Q&A.docx

QUESTIONS AND ANSWERS

HEALTH INSURANCE SERVICES

REQUEST FOR PROPOSAL (RFP) NUMBER 19AM10-19-R-0001

Below are answers to the questions received from offerors for the subject solicitation by March 29, 2019.

1. Question – Can you tell us the name of the insurance company who currently provides this health insurance?

Answer – Our current insurance provider is INGO Armenia and you may contact them at Tel: (37410) 59-21-21 or by email: info@ingoarmenia.am.

2. Question – In Section B.2.PRICES estimated number of employees is 59 (self only) and 263 (family plan). Does it mean that the total number of insured persons is 322 or 263 (family plan) you mean 263 families? Could you please clarify the total number of insured persons?

Answer – The estimated total number of insured persons is 885 (this number does not include ORE, Employee Association and Peace Corps statistics), out of which there are 59 single employees and 263 families. The current employee statistics is attached to this document.

3. Question – In B.2.7 Fourth option year of Contract family plan is mentioned 563, is that correct or it should be 263?

Answer – Section B, paragraph B.2.7. Fourth Option Year of Contract is revised as follows: Estimated number of employees under family plan is corrected to read 263. The Amendment A001 of Solicitation Number 19AM10-19-R-0001 was issued on March 29, 2019 to correct this typo.

4. Question – Exhibit A, B, C & D - Employee statistics is not attached with the Solicitation. Please provide the Employee Statistics. Answer – Exhibit A “Employee Statistics” is attached to this document. Please note that it does not include ORE, Employee Association and Peace Corps statistics. Exhibits B, C, D cannot be attached at this point, they will be attached when actual riders are signed.

5. Question – Provide claims history for health Insurance for the current year and EACH of the last 5 years - 2019 (till now), 2018, 2017, 2016, 2015, and 2014. 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. Please provide separate claims history for (a) Claims in Armenia and (b) Claims from outside Armenia along with country names. Answer – Please see below table for claims history. We do not have breakdown of claims per territories.

6. Question – Do the above claim numbers include claims from ORE, Peace Corps and EAE employees? Answer – Yes.

7. Question – Provide premium history for health Insurance for the current year and EACH of the last 5 years - 2019 (till now), 2018, 2017, 2016, 2015, and 2014. 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.

Answer – It is not a standard practice in Armenia to disclose premium history for corporate clients, the information considered confidential. Although, if requested, we can provide the award price for the current contract.

8. Question – Provide average insured member counts for the current year and EACH of the last 5 years - 2019 (till now), 2018, 2017, 2016, 2015, 2014. 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. Answer – Please see the table under Question 5.

9. Question – Advise if the current 2019 benefit schedule for health insurance is the same as the benefit schedule being requested new under 19AM10-19-R-0001; and if not advise us on the differences. Alternatively, you can simply provide the previous solicitation document. Answer – The current benefit plan for health insurance is different from the one being requested under new solicitation number 19AM10-19-R-0001. The previous solicitation is attached to this document.

10. Question – Are there any HIV/AIDs cases? If Yes, please provide number (please note we are not seeking protected private information, we do not need the names or identification; we just need to know the total number of people who are currently being treated for HIV/AIDs to assess the risk and price accordingly). Answer – There is no information available about HIV/AIDs cases.

11. Question – When is this plan likely to commence? Answer – The target date is June 22, 2019.

12. Question – Under C.1.1.17 (Out of Country Medical Treatment) it appears like employees need to be covered anywhere in the world including USA. If the coverage area includes the US then it is not possible to offer a plan with Armenian premiums and then pay claims from USA at US hospital rates. Please confirm that the intention of C.1.1.17 is to provide out-of-country benefits equivalent to that in Armenia (i.e. as though treatment was obtained in Armenia or in a country with healthcare cost equivalent to that in Armenia when the particular treatment is not available in Armenia) and subject to the same total maximum annual limit as for medical expenses incurred in-country. Answer – Any services incurred out of country will be covered up to the maximum annual limit.

13. Question – We would like to know if you have been informed of Catastrophic cases presented last year, such as: Hemodynamics, Open Heart Surgery, Orthopedic Mayor Surgeries, Organ Transplant, Traumatic Accident, Cancer and Oncology Cases (Radio and Chemotherapy), and hospitalizations with more than 10 days.

Answer – Yes. We had 10 such cases during period from September 2017 through March 2019.

14. Question – Have there been any claims more than $10,000 within the last year? If yes, please indicate the number and amounts of such claims. Answer – No.

15. Question – Section C, Clause C.1.1.13 – Mental Health and Substance Abuse Care.

The clause says: “Services must be provided by a licensed psychiatrist, psychoanalyst, psychologist, or psychiatric social worker”. The issue is the following: Psychiatrists, psychoanalysts, psychologists, or psychiatric social workers are not being licensed in Armenia. All these specialists are receiving a relevant education and/or qualification. Moreover this kind of activity is also not licensed in Armenia. Psychiatric, psychoanalytic and/or psychologic services can be provided both in licensed and in non-licensed facilities. What is your intention and how you want these services to be covered in Armenia?

Answer – The intention is to ensure that employees are receiving mental health care from people who are qualified to practice in the country.

16. Question – Section C, Clause C.1.1.14 - Rehabilitative and Habilitative Services and Devices. The clause says: “Rehabilitative services (e.g., recovering skills, such as speech therapy after a stroke or physical therapy after an accident) and habilitative services (e.g., developing skills, such as speech therapy for children) that help develop skills needed for everyday life.” Meanwhile in the clause C.1.2 Exclusions to Coverage there is a following note: “There is no reimbursement for elective cosmetic surgery; spa cures; rejuvenation cures; massage; exercise therapy; long-term rehabilitative therapy”. There is a contradiction between the coverage and exclusions in terms of long-term rehabilitative therapy. Can you please kindly clarify what should be covered and what not?

Answer – Most physical therapy requirements, i.e. after an accident, surgery or stroke, require anywhere from two to 12 weeks of therapy to support recovery. “Long term rehabilitative therapy” is therapy that goes on for months and even years and generally involves in-patient, round the clock care.

17. Question – Section C, C.1.1.16 Excess Coverage. When LE staff can choose this coverage: at the commencement date of the insurance or during the insurance period as well?

Answer – Qualifying events to elect Excess Coverage are: Within 30 days of the start of the health insurance contract, upon employment, or at the beginning of each calendar year. It would also be available for a life event, for example, upon marriage or birth of a child.

18. Question – Section C, C.1.1.17 Out of Country Medical Treatment. The clause says: “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-country.” There is a big difference between the costs of medical services in Armenia and abroad, e.g. USA, Europe, Russia, etc. E.g. Gallbladder surgery costs around USD 500 in Armenia, but USD 7,500 in US. Both are within total maximum annual limit. How much will the reimbursement make if an Insured person decides to get the treatment out of Armenia? Please provide your answer both for this particular example and in general.

Answer – The reimbursement rate would be to cover, within the annual limit, the costs of the treatment. (Treatments out of country that otherwise would not be covered in country, will not be covered, i.e. elective cosmetic surgery.)

19. Question – According to paragraph 2 Clause C.1.1 of the current Contract No. S-AM100-13D-0001 “Reimbursements or payments shall be made for covered medical expenses incurred, subject to the stated limits, for reasonable and customary costs of covered benefits.” There is no note about reasonable and customary costs in the solicitation No. 19AM10-19-R-0001. This question is particularly very relevant to dental expenses, where filling may vary from AMD 10,000 up to AMD 60,000 per tooth, false teeth may vary from AMD 40,000 up to AMD 120,000 per unit. What is your intention in respect of this?

Answer – The intention is to control costs and manage opportunities for fraud. If your dentist charges 60,000 but the norm is 30,000, you may decide to change dentists if you don’t want to be out of pocket. It still allows an employee to stay with a doctor with the understanding that higher costs would be borne by the insured. Reasonable and customary costs should be based on what is customary in a country in terms of the definition of medical services.

ATTACHMENTS:

· Employee Statistics

· Previous Solicitation