been extended? Regarding the "out of country" clause, should we understand that treatment prices in Albania will not be used as a reference for reimbursement of treatment abroad? Please confirm that when medical treatment is obtained outside the host country, the insurer will limit reimbursement to the level of charges that would be considered reasonable, customary, and medically necessary under the standards and pricing framework applicable in the host country (Albania). Medical services out of Albania, especially in western Europe, are much higher than the same services in Albania. When a medical service is received out of Albania, should reimbursement be made based on the value of the invoice presented or does the Insurer reserve the right to reimburse based on the price of the same service in Albania?

Response No. 25: Yes, this interpretation is consistent with the solicitation requirements.

Section C.1.1.17 states: "C.1.1.17 Out-of-Country Medical Treatment: Medical expenses incurred out-of-country will be covered, but coverage will be the same and subject to the same total maximum annual limit as for medical expenses incurred in Albania." The phrase "coverage will be the same" means that out-of-country medical expenses are subject to the same coverage terms, benefit percentages, limitations, and reasonable and customary cost standards that apply to medical expenses incurred in Albania. Therefore, reimbursement for out-of-country treatment would be limited to what would be considered reasonable, customary, and medically necessary under Albania's pricing framework and standards.

Question No. 26: Please confirm that the services to be performed outside the country: will coverage be provided for emergency medical transportation, such as air ambulance, ground transportation, and other methods considered emergency medical transport?

Response No. 26: No, emergency medical transportation for out-of-country treatment is not covered. Section C.1.1.18 explicitly states: "C.1.1.18 Transportation for Out of Country Treatment. Transportation for out of country treatment is not a covered expense." This means that air ambulance, ground transportation, and other emergency medical transport methods for out-of-country treatment are not required covered benefits under this contract. Note that ambulance coverage under Section C.1.1.3 (Minimum Coverage – 80%) applies only to transport within Albania to move a patient to the nearest hospital able to provide treatment or between medical facilities.

Question No. 27:

Please provide explanation about the exclusion "long term rehabilitative therapy."

Please provide explanations on services that are considered as covered under the Albanian Medical Country Program/Public Health Scheme that are considered as exclusions under this contract.

Response No. 27:

Usually when it is six months and over is considered ‘Long Term Treatment.' Section C.1.1.14 covers "Rehabilitative and Habilitative Services and Devices" at 50% minimum coverage for services that help recover or develop skills needed for everyday life. The distinction is that short-term, medically necessary rehabilitative services following injury or illness are covered, while extended, maintenance-level therapy is excluded.

Regarding the Albanian Public Health Scheme: Per Section C.1.3, "There is no reimbursement for expenses that will be reimbursed or paid directly under a host country medical program.

Question No. 28: Please indicate the approximate percentage of claims related to treatment outside Albania.

Response No. 28: Specific data on the percentage of claims related to out-of-country treatment is not available. However, per Section C.1.1.17, medical expenses incurred out-of-country are covered subject to the same terms, coverage percentages, and annual maximum limits as expenses incurred in Albania.

Question No. 29: Point C 1.1.19 180-day coverage for dependents after employee's death.

Further information is needed. Is this clause applied only for dependents that are already insured at the time of the employee's death? Or is this clause also applied to dependents that are not insured at the time of the employee's death? Since the premium is paid with installments, after the employee dies, will the US embassy continue to pay the premium for the dependents for the period of 180 days?

Response No. 29: Per Section C.1.1.19, "At the time of a covered employee's death, his/her eligible dependents covered under post's medical plan are eligible to continue receiving the same level of medical coverage for up to 180 days." This applies only to dependents who were already covered under the employee's plan at the time of death. The clause further states "This optional benefit is subject to availability of funds at post." The Embassy will continue to pay premiums for these dependents during the 180-day period, subject to fund availability.

Question No. 30: Please specify if we understand it correctly. The solicitation requests that the health cover should provide for C.1.2 "Annual Maximum Limit" and C 1.1.16 "Catastrophic coverage", while C 1.1.21 "Excess Coverage" is optional. Since C 1.1.21 "Excess Coverage" is optional, and the cost is borne by the insured (LE Staff), where are we supposed to provide the information about the cost for this additional cover, since the Section B "Price – Health Insurance" seems to not have a place for it? If we fail to provide an offer for C 1.1.21 "Excess Coverage", does this disqualify us on grounds of not meeting the solicitation requirements?

Response No. 30: The premium rate for C.1.1.21 Excess Coverage should be entered in Section B, in the "Rider Category" rows provided in tables B.2.3 through B.2.8. This is clearly marked as a rider "not included in the Total Price for Base Year Calculation."

Question No. 31: The requests in point C 1.1.16 "Catastrophic coverage" and C 1.1.21 "Excess Coverage" seem to overlap each other. If C 1.1.21 "Excess Coverage" is also selected by the insured, in case of a serious illness or a severe accident, or even any other circumstance where the medical expenses might exceed the Annual Maximum Limit, which one of the following will be executed: C 1.1.16 "Catastrophic coverage" or C 1.1.21 "Excess Coverage"?

Response No. 31: These are distinct coverages. Per Section C.1.1.16, Catastrophic Coverage provides an additional ALL 3,652,000 per covered individual per contract year for major medical conditions resulting from a single illness/accident that exceed the standard maximum coverage limit (C.1.2 Annual Maximum Limit of ALL 3,652,000). This is included in the base contract premium paid by the Government. Per Section C.1.1.21, Excess Coverage is an optional rider that provides an additional ALL 3,652,000 per covered individual per contract year for any covered expense that exceeds the annual maximum. This is paid 100% by the employee if elected. If an employee has elected Excess Coverage and expenses exceed the Annual Maximum Limit, the Catastrophic Coverage (C.1.1.16) would apply first for qualifying catastrophic conditions. If expenses exceed both the Annual Maximum and Catastrophic Coverage limits, or if the condition doesn't qualify as catastrophic, the Excess Coverage (C.1.1.21) would apply for employees who elected this optional coverage.

Question No. 32: Point C. 1.2 Annual Maximum Limit, is requested as a total of the sums of benefits per individual paid during 1 year for clauses C 1.1.1 to C 1. 1.14?

Response No. 32: Yes, with clarifications. Per Section C.1.2, "The maximum annual reimbursement per covered individual per contract year, not including expenses defined under Exclusions and Limitations (C.1.3) and C.1.1.16, Catastrophic Coverage, or those covered under C.1.1.15, HIV/AIDS, and C.1.1.21 Excess Coverage is equivalent to ALL 3,652,000 per patient per contract year." This means the Annual Maximum Limit applies to the sum of all covered benefits in C.1.1.1 through C.1.1.14, but does NOT include the separate limits/coverages for HIV/AIDS (C.1.1.15), Catastrophic Coverage (C.1.1.16), or Excess Coverage (C.1.1.21).

Question No. 33: We need further explications for point C.1.1 and point C.1.1.17. Point C.1.1 points that reimbursements are subject to reasonable and customary costs in the locality where treatment was provided. While point C.1.1.17 points that Medical expenses incurred out-of-country will be covered, but coverage will be the same and subject to the same total maximum annual limit as for medical expenses incurred in Albania.

Response No. 33: See Response No. 25

Question No. 34: Section H, point H.4, b), 5) states: 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. If understood correctly, the minimum criteria of this solicitation is that direct billing to hospitals/clinics is applied only for surgery.

While for any other medical procedure, either direct billing or reimbursement to the insured employee is acceptable under the minimum criteria set by this solicitation.

Response No. 34: Per Section H.4(b)(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." This specifically addresses surgery.

For other medical procedures, the contractor may use either direct billing arrangements or reimbursement to the employee, as described in Section H.4(b)(1) and (b)(4). The contractor should describe its approach to direct billing and reimbursement in the technical proposal (Section L.4.3, Part 2).

Thank you for your interest in this solicitation.

Sincerely, Chris Carlisle Contracting Officer